UnitedHealthcare to Launch Prior Authorization Gold Card Program for Reduced Burden

UnitedHealthcare is taking steps to alleviate the burden of prior authorizations on healthcare providers. The company is launching a Prior Authorization Gold Card Program.

This program aims to reduce administrative tasks for providers, allowing them to focus on patient care. By streamlining the prior authorization process, UnitedHealthcare hopes to improve the overall patient experience.

The Prior Authorization Gold Card Program will provide a one-touch approval process for certain medications and services. This means that providers will no longer need to submit multiple requests for approval.

The program is designed to be efficient and hassle-free, giving providers more time to devote to their patients.

The UnitedHealthcare Gold Card program is now live, with a launch date of October 1.

To qualify for this program, a provider group must meet certain criteria for each of the past two consecutive years.

A provider group must be in-network for at least one line of business.

They must also have a minimum annual volume of at least 10 eligible prior authorizations in each of the two consecutive years.

These prior authorizations must be across Gold Card eligible codes.

Additionally, the provider group must have a prior authorization approval rate of 92% or more in each of the two years evaluated, after appeals, on the eligible prior authorization volume.

Practices can check their gold card qualification status through the UHC portal.

Prior authorization plays a crucial role in reducing costs and improving quality by ensuring members receive coverage for safe, effective care supported by the most up-to-date clinical guidelines.

Only 2% of claims paid at UnitedHealthcare require prior authorization, making the process relatively efficient.

Less than 2% of UnitedHealthcare's members experience a prior authorization denial annually.

The estimated waste due to overtreatment and low-value care in the U.S. is between $76 billion to $101 billion annually, highlighting the need for streamlined processes like prior authorization.

Prior authorization can help take unnecessary costs out of the system by ensuring providers and members know if a service will be covered before care is delivered.