August 2024 Issue
UnitedHealthcare launches national Gold Card Program
On Oct. 1, 2024, UnitedHealthcare will launch a national Gold Card Program that waives some behavioral health prior authorization requirements for eligible providers. Practices that earn Gold Card status will instead be required to complete a short, simple Advance Notification for services.
As part of the program, Optum Behavioral Health will manage the waiver reviews and notifications for all network behavioral health services/substance use disorder providers. Here’s what you need to know:
How do I apply for the program?
Practices do not need to apply for Gold Card status. Eligibility will be determined annually based on the criteria outlined below.
What criteria do I need to meet to earn Gold Card status?
Practices (defined by a single Tax ID) must meet all of the following criteria to qualify for the Gold Card program:
- 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 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 busiess for each of 2 consecutive years
Does the program apply to all health plans?
- The Gold Card program applies to behavioral health services covered by eligible UnitedHealthcare commercial, Individual Exchange,* Medicare Advantage and UnitedHealthcare Community plans.
What codes are eiligible for the waiver?
- There are 17 procedure and revenue codes that are currently reviewed for Gold Card waivers, including some for intensive outpatient services, partial hospitalization programs and psychological testing.
How will I know if I have a waiver?
- You’ll be able to check the Provider Express secure portal for your Gold Card status on Sept. 1. The waivers are then effective on Oct. 1.
How often is Gold Card eligibility reviewed?
- Practices will be evaluated annually. Any change to Gold Card status will be effective the first day of October every year.
Once I’ve earned a waiver, does it apply indefinitely?
- No. 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.
*UnitedHealthcare Individual Exchange plans are also referred to as UnitedHealthcare Individual & Family ACA Marketplace plans.
Return to Top of Mind Home Page
Article published August 13, 2024