Prior-authorization requirements have long been a tool used by insurance carriers to “manage” care and promote “efficiency”. But, the burden pre-authorizations put on medical providers and facilities is significant and the payer industry is being pushed to change their practices by recent governmental actions. Modern Healthcare recently provided some encouraging statistics on this trend: Cigna announced in August 2023, that it would eliminate prior-auth requirements for 600 genetic tests, surgical procedures and durable medical equipment; United Healthcare plans will eliminate 20% of prior-auth requirements for its 47.5 million insureds in 2023. Elevance Health (BCBS in 14 states), announced in July that it has connected a “bi-directional data exchange” to more than 1700 hospitals’ electronic health records to speed the precertification process. UHC is also rolling out a “gold card” program through which qualifying providers can simply notify the insurer of pending care rather than request preapproval.
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