Centene Plans to Waive Prior Authorization for 160,000 Qualifying Providers Starting in November

Centene Corporation announced on October 13 that it will launch a National Performance-Based Gold Card Program in November 2026, initially extending to more than 160,000 qualifying providers for select outpatient services.

Under the program, providers that earn gold card status will submit a pre-notification before rendering certain services rather than waiting for a full prior authorization review. Centene said eligibility will be determined by objective performance metrics: a provider's approval history, documentation quality, adherence to regulatory requirements, and compliance with medical policies. The company said it plans to expand the program to additional service types and more providers over time.

The program applies across Centene's Medicare Advantage, Medicaid, and commercial health plan lines. For Medicare Advantage enrollees whose providers qualify, the change could mean fewer delays in receiving covered outpatient care.

The announcement follows a similar move by UnitedHealthcare, which said in September it would drop prior authorization requirements for roughly 1,700 procedure codes starting October 1. CMS has pressed Medicare Advantage insurers to reduce prior authorization burdens, pointing to federal data showing that the vast majority of appealed denials are ultimately reversed.

Gold card programs function by tracking a provider's history of approved prior authorization requests and exempting that provider from the standard review process when its record meets defined thresholds. The pre-notification step that replaces it is designed to preserve some clinical oversight while reducing administrative delays for patients.