UnitedHealthcare's national gold-card program: 5 things to know

[Duaine]

UnitedHealthcare has released more details about its national gold-card program that is set to take effect on Oct. 1.

Here are five things to know:

1. Providers will not have to apply for the gold-card program but must meet certain eligibility requirements:

• Be in-network for at least one UnitedHealthcare commercial, individual exchange, Medicare Advantage or community (Medicaid) plan.
• Meet a minimum annual volume of at least 10 prior authorizations each year for two consecutive years across gold-card-eligible codes.
• Have a prior authorization approval rate of 92% or more across all gold-card eligible codes for each of the review years.

2. Providers that earn gold-card status are required to complete advance notification for services, but no clinical information will be requested.

3. The full gold-card-eligible procedure code list can be found here.

4. UnitedHealthcare will conduct annual evaluations for gold-card qualification. Gold-card status determinations will be effective Oct. 1 every year.

5. Providers may lose gold-card status because of patient safety issues, failure to cooperate with quality and patient safety activities, failure to make timely responses to requests for information, or they no longer meet program requirements.

UnitedHealthcare first floated plans for a national gold-card in March 2023 when it also said it would cut 20% of its prior authorization requirements. The cuts took effect in two phases, the first in September 2023 and the second in November 2023.

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