UnitedHealthcare To Begin Reducing Prior Authorizations This Summer

Prior authorization has been a continual source of frustration for providers, and Wednesday UnitedHealthcare, the country’s largest insurer, said it will offer some relief.

The payer giant will cut nearly 20% of its current prior authorizations, according to a new release, in a bid to simplify the process for both providers and its members. UnitedHealth will begin reducing codes in the third quarter, and the efforts will continue through the rest of the year.

UHC said the code reductions will extend to most commercial, Medicare Advantage and Medicaid plans. Removing these prior authorizations will be in compliance with state and federal regulations as well as the insurer’s commercial contracts.

“Prior authorizations help ensure member safety and lower the total cost of care, but we understand they can be a pain point for providers and members,” said Anne Docimo, M.D., chief medical officer of UnitedHealthcare. “We need to continue to make sure the system works better for everyone, and we will continue to evaluate prior authorization codes and look for opportunities to limit or remove them while improving our systems and infrastructure.

“We hope other health plans will make similar changes,” she added.

In addition, UnitedHealthcare said it will in 2024 launch a national Gold Card program for provider groups. In this initiative, groups that meet certain eligibility requirements can skip prior authorization for most procedures, applicable across UHC’s coverage lines.

The news was first reported by The Wall Street Journal. The WSJ article also noted that Cigna and CVS Health’s Aetna have made similar moves, with the former cutting prior authorization requirements for 500 series and devices since 2020.

Aetna, meanwhile, has put a focus on automation for prior authorization, according to the article. Electronic prior authorization has been highlighted across the industry as a way to ease the burden associated with utilization management while keeping its protections in place.

Insurers are also taking steps to get out ahead of incoming prior authorization regulations, which are expected to be finalized soon.

 

Source Link

Recommended Articles

P4ESC Warns Congress Not to Tax Health Benefits

“We oppose taxing health benefits,” said Neil Trautwein, P4ESC’s Executive Director. “Policymakers will find how widely unpopular the idea will be with Americans with this type of coverage if they take this unwise step,” added Trautwein.

Read More

At Social Security, These Are the Days of the Living Dead

In multiple instances over the past few weeks, Social Security Offices have seen people come in for whom “there is no information on the record, just that they are dead.” So employees have to “resurrect” them — affirm that they’re living, so they can receive their benefits.

Read More

Out-Of-Pocket Drug Spending Hit $98B In 2024: Report

Americans spent $98 billion out of pocket on prescription drugs in 2024, marking a cumulative 25% increase over five years, according to an annual report from analytics firm IQVIA. Why it matters: Lowering prescription drug costs remains a priority for both Democrats and Republicans. The Biden administration led Congress in passing a landmark legislative package to negotiate select drug ...

Read More

Trump Signs Executive Order To Encourage U.S. Drug Manufacturing

U.S. President Donald Trump signed an executive order on Monday that aims to reduce the time it takes to approve pharmaceutical plants in the country, as part of new regulations to encourage domestic manufacturing. The order directs the U.S. Food and Drug Administration to streamline reviews and work with domestic manufacturers to provide early support ...

Read More
arrowcaret-downclosefacebook-squarehamburgerinstagram-squarelinkedin-squarepauseplaytwitter-squareyoutube-square