2023 has been a tumultuous year when it comes to prior authorizations, as some payers have repealed major barriers to procedures, while others have added new rules.
"Year after year, medical practices identify prior authorization requirements as the most challenging and burdensome obstacle to delivering high-quality patient care," Anders Gilberg, senior vice president of government affairs for the Medical Group Management Association, told Becker's.
Companies cutting back prior authorizations
On Aug. 1, Humana rolled back prior authorization requirements for cataract surgery for Medicare Advantage beneficiaries in Georgia. The insurer started requiring pre-approval for the procedure a year ago. Insurer Aetna also implemented a similar rule two years ago, but cut the requirement in July 2022.
On Sept. 1, UnitedHealthcare plans to begin a two-phased approach to eliminate prior authorization requirements for several procedure codes. On Sept. 1 and Nov. 1, codes will be eliminated for UnitedHealthcare Medicare Advantage, UnitedHealthcare commercial, UnitedHealthcare Oxford and UnitedHealthcare Individual Exchange plans. On Nov. 1, codes will be eliminated for the UnitedHealthcare Community Plan as well.
Health Care Service Corp., a health plan operator for 18 million members across Illinois, Montana, New Mexico, Oklahoma and Texas, launched an integration plan to add artificial intelligence and augmented intelligence to reform its prior authorization process. The intelligence tool will make the prior authorization process 1,400 times faster, according to a news release.
UnitedHealthcare doubling down on GI prior authorization
While UnitedHealthcare chose not to move forward with a proposed prior authorization plan for certain GI procedures, on June 1, it implemented an "advanced notification" process that many industry groups are saying is just as burdensome. The plan requires providers to input certain patient information before going forward with endoscopy procedures.