The payer giant will reduce codes in the summer with the aim of easing the administrative process.
UnitedHealthcare is responding to concerns over prior authorization's potential to delay care and create burden by introducing code reductions this summer, the company announced.
The nation's largest health insurer said it will eliminate nearly 20% of current prior authorizations beginning in the third quarter for most commercial, Medicare Advantage, and Medicaid businesses.
The move is "part of a comprehensive effort to simplify the health care experience for consumers and providers."
Additionally, the insurer stated that it will also implement a national Gold Card program for provider groups in early 2024, which will get rid of prior authorization requirements for most procedures.
"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," Dr. Anne Docimo, chief medical officer of UnitedHealthcare, said in the press 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."
UnitedHealthcare's efforts to scale back on prior authorization are a step in the right direction, but more still needs to be done to ensure the process isn't harming patients and overwhelming providers.
In a recent poll of practicing physicians by the American Medical Association, 89% of respondents said prior authorization has had a negative impact on patient clinical outcomes, with 94% saying it delayed access to necessary care.
Furthermore, 86% of physicians reported that prior authorization requirements sometimes, often, or always led to higher overall utilization.
Regulations are on the way for insurers that are expected to streamline the process by requiring certain payers to implement electronic prior authorization.
Jay Asser is the contributing editor for strategy at HealthLeaders.
KEY TAKEAWAYS
In a bid to simplify the experience for patients and providers, UnitedHealthcare will introduce code reductions in the third quarter of this year.
The reduced codes will affect most commercial, Medicare Advantage, and Medicaid plans, and are expected to eliminate nearly 20% of prior authorizations.
With regulations on the horizon, payers need to prepare to streamline the process and implement electronic prior authorization.