UnitedHealthcare is set to eliminate close to two-thirds of pediatric prior authorization requirements by the end of the year.
The insurance giant announced Friday morning that it will nix prior auth on an array of diagnostic tests, routine surgeries and specialty services, including cardiology, neurology, pulmonology and orthopedics.
UnitedHealth also said it will offer authorization waivers for certain procedures when they’re performed at leading pediatric hospitals as a reflection of their “consistent use of well-established care practices.” The insurer said that the facilities in this program represent a broad national network across medical and surgical specialties.
“Parents should be able to spend less time having to navigate the health system and more time focusing on their children as they get the care they need,” said Tim Noel, CEO of UnitedHealthcare, in the announcement.
“These changes are part of our broader efforts to simplify healthcare and allow families—and their doctors and nurses—to pursue routine care with far fewer administrative steps, while higher-risk procedures continue to undergo reviews,” Noel added.
The company is undertaking a broad review of all pediatric prior authorizations to determine which can be rolled back while maintaining safety and quality. It said it plans to eliminate pre-approvals for some diagnostic imaging, sleep studies, routine outpatient tests and some surgical services and therapies that are approved consistently.
UnitedHealthcare said prior authorization will remain in place for services with high clinical complexity or variability, such as experimental treatments, or where it is required by regulations.
The company said the changes will take effect across its commercial and Medicaid plans.
The move is the latest from the company as it aims to reduce prior authorization requirements. For example, last month, UnitedHealth said it would exempt rural providers from most prior auth requirements.
The company has also made a push to reduce a wide swath of reauthorizations at its pharmacy benefit manager, Optum Rx.
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