CONNECT WITH US
HealthTech

HealthTech

Centene joins insurers waiving prior authorizations for top providers

Healthcare Dive logo

Published on

Add as a preferred source on Google
Centene joins insurers waiving prior authorizations for top providers

Centene is the latest insurer to adopt a gold card program as states and the Trump administration push for prior authorization reform.

The program, called 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’ll be able to give care without waiting for the insurer's approval, according to the announcement.

Healthcare providers have lauded gold card programs because they remove significant administrative barriers to completing prior authorizations. The programs also enable faster patient care, bypassing lengthy wait times for insurance approval.

Historically, insurers haven't been eager to adopt gold card programs voluntarily, fearing they will lead to over-utilization of expensive, unnecessary care.

However, nearly a dozen states have passed legislation mandating that insurers implement similar programs to mitigate delays in patient care and address physician burnout. More states, including New York, are also considering similar legislation.

Scrutiny on prior authorization has also come from the federal level, with the Trump administration securing voluntary pledges from major insurers last year to cut down on the processes. In April, insurers said they had cut 11% of prior authorizations so far.

Some health insurers are reading the writing on the wall and standing up their own gold card programs. Humana launched a program this year that waives prior authorization requirements for certain items and services for eligible providers.

UnitedHealthcare also expanded its program earlier this month, allowing more provider groups to qualify for so-called prior authorization fast passes.


Source link

Disclaimer

We strive to uphold the highest ethical standards in all of our reporting and coverage. We TheMorningPulse.fyi want to be transparent with our readers about any potential conflicts of interest that may arise in our work. It's possible that some of the investors we feature may have connections to other businesses, including competitors or companies we write about. However, we want to assure our readers that this will not have any impact on the integrity or impartiality of our reporting. We are committed to delivering accurate, unbiased news and information to our audience, and we will continue to uphold our ethics and principles in all of our work. Thank you for your trust and support.