UnitedHealth Group is taking steps to reduce the use of its prior authorization process by 20% for some non-urgent surgeries and procedures. This move is ahead of a final rule expected to reduce the time allowed for PA approval and require electronic FHIR API standards. The procedure code reductions will start this summer and continue throughout the year for most commercial, Medicare Advantage, and Medicaid businesses. UnitedHealthcare’s aim is to simplify the healthcare experience for consumers and providers, and they will be implementing a national Gold Card Program for providers that meets eligibility requirements, eliminating prior authorizations for most procedures in early 2024.
The decision to reduce the use of prior authorizations comes after physicians expressed concerns about the administrative burden and care delays for patients. Cigna and Aetna are also making moves to revamp the prior authorization process. UnitedHealthcare will deploy a range of initiatives over the next several years to create an enhanced prior authorization experience through improved automation and faster decision-making, aligning with the most recent guidance from the Centers for Medicare and Medicaid Services.
CMS released a proposed rule in December 2022 to streamline the prior authorization process, which would require the implementation of a Health Level 7 (HL7) FHIR standard APIs to support electronic prior authorization. The provisions will be implemented starting on January 1, 2026. However, provider groups have requested that they begin before that date.