• Major payer to reduce prior authorizations

    Update: On Aug. 1, 2023, UHC announced the codes for which prior authorization would be eliminated. Because many of the codes on the removal list are low-volume codes in primary care, this change is unlikely to have a significant impact on family physicians. While reductions in prior authorization requirements will occur across all UHC lines of business, the specific reductions will vary by plan type.

    UnitedHealthcare (UHC) recently announced it will reduce the burden of prior authorizations (PA) across most of its commercial, Medicare Advantage, and Medicaid plans.

    UHC is eliminating prior authorization requirements for codes that account for roughly 20% of its current PA volume, with reductions beginning in the third quarter of the year. The PA reduction process will comply with state and federal requirements, as well as existing commercial health plan contracts.

    In early 2024, UHC also plans to implement a national “Gold Card Program” for eligible physician groups that will eliminate PA requirements for most procedures. Qualifying physician groups will be able to follow a notification process for most procedure codes, rather than a prior authorization process.

    UHC is also using more automation to improve the PA experience and speed decisions, and it plans to introduce a new feature allowing patients to track their PA requests online at myuhc.com or through the company’s mobile app.

    The announcement of UHC’s changes comes after years of advocacy by the American Academy of Family Physicians (AAFP) and other groups, urging insurance companies and the Centers for Medicare & Medicaid Services to reduce the burden PA places on physicians and other health care professionals. The gold card program is one of the changes the groups specifically requested. The AAFP has asked UHC to also include medications in the program.

    The AAFP has developed a prior authorization policy, as well as a set of principles for administrative simplification that it asks payers to follow. 

    See also:

    Beating the Prior Authorization Blues [FPM article],

    Family Medicine Practice Hacks: Prior Authorization [AAFP video],

    Prior Authorizations: What They Are and How to Make Them Easier [AAFP].

    — Brennan Cantrell, AAFP Commercial Health Insurance Strategist

    Posted on April 3, 2023

    Disclaimer: The opinions and views expressed here are those of the authors and do not necessarily represent or reflect the opinions and views of the American Academy of Family Physicians. This blog is not intended to provide medical, financial, or legal advice. Some payers may not agree with the advice given. This is not a substitute for current CPT and ICD-9 manuals and payer policies. All comments are moderated and will be removed if they violate our Terms of Use.