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Medicaid: Prior auth reduction efforts expand to more states
Act
by Oct 15, 2026
Effective date
Nov 1, 2026
Identified
Oct 1, 2026
Summary
UnitedHealthcare Community Plans is expanding prior authorization reductions across six states, eliminating prior auth requirements for select CPT codes effective November 1, 2026 (Arizona, New Mexico, New York, Ohio) and December 1, 2026 (Missouri, Washington). Billing teams must identify which codes are impacted in their state and remove prior authorization requirements from workflows for affected procedures.
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What to do
by Oct 15, 2026 · 6 steps
01Contact UnitedHealthcare or access the Prior Authorization and Notification Tool to obtain the complete list of CPT codes with eliminated prior auth requirements for your state(s).
02Billing team must update billing system rules to remove prior authorization mandates for affected codes in Arizona, New Mexico, New York, and Ohio.
03By November 15, 2026: Repeat process for Missouri and Washington codes.
04Update all encounter templates, billing workflows, and provider alerts to reflect that prior auth is no longer required for these select codes.
05Failure to remove unnecessary prior auth requests may delay claim processing and patient care.
06Document changes in compliance audit trail.
Original notice
Medicaid: Prior auth reduction efforts expand to more states
uhcprovider.com · Always check the source before changing claims.