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The utilization of the prior authorization process has been reduced by 20% by UnitedHealth Group

Experienced Medicare Broker Consulting with Client in Michigan

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.

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What Our Customers Have To Say

Shecter Calendar
Shecter Calendar
2023-05-12
Very knowledgeable, friendly, easy to work with.
Cindy
Cindy
2023-05-11
Jim was a great resource who was recommend by my financial advisor. His explanations of the various options were straight forward and very informative. He asked me pertinent questions about my health in order to tailor a plan to best fit my needs.
beth swartz
beth swartz
2023-05-10
very knowledgable
Loventry Robinson
Loventry Robinson
2023-05-10
Jim is patient and very knowledgeable in his work. He helped me to get the Medicare advantage plan I wanted, and I am very satisfied.
Teresa Orr
Teresa Orr
2023-05-10
Jim was very helpful in explaining coverages and explaining the steps I needed to take to get Medicare. I highly recommend him. He is very knowledgeable on all aspects of care and made it easy for me to enroll in coverage.
Laurie Eisenbraun
Laurie Eisenbraun
2023-05-08
Jim was able to provide tailored Medical Gap policy solutions that fit my and my husbands individual needs. Jim is knowledgeable about all the potential policies that could work for us.
Denise Bensch
Denise Bensch
2023-05-04
I want to thank James Neil for making the Medicare Insurance sign up process so easy. He took what I thought would be a frustrating and confusing process, and made it a pleasure. He clearly explained our options and gave us information in an easy to understand manner. I will definitely recommend his services to friends and family.
Chris Bensch
Chris Bensch
2023-05-04
Mr. Neal is extremely knowledgeable & helpful. He did an excellent job of explaining how everything works and presented our options clearly. I'd strongly recommend anyone nearing retirement, considering a benefit change or simply looking for an overview of their options contact him.
Patrick Lennane
Patrick Lennane
2023-05-01
Awesome experience, explained all options clearly and made it easy to make a healthcare decision. Highly recommend!
KATHY TROHA-AUSTIN
KATHY TROHA-AUSTIN
2023-04-24
These two (Jim and Jennifer) were awesome. Extremely knowledgable about the entire process. Would highly recommend them.