UnitedHealthcare plans to launch a program in October geared toward streamlining prior authorization for qualifying providers. The company’s “gold card” program will be offered across its commercial, individual exchange, Medicare Advantage and Medicaid business lines. The Gold Card program will allow certain providers to use a simplified process for about 500 procedure codes.
In-network provider groups that have submitted at least 10 prior authorization requests for eligible procedures over each of the past two years –with a 92% or higher UnitedHealthcare approval rate – can submit what the insurance company calls an ‘advance notification’ and forgo clinical documentation review for selected services.
Here is the list of CTP codes covered by the program. A quick review of the list did not reveal any procedures relevant to wound care or hyperbaric medicine, although many imaging procedures are on the list which may reduce the frustration of obtaining some diagnostic imaging studies.
–Caroline
Resources:
UnitedHealthcare National Gold Card Program
You don’t need to apply for the UnitedHealthcare National Gold Card program. However, the following eligibility requirements must be met. Provider care group tax ID numbers (TINs) must:
- Be in network for at least one UnitedHealthcare health plan such as UnitedHealthcare commercial, UnitedHealthcare Individual Exchange*, UnitedHealthcare® Medicare Advantage and UnitedHealthcare Community plans, and
- Meet a minimum annual volume of at least 10 eligible prior authorizations each year for 2 consecutive years across Gold Card-eligible codes, and
- Have a prior authorization approval rate of 92% or more across all Gold Card-eligible codes for each of the review years
UnitedHealthcare Gold Card Program Interactive Guide
Find out if you qualify:
- Sign in to the UnitedHealthcare Provider Portal > Select Prior Authorizations & Notifications
- Select the Gold Card status lookup tool from the Quick links & tools section on the right side of the page
- See the current Gold Card status of all TINs associated with your account > select desired TIN
Find more information on: UnitedHealthcare Insights page.
Once a TIN has qualified for our National Gold Card program, the status covers all providers associated with that TIN. This means, when ordering a Gold Card service, any provider associated with a Gold Card qualified TIN will not require a prior authorization on the Gold Card designated codes. An advance notification is required.
