First Wave of UHC Prior Auth Cuts Begin, But Will it Matter?

In an effort to soften the payer/provider relationship, many large health insurers are rolling back on prior authorizations.

UnitedHealthcare (UHC) is the latest to cut back on its prior authorization list. 

Beginning last week, the health insurer removed hundreds of codes from its prior authorization list—mostly for genetic testing. More codes for radiology services are scheduled to be removed November 1.

Prior authorizations have long been a pain point for revenue cycle leaders, so while UHC says these removed codes account for tens of thousands of prior authorization requests a year, how much will it really help your operations?

Between the administrative time spent on submitting requests to the heap of denials they can accrue, any reduction in volume will likely speed up some revenue cycle processes—but as UHC is one payer in a large market, without a complete overhaul, this change is unlikely to make a huge dent in the overall revenue cycle prior authorization burden.

As leaders will likely still struggle with the administrative burden in 2024 and beyond, automation may be the key to lighten the workload. In fact, 39% of respondents in a recent survey said the biggest area of focus for their revenue cycle management automation in 2024 will be on prior authorization.

The decision for UHC to roll back prior authorizations comes on the heels of a substantial back-and-forth with gastrointestinal providers earlier this year.

UHC was set to require added prior authorizations for nearly half (47%) of gastrointestinal endoscopies starting June 1, saying more prior authorizations were needed to curb costs related to alleged overuse of some of these procedures by physicians.

But, after intense pushback from large medical associations, UHC pulled back.