US health insurers advance measures to standardize prior authorization requirements
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FILE PHOTO: The corporate logo of UnitedHealthcare, the insurance unit of UnitedHealth Group, appears on the side of one of their office buildings in Santa Ana, California, U.S., April 13, 2020. REUTERS/Mike Blake/File Photo
April 24 (Reuters) - UnitedHealth and CVS Health said on Friday they have standardized data and submission requirements for more than half of their prior authorizations, as part of an industry effort to reduce delays and paperwork for patients and doctors.
U.S. health insurers, which have come under scrutiny to simplify their requirements for prior approval on medicines and medical services, have been working to deliver on commitments made last year to cut red tape and improve transparency.
• UnitedHealthcare, UnitedHealth's insurance unit, said more than 70% of prior authorization requests will be part of this standardized process by the end of the year.
• The process will apply across its commercial plans, government-backed Medicare Advantage and Medicaid businesses, the insurer said.
• CVS Health said its Aetna insurance unit has standardized 88% of its prior authorization volume.
• The standardized approach will be used for medical services that are commonly subject to prior authorization, such as orthopedic surgeries and imaging services, including CT scans and MRIs, industry group AHIP said.
• UnitedHealthcare said it aims to improve predictability, reduce rework and decrease the number of requests for additional information by standardizing the information health plans require to support prior authorizations.
• It also plans to expand the program to additional medical services and continue cutting the number of procedures that require prior approval.
• UnitedHealthcare said the changes will not affect coverage rules or the medical reasons used to approve or deny care.
(Reporting by Sahil Pandey and Mariam Sunny in Bengaluru; Editing by Shreya Biswas)
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