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UnitedHealthcare, Cigna, Aetna revamping prior authorization ahead of CMS rule

Major insurers are taking steps to eliminate, streamline and automate some of the paperwork required for patients to get many medical tests and procedures, before the proposed CMS rule is finalized.

UnitedHealthcare announced on Wednesday that it will reduce the use of its prior authorization process by 20% for some non-urgent surgeries and procedures.

The reductions will begin in the third quarter and continue through the rest of the year for most commercial, Medicare Advantage and Medicaid businesses. Cigna and Aetna also are making moves to revamp their prior authorization processes, according to The Wall Street Journal.

“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,” said Dr. Anne Docimo, chief medical officer for UnitedHealthcare. “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.”

The move comes ahead of a Centers for Medicare & Medicaid Services rule expected to be finalized soon that would limit the amount of time insurers have to approve prior authorization requests. In December, the federal government proposed several changes that would force health plans, including Medicaid, Medicare Advantage and Affordable Care Act marketplace plans, to speed up prior authorization decisions and provide more information about the reasons for denials. Starting in 2026, it would require plans to respond to a standard prior authorization request within seven days instead of the current 14 and within 72 hours for urgent requests. The proposed CMS rule was scheduled to be open for public comment through mid-March.

UnitedHealthcare plans to implement a national gold card program early next year for providers that meet eligibility requirements, which would eliminate prior authorizations for most procedures. The company also said it will deploy a range of initiatives over the next several years, aligned with the most recent guidance from the CMS, creating an enhanced prior authorization experience through improved automation and faster decision making.

The majority (94%) of physicians reported that prior authorization led to delays in patient care and has caused increased administrative burden, a recent survey from the American Medical Association found.

BenefitsPro Reporter: Alan Goforth


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