UnitedHealthcare announces Gold Card program for some prior authorizations

UnitedHealthcare (UHC) has announced it will launch a Gold Card program Oct. 1 intended to ease some prior authorizations. Practices that qualify will receive a streamlined prior authorization process for certain medical, behavioral, and mental health services (UHC says it will publish a list of the services on Sept. 1).

The AAFP is evaluating the program's impact on family physicians. This blog will be updated as we learn more.

Eligibility and requirements

UHC will evaluate practices defined by a single tax ID number (TIN) to determine whether they meet all the following criteria to qualify for the program:

• In-network with at least one UHC commercial, Medicare Advantage, Individual Exchange, or Community plan;
• A minimum annual volume of at least 10 eligible prior authorizations across participating lines of business for two consecutive calendar years across all Gold Card-eligible codes; and
• A prior authorization approval rate of 92% or higher for two consecutive years. This rate applies to prior authorization status for Gold Card-eligible codes, across all participating lines of business, after all appeals were exhausted.
• Practices that earn Gold Card status will be required to complete an advance notification for Gold Card services.
• Practices don't need to apply for Gold Card status. UHC will determine eligibility and notify practices automatically. Gold Card status applies to all in-network UHC products.
• UHC may request medical records to monitor Gold Card status. Failure to provide the requested information may affect Gold Card status.

UHC will evaluate practices annually for Gold Card status, effective Oct. 1. Practices could lose Gold Card status due to patient safety concerns, non-cooperation, or failure to meet program requirements.

Practices can request a Gold Card status review within 30 days of notification on the UnitedHealthcare Provider Portal. The portal outlines the required information for review requests. Any status changes will be communicated.

The Gold Card Program will be effective in all states and will be modified, when necessary, to meet state requirements. UHC will apply any state criteria, as required, for the applicable product.

Review UHC’s announcement for further details about the program. Contact your local UHC provider relations representative if you have questions about the new policy.

— Brennan Cantrell, AAFP Commercial Health Insurance Strategist

Posted on Aug. 1, 2024