How to check if your practice is eligible for UHC’s Gold Card prior authorization program

As the AAFP continues to advocate for streamlined processes that reduce administrative burden and improve the patient-physician relationship, UnitedHealthcare (UHC) released more details this week about its new Gold Card program for prior authorizations.

Practices are now able to check if they’re eligible for the program, and see which prior authorizations UHC will initially include in it.

According to UHC, to determine eligibility practices should do the following:  

• Sign to the UHC Provider Portal, then, select Prior Authorizations & Notifications.
• Select the Gold Card Status lookup tool from the “Quick links & tools” section on the right side of the page.
• See the current Gold Card status of all Tax Identification Numbers (TIN) associated with your account, then, select your TIN.

If your TIN did not qualify, your practice or dedicated TIN administrator may request a one-time review, but UHC will only consider reviews submitted by Oct. 1, 2024. You can initiate the review by chatting with a live representative on the UHC Provider Portal. You will need your TIN, at least one National Provider Identifier (NPI) number for your group, the state where you perform services, and any specific Gold Card codes in question.

According to UHC’s Gold Card program FAQs, practices that didn’t initially qualify for Gold Card status will be reevaluated during the next qualification cycle, which will take effect Oct. 1, 2025. UHC plans to reevaluate clinician eligibility and participation annually.

Practices can find detailed physician reporting associated with each TIN on UHC Insights. If you need help getting access, practices can find more information on UHC’s Insights page.

Once a TIN has qualified for UHC’s Gold Card program, the status covers all clinicians associated with that TIN. This means, when ordering a Gold Card service, any clinician associated with a Gold Card qualified TIN will not require a prior authorization on Gold Card-designated codes.

Which codes are included

UHC also released their Gold Card-eligible procedure list, which includes hundreds of codes that will be included in the program starting Oct. 1. The codes include various surgical procedures, laboratory, medicine, and radiology, including some gold-carded MRIs and CTs that could impact family physicians. Practices in the program must submit an advance notification for Gold Card services, but UHC will request no clinical information as it would with a traditional prior authorization. Practices can start an advance notification in the same method as a prior authorization request. If the tax ID, CPT code, and health plan member all qualify for the Gold Card program, practices will receive notice that no additional information is needed.

State Gold Card programs may differ from the national Gold Card program. If applicable, your state Gold Card data is available within UnitedHealthcare Insights. State Gold Card program details: Arkansas, Louisiana, Michigan, New Mexico, Texas, and West Virginia.

For additional specifics about the program, please see UHC’s national Gold Card program FAQs or UHC national Gold Card program protocol. Contact your local UHC provider relations representative if you have questions about the new policy.

— Brennan Cantrell, AAFP Senior Strategist, Market Transformation

Posted on Sept. 5, 2024