UnitedHealth Reports Q1: Denial Rates Tick Up to 16.2%
UnitedHealth Group's Q1 2026 filing reveals a continued trend of prior authorization tightening. Medical loss ratio improved to 82.4% (vs 83.1% YoY), driven partly by higher initial denial rates. Surgical categories seeing the most aggressive review include orthopedic procedures, advanced imaging, and outpatient cardiac. Hospitals with >15% denial rates should expect further headwinds from commercial payers.
Prior Authorization Reform: CMS Final Rule Mandates 72-Hour Turnaround
CMS finalized the Interoperability and Prior Authorization Rule (CMS-0057-F), requiring Medicare Advantage and Medicaid managed care plans to process prior authorization requests within 72 hours (urgent) or 7 days (standard). Plans must also provide denial reason codes. Expected to reduce prior auth denials by 15-20% and accelerate revenue recognition for hospitals with high MA patient populations.