From UnitedHealthcare announcing a start date for its national gold-card program to a California payer cutting nearly a quarter of its requirements, here are eight updates on prior authorization Becker's has reported since July 11:
1. Centene is the most likely to overturn a prior authorization denial decision when appealed, while Humana is the least likely, according to a KFF analysis.
2. L.A. Care Health Plan removed 24% of its prior authorization requirements.
3. Medicare Advantage insurers denied 7.4% of prior authorization requests in 2022, according to data published by KFF.
4. KFF released a report that analyzes prior authorization activity between healthcare providers and Medicare Advantage insurers, based on data submitted by MA insurers to CMS.
5. UnitedHealthcare will launch its national gold-card program on Oct. 1.
6. Humana CEO Jim Rechtin is putting his support behind federal legislation aimed at reforming the Medicare Advantage prior authorization process.
7. Physicians are increasingly turning to generative AI to appeal denied prior authorizations.
8. Illinois Gov. JB Pritzker signed legislation that will ban prior authorization for admission for inpatient psychiatric services, beginning in 2026. Payers will also be required to publish all services that require prior authorization on their website, and face stricter requirements to maintain an accurate provider network directory.