Prior authorization reform: Turning regulatory pressure into a competitive edge

Prior authorization (PA) reform is no longer on the horizon — it’s here.

From the federal GOLD CARD Act to a wave of new state laws, policymakers are responding to years of pressure by pushing for faster timelines, fewer denials and more transparency.

For payers , these reforms are more than compliance checkboxes. They’re a high-stakes operational challenge — and a rare opportunity to modernize how you manage claims and utilization management (UM).

The Pressure is Rising

Recent policy changes are forcing payers to rethink claims operations:

Gold carding for high-approval providers — Track performance to identify and exempt qualifying providers.

Ban on retroactive denials — Strengthen front-end review to prevent costly errors.

Chronic care flexibility — Adjust monitoring as some