Streamlining the prior authorization process for a better health care experience
UnitedHealthcare is working to reduce prior authorizations with the goal of improving speed to care and reducing the administrative burden for providers.
While prior authorizations are an important checkpoint to ensure a service or procedure is safe, medically appropriate and cost-effective, UnitedHealthcare understands that they can be a pain point for both members and care providers, especially if they cause unintended delays in care.
That’s why UnitedHealthcare continues to evaluate and take steps to speed up, reduce or even eliminate prior authorizations where appropriate. In 2023, this included reducing the total volume of prior authorizations by nearly 20% for common procedures, treatments and services. And for 2025, UnitedHealthcare announced a goal to reduce that volume by another 10%.
Today, UnitedHealthcare does not require a prior authorization review for more than 98% of claims.1 Of the remaining nearly 2% of claims that need prior authorization, over 93% of those end up getting approved.2
30%
average reduction of prior authorizations per year for qualified Gold Card provider groups4
Furthering these efforts, UnitedHealthcare launched its Gold Card Program, which recognizes and awards provider groups who consistently adhere to evidence-based care guidelines by reducing their total prior authorization requirements across 514 codes, impacting many specialties including primary care, orthopedics, cardiology, oncology and more.
Instead of submitting formal prior authorizations, these qualifying provider groups only need to follow a simple administrative notification process for most procedure codes. This helps to remove some of the administrative burden experienced by providers, allowing them to spend more time with their patients, which may lead them to deliver a higher quality of care and better health outcomes as a result.3 The Gold Card Program has reduced the volume of prior authorization requests by an average of 30% for eligible provider groups.4
UnitedHealthcare also recently teamed up with America’s Health Insurance Plans (AHIP) and other health insurance companies to further these efforts at an industry level. These shared commitments, which are projected to benefit 257M Americans,5 include:
- Standardizing electronic prior authorizations
- Reducing the scope of claims that are subject to prior authorization
- Ensuring continuity of care when patients change plans
- Enhancing communication and transparency on prior authorization determinations
- Ensuring medical review of non-approved requests
- Expanding real-time responses, with the goal that at least 80% of electronic prior authorization approvals in 2027 will be answered in real-time (as long as they include all necessary clinical documentation)
How this impacts employers: By streamlining the prior authorization process for members and providers, employees may be able to receive the care they need more quickly and without delay due to administrative processes. As a result, employers may not receive as many questions or complaints from their employees, and overall employee satisfaction with their health plan may improve.
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