Prior authorization has been a source of frustration for patients, providers, and payers alike for several years. In an effort to combat this issue, more than 50 health insurers – including nearly every major plan in the country – recently announced a unified pledge to reduce administrative burden, improve transparency, and modernize the PA process. The commitments are bold:

• Reduce the volume of services requiring PA
• Adopt FHIR-based APIs to enable real-time decisions
• Improve clarity and consistency in how denials are communicated
• Support continuity of care when patients switch plans

It’s a powerful step forward. But turning these promises into real change won’t happen through policy alone – efficient and scalable data management will be critical in improving the patient and provider experience and even simplifying operations for payers.

Prior authorization touches nearly every corner of a health plan’s operation – clinical review, claims, provider contracting, member engagement, regulatory compliance. Yet the data supporting those workflows is often fragmented, outdated, or inaccessible at the point of decision.

Take a common scenario: a member’s provider submits a request for a particular medication. That request may arrive via fax, PDF, or EHR. The clinical rationale is buried in unstructured notes. Authorization history may live in one system, benefits eligibility in another, and plan-switch history in yet another. Take scenarios like that and multiply it by millions of requests per year, and it’s no wonder decisions are delayed or denied – often unfairly.

The result? Frustrated patients. Burned-out providers. And a growing trust deficit that no amount of process reform can fix on its own.

At Informatica, we believe real change starts with the data. When payers can bring together clean, connected, and trusted data across their ecosystems, they unlock the ability to:

• Make faster, more accurate PA decisions using real-time, complete data
• Use AI to intelligently route or automate routine requests
• Provide members and providers with a clear, up-to-date status, and reasons for decisions
• Comply with CMS mandates for electronic prior authorization by 2026
• Improve member experience – and ultimately, outcomes

Our Intelligent Data Management Cloud (IDMC) enables this transformation. It helps payers activate data through AI for smarter decisions, connect siloed systems and apply data quality and governance at scale – all while ensuring trust and transparency.

The new industry pledge sets 2027 targets for automation and real-time approvals. But we know that deadlines alone don’t drive progress – ambition, insight and accountability do.

This is a moment for payers to lead with intention. To see prior authorization not just as a compliance checkbox, but as a gateway to restoring trust with members and providers. To shift from reactive operations to proactive care. That begins with a unified, intelligent data foundation.

Let’s move from crisis to catalyst – together.

For more information read this solution brief.