UnitedHealthcare Gold Card Program 

Rewarding eligible behavioral health providers with prior authorization waivers for select services  

The new UnitedHealthcare National Gold Card Program rewards practices that consistently use evidence-based guidelines to develop treatment plans for patients. As part of the program, Optum Behavioral Health manages the waiver reviews and notifications for all network behavioral health services providers. The Gold Card program is open to any network behavioral health clinician who provides intensive outpatient services, partial hospitalization programs and/or psychological testing to eligible member groups.*    

        Quick Reference Guide                               Program Overview

Practices (defined by a single Tax ID) must meet all qualification criteria:

• Network participation for at least 1 line of business – Commercial, Medicare Advantage,Medicaid
  or Individual Exchange
• Minimum annual volume of at least 10 eligible prior authorizations for Gold Card-eligible codes
  across participating lines of business for 2 consecutive 12-month periods, 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 12-month periods

Providers who earn a Gold Card waiver will no longer need to submit clinical prior authorization requests for select behavioral health care services.

Instead, you’ll complete a simple Advance Notification process – which eliminates the medical necessity review. The notification:

• Confirms member eligibility, benefit coverage, and your network status for the member’s health plan, and
• Identifies exclusions where individual states may have their own regulatory requirements regarding prior authorization for these services.

For the Gold Card waivers effective on Oct. 1, 2024, the initial qualification period for prior authorization review was
April 1, 2022 through March 31, 2024.

 Practices will be evaluated annually. Updated Gold Card status determinations will be effective the first day of October
every year. Any changes to the timing of Gold Card qualification reviews will be communicated in advance.

    The Gold Card program qualifies providers at the federal taxpayer identification number (TIN) level. Individual providers within
    a group must have a National Provider Identifier (NPI) associated with a TIN that qualifies for Gold Card status.

    The waiver applies only to the 17 specified codes. Prior authorization requests must still be submitted for other behavioral health
    services which require them. Providers should confirm member eligibility and benefits before rendering services to members.

Disagree with your Gold Card 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. 

Annual Eligibility Reviews

Practices will be evaluated annually. Any change to Gold Card status will be effective the first day of October every year.