Prior Authorization

Prior authorization pressure is intensifying on two fronts: Washington seniors are reporting denied or delayed Medicare care under an AI-enabled review program, raising operational and compliance concerns for Medicare Advantage plans, providers, and ACOs managing post-acute and high-risk patients (OPB). Separately, UnitedHealthcare plans to trim pediatric prior authorizations, signaling payer recalibration as scrutiny grows over utilization-management burden and automated denials; for VBC stakeholders, the immediate issue is whether prior-auth reform reduces avoidable care delays without weakening cost and quality controls.