UnitedHealthcare Slashes Prior Auth for 1,700 Codes

UnitedHealthcare announced a major initiative to streamline healthcare services, effective October 1. The insurer is eliminating prior authorization requirements for 1,700 diagnostic codes, impacting treatments and procedures across all its plans, including commercial, Medicare Advantage, Medicaid, and Affordable Care Act individual coverage. This move is designed to significantly reduce administrative tasks for providers and allow them to dedicate more time to patient care.

The company is also launching a rural prior authorization waiver program on November 1. This program aims to decrease administrative burdens for eligible rural hospitals and their affiliated providers. Furthermore, UnitedHealthcare is accelerating payments by up to 50% for approximately 1,400 rural and Critical Access Hospitals during the third quarter.

These changes are part of a broader commitment by UnitedHealthcare to reduce prior authorization demands. Earlier this year, the company pledged to eliminate these requirements for 30% of healthcare services by the end of 2026. The insurer notes that while pre-authorization affects a small percentage of claims, it generates millions of reviews annually, with about 92% typically approved within 24 hours.

The insurer's actions align with industry-wide pressure from patients, physicians, lawmakers, and regulators to ease prior authorization processes. Recent analyses indicate that denial rates for these requests have ranged from 12% to 18% for Medicare Advantage, Medicaid, and ACA enrollees.