Centene is aiming to simplify the prior authorization process with the launch of a new nationwide gold card program.
The national, performance-based program will initially roll out to 160,000 eligible providers in November, covering select outpatient services. The goal, Centene said, is to streamline prior auth without minimizing critical quality and clinical standards.
Providers must demonstrate a consistent record of following evidence-based guidance and of meeting clinical review requirements. Performance metrics considered include approval history, documentation quality, adherence to regulatory requirements and compliance with medical policies.
The insurer said that the program was designed using anonymous feedback from providers in 24 states.
Centene said in an announcement that it plans to build the program out to additional service types and more providers in the future.
"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 announcement. "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."
A provider that earns Gold Card status will establish a pre-notification process for certain medical services. This reduces the administrative touchpoints necessary to secure an approval for providers that have an established history of successful approvals.
Centene said it will reach out to providers with additional detail on requirements, eligible and next steps to participate. Providers that do not quality for the initial launch will have future opportunities, the insurer said.