UnitedHealthcare Revolutionizes Behavioral Health Administration with New National Gold Card Program
Capline Healthcare Management is pleased to share this important update from UnitedHealthcare. UnitedHealthcare introduced the National Gold Card Program, effective October 1, 2024, to reduce a significant amount of administrative burden around claims for behavioral health providers.
Under the new program, Gold Card status practices will no longer be required to submit prior authorization requests for the majority of mental health and substance use disorder services. These will be replaced by a simple Advance Notification to verify member eligibility and benefits. Towards reducing the administrative burden on providers and enabling the Provider to devote large blocks of time strictly to the patients.
Eligibility for Gold Card status is based on a practice's history of consistently adhering to evidence-based guidelines and the high approval rates for prior authorizations. An individual practice will be eligible for the Gold Card provided that it meets the following criteria: participation in at least one line of business, such as Commercial, Medicare Advantage, Medicaid, or Individual Exchange; at least a 92% authorization approval rate in two consecutive years.
Optum Behavioral Health will be administering this program and will measure practice metrics annually for eligibility. Practices will be notified of Gold Card status on or about each September with waivers effective October 1. This is a national program; however, any state statutory or regulatory requirement may supersede the national program where such laws or regulations exist or are enacted.
Please email any questions or further requests for information to Optum Behavioral Health at this address: bh_gold_card@optum.com. Capline Healthcare Management remains committed to keeping our clients updated on the latest in healthcare management. We believe the National Gold Card Program will enhance the speed and quality of behavioral health care for both providers and patients. Keep watching for more information, and get your practice ready for this program which will be implemented on Oct 1, 2024.
