September 12, 2024
The UnitedHealthcare (UHC) Gold Card Program will exempt qualified practices from prior authorization requirements for specific medical, behavioral and mental health services. According to UHC, practices granted Gold Card status will be required to adhere to the payor’s advance notification process for Gold Card services, despite the prior authorization exemption under the Gold Card Program. UHC said it may also require medical records as part of the monitoring and continuing evaluation of practices qualified for the Gold Card status.
Currently, approximately 500 current procedural terminology (CPT) codes for medical services are included in the program, but United Healthcare has indicated that eligible codes may be added or eliminated in the future based on the latest clinical evidence.
Gold Card statuses will be updated and published annually on September 1, and practices who wish to dispute their status can request a review within 30 calendar days of publication. UHC has published an interactive guide that will walk practices through the process of looking up their Gold Card status. Practices are encouraged to look up their Gold Card status as soon as possible, so they will have time to dispute their status if needed for the upcoming year. Disputes must be filed by September 30, 2024.
The California Medical Association (CMA) is currently evaluating the UnitedHealthcare Gold Card program announcement and its impact upon physician practices, with a focus on how burdensome the advance notification process and records requests may be on practices.
More About the UHC Gold Card Program
According to UnitedHealthcare, to qualify for the Gold Card Program practices must participate in in at least one UHC line of business, have a minimum of 10 prior authorizations for Gold Card eligible codes annually over two consecutive calendar years, and have a prior authorization approval rate of 92% or higher for the same codes across all participating lines of business in each year.
Practices are not required to apply for Gold Card status. UHC will assess and communicate each practice’s status annually, along with performance reporting based on the program’s eligibility criteria. Practices who wish to dispute their status can request a review within 30 calendar days of status notification.
Additional details about the program are available on UHCprovider.com or through chat 24/7 in the UnitedHealthcare Provider Portal.
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