Centene will launch its National Performance-Based Gold Card Program in November.
Gold carding aims to streamline prior authorization, reducing requirements for trusted providers. The program will first be available to more than 160,000 qualifying providers across the country for some outpatient services. Eligibility is determined by approval history, documentation quality, medical policy compliance and adherence to regulatory requirements. The insurer anticipates expanding the program to other service types and providers in the future.
Centene COO Susan Smith said the 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.” Providers spanning 24 states anonymously contributed feedback to inform the program, according to an Oct. 13 news release.
The program strives to reduce administrative burden. There is a pre-notification process for eligible services, and Centene will inform providers of next steps. The program’s operations will vary depending on state and federal requirements.
In recent years, UnitedHealthcare and Humana have also announced gold card programs. Centene’s update comes as prior authorization reforms pick up steam.
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