Gold carding is a process that exempts trusted healthcare providers from prior authorization requirements based on their history of delivering guideline-adherent care. It streamlines approvals, reduces administrative burden, and rewards high-quality performance
Gold carding is changing the way healthcare providers manage prior authorization (PA). This approach rewards providers who consistently deliver care aligned with clinical guidelines. By reducing the administrative burden of PA, gold carding allows providers to focus more on patient care.
Key Facts
- Reduced Administrative Burden – Gold carding can cut down prior authorization requests by up to 90%.
- Improved Provider Satisfaction – 70% of providers report higher job satisfaction with streamlined PA processes.
- Enhanced Patient Care – 65% of providers say that gold carding allows them to spend more time with patients.
- Cost Efficiency – Implementing gold carding can save healthcare systems millions in administrative costs.
- Guideline Adherence – Providers with gold cards are 50% more likely to adhere to treatment guidelines.
Understanding Gold Carding
Gold carding simplifies the PA process by granting certain providers an exemption from prior authorizations based on their track record of delivering high-quality care. When a provider consistently meets clinical guidelines, they can earn a “gold card.” This card allows them to bypass the complex and often time-consuming PA process, enabling them to focus on what matters most: their patients.
How It Works
The gold carding process typically includes several key steps:
- Eligibility Assessment – Payers evaluate providers based on their adherence to clinical guidelines and quality metrics.
- Reward Issuance – Eligible providers receive a gold card, granting them expedited access to necessary services without the need for prior authorization.
- Ongoing Monitoring – Providers are regularly assessed to ensure they maintain the standards required for gold card status. If they fall short, they may lose their gold card privileges.
Successful Implementations
Several healthcare systems have successfully implemented gold carding. For example, Highmark Health reported a significant reduction in PA requests after introducing active gold carding. Providers noted increased efficiency and reduced frustration, leading to improved patient outcomes.
Another successful model comes from the American Medical Association (AMA) advocacy, which has encouraged the adoption of gold carding across various states. These initiatives have led to streamlined processes, allowing physicians to prioritize patient care over paperwork.
Best Practices for Integration
To effectively integrate gold carding into your utilization management (UM) strategy, consider these best practices:
- Clear Communication – Inform providers about the criteria for gold card eligibility and how they can maintain their status.
- Continuous Feedback – Regularly solicit feedback from providers to identify challenges and areas for improvement in the gold carding process.
- Training and Support – Provide training sessions to help providers understand guidelines and the benefits of gold carding.
Key Takeaways
- Gold carding incentivizes providers for consistent, guideline-adherent care.
- Successful implementations can significantly decrease the time spent on prior authorizations.
- Best practices include effective communication and continuous feedback to providers.
FAQs
How do I get approved for gold carding as a provider?
Your practice can qualify by consistently meeting clinical guidelines and demonstrating high-quality care. Payers will evaluate your performance based on specific metrics.What causes a provider to lose gold carding status?
If you lose your gold card, you will need to follow the standard prior authorization process again. It’s important to maintain adherence to clinical guidelines to retain your status.Does gold carding improve patient care or outcomes?
Gold carding allows you to spend more time with your patients by reducing administrative tasks. This leads to a more focused approach to patient care and improved outcomes.
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Sources
- American Academy of Neurology
Gold Carding Policies
https://pmc.ncbi.nlm.nih.gov/articles/PMC10783970/ - Highmark Health
Simplifying Prior Authorization with Active Gold Carding and Other Innovations
https://www.highmarkhealth.org/blog/future/Simplifying-Prior-Authorization-with-Active-Gold-Carding-and-Other-Innovations.shtml - American Medical Association (AMA)
“Gold card” approach to prior authorization introduced in Congress
https://www.ama-assn.org/practice-management/prior-authorization/gold-card-approach-prior-authorization-introduced-congress
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