In support of our ongoing mission to help members access quality, affordable health care, Univera Healthcare is participating in a joint effort to streamline, simplify and reduce prior authorization. This effort supports the federal government’s efforts to improve the prior authorization process and involves Univera Healthcare, and other insurers who have voluntarily come together to agree to actions that will make the prior authorization process faster, more seamless and more streamlined for our members.
Specifically, these actions will help:
- Standardize provider submissions for electronic prior authorization, giving doctors more time for patients by lessening administrative burden.
- Further reduce the use of prior authorization for certain in-network medical services by 2026.
- Ensure a seamless process for members who switch health insurance companies by honoring their previous health insurance company’s prior authorization approvals for benefit-equivalent in-network services as part of a 90-day transition period, by 2026.
- Make the process more transparent by ensuring our communications to members about prior authorization are clear and contain personalized information including what is needed to support approval, next steps, and available appeal processes.
- Fast-track responses for electronic prior authorization requests by committing to answering at least 80% of requests in near real-time in 2027.
- Affirm that licensed physicians personally lead reviews of unapproved prior authorization requests.
While we have formally committed to these improvements, much of this work is already in progress at our organization.
These improvements are being implemented across insurance markets, including for those with Commercial coverage, Medicare Advantage and Medicaid managed care, and will benefit millions of people across upstate New York.
Prior authorization is an effective tool for balancing quality, safety and managing rising costs. While the vast majority of services do not require prior authorization, we recognize the frustration people often feel about their experience with it, and we’re committed to doing our part to improve it.
In addition to the commitments in the pledge, we remain focused on efforts to improve care while also controlling rising healthcare costs. Examples of those efforts include working with providers to help members safely transition from hospital to home sooner, offering programs that improve the health of those with diabetes, hypertension and chronic kidney disease and connecting members in need to in-home care.
Improving the prior authorization process will help us create an efficient, affordable and sustainable health care system for everyone. Working together—across health insurers and with care providers—we will ensure that patients receive the most effective care, at a more affordable cost.
