October 2024 Issue
National Gold Card waivers effective Oct. 1
UnitedHealthcare is launching a national prior authorization waiver program on Oct. 1, 2024 – the UnitedHealthcare Gold Card program. It will waive select prior authorization requirements for eligible network (contracted) providers.
Optum Behavioral Health manages the Gold Card waiver reviews and notifications for all network behavioral health services providers, on behalf of UnitedHealthcare. Eligible providers were notified in early September whether or not they’ve qualified for the prior authorization waiver. For complete details, review the Quick Reference Guide.
Key things to know
- 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 before rendering services to members. An advance notification request is started the same way as a prior authorization request. There are two options: Through the Provider Express secure portal or by calling the number on the back of the member’s ID card.
- 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 two consecutive 12-month periods (April 1, 2022 –March 31, 2024), 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.
- Who's eligible to recieve 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.*
- What happens next?
- If you did not 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.
- If you did not 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:
- What if I disagree with my waiver status?
- You may request a review of your Gold Card status by sending an email to bh_gold_card@optum.com. Requests must be received by Oct. 3, 2024
Questions?
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.