UnitedHealthcare will launch a national gold-card program Oct. 1 for providers that consistently adhere to evidence-based guidelines to bypass prior authorizations for some medical services.
Five things for spine and orthopedic surgeons to know:
1. Under the new program, gold card practices will simply complete an advanced notification for the services to confirm member eligibility and trigger coverage. The advanced notification also shares real-time information with UnitedHealthcare to identify applicable care management programs and resources for members.
2. The insurer noted some states may have regulatory requirements that would impact its gold care program and specific codes.
3. UnitedHealthcare plans to release a list of gold card-eligible services Sept. 1 and begin the program Oct. 1. The program applies to commercial, individual exchange, Medicare Advantage and community plans.
4. In March 2023, the insurer said a national gold card would cut 20% of prior authorization requirements.
5. Orthopedic and spine surgeons have welcomed the concept of "gold card" designation to avoid lengthy prior authorizations and denials. But when UnitedHealthcare initially floated the idea for a national gold card last year, some surgeons were less than enthusiastic.
"The codes that were eliminated are some of the least utilized codes," Adam Bruggeman, MD, an orthopedic surgeon at Texas Spine Center in San Antonio, told Becker's at the time. "I'm not sure I have billed any of those codes in the last 10 years, or perhaps have only done so a handful of times. It would be interesting to see the frequency with which the eliminated codes were billed across the U.S. and what percentage of cases these codes represent for prior authorization as a percentage of all codes that require prior authorization. We continue to advocate for true reform, including finalizing the proposed rules and gold card-style legislative efforts at the state and federal levels."