Black Book Research identifies Cohere Health, Innovaccer, and Waystar among leading vendors rapidly adapting to new industry rules.
NEW YORK CITY, NY / ACCESS Newswire / July 26, 2025 / U.S. healthcare is undergoing a pivotal shift as major insurers-led by UnitedHealthcare and Humana-begin to significantly reduce or eliminate prior authorization (PA) requirements for hundreds of routine procedures. Accelerated by federal policy, provider frustration, and consumer demands for timely access to care, these sweeping changes signal a new era in PA technology and operations, according to a July 2025 flash survey conducted by Black Book Research.
Industry Drivers: Regulatory Action Meets Provider and Consumer Pressure
Insurers covering over 250 million Americans have committed to streamlining or removing PA burdens by the end of 2026. This is partly driven by the Centers for Medicare & Medicaid Services (CMS), which is launching a pilot program in six states in January 2026 requiring faster, more transparent prior authorizations for select Medicare services. CMS has also announced national response time standards for Medicare Advantage plans, further intensifying the need for automation and interoperability in PA processes.
Key Survey Insights from the Field
Black Book Research's flash survey compiled viewpoints from: 24 IT leaders representing the top 10 PA vendors; 108 managed care and health plan IT and operational decision-makers; 142 healthcare providers and administrative leaders; and 100 healthcare consumers with recent PA experiences.
Notable Findings:
84% of managed care executives support reducing PA requirements
96% of healthcare providers report improved workflows and lower administrative burdens
99% of consumers favor eliminating PA for routine care; 83% say they've experienced harmful care delays
67% of health plans expect to reevaluate or end contracts with existing PA vendors by 2026
Additional Observations:
90% of providers foresee broad adoption of interoperable PA tools by 2027
94% of payers plan substantial investment in AI-based PA platforms
100% of consumers prefer providers with automated and transparent PA processes
96% of PA vendor executives acknowledge their current solutions require modernization within two years
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Vendors Rapidly Adapting and Leading the Innovation Curve: Client Top KPI Scores
Black Book highlights the top-performing vendors already making critical advancements to align with industry shifts:
Cohere Health - Excels in AI-based automation, payer-provider integration, and CMS-aligned interoperability
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