How the UnitedHealthcare Gold Card program helps modernize prior authorization
Prior authorization serves as an important checkpoint to help enable access to coverage of clinically appropriate services or medications. UnitedHealthcare continues to take steps to modernize and streamline the process.
Launched in 2024, the first-of-its-kind national UnitedHealthcare Gold Card program recognizes provider groups who consistently adhere to evidence-based care guidelines.
Starting Oct. 1, 2026, additional provider groups will be eligible. Provider groups can now view their updated Gold Card program status in the UnitedHealthcare Provider Portal.
Since the program began, we’ve seen an 80% increase in the number of provider groups that have qualified for our Gold Card program. The increase reflects another year of prior authorization submissions and our continued transparency in sharing program criteria and qualification data in the provider portal.
Gold Card provider groups are seeing a reduction in their total prior authorization request volume. Last year, we surveyed our most active Gold Card users, and 94% of respondents said they are satisfied overall. That same percentage agreed that the program has reduced administrative tasks.
Qualifying care provider groups follow a simple notification process for eligible procedure codes rather than the prior authorization process. This advance notification helps confirm eligibility and network status, but it does not require clinical information.
Gold Card status applies across UnitedHealthcare’s Commercial, Individual Exchange, Medicare Advantage and Medicaid plans. Delegated membership is excluded from the program at this time.
The program is continually evaluated to incorporate additional improvements, while communicating enhancements along the way.
How the UnitedHealthcare Gold Card program works
To qualify for the UnitedHealthcare Gold Card program, a provider group must meet the following criteria for each of the past two consecutive years:
- In-network for at least one line of business
- A minimum annual volume of at least 10 eligible prior authorizations in each of the two consecutive years of the qualification period across Gold Card eligible codes
- 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
Provider groups can view their UnitedHealthcare Gold Card program status via the UnitedHealthcare Provider Portal. If provider groups haven’t qualified, they can learn more about how they can qualify in the future.
The importance of prior authorization
Prior authorization plays an important role in improving quality and reducing costs, as it can help members access coverage for safe, effective care supported by the most up-to-date clinical guidelines.
- Prior authorization can help providers and members know if the service requested will be covered before the care is delivered.
- When our members seek care, prior authorization is not needed before receiving care 98% of the time.
- Nine out of every 10 prior authorizations submitted are approved, and nearly all decisions are made within 1 day.
- Prior authorization is never required in an emergency setting.
Prior authorization can also help take unnecessary costs out of the system. Estimated waste due to overtreatment and low-value care in the U.S. costs between $76 billion and $101 billion annually.1
The UnitedHealthcare Gold Card program is an important initiative in our continual efforts to modernize the prior authorization process and simplify the healthcare experience for both consumers and providers.
Additional efforts include eliminating authorization requirements for 30% of healthcare services that previously required insurer approval, expanding support for rural communities by exempting qualifying rural providers from most medical prior authorization requirements, and removing two-thirds of authorization requirements for members under age 18 by year’s end.
For more information on the Gold Card program, including eligibility criteria and a comprehensive list of Gold Card eligible CPT® codes, visit our national Gold Card program information page.
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