Amid state and federal efforts to reform prior authorization, Centene has introduced a gold card program, joining other insurers in exempting top providers from routine prior authorization for specific services, procedures, or prescriptions, based on performance and compliance criteria.
More than 160,000 providers nationwide will immediately have access to the program based on their approval history with the insurer, documentation quality, and compliance with plans’ medical policies and regulatory requirements.
The National Performance-Based Gold Card Program will only apply to certain outpatient services first, with Centene expecting to expand the scope of services and number of eligible providers over time. Qualifying providers must submit a pre-notification before rendering services, but they will be able to give care without waiting for the insurer’s approval.
Healthcare providers have lauded gold card programs because they remove significant administrative barriers to completing prior authorizations, enabling faster patient care and bypassing lengthy wait times for insurance approval. Historically, insurers have not been eager to adopt gold card programs voluntarily, fearing they will lead to over-utilization of expensive, unnecessary care.
Nearly a dozen states have passed legislation mandating that insurers implement similar programs to mitigate delays in patient care and address physician burnout. The Trump administration has also secured voluntary pledges from major insurers to cut down on prior authorization processes, with insurers reporting an 11% reduction so far.
Some health insurers, including Humana and UnitedHealthcare, have launched or expanded their own gold card programs, waiving prior authorization requirements for certain items and services for eligible providers. UnitedHealthcare’s program has increased the number of eligible provider groups by 80% since its start two years ago.
Centene’s gold card program is set to launch next month, and the company expects to expand the program over time. The move is seen as a positive step towards reforming the prior authorization process and improving patient care, and it will be closely watched by healthcare providers and patients alike.
