Utilization Management
Expert articles and analysis related to utilization management.
AI Summary — Last 7 Days
Utilization management pressure intensified this week as UnitedHealthcare moved to eliminate prior authorization for 1,700 service codes, including home health, signaling a payer effort to reduce administrative friction while preserving broader UM leverage in Medicare Advantage and commercial risk arrangements (Healthcare Dive). At the same time, uneven prior-auth denial patterns and emerging MA network disruption—such as Mass General Brigham’s MA plan dropping Dana-Farber—underscore a growing VBC tension: plans are loosening some authorization rules publicly while narrowing networks and managing oncology, post-acute, and specialty spend more aggressively behind the scenes. CMS oversight is also in focus after OIG found Medicare Part D sponsors made $587.7 million in ineligible OTC-drug payments labeled as prescription-only, adding compliance pressure for plans operating under risk-based pharmacy and total-cost-of-care models (OIG).
Related Articles
Charted: Prior auth denials are all over the map
Charted: Prior auth denials are all over the map  Advisory Board
UnitedHealthcare cuts prior authorization from 1,700 codes
The list tells providers what treatments will no longer need preapproval this October, part of UnitedHealthcare’s pledge to cull 30% of its much-maligned utilization management controls. The codes spa...
UnitedHealthcare to nix prior auth on 1,700 services on Oct. 1
UnitedHealthcare to nix prior auth on 1,700 services on Oct. 1Â Â Fierce Healthcare
ACP Urges Congress to Hit Pause on Use of AI in Prior Authorization - American College of Physicians - American College of Physicians | Internal Medicine
ACP Urges Congress to Hit Pause on Use of AI in Prior Authorization - American College of Physicians  American College of Physicians | Internal Medicine
Prior authorization: what physicians say, in their own words
Prior authorization: what physicians say, in their own words  KevinMD.com
UnitedHealth Group To Cut Prior Authorizations For 1,700 Services, Including Home Health
UnitedHealthcare to drop prior authorization requirements for 1,700 services
UnitedHealthcare to drop prior authorization requirements for 1,700 services  Becker's Payer Issues
UnitedHealthcare eliminates 30% of prior authorization requirements
UnitedHealthcare eliminates 30% of prior authorization requirements  Healthcare Finance News
Prior authorization: what physicians say, in their own words
Prior authorization: what physicians say, in their own words  KevinMD.com
Charted: Prior auth denials are all over the map
Charted: Prior auth denials are all over the map  Advisory Board