Vermont Gold Card Prior Authorization Pilot Program
On January 15, 2022, MVP introduced the Vermont Gold Card Prior Authorization Pilot Program which seeks to eliminate or streamline certain prior authorization requirements. The Vermont Gold Card Prior Authorization Program is for Commercial and Exchange Members in Vermont.
MVP is dedicated to working with Providers to optimize administrative processes while complying with all applicable regulatory requirements. This Pilot Program is designed to test a new prior authorization process that complies with Vermont Law Act 140, Prior Authorization Reform.
Criteria for qualifying for the Vermont Gold Card Pilot Program
A Practice would have to submit five or more requests over six months for the qualifying Gold Card procedures and have an approval rating of 95% or for Imaging and Pharmacy claims.
Pharmacy Benefit for Qualifying Providers
Qualifying Providers will no longer need to submit a prior authorization request for the following Calcitonin Gene-Related Peptide (CGRP) Receptor Antagonists:
Imaging Benefit for Qualifying Providers
Qualifying Providers will be exempt from submitting clinical information to aid in determining medical necessity for the following CPT codes:
|70551||MRI Head Without Contrast|
|70552||MRI Head With Contrast|
|70553||MRI Head With and Without Contrast|
When entering one of the eligible Gold Card CPT codes, it will auto-approve and generate the AUTH ID that will be transmitted to MVP.
MVP is awarding Gold Card status at the group (Tax ID) level. Based on the criteria above, seven groups in Vermont are eligible for inclusion in this program. In the Imaging component, 45% of the groups are Primary Care Providers; in the Pharmacy component, 11% are Primary Care Providers.
For questions about the Vermont Gold Card Prior Authorization Pilot Program, please contact your Professional Relations Representative [link to 1.12.1].