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

• 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

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. 

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.