Highmark Welcomes Over 10,900 New Clinicians to Gold Card Program
Highmark is pleased to announce that over 10,900 new clinicians have qualified for our expedited prior authorization program, known as the Gold Card Program, which provides streamlined approval for select services. Qualification to the program is a recognition of each provider practice or individual clinician’s adherence to evidence-based guidelines and appropriate care.

The Gold Card Program is part of Highmark’s efforts to accelerate access to appropriate care, reduce administrative burden, and streamline complex transactions for our providers.

Beginning May 24, 2024, those newly gold-carded providers will experience a simplified process for obtaining prior approval for services that typically require a comprehensive prior authorization review.

About the Gold Card Program

For additional details on eligibility criteria and how the program works, please see our Gold Card Program page on the Provider Resource Center.

Launched in 2022, Highmark’s Gold Card Program has experienced considerable growth — with over 17,000 providers currently enrolled. We are committed to further expansion and are exploring the inclusion of additional service types.

A key driver behind the program's growth is Active Gold Carding, a data-driven educational initiative where Highmark and provider groups collaborate to identify and address the root causes of denials. This proactive approach aims to enhance appropriate ordering practices and support more clinicians in achieving gold card status.

Clinicians who qualify for our Gold Card Program see the following benefits:

  1. Reduces staff processing time by up to 85%, minimizing administrative burden.
  2. Eliminates wait time for authorization decisions, enhancing efficiency.
  3. Provides practitioners with greater flexibility to schedule services, improving patient care coordination.

Dr. Susan Deakin, an internal medicine physician at Allegheny Health Network, participated in the Active Gold Carding pilot program.

“It has been a significant improvement in health care delivery,” Dr. Deakin said. “A patient can schedule their test immediately without having to wait for the authorization or worry there will be an issue. My office staff doesn’t have to confirm or work on authorizations, freeing them up for other direct patient care activities. Most importantly, it provides a better patient experience.”

To qualify for the program, provider practices or individual clinicians must meet specific criteria, including maintaining an historical authorization approval rate of 99% or higher.

*Note: The Gold Card Program, including qualification criteria, varies in the state of West Virginia in accordance with West Virginia Senate Bill 267.

Dr. Deakin is also the Living Health Medical Director for Highmark Health. Highmark’s Living Health model puts the patient and clinician at the center of our system — and aligns seamlessly with our Gold Card Program which streamlines the authorization process, empowering clinicians to focus on patient care while guaranteeing members access to the necessary treatments promptly.

For additional questions about Highmark’s Gold Card Program, please contact GoldCardInquiries@highmark.com.


 

esubscribe