Centene to let 160,000 providers skip some prior authorization waits
Health insurer Centene will start a national "gold card" program in November, Healthcare Dive and Modern Healthcare reported. More than 160,000 doctors and other providers with good track records will not have to wait for the insurer's OK on some outpatient care. Centene plans to add more services over time.
Centene will launch a national "gold card" program next month that lets top-performing providers skip routine prior authorization for some services, Healthcare Dive and Modern Healthcare reported.
More than 160,000 providers nationwide will qualify right away, Healthcare Dive reported. Eligibility is based on their approval history with the insurer, documentation quality and how well they follow medical policies and rules, the company said.
The program, called the National Performance-Based Gold Card Program, will apply first to certain outpatient services, and Centene expects to expand the services and the number of eligible providers over time, Healthcare Dive reported. The program will cover Centene's commercial, Medicare Advantage and Medicaid plans, a company spokesperson told Modern Healthcare.
Qualifying providers must still send a notice before giving care, but they won't have to wait for the insurer's approval, Healthcare Dive reported. Centene said it designed the program using anonymous feedback from providers in 24 states, Fierce Healthcare reported.
"At Centene, we're committed to making it easier for providers to deliver access to high-quality, evidence-based care," said Susan Smith, Centene's chief operating officer, in the company's announcement, Fierce Healthcare reported. "The Gold Card Program was shaped through deep collaboration with providers, ensuring its review process is grounded in the real-world needs of those delivering care every day."
Prior authorization requires providers to get an insurer's approval before giving some care. Providers praise gold card programs because they cut paperwork and speed up care, Healthcare Dive reported. Insurers have been slow to adopt them because they fear more costly, unneeded care.
Nearly a dozen states have passed laws requiring insurers to run similar programs, Healthcare Dive reported. Last year, the Trump administration got major insurers to pledge to cut back on prior authorization. Humana and UnitedHealthcare also run gold card-style programs, Healthcare Dive reported.
Providers say reforms have not yet made a big dent in their prior authorization workloads, Healthcare Dive reported.
What we know: Centene's gold card program starts in November for more than 160,000 eligible providers and select outpatient services.
What we don't: Which services will be added later and how much the program will cut wait times.
Where outlets agree Healthcare Dive and Modern Healthcare both report that Centene will launch its gold card program next month for more than 160,000 providers.
Where they differ The outlets cited here report the same key facts so far.