OIC begins rulemaking regarding alternative prior authorization mechanisms

July 26, 2017

The Office of the Insurance Commissioner OIC) has begun a rulemaking process regarding alternative prior authorization processes, sometimes known as “gold carding.” Under these arrangements, health carriers and providers implement an expedited alternative to the standard prior authorization process when a provider can show they meet the carrier’s clinical and pre-service requirements. The OIC has expressed concern that such arrangements have the potential to discriminate against consumers and providers. The OIC is seeking information from carriers and providers that participate in gold carding, specifically:

  • What standards do carriers use to determine the eligibility of providers to participate?
  • How do you define gold carding?
  • What’s the process by which a participating provider gets prior authorization?
  • What consumer and provider protections do you recommend for programs?

Responses are due by August 18, 2017 and should be sent to the OIC Rules Coordinator. WSHA plans to comment and encourages providers that participate in these arrangements with carriers to submit comments. We ask that hospitals also send WSHA a copy of their comments.

WSHA believes these arrangements are beneficial for both patients and providers and should be encouraged and expanded as they reduce the amount of time and administrative burden to get services approved. We are concerned a protracted rulemaking process or unreasonable restrictions may hinder progress that is being made.  (Andrew Busz, andrewb@wsha.org)


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