UnitedHealthcare (UHC) launched the Gold Card Program, exempting qualified medical, behavioral, and mental health practices from prior authorization requirements for specific services. However, these practices must still follow UHC’s advance notification process for Gold Card services. UHC also reserves the right to request medical records to monitor and evaluate Gold Card practices.

The California Medical Association (CMA) is reviewing the program’s announcement, particularly the potential burden that the advance notification process and records requests may place on physician practices.

Eligibility and Application Details

To qualify for the Gold Card Program, practices must participate in at least one UHC line of business, have a minimum of 10 prior authorizations for Gold Card-eligible codes annually over two consecutive years, and maintain a prior authorization approval rate of 92% or higher for those codes. Practices do not need to apply for the Gold Card status; UHC will assess eligibility annually and provide performance reports. Practices that disagree with their status can request a review within 30 days of notification.

A detailed list of eligible services under the Gold Card Program will be released on September 1, 2024. Further information will be available on UHCprovider.com or the UnitedHealthcare Provider Portal’s 24/7 chat service.