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Health Insurers Streamline Prior Authorizations
24 Apr
Summary
- UnitedHealth and CVS Health standardized data for over half of prior authorizations.
- This move aims to reduce delays and paperwork for patients and doctors.
- Standardization applies to common services like orthopedic surgeries and imaging.
UnitedHealth and CVS Health have announced a significant step towards simplifying healthcare administration by standardizing data and submission requirements for more than half of their prior authorization processes. This collaborative effort aims to alleviate delays and reduce the administrative burden on both patients and medical professionals.
UnitedHealthcare will have over 70% of its prior authorization requests integrated into this standardized system by the end of 2026. The initiative spans its commercial, Medicare Advantage, and Medicaid plans, focusing on commonly authorized medical services like orthopedic surgeries and imaging, including CT scans and MRIs.
CVS Health's Aetna insurance unit has already standardized 88% of its prior authorization volume. This standardization is expected to enhance predictability, minimize rework, and decrease requests for additional information. UnitedHealthcare plans to expand this program to more services and further reduce the number of procedures requiring prior approval, while maintaining existing coverage rules and medical criteria.
