Health · Healthcare & Policy · 1 hr ago
Centene to waive prior approvals for more than 160,000 providers
Centene will launch a gold card program next month to ease prior authorization rules for eligible healthcare providers across the United States.
Prior authorization is when an insurer must approve certain care before a provider can deliver it.
More than 160,000 providers will initially qualify based on their approval history, documentation and compliance with medical policies and rules.
The program will first cover certain outpatient services, and eligible providers must notify Centene before providing care but will not need to wait for approval.
The change could reduce delays in patient care and administrative work for providers.
States and the federal government are pushing insurers to reform prior authorization, and similar programs have been introduced by other insurers.
Centene expects to add services and eligible providers over time, though providers and patients continue to raise concerns about approval delays.
Centene will give more than 160,000 providers nationwide access to a new program that waives routine prior authorization for certain services.
The National Performance-Based Gold Card Program is due to launch next month.
Providers will still need to submit pre-notification but will not have to wait for insurer approval before providing qualifying care.
The program will initially cover certain outpatient services, with Centene expecting to expand it over time.
The move comes as states and the Trump administration push for reforms to prior authorization.
- Who
- Centene and more than 160,000 providers nationwide.
- What
- Centene will launch a program waiving routine prior authorization for qualifying providers and certain services.
- When
- Centene announced the program on Tuesday; it is due to launch next month.
- Where
- Nationwide.
- Why
- The program is part of efforts to reform prior authorization and reduce delays in patient care.
Healthcare providers
Insurers
Prior authorization
Healthcare providers
Providers have praised gold card programs for removing administrative barriers and enabling faster patient care.
Insurers
Insurers have historically been reluctant to adopt such programs voluntarily, fearing they could lead to overuse of expensive, unnecessary care.
Centene announced that it will launch the National Performance-Based Gold Card Program.
Centene is due to launch the program.
- Eligible providers
- More than 160,000 nationwide
- Program name
- National Performance-Based Gold Card Program
- Initial coverage
- Certain outpatient services
- Provider requirement
- Submit pre-notification before rendering services
- Approval process
- Qualifying providers can provide care without waiting for insurer approval