UnitedHealth Rolls Back Gastroenterology Prior Authorization Plan Amid Backlash
Carrier Updates
Thursday, June 08 2023
UnitedHealth has rescinded a plan to require prior authorization for colonoscopies and other endoscopic procedures, following backlash from physician groups. UnitedHealth, which operates the biggest private health insurer in the U.S., was set to require prior authorizations for the procedures this week, but announced it was instead enacting an alternative advance notification process.
Provider groups still slammed the new process, which requires doctors to collect and submit patient data to the insurer before most endoscopic procedures, claiming that it raised documentation requirements on physicians and is a glide path to stricter prior authorization policies. The new advance notification process is the latest development in an ongoing back and forth between UnitedHealth, the parent company of payer UnitedHealthcare, and provider groups over prior authorization.
UnitedHealth was set to enact prior authorization for 61 endoscopy codes starting in June for its more than 27 million commercial beneficiaries. The payer argued the policies would hold physicians to evidence-based practices for clinically appropriate care.
However after several meetings with provider groups, UnitedHealth agreed to temporarily postpone the prior authorization program in exchange for advance notification. UnitedHealth will run the pilot program collecting data for at least seven months, according to the American Hospital Association, which discussed the policy wit UnitedHealth.
Read the full story here
Provider groups still slammed the new process, which requires doctors to collect and submit patient data to the insurer before most endoscopic procedures, claiming that it raised documentation requirements on physicians and is a glide path to stricter prior authorization policies. The new advance notification process is the latest development in an ongoing back and forth between UnitedHealth, the parent company of payer UnitedHealthcare, and provider groups over prior authorization.
UnitedHealth was set to enact prior authorization for 61 endoscopy codes starting in June for its more than 27 million commercial beneficiaries. The payer argued the policies would hold physicians to evidence-based practices for clinically appropriate care.
However after several meetings with provider groups, UnitedHealth agreed to temporarily postpone the prior authorization program in exchange for advance notification. UnitedHealth will run the pilot program collecting data for at least seven months, according to the American Hospital Association, which discussed the policy wit UnitedHealth.
Read the full story here