Centene launches gold card program waiving prior authorizations for top providers

Centene announced on October 13, 2026, that it will launch a National Performance-Based Gold Card Program in November 2026, granting over 160,000 top-performing providers prior authorization exemptions for select outpatient services. The move follows growing state legislative mandates and federal pressure to ease administrative burdens. However, industry analysis shows prior authorization relief remains complex across plan types, with parallel cuts by UnitedHealthcare excluding pediatric therapy.

Centene launches national gold card program

• ▪Under Centene's gold card program, qualifying healthcare providers must submit a pre-notification before delivering services but can proceed with patient care without awaiting insurer approval.
• ▪Centene announced on October 13, 2026 that it will launch its National Performance-Based Gold Card Program in November 2026 to exempt qualifying healthcare providers from routine prior authorization requirements.
• ▪Centene's National Performance-Based Gold Card Program will initially apply to select outpatient services, with Centene planning to expand covered services and provider eligibility over time.
• ▪Centene granted immediate access to its gold card program to more than 160,000 providers nationwide based on approval history, documentation quality, and regulatory and policy compliance.

Regulatory and industry reform on prior authorizations

• ▪In 2026, major health insurers including Humana and UnitedHealthcare expanded or introduced programs waiving prior authorization requirements for select services and eligible providers.
• ▪State legislatures and federal officials have increased pressure on health insurers to reform prior authorization, with nearly a dozen states enacting laws mandating gold card programs.
• ▪Under a voluntary pledge secured by the Trump administration to reform prior authorizations, major health insurers reported reducing prior authorization requirements by 11% as of April 2026.

UnitedHealthcare changes prior authorization policies

• ▪UnitedHealthcare expanded prior authorization requirements for physical, speech, and occupational therapy for Medicare Advantage members in specific Arizona and California plans on February 1, 2026.
• ▪UnitedHealthcare's October 1, 2026 prior authorization exemptions for speech and swallowing treatments applied exclusively to Medicare Advantage and Dual Eligible Special Needs Plans covering populations aged 65 and older.
• ▪UnitedHealthcare reported an 80% increase over two years in the number of provider groups eligible for its prior authorization fast pass program.
• ▪UnitedHealthcare eliminated 30% of its prior authorization requirements on October 1, 2026, but excluded all applied behavior analysis, physical, occupational, and speech therapy codes for pediatric patients across commercial, individual exchange, and Medicaid plans.

Prior authorization for CPT code 92507

• ▪The American Medical Association CPT Editorial Panel slated speech-language pathology CPT code 92507 for deletion effective January 1, 2027, replacing it with 10 time-based codes that do not automatically inherit prior authorization exemptions.
• ▪CPT code 92507 was the speech treatment code that gained UnitedHealthcare's October 1, 2026 prior authorization exemption and is billed most frequently by pediatric speech practices.