Prior authorization relief initiatives
Our commitment to simplifying prior authorizations
We're continuing to simplify the health care experience by reducing prior authorization requirements, supporting providers who serve rural communities, expanding prior authorization relief for members under the age of 18 and recognizing providers with a proven record of quality care.
These efforts are designed to help you spend less time on administrative tasks and more time caring for patients.
Program eligibility and requirements can vary by plan, service, provider and location. You can continue to use the same submission pathways to confirm current authorization requirements, waiver eligibility and program participation.
Broad prior authorization reductions
We reduced prior authorization requirements by about 30%. The reductions include select services across participating UnitedHealthcare plans, including some outpatient surgeries, diagnostic tests, therapies and chiropractic care.
What this means for you
For included services, prior authorization is no longer required. Continue to verify prior authorization and notification requirements using the existing submission pathways before providing services, as requirements may vary by plan, service, provider and location.
Rural health support initiatives
Eligible rural facilities can receive accelerated claims payments. You’ll also no longer need to submit medical necessity documentation for prior authorization, only an advanced notification.
What this means for you
This initiative is designed to reduce administrative work, support the financial stability of rural hospitals and help patients access care closer to home.
Eligible facilities have received information about the applicable codes and requirements. Continue to use the Prior Authorization and Notification tool to verify authorization and notification requirements for each service.
Pediatric prior authorization reductions
Effective Dec. 1, 2026, prior authorization requirements will be reduced by two-thirds for eligible patients under age 18, including many diagnostic services, routine surgical procedures and specialty care services across pediatric subspecialties such as cardiology, neurology, pulmonology and orthopedics.
Eligible plans
These reductions apply to UnitedHealthcare commercial plans, Individual Exchange plans and select UnitedHealthcare Community Plans. State, federal and product-specific requirements may affect eligibility and participation varies by plan and state. Continue to verify requirements at the time of submission.
Plans not included
The program does not apply to UMR plans that follow the UMR prior authorization list, Health Plan of Nevada Medicaid, Dual Eligible Special Needs Plans or UnitedHealthcare® Medicare Advantage plans.
What this means for you
Fewer prior authorization requirements for your patients under age 18 can mean fewer administrative steps for your team and a more straightforward path to care for eligible pediatric patients. You’ll still need to verify authorization and notification requirements before providing the service because participation varies by plan and state.
National Gold Card Program
The National Gold Card Program offers eligible provider groups who consistently adhere to evidence-based care guidelines relief from select prior authorization requirements while helping streamline administrative processes. The program launched in 2024 and has grown the volume of participating provider groups by 80% since inception. Get the details.
What this means for you
If your provider group is eligible, you’ll have fewer authorization and notification requirements for select services, helping reduce administrative work for your team and simplify the path to patient care.
Frequently asked questions
After submission of an advance notification through the Prior Authorization and Notification tool or other submission pathways, confirmation is available through UnitedHealthcare systems and can be viewed by both ordering and rendering providers.
State, federal and product-specific requirements may affect how prior authorization and notification rules apply. You should always verify requirements at the time of submission, and we’ll communicate program updates through established provider channels.
Included services shouldn’t require upfront medical necessity review, which should reduce related administrative steps. Services and providers that don’t meet the eligibility requirements for these programs may continue to follow standard prior authorization and review processes.
An advance notification can be started the same way as a prior authorization request, including through the UnitedHealthcare Provider Portal, Point of Care Assist, Electronic Data Interchange (EDI), phone or fax.
You can use the same submission pathways used today, including the UnitedHealthcare Provider Portal, Point of Care Assist, EDI, phone or fax. Office staff with appropriate portal permissions may be able to submit or view information based on the access available to the organization.
The rural health prior authorization waiver program is separate from the Gold Card Program and doesn’t replace it. Gold Card eligibility is based on consistent adherence to evidence-based guidelines, while the rural waiver is based on participation in an eligible rural TIN.
Providers who qualify for Gold Card status will retain that status and may also benefit from the rural waiver if eligible. Both programs share the goal of reducing administrative requirements and simplifying the prior authorization process. For eligible rural providers, the waiver is expected to reduce about 70% of prior authorization volume.