August 2026 Top of Mind

Check 2026 National Gold Card prior authorization waivers
starting Sept. 1

Mark your calendars – September 1 is a golden day you don't want to miss. That's the day you can check if you’re received UnitedHealthcare’s National Gold Card Program waiver. The waiver eliminates prior authorizations on eligible behavioral health procedure codes.

The Gold Card program simplifies administrative workflows and reduces overall clinical prior authorization requests. Optum Behavioral Health manages the waiver reviews and notifications for all eligible network behavioral health providers. The Gold Card program applies to behavioral health services covered by eligible UnitedHealthcare commercial, Individual Exchange,* Medicare Advantage and Community (Medicaid) plans.

To see if you qualified

Starting Sept. 1, you can check 2026 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 earn an exemption for the first time this year:
  • The Gold Card prior authorization exemption takes effect on Oct. 1, 2026.
  • Beginning that day, you will no longer need to submit prior authorization requests for the designated codes.
  • Instead, you’ll be required to complete a short Advance Notification for services.
• 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.

Gold Card qualification criteria

Practice eligibility (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, Community Plan (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 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 calendar years.

If you have questions about your Gold Card status

You may request a one-time review of your 2026 Gold Card status by emailing a reconsideration request within 30 days of when the status was made available on the Provider Express secure portal. Requests should be emailed to bh_gold_card@optum.com, We will communicate any Gold Card status changes directly to your practice.

Questions? We’re here to help.

For general questions, please visit the National Gold Card Program webpage. 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 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.