UnitedHealthcare cutting 20% of prior authorizations

UnitedHealthcare is moving forward with a plan to eliminate 20 percent of its current prior authorizations and implement a national gold-card program. 

Code reductions will begin this summer and continue through the rest of the year for most commercial, Medicare Advantage and Medicaid plans, according to a March 29 UnitedHealthcare news release. 

The national gold-card program will be implemented in early 2024, according to the release. The program will apply to most UnitedHealthcare members across commercial Medicare Advantage and Medicaid plans. Qualifying provider groups will follow a simple notification process for most procedure codes rather than the prior authorization process 

"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," Anne Docimo, MD, chief medical officer of UnitedHealthcare, said in the release. "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."

American Medical Association President Jack Resneck Jr., MD, told The Wall Street Journal March 29 that he is cautiously optimistic about UnitedHealthcare's changes but wants to see the details to be sure they will bring meaningful improvements. 

Molly Smith, the American Hospital Association's group vice president for policy, told Becker's that while AHA has not yet seen the specifics, "cutting back on unnecessary prior authorization is a much-needed step forward." She added that AHA will work with its members to monitor the implementation of the policies to "ensure they do indeed remove unnecessary barriers to care for patients and wasteful administrative burden on providers."

Two lawmakers who sponsored a Medicare Advantage prior authorization reform bill that passed the House last year applauded UnitedHealthcare's announcement. 

Rep. Mike Kelly of Pennsylvania said he is hopeful UnitedHealthcare's announcement is the first of many from commercial payers about the "much-needed reforms to prior authorization."

Rep. Suzan DelBene of Washington said the announcement is a step in the right direction, but added that the changes should have been instituted long ago.  

"The rules should be the same across Medicare Advantage and there needs to be greater transparency and accountability in the program. That's why we must see today's news as adding urgency to passing legislation that brings this archaic practice into the 21st century," she said. 

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