National Gold Card waiver status now available

UnitedHealthcare is launching a national prior authorization waiver program on Oct. 1, 2024 – the UnitedHealthcare Gold Card program. It will waive select behavioral health prior authorization requirements for eligible network (contracted) providers. 

Eligible providers were notified in early September whether or not they’ve qualified for the prior authorization waiver. You can also check your waiver status in the Provider Express secure portal.

For complete details, review the Program Overview and Quick Reference Guide.

Who’s eligible to receive a waiver? 

The Gold Card program is open to any network clinician who provides intensive outpatient services, partial hospitalization programs and/or psychological testing to eligible member groups.*

How do I know if I have a Gold Card prior authorization waiver? 

If you provided any of the eligible services to members over the last 2 years, you received either an email or letter in the mail in early September. The notice outlines whether or not you qualified for the waiver. You can also check your status in the Provider Express secure portal. Step-by-step instructions are in the Quick Reference Guide.

What does it mean if I’ve qualified for a waiver?

Beginning Oct. 1, you will not need to submit prior authorization requests for 17 procedure and revenue codes for intensive outpatient services, partial hospitalization programs and psychological testing. 

Instead, you’ll need to complete a short, simple Advance Notification for services through the Provider Express secure portal before rendering services to members.

What if I didn’t qualify for a waiver? What happens next?

If you didn’t qualify for a waiver, you must continue to submit prior authorization requests for all services that require approval before services are rendered. You can review prior authorization requirements via the:

Provider Express secure portal: Log in with your One Healthcare ID and password to check member eligibility and benefits. 

Prior authorization webpage on Providerexpress.com: Lists are available for Medicaid (by state), Medicare Advantage, Commercial and Individual Exchange plans. 

What if I disagree with my waiver status?

You may request a review of your Gold Card status by emailing  bh_gold_card@optum.com. Requests must be received by Oct. 3, 2024.

Questions?

Optum Behavioral Health manages the Gold Card waiver reviews and notifications for all network behavioral health services providers, on behalf of UnitedHealthcare. If you have questions that aren’t addressed in the Quick Reference Guide or Program Overview noted above, please email Optum Behavioral Health at bh_gold_card@optum.com.

* The Gold Card program applies to behavioral health services covered by eligible UnitedHealthcare commercial, Individual Exchange, Medicare Advantage and UnitedHealthcare Community plans. UnitedHealthcare Individual Exchange plans are also referred to as UnitedHealthcare Individual & Family ACA Marketplace plans.