National Digital MSK Leader Contributes to AHIP Partner-Initiative Leading to 11% Prior Authorization Reduction Amongst Payers

American Specialty Health's Long–Standing Policies Help Alleviate Administrative Burdens for More Than One Million Health Plan Members

SAN DIEGO, April 14, 2026 /PRNewswire/ -- As part of an AHIP announcement April 7 outlining industry–wide efforts to modernize prior authorization, American Specialty Health (ASH) emerged as a key partner working alongside the national trade association and participating health plans to drive meaningful improvements in how care is accessed and delivered across the healthcare system.

ASH joined the AHIP alliance in June 2025 as part of a voluntary, industry–wide commitment to streamline prior authorization while preserving evidence–based clinical safeguards. ASH's role reflects years of investment in clinically grounded processes designed to improve access to care, reduce unnecessary administrative steps, and support health plans in delivering appropriate, timely treatment for members.

The recent AHIP update signals a coordinated industry effort to strengthen quality and efficiency in utilization management—an effort ASH supports through its long–standing Clinical Performance System (CPS) model designed to better serve both members and providers.

"Meaningful reductions in prior authorization happen when health plans have confidence in provider performance and clinical decision–making," said George DeVries, ASH president and CEO. "ASH supports that confidence through high prior authorization approval rates, trusted provider relationships, and timely clinical review."

Through its tiered Clinical Performance System, ASH works with health plan partners to apply varying levels of clinical oversight based on provider performance, reserving medical necessity reviews for cases that call for additional consideration. This performance–based model is designed to help plans streamline delegated utilization management processes, reduce unnecessary prior authorization, and focus clinical resources where they add the most value.

The ASH approach over the past 39-years emphasizes evidence-based, clinical peer medical necessity review. More than 80% of the 1.2 million cases treated by ASH providers in 2025 were approved without medical necessity review through its performance–based clinical oversight model—enabled by gold carding for high–performing providers. Of the remaining cases that needed a medical necessity review, more than 97% were approved in less than one business day after medical review conducted by licensed clinicians.

Clinical peer reviews help reduce friction for providers while supporting access to clinically necessary care. The medical review process supports member safety, quality of services, and efficiency of healthcare services. Of the members who are treated in the ASH system, 95% stated their provider was successful in treating their primary condition.

"For many years, ASH has supported health plans with performance–based approaches that reduce the need for routine prior authorization while maintaining strong clinical oversight," said ASH Chief Health Services Officer Douglas Metz, DC. "AHIP's latest initiative reinforces the value of best practices we have long recognized. When provider performance is consistently evidence-based, prior authorization in the form of medical necessity reviews stays focused on more complex cases. Many providers in the ASH network are gold carded to reduce administrative costs. By working with ASH, health plans reduce administrative friction and better support providers and members without compromising clinical integrity."

Dr. Metz added, "Reducing the scope of claims subject to prior authorization requires thoughtful execution. Our role is to help health plans operationalize these commitments at scale—supporting efficiency, consistency, and evidence–based decision–making across delegated services."

Outside of highlighting a reduction of prior authorization collectively amongst initiative partners, AHIP announced additional progress in improving the delivery of healthcare services to include enhancing continuity of care when members change plans and improving communication and transparency around coverage determinations.

ASH supports these additional efforts by ensuring continuity of care during coverage transitions by maintaining processes that help prevent disruption for members receiving delegated services such as physical therapy and chiropractic care. Additionally, the company evaluates written communications to improve readability for patients and providers and offers translation and interpretation services in more than 250 languages to support clearer, more accessible prior authorization communications.

More information about the AHIP-led effort to drive changes leading to a faster, more standardized and simplified experience, benefiting patients and providers can be found here.

About American Specialty Health

Founded in 1987, American Specialty Health Incorporated (ASH) is a leading national, musculoskeletal (MSK) HealthTech company. ASH co-founder, George DeVries, states "ASH exists to make health care better. We are committed to making healthcare more affordable, simpler, and accessible." 

Through its subsidiaries, ASH offers both clinical and fitness programs. Its national clinical provider network includes more than 126,000 integrative in-clinic and virtual providers including physical, occupational, and speech language therapists, as well as chiropractors, acupuncturists, massage therapists, registered dietitians, nutritionists, podiatrists, naturopaths, and over 25,000 fitness centers and exercise studios. ASH also offers a Digital MSK Platform that provides members with options to access digital MSK self-care recovery tools. The Digital MSK Platform includes a national network of virtual PTs and OTs to support all our digital solutions programs. Our Site-of-Care Hospital Outpatient PT/OT program is designed to support health plans in delivering more cost-effective PT/OT services for their members. Providing MSK recovery solutions for chronic and acute conditions, ASH leverages technology and clinical performance systems to expedite claims, customer service resolutions, and clinical management activities.

ASH provides benefit administration for hundreds of health plans including fully insured and self-funded health plans, as well as Medicare Advantage, Medicaid, DSNP, Exchange, and other programs. Accredited by NCQA, URAC, and HITRUST, ASH meets national health care standards. ASH has received many awards and honors, including 11 different years making the "Inc. 5000 List of America's Fastest Growing Private Companies." ASH is a trusted partner covering more than 62 million members nationwide in its clinical and fitness programs. For more information about ASH, visit ASHCompanies.com; follow on LinkedIn and Facebook; or call 800-848-3555.

Media Contact:
Jack Chirrick
American Specialty Health
(619) 557–2361
[email protected]

SOURCE American Specialty Health Incorporated