20% Prior Authorizations Cutting by UnitedHealthcare

 Wayne Carter RCM
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Good News for Providers as UnitedHealthcare Cuts Down 20 Percent of Prior Authorizations

Constantly evolving healthcare authorization requirements by insurance providers play a pivotal role in shaping the landscape of medical services and patient experiences, especially by the United Health Group. UnitedHealthcare, a prominent name in the health insurance industry, is set to make significant changes that are poised to impact both healthcare providers and patients. In this blog post, we delve into the plan by UnitedHealthcare to eliminate 20 percent of its current prior authorizations and introduce a game-changing national gold-card program under the UHC prior authorization list.

The Evolution of Prior Authorization in Healthcare

Prior authorizations have long been a part of the healthcare ecosystem, serving as a gatekeeper to certain medical services, treatments, medications, and procedures. They are a crucial tool for health insurance companies to assess the necessity and cost-effectiveness of proposed healthcare interventions. However, they have also been a source of frustration for healthcare providers and patients alike, often characterized as a cumbersome administrative process in revenue cycle management.

UnitedHealthcare recognizes the need for a more streamlined approach to prior authorizations. According to a March 29th news release, the company is embarking on a transformative journey to reduce prior authorizations across its commercial, United Healthcare Advantage Plan, and Medicaid plans. The initiative is expected to roll out in stages, commencing in the summer and extending throughout the year.

Introducing the National Gold Card Program

One of the most significant developments in UnitedHealthcare’s plan is the introduction of the national gold-card program, slated for implementation in early 2024. This program is set to benefit a vast majority of UnitedHealthcare members across their commercial, Medicare Advantage, and Medicaid plans. The key innovation of this program is the shift from the traditional prior authorization process to a simplified notification process for most procedure codes.

This transition promises to streamline the healthcare experience for both providers and patients. Qualifying provider groups will be able to follow a straightforward notification process for specified procedures, eliminating the need for time-consuming prior authorization steps. This move aims to strike a balance between member safety and the overall cost of care while addressing the concerns of healthcare providers.

A Message from UnitedHealthcare's Chief Medical Officer

Anne Docimo, MD, the chief medical officer of UnitedHealthcare, emphasized the importance of these changes in the news release, stating, “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. Docimo further added, “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 commitment to enhancing the healthcare experience by simplifying the prior authorization process is evident. The company aims to lead by example, hoping that other health plans will follow suit and adopt similar changes that benefit both providers and patients.

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Reactions from the Healthcare Community

The announcement by UnitedHealthcare has generated mixed reactions within the healthcare community. American Medical Association President Jack Resneck Jr., MD, expressed cautious optimism about these changes. He emphasized the need to scrutinize the details to ensure that they bring meaningful improvements to the healthcare landscape.

Molly Smith, the American Hospital Association’s group vice president for policy, offered a positive perspective, stating that “cutting back on unnecessary prior authorization in healthcare is a much-needed step forward.” She further added that the American Hospital Association would collaborate with its members to monitor the implementation of these policies, ensuring that they genuinely eliminate unnecessary barriers to care for patients and reduce wasteful administrative burdens on providers.

Congressional Support for Reform

UnitedHealthcare’s announcement also received support from lawmakers who have been advocating for reform in the area of prior authorizations. Rep. Mike Kelly of Pennsylvania expressed hope that UnitedHealthcare’s move would be the first of many from commercial payers, heralding “much-needed reforms to prior authorization in healthcare”

Rep. Suzan DelBene of Washington acknowledged the significance of this step but also noted that such changes should have been implemented earlier. She stressed the importance of consistent rules across Medicare Advantage and called for greater transparency and accountability in the program. DelBene concluded, “That’s why we must see today’s news as adding urgency to passing legislation that brings this archaic practice into the 21st century.”

Why does UHC reduce prior authorization in healthcare?

UnitedHealthcare’s plan to reduce prior authorizations by 20 percent and introduce the national gold-card program marks a significant shift in the healthcare landscape. The company’s commitment to improving the healthcare experience for both providers and patients is evident. While the healthcare community and lawmakers cautiously applaud these changes, the true impact of these reforms will become clearer as they are implemented.

As the healthcare industry continues to evolve, it is essential for insurance providers to strike a balance between ensuring member safety, controlling costs, and simplifying administrative processes. UnitedHealthcare’s initiative serves as a notable step in this direction, and it remains to be seen how other players in the industry will respond. As healthcare stakeholders work together to navigate these changes, the ultimate goal remains unchanged: to provide quality care that is accessible, efficient, and patient-centered by verifying patient eligibility.

In conclusion, the reduction of prior authorizations by UnitedHealthcare represents a significant development in the ongoing efforts to enhance the healthcare experience for all stakeholders involved, ushering in a new era of streamlined processes and improved access to care.

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Wayne Carter

I've been working in healthcare industry of the United States in various types of departments since 2013. Started my career from the bottom as a Accounts Receivable executive, Practice management team handler, Entire Practice Management and now I'm employed at BillingParadise as a Content Lead. Areas of Expertise: End-to-End Revenue Cycle Management, Content Writing, Digital Marketing, RCM applications and Software, Healthcare Business Development, Healthcare Sales, and Healthcare Automation.

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