Humana and athenahealth expand electronic prior authorization capabilities nationwide, reducing administrative burden for physicians and helping patients access care faster

New end-to-end capabilities integrate more of the prior authorization process directly into existing provider workflows, reducing administrative work and expediting care for patients

BOSTON & LOUISVILLE, Ky.--(BUSINESS WIRE)--Humana and athenahealth today announced an expansion of electronic prior authorization capabilities across athenahealth’s nationwide network of more than 180,000 physicians and clinicians, bringing more of the process directly into the tools they already use. The collaboration supports Humana’s broader strategy to help patients access care more quickly by requiring prior authorization less often and making it simpler, faster and more connected when it is needed, while reducing administrative work for providers.

Prior authorization builds checks and balances into the healthcare system to ensure that patients receive the right care at the right time. It also helps ensure that care is safe, high-quality and evidence-based. At the same time, prior authorization can add complexity and create frustration for patients and providers. Humana and athenahealth are working to reduce the paperwork, phone calls and manual steps often associated with prior authorization, making the process easier for providers and faster for patients.

Early indicators show the potential to reduce administrative work for physician practices. By helping identify and exchange needed clinical information electronically, the integration can reduce the back-and-forth that occurs when additional documentation is needed before a decision can be made. In September, more than 6,000 providers processed nearly 35,000 electronic prior authorization transactions with Humana, with more than 70% completed without requiring additional information from practice staff.¹

“Our goal is straightforward: help people get the right care at the right time while reducing unnecessary burden on the physicians and care teams who serve them. That means requiring prior authorization less often and making it faster, easier and more connected when it is necessary,” said Dr. Traci Granston, Humana Vice President of Clinical Innovation and Trend. “This collaboration with athenahealth is another step forward, ensuring that providers spend less time navigating administrative processes and more time focused on patient care.”

Bringing prior authorization into the provider workflow

athenahealth’s electronic prior authorization capability goes beyond determining whether an authorization is required. It brings documentation, electronic submission and health plan decisions together within athenaOne®, using FHIR-based industry interoperability standards, including Coverage Requirements Discovery (CRD), Documentation Templates and Rules (DTR) and Prior Authorization Support (PAS), to support electronic information exchange throughout the process.

Through athenaPayer®, Humana can connect with clinicians across the athenaOne network rather than relying on separate connections with individual practices or health systems. Together, the capabilities create a more connected experience in which information can move more seamlessly between providers and the health plan.

“Every phone call, fax and portal log-in adds work for a practice trying to get a patient the care they need,” said Paul Brient, athenahealth Chief Product and Operations Officer. “Prior authorization shouldn’t require care teams to navigate a different process for every health plan. By connecting health plans and practices through one solution with a common workflow, we’re creating a more scalable way to exchange information, reducing work for both providers and payers while, most importantly, helping patients access care faster.”

The expansion builds on athenahealth’s prior authorization collaboration with Humana and Availity, which was recognized and featured in a 2024 KLAS Points of Light case study. In May 2026, CMS named both Humana and athenahealth early adopters in its Electronic Prior Authorization Acceleration Initiative.

For more information about athenahealth’s medical electronic prior authorization capabilities, visit Medical Prior Authorization for Payers.

About athenahealth

Since 1997, athenahealth has been curing complexity for ambulatory healthcare practices and the patients they serve, empowering them to deliver the best possible care and business outcomes through innovative clinical, financial, and patient engagement solutions. athenahealth connects practices, health systems, payers, partners, and patients to create a thriving ecosystem that delivers accessible, high-quality, and sustainable healthcare for all. Learn more at www.athenahealth.com.

About Humana

Humana (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.

¹ Source: athenahealth internal data, Sept. 1-30, 2026. Completed Humana electronic prior authorization transactions include determinations that authorization was not required, as well as electronic approvals and denials. The 70% figure reflects transactions completed without additional information requested from practice staff.