UnitedHealthcare will launch a national program Oct. 1 for physicians to override traditional prior authorization requirements.
The gold card program, which applies to commercial, individual exchange and Medicare Advantage plans, allows certain physician practices to not submit prior authorization requests for “certain medical, behavioral and mental health services,” according to a fact sheet released by the company.
Instead, practices that earn gold card status must fill out a simple advance notification to confirm member eligibility and coverage for services.
To be eligible for gold card status, practices must show a prior authorization approval rate of 92% or higher for two consecutive years.
“The UnitedHealthcare Gold Card program is the next step in our continual efforts to modernize the prior authorization process and simplify the health care experience for consumers and providers,” a spokesperson told Fierce Healthcare in a statement. “The program will recognize provider groups who consistently adhere to evidence-based care guidelines.”
UnitedHealthcare did not comment on whether this new policy would lead to more instances of post-procedure denials or clawbacks at this time.
The insurer said this shift will benefit providers and patients. Providers will be able to more quickly support patients with information regarding CPT code gold card eligibility, whereas patients will access services they need more easily.
There are no applications to obtain gold card status. UnitedHealthcare will notify physicians if their practice meets the requirements, and they will mandate medical records for ongoing evaluation of the practices.
“Practices may lose Gold Card status because of patient safety issues, failure to cooperate with quality and patient safety activities, not timely responding to requests for information, or if they no longer meet program requirements,” the fact sheet reads.
More details on eligible services and codes on will be released in early September.
Gold carding legislation has been passed in five states, and legislation is pending in 13 other states, reported KFF Health News in February. In 2022, a survey (PDF) of 26 insurance plans found that more than half used gold carding. These plans said gold carding worked best for primarily high-tech imaging but also for orthopedic services, elective inpatient medical services and cardiology.
Nearly half of these plans said gold carding reduced administrative burden, while a third of respondents said it is administratively difficult to implement.
UnitedHealth teased the introduction of a gold card program this year in March 2023.