United Health Care Announces Plans to Reduce Prior Authorization Requirements and to Adopt Gold Card Programs
On March 30, 2023, United Health Care (UHC) announced a plan to reduce prior authorization requirements for (yet undefined) services as well as adoption of Gold Card programs. Their announcement indicated they intend to reduce nearly 20% of prior authorizations required beginning in July 2023. Of note, the health plan did not identify which procedures would be affected, nor whether how whether their new policy would apply to retrospective review and denials after a procedure had been performed. These positive changes made by UHC are the result of multi-year sustained efforts made by clinical community and groups like NANS that have longed prioritized reducing the burden of prior authorization on physicians and practices.
UHC also announced that starting in early 2024, they will implement a national Gold Card program for care providers meeting eligibility requirements, eliminating prior authorization requirements “for most procedures." This would apply to commercial, Medicare+Advantage and managed Medicaid programs. Services must still be deemed a covered benefit by the health plan with care providers qualifying for this program. In Texas Gold Card qualification occurs when, during a prior six-month period, a physician was approved for at least 90% of prior authorizations for a particular service and as a result that physician will not be subject to prior authorizations for that service for the next six months. West Virginia implemented a similar program. New York, Colorado, Indiana, Kentucky, Mississippi, Tennessee and Virginia are States now pursuing similar legislation. The U.S. Congress is also advancing its own Federal legislation to reduce the burden of Prior Authorization (e.g. HR 7995).
NANS is pleased with this announcement and will work with UHC to ensure the implementation of the plan achieves its stated goals for our members. We will also continue to advocate for states, the U.S. Congress, and private payers to pursue administrative relief for physician practices.
Read the UHC press announcement here
Write something about yourself. No need to be fancy, just an overview.
Copyright © 2024 North American Neuromodulation Society. All Rights Reserved.
111 North Wabash Avenue
Chicago, IL 60602
Phone: (773) 648-7845
Fax: (773) 648-7847