Former Authorization Revamped by Cigna, UnitedHealth Group

UnitedHealth Group and Cigna are modifying their prior authorization processes in the face of new federal regulations aimed at reducing the burden on providers and patients.

UnitedHealthcare will eliminate about 20% of existing prior authorizations for its commercial, Medicare Advantage and Medicaid members beginning in the third quarter, the insurer announced Wednesday. Next year, UnitedHealth will implement a national “Gold Card” program, through which qualified providers notify the insurer of pending care instead of requesting prior authorization. This will eliminate the need for prior authorization in most cases, according to the company.

UnitedHealth did not immediately respond to requests for an interview about why exchange plans were absent from these proposals, what processes would be involved, how it would determine eligibility for providers and how the notification process would work.

“We will continue to evaluate the prior authorization codes and look for opportunities to limit or remove them while we improve our systems and infrastructure. We expect other health plans to make similar changes.”

Cigna has removed prior authorization reviews for nearly 500 services and devices since 2020, Dr. Scott Josephs, national medical officer, wrote in an email. About 6% of medical services are subject to Cigna’s prior authorization and the insurer uses an electronic process to respond rapidly to multiple requests, a spokesperson wrote in an email.

Health insurance lobbying groups AHIP, Aetna, Centene, Elevance Health, Humana and Molina Healthcare did not immediately respond to interview requests.

Providers complain that prior authorization requirements have burst in recent years, and that care is delayed. For example, the inspector general of the Department of Health and Human Services reported last year that Medicare Advantage insurers unreasonably refused 13% of prior authorization requests.

The Centers for Medicare and Medicaid Services is scheduled finalization of proposals Next month health insurers will be required to automate prior authorizations, process them more quickly, justify denials and publicly report data on their decisions.

This is a developing story. Please check back for updates.

Source link

Leave a Comment