Resources

Client Alerts, News Articles, Blog Posts, & Multimedia

Everything you need to know about BMD and the industry.

The Second Wave of UnitedHealthcare's Prior Authorization Cuts Started in November

Client Alert
December 11, 2023

In August 2023, UnitedHealthcare released its plan to eliminate roughly one-fifth of its then-current prior authorization requirements. The first round of prior authorization cuts took effect on September 1, 2023. In that round, UnitedHealthcare eliminated the necessity for some prior authorizations for UnitedHealthcare Medicare Advantage, UnitedHealthcare commercial, UnitedHealthcare Oxford and UnitedHealthcare Individual Exchange plan members. The second and final round of prior authorization cuts began on November 1, 2023. The November 2023 Prior Authorization Cuts apply to the same plans as well as community plans (i.e., Medicaid managed care plans).

UnitedHealthcare’s Prior Authorization Cuts

The prior authorization cuts are part of UnitedHealthcare’s comprehensive effort to simplify the healthcare experience for members and providers. In sum, the cuts account for nearly 20% of UnitedHealthcare’s overall prior authorization volume.

The prior authorization process requires a patient to obtain approval from their health plan before proceeding with a medical service. The process results in barriers to timely care for patients, and is expensive, inefficient, and administratively burdensome for providers. Payers claim that providers do not always make appropriate, high-value healthcare decisions for their patients.

Starting November 1, 2023, some prior authorization codes procedures in cardiology, genetic testing, hysterectomy, spine surgery, radiology, arthroplasty, vein procedures and site of service sterilization were removed. Examples include:

  • Spine surgery codes 22864 (removal disc arthroplasty anterior 1 interspace cervical), 22865 (removal disc arthroplasty anterior 1 interspace lumbar), and 0095T (removal total disc arthroscopy anterior approach, each additional interspace, cervical); and
  • Cardiology codes 93303 (complete transthoracic echocardiography for congenital cardiac anomalies), 93304 (transthoracic echocardiography for congenital cardiac anomalies; follow-up or limited study), and 93306 (performing and interpreting of a complete transthoracic echocardiogram). 

Prior Authorization Cuts Are Becoming a Trend

UnitedHealthcare is not the only payer that has announced prior authorization cuts this year. In August 2023, Cigna Healthcare removed roughly 25% of medical services from prior authorization requirements. This cut encompassed more than 600 codes, including roughly 100 surgical codes and 200 genetic testing codes, in addition to codes for durable medical equipment, prosthetics, and other services. Additionally, in September 2023, Blue Cross Blue Shield of Michigan announced that it was cutting approximately 20% of its prior authorization requirements and expanding its gold card program, which adjusts prior authorization requirements for providers with a track record of high-quality care and a high approval rating over six months or more.

In 2024, United Healthcare plans to implement a national gold card program for provider groups that meet eligibility requirements. Instead of adhering to the prior authorization process, qualifying providers in the program will follow a simplified notification process. UnitedHealthcare is set to publish informational guidance on this program before the end of the year.

If you have questions about the prior authorization process or UnitedHealthcare's prior authorization cuts, please contact your local BMD Healthcare Attorneys Daphne Kackloudis at dlkackloudis@bmdllc.com or Jordan Burdick at jaburdick@bmdllc.com.

Health LawHealthcareHealth InsuranceDaphne KackloudisJordan Burdick
Client Alert

Interim Final Rule for Surprise Billing

July 12, 2021In an effort to implement the new bipartisan No Surprises Act, on July 1, 2021, the Department of Health and Human Services (HHS), along with the Departments of Labor and Treasury, issued an interim final rule to safeguard patients against unforeseen medical bills arising from out-of-network care.Client Alert

President Biden Seeks to Limit Non-Compete Agreements

July 8, 2021Today, President Biden announced he would issue an Executive Order that calls on the Federal Trade Commission (FTC) to adopt rules to curtail worker non-compete agreements. Interestingly, a week ago, the FTC approved changes to its Rules of Practice to modernize and expedite the way it issues Trade Regulation Rules. If you have followed our alerts, we predicted the elimination of non-competes would probably happen. In 2016, then-Vice President Biden was a vocal opponent against non-compete agreements. He led the Obama administration’s initiative seeking to limit or eliminate non-compete agreements. In his presidential campaign, Biden promised to “work with Congress to eliminate all non-compete agreements, except the very few that are absolutely necessary to protect a narrowly defined category of trade secrets . . ..”Client Alert

New NIL Opportunities for Student-Athletes Require Diligent Review

July 8, 2021On June 28, 2021, Governor Mike DeWine signed Executive Order 2021-10D, “Establishing the Duties of Colleges and Universities as to Name, Image, and Likeness Compensation of Student-Athletes.” The Executive Order was motivated by the passage of similar name, image, and likeness (“NIL”) regulations in seventeen (17) other states; Ohio followed suit to avoid a significant competitive disadvantage in attracting student-athletes to the state.Client Alert

Tax Savings Potentially on the Chopping Block under President Biden’s American Jobs Plan and American Families Plan

June 18, 2021Recently, President Biden has proposed several tax law changes in his American Jobs Plan and American Families Plan. Outlined below, are a few of the tax savings that could be significantly changed or eliminated under Biden’s plans.Client Alert

Here are the Final Candidates for Mayor of Cleveland

June 17, 2021Earlier this year, current Cleveland Mayor, Frank Jackson, announced he would not run for re-election this fall. With no need to beat an incumbent, the Cleveland mayoral race suddenly became competitive. Thirteen individuals declared their intent to run for mayor. The City of Cleveland, however, has a difficult qualification requirement to run: 3,000 valid signatures from Cleveland residents. The deadline to file a petition to run, with the 3,000 valid signatures, had to be submitted by June 16 (yesterday).
Older posts
Newer posts