Centene announced Tuesday that it will launch a National Performance-Based Gold Card Program next month, joining a growing list of insurers easing prior authorization rules for top providers. More than 160,000 providers nationwide will immediately qualify based on their approval history, documentation quality, and compliance with medical policies. The program initially applies to certain outpatient services, and Centene expects to broaden both the scope of services and the number of eligible providers later.
Under the program, qualifying providers must submit a pre-notification before delivering care, but they will no longer need to wait for insurer approval. The move follows similar steps by Humana, which launched a gold card program this year, and UnitedHealthcare, which expanded its own program earlier this month and said eligible provider groups have grown 80% since its start two years ago.
Insurers have historically resisted such programs over concerns about over-utilization of unnecessary care. But nearly a dozen states have passed laws mandating them, and the Trump administration secured voluntary pledges from major insurers last year to reduce prior authorizations. Even so, provider groups and patients say reforms have yet to meaningfully ease their administrative burdens or speed up care, and they continue to push for gold card programs, which were not explicitly part of the federal pledge.