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- UnitedHealthcare Launches Program to Override Prior Authorization Requirements October 1
On October 1, UnitedHealthcare is launching a national Gold Card program, which will recognize provider groups who consistently adhere to evidence-based care guidelines. Qualifying care provider groups will follow a simple notification process for eligible procedure codes rather than the prior authorization process. This advance notification will confirm eligibility and network status, but it will not require clinical information. Gold Card status will apply across UnitedHealthcare’s Commercial, Individual Exchange, Medicare Advantage and Medicaid plans.
To be eligible for gold card status, practices must show a prior authorization approval rate of 92% or higher for two consecutive years. Provider groups can now view their UnitedHealthcare Gold Card program status via the UnitedHealthcare Provider Portal
The CAP has advocated for gold card programs to reduce physician practice burdens and prevent patient care delays for many years. In a March 2023 letter, the CAP asked the Centers for Medicare & Medicaid Services (CMS) to streamline prior authorization processes in Medicare Advantage (MA) and other public health plans though gold card programs. The CAP has also successfully advocated in Arkansas for a gold card payment safeguard which ensures health plans do not deny or reduce reimbursement for pathologists who complete a service requested by an exempt gold-card provider. Wyoming recently became the second state to codify CAP’s gold card payment safeguard.
For more information on the program, including eligibility criteria and a comprehensive list of Gold Card eligible CPT codes, visit UnitedHealthcare’s national Gold Card program information page.