UnitedHealthcare, Cigna & Aetna Ease Prior Authorizations Ahead of CMS Rule

Multiple major insurers - including UnitedHealthcare, Cigna, and Aetna – are making changes to their prior authorization policies. This includes eliminating, simplifying, and automating much of the paperwork that patients need before getting non-urgent surgeries, procedures, and tests. 

In the case of UnitedHealthcare, nearly 20% of current prior authorizations will be eliminated as part of an overall effort to simplify the health care experience for consumers and providers. These code reductions will begin in Q3 of 2023 and will continue through the rest of the year for most Commercial, Medicare Advantage, and Medicaid businesses. However, any removal of prior authorization will still comply with all state and federal requirements and will be done in accordance with existing commercial health plans. 

Furthermore, carriers like Cigna and Aetna will follow suit and reduce prior authorizations while simultaneously making them easier and more streamlined. 

This change in policy and procedure is coming ahead of a soon-to-be Centers for Medicare & Medicaid Services (CMS) regulation that limits the amount of time insurers have when approving prior authorization requests. This rule was designed to rectify the administrative hassles of prior authorization by requiring an automated process, shorter turnaround times for decisions about coverage, and increased transparency.

This new CMS rule is likely a result of a December 2022 proposal by the federal government that would force plans like Medicaid, Medicare Advantage, and Affordable Care Act (ACA) marketplace plans to speed up prior authorization requests while also providing more detailed reasoning for denials. Beginning in 2026, it would require plans to respond to a standard prior authorization request within seven (7) days instead of the current fourteen (14). It would also require a response within seventy-two (72) hours for urgent requests. 

This process of speeding up prior authorization requests is part of a wider, more comprehensive move to improve health care efficacy for both patients and providers. According to a recent survey from the American Medical Association (AMA), 94% of physicians reported that prior authorization led to delays in patient care and has caused increased administrative burden.