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UnitedHealthcare National Gold Card program

UnitedHealthcare remains committed to modernizing the prior authorization process and simplifying the health care experience for consumers and health care professionals. Our UnitedHealthcare National Gold Card program is available for provider groups who meet eligibility requirements.

The National Gold Card program recognizes qualified practices that have consistently demonstrated adherence to evidence-based guidelines. Qualified practices will submit an advance notification which eliminates the need for clinical documentation review for specific Gold Card services. 

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Learn how to check your Gold Card status and related details in our step-by-step interactive guide.

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Get to know the program, criteria, and important details in the UnitedHealthcare Gold Card program protocol.

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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 92.0% or more across all Gold Card-eligible codes for each of the review years

UnitedHealthcare Insights provides access to detailed reporting on the health care professionals associated with each TIN. As a UnitedHealthcare Provider Portal user, you may already have access to this tool. If you need help getting access, you can find more information on our 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.

Check out our National Gold Card program interactive guide for more details about Insights reporting. 

Please note: If your TIN did not qualify, and you believe your TIN met the eligibility criteria, your dedicated TIN administrator may request a one-time review of your Gold Card status. You can initiate this review by chatting with a live advocate from the UnitedHealthcare Provider Portal. Only reviews submitted by Oct. 1, 2024, will be considered. 

  • To get started in the UnitedHealthcare Provider Portal, select Sign In at the top-right corner of this page 
  • Enter your One Healthcare ID and select the chat icon at the bottom-right corner of the page. You will be asked what you want to chat about, select Prior authorization > Gold Card Program > Check Gold Card Status

When you initiate your review via chat, you’ll need your tax ID, at least one NPI from the group, the state where services are performed, and any specific Gold Card codes in question.

Practices that earn Gold Card status are required to complete advance notification for services. Claims with Gold Card eligible CPT® codes will not be paid absent advance notification. Advance notification benefits patients and other providers rendering care as provided below:   

  • Provider care coordination: enables other providers and facilities supporting care for plan members to quickly and easily validate the service is covered. This lets them know that further authorization is not required and helps ensure scheduling of services. It also helps verify that the Gold Card eligibility for a CPT code applies to other providers caring for each plan member.
  • Patient cost protections: validates member eligibility and network status using our online tools. This can help plan members maximize their health plan benefits.
  • Health plan care coordination:  shares real-time information with UnitedHealthcare to help us identify applicable care management programs and other resources to help advance each plan member’s health journey.
  • Identify exclusions:  individual states may issue regulatory requirements impacting the National Gold Card program and specific codes.

Check out our National Gold Card program interactive guide for more details. 

Additional resources

  1. Gold Card-eligible procedure code list
  2. UnitedHealthcare National Gold Card program frequently asked questions
  3. UnitedHealthcare National Gold Card program protocol
  4. State Gold Card programs may differ from our National Gold Card program. If applicable, your state Gold Card data is available within UnitedHealthcare Insights. State Gold Card program details: ArkansasLouisianaMichiganNew MexicoTexas and West Virginia

Questions?

Connect with us through chat 24/7 in the UnitedHealthcare Provider Portal.

*Also referred to as UnitedHealthcare Individual & Family ACA Marketplace plans.
CPT® is a registered trademark of the American Medical Association.