Kennedy is leading the prior authorization reform and insurers have pledged to cooperate. For people who work in prior auth, how will this affect your job?
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More tricks. UHG doesn’t have any integrity, they speak with a fork tongue. Probably have their fingers crossed at the table and as they walk away they allready are undermining what they agreed to. They don’t follow the 2 midnight rule why would they abide by agreements made for preauth. They don’t follow their own medical necessity criteria , constantly denying when it meets criteria for the service to be covered.
@ak @ak it isn’t pointless at all. It’s doing exactly what it’s designed to do with each and every fabricated, exponentially quantified tick for its shareholders while the people in ‘mUrica die of absurdly preventable “conditions” they have encoded to, such as childbirth, die an average of 8 years sooner than the rest of the world, get sued for non-payment, file for bankruptcy, and shoot puppet people in boardrooms because they’ve had enough. There’s no justifying the last of those, but THAT certainly wasn’t pointless either.
@aq CMS is cutting standard pre service time frame to 7 days on 1/1/26. NCQA is propping the same.
@OP UHC has a long history of modifying PA lists (removing or adding services). CMS dictates the PA decision turnaround time (routine requests are 14 days and expedited requests 72 hrs). I am curious if the existing CMS decision making timeframes will be modified.
Wondered the same thing. Did we write off our entire prior auth product in order to score RFK points? Does anyone really think that's going to stop Medicaid cuts or billing scrutiny?
What's next? We promote use of a national Medicare reimbursement schedule to provide uniform reimbursements from all Payers to all Providers regardless of competitive/monopolistic conditions in each state/market? That's the right thing to do, but it lays bare how pointless our healthcare payment system is.