What this page covers

  1. UnitedHealthcare (Optum, UMR, Surest)
  2. Aetna / CVS Health
  3. Cigna / Evernorth
  4. Humana
  5. Anthem / Elevance (non-BCBS)
  6. Kaiser Permanente
  7. Molina Healthcare
  8. Oscar Health
  9. 2026 Gold Card programs
  10. How Flexbone routes per payer

Commercial payer PA is the largest single PA bucket in most practices. The delegation maps change quarterly, the portals all differ, and each payer has its own sub-segments (UMR, Surest, Optum inside UHC; Aetna MA vs commercial; Cigna individual vs group). This page walks each payer with 2026 rules and how Flexbone routes.

UnitedHealthcare (with Optum, UMR, Surest)

UnitedHealthcare is the largest US commercial payer by membership. The UHC umbrella includes the main UHC commercial and MA books, Optum (specialty pharmacy, behavioral, MSK, RBM), UMR (self-funded TPA), Surest (the former Bind Benefits, now UHC-owned), Oxford (NY/NJ regional), and Rocky Mountain Health Plans. PA infrastructure is primarily in-house at UHC with Optum modules for specialty services. Key 2026 rules: UHC Advance Notification for select procedures (notification, not PA), continued strict PA on MSK (Optum MSK), cardiology shifted in-house from prior Optum delegation, radiology primarily in-house with NIA for select contracts. Portal: uhcprovider.com. Gold Card program active for qualifying providers.

Flexbone PA audit

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In 30 minutes we will map your current PA volume, denial drivers, EHR coverage gaps, and the three highest-ROI automations to ship next quarter, scoped to the payers and procedures you actually run.

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Aetna / CVS Health

Aetna (owned by CVS Health) runs commercial, MA, and exchange books with extensive delegation: eviCore for radiology, cardiology, MSK, oncology pathways, sleep, and radiation therapy. Specialty drugs route through CVS Caremark and CVS Specialty. Behavioral through Aetna Behavioral or Magellan. Bariatric through Aetna Institutes of Quality. 2026: continued tight specialty-drug PA, expansion of value-based care programs. Portal: Availity for most transactions, Aetna.com provider portal for plan-specific.

Cigna / Evernorth

Cigna commercial routes major medical PA through eviCore (Cigna-owned). Pharmacy through Express Scripts (Evernorth). Behavioral through Evernorth Behavioral Health. MSK through eviCore. The Evernorth brand consolidates Cigna\u2019s pharmacy, care management, and specialty services. Fertility through Cigna Fertility network. 2026: continued eviCore delegation for most specialty services. Portal: Availity or Cigna provider portal.

Talk to our teamAbout commercial payer prior authorization prior authorization workflows and a scoped Flexbone rollout.See the PA platformHow Flexbone automates PA end to end across payer portals, phone, and EHR.

Humana

Humana is heavily Medicare Advantage-focused but has a commercial and TRICARE (Humana Military) presence. PA delegation: eviCore for radiology, cardiology, MSK, oncology pathways; HealthHelp for select radiology and cardiology; Humana Specialty Pharmacy for specialty drugs; Humana Behavioral for BH. Medicare Advantage post-acute is heavily scrutinized with in-house concurrent review. Humana Military serves TRICARE East region. Portal: availity and humana.com provider portal.

Anthem / Elevance (non-BCBS lines)

Anthem (Elevance Health) operates 14 BCBS state plans and multiple non-BCBS books (Amerigroup Medicaid, Healthy Blue, CarelonRx). BCBS plans covered separately at BCBS plans. Non-BCBS: Carelon handles radiology, cardiology, MSK, behavioral, and post-acute across the Elevance umbrella. CarelonRx handles pharmacy. 2026: continued Carelon expansion and consolidation of UM.

7-day pilot

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A live pilot on real cases with a shared dashboard showing which submissions went out zero-touch, which peer-to-peers Flexbone booked, which denials were appealed automatically, and what your team saved in hours.

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Kaiser Permanente

Kaiser is a fully integrated payer-provider system (CA, CO, GA, HI, MD, OR, VA, WA). PA inside Kaiser is internal for most services. External providers treating Kaiser members typically go through Kaiser\u2019s direct authorization process, often through the regional medical office. No external UM delegates apply.

Molina Healthcare

Molina serves Managed Medicaid, Medicare Advantage Dual Special Needs Plans (D-SNP), and ACA marketplace. PA primarily in-house with some delegation. Strong presence in Medicaid-dominant states (CA, OH, NM, TX, WA, FL). Separate state plans follow state Medicaid PA requirements.

Talk to our teamAbout commercial payer prior authorization prior authorization workflows and a scoped Flexbone rollout.See the PA platformHow Flexbone automates PA end to end across payer portals, phone, and EHR.

Oscar Health

Oscar is a tech-forward commercial and exchange insurer with narrow networks and a strong digital provider portal. PA is primarily in-house with some delegation. Growing presence on ACA exchanges in multiple states.

2026 Gold Card programs

Several payers operate Gold Card or advance-auth-bypass programs for high-performing providers. UHC Gold Card covers select procedures for providers with approval rates above threshold. Aetna has a Fast Track program. Cigna has simplified submission paths for high-volume providers. State laws in TX (HB 3459) and other states mandate Gold Card programs with specific criteria. Flexbone tracks which providers qualify for which programs and routes accordingly.

How Flexbone routes per payer

Flexbone maintains a current payer rule base updated quarterly. When a PA is initiated, the system reads the payer, the service line, and the procedure, then routes to the correct portal/delegate automatically: eviCore for Aetna cardiology, Carelon for Anthem MSK, Optum for UHC MSK, CVS Caremark for Aetna specialty drug, and so on. See PA portals and UM vendors for the delegate detail.