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Gold Carding: Getting Out of Prior Authorization Entirely

Some payers exempt consistently-approved providers from authorization requirements. Almost nobody applies, because almost nobody knows the program exists.

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2 min read · by White Glove Medical Billing
A single pass card lying apart from a stack of forms

Some payers operate programs that exempt providers with consistently approved authorization requests from having to submit them. The mechanics vary and so does the name, but the principle is the same: demonstrate a track record and the requirement is waived for defined services.

Why it exists

Authorization is expensive for payers too. Reviewing requests that are approved almost every time is cost without benefit. Exempting reliable providers reduces their administrative load as well as yours.

Several states have also legislated in this area, requiring plans to operate exemption programs under defined conditions — so in some jurisdictions this is not merely a payer courtesy.

Why practices miss it

  • Payers rarely promote it, and the criteria live deep in provider manuals.
  • Qualification is usually per service and per provider rather than blanket, so it does not feel like a single achievable thing.
  • Nobody owns it. It falls between credentialing, billing, and clinical operations.

Whether it is worth pursuing

Do the arithmetic first. Authorizations per month for your highest-volume service, times your cost per authorization. If that number is meaningful, it justifies the hour it takes to find the criteria and check whether your approval rate qualifies.

Start with your largest commercial payer and the single service you authorize most. That is where the exemption is worth the most and where your track record is longest — and if the answer is no, you have lost an hour rather than a program.

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