UnitedHealthcare Announces National Gold Card Program

September 5, 2024

On October 1, UnitedHealthcare will launch its National Gold Card Program, through which qualified practices will be exempt from submitting prior authorization requests for select services. 

Practices don’t need to apply to the program. However, provider care group tax ID numbers (TINs) must meet the following eligibility criteria: 

• 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 two 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. This rate applies to prior authorization status for Gold Card eligible codes, across all participating lines of business, after all appeals were exhausted. 

Practices awarded Gold Card status will be required to complete a simple advance notification for services. UnitedHealthcare maintains that these advance notifications benefit patients and providers by facilitating care coordination, protecting patient costs, and identifying regulatory exclusions that may be imposed by the state of Minnesota. 

For more information, visit the UnitedHealthcare Gold Card Program website and FAQ.  

The MMA will continue to update its members on the implementation of the program. Please contact Adrian Uphoff, health policy analyst, with questions.