August 2025 Top of Mind

Check your Gold Card waiver status starting Sept. 1

UnitedHealthcare’s annual National Gold Card Program waives prior authorizations on eligible behavioral health procedure codes. Providers with newly earned exemptions will instead be required to complete a short Advance Notification for services effective Oct. 1. Check your status beginning Sept. 1.

The Gold Card program simplifies administrative workflows and reduces overall clinical prior authorization requests. It applies to behavioral health services covered by eligible UnitedHealthcare commercial, Individual Exchange,* Medicare Advantage and UnitedHealthcare Community plans.

Optum Behavioral Health will manage the waiver reviews and notifications for all eligible, network behavioral health services/substance use disorder providers.

Gold Card qualification criteria

Practice eligibility, which is defined by a single Taxpayer Identification Number (TIN), is based on a review of your prior authorization history. To qualify, you must meet all of the following criteria:

• Network participation for at least one line of business – Commercial, Medicare Advantage, Medicaid or Individual Exchange*,
• A minimum annual volume of at least 10 eligible prior authorizations across participating lines of business for 2 consecutive calendar years for any of the 18 Gold Card eligible codes, and
• A prior authorization approval rate of 92% or more after appeals have been exhausted for Gold Card eligible codes, across participating lines of business for each of 2 consecutive years.

How to see if you qualified**

Starting Sept. 1, providers can check their 2025 Gold Card status in the Provider Express secure portal.

• If you didn’t qualify last year: Be sure to check the portal as you may have received an exemption this year.
• If you qualified last year: You don’t need to take any action. Unless you hear from us, your Gold Card status remains unchanged. Your exemptions remain in effect for the same procedure codes.

All Gold Card prior authorization exemptions will automatically take effect on Oct. 1.

What if I have questions about my Gold Card status?

Providers may request a one-time review of their 2025 Gold Card status by emailing a reconsideration request to bh_gold_card@optum.com within 30 days of when the status was made available on the Provider Express secure portal.

We will communicate any Gold Card status changes directly to your practice.

Questions? We’re here to help.

For general questions, please visit ProviderExpress.com. You may also email Optum Behavioral Health at bh_gold_card@optum.com.

* UnitedHealthcare Individual Exchange plans are also referred to as UnitedHealthcare Individual & Family ACA Marketplace plans.

** Medical records may be requested to monitor practices that have qualified for Gold Card status. Practices may lose Gold Card status because of patient safety issues, failure to cooperate with quality and patient safety activities, lack of timely response to requests for information, or if they no longer meet program requirements. Any changes to the timing of Gold Card qualifications will be communicated in advance.