Understanding how Health Plans have Programs to Simplify Access for Providers and Patients

Health plans are increasingly looking for ways to simplify healthcare delivery by reducing administrative burdens for providers and improving access to care for patients. A key example is United Healthcare's (UHC) Gold Card Program. This program allows select providers to bypass prior authorization for certain services, speeding up the time it takes to deliver care.

The program offers several notable advantages for both providers and patients:

• Faster Access to Care:  

• Reduced Administrative Tasks:  

• Stronger Provider-Insurer Relationship

• Enhanced Patient Experience:  

The Gold Card Program is designed to reward healthcare providers who consistently meet quality and compliance standards by giving them more autonomy in treating patients. 

However, not all services are covered under the Gold Card Program. Primarily, genetic testing is not currently included under the Gold Card Program. Providers must still go through the traditional prior authorization process for these services.

Services that are included in the UHC Gold Card Program typically fall under commonly utilized codes, such as:

• 70450 – CT Head/Brain without contrast

• 71250 – CT Chest without contrast

• 70540 – MRI Orbit Face/Neck without contrast

The absence of coverage for genetic testing continues to impose significant administrative challenges on providers, requiring additional time to manage prior authorizations. Many providers are burdened with increased paperwork and delays, impacting both efficiency and patient care. careviso offers an effective solution to alleviate these burdens for both physicians and patients. Our technology platform provides a comprehensive set of tools designed to streamline the prior authorization process, ultimately reducing administrative hurdles and optimizing the PA workflow.