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.