UnitedHealthcare to launch prior authorization gold card program

UnitedHealthcare is launching a program next month geared toward streamlining prior authorization for qualifying providers.

The UnitedHealth Group subsidiary's "gold card" program, offered across its commercial, individual exchange, Medicare Advantage and Medicaid business lines, will allow certain providers to use a simplified process for about 500 procedure codes.

Related article: Why insurers are scaling back prior authorization

Through the program, in-network provider groups that have submitted at least 10 prior authorization requests for eligible procedures over each of the past two years — with a 92% or higher UnitedHealthcare approval rate — can submit what the insurance company calls an "advance notification" and forgo clinical documentation review for selected services. The initiative was first announced last year.

UnitedHealthcare estimates that roughly 20% of provider groups that submitted enough prior authorization requests qualify for the program. It did not respond to follow-up requests for comment regarding how many provider groups are expected to qualify overall, or the potential effect of the program on prior authorization volume as a whole.

Other companies, including Health Care Service Corp. and Highmark, offer gold card programs to select providers.

UnitedHealthcare last year cut almost 20% of its prior authorizations, with Cigna, L.A. Care Health Plan and some Blue Cross and Blue Shield plans taking steps to reduce their preapproval requirements as well. Some providers have expressed skepticism, however, over whether such changes will actually lessen their administrative burden.

Policymakers and regulators have also taken action. Several states have passed laws over the past few years aimed at reducing the number of prior authorization requirements for providers, with some creating their own gold card programs. The Centers for Medicare and Medicaid Services in January finalized a rule mandating faster reviews of preapproval requests for government-sponsored health plans.