What is the Gold Card Program?
The Gold Card Program (GCP) allows providers to be exempt from the usually required preauthorization for certain services/products when they meet national benchmarks for condition-specific care measures.
Who can qualify for the Gold Card Program?
Qualified medical/surgical and mental health/substance use disorder providers who have consistently demonstrated adherence to best practices and evidence-based guidelines can be recognized.
How do I become eligible for the Gold Card Program?
To be eligible for the Gold Card Program in Utah, a provider group must be at or below threshold for the percentage of patients taken to surgery for the following conditions:
ENT Providers
OB/GYN Providers
NOTE: These rates are based on provider groups, not individual providers.
Provider groups in Colorado can be eligible for the Gold Card Program for prescribing Oriahnn or performing hysterectomies within the following thresholds:
Hysterectomy: At least 10 measured markers each with a minimum of 10 episodes/year/diagnosis for endometriosis and benign tumor (fibroid). The provider group must achieve a weighted score of 85% pass of markers at or below 75th percentile based on national metrics. These rates are based on provider groups, not individual providers.
How often does my eligibility need to be reviewed?
Gold Card providers will be subject to a review every 6 months and audited on a quarterly basis to confirm that services billed under the program meet applicable criteria and program requirements.
How do I keep my Gold Card eligibility?
In order to keep your Gold Card eligibility, you must continue to be at or below the thresholds for the applicable procedures by the annual review. This occurs in April for ENT providers and in July for OB/GYN providers.
Eligibility groups
During a mid-cycle review and an annual review, your provider group will be evaluated and will fall into one of the following categories:
During a mid-cycle review and an annual review, your provider group will be evaluated and will fall into one of the following categories:
Approved: Your group currently meets all Gold Card requirements and is approved for preauthorization leniency. At least 10 measured markers each with a minimum of 10 episodes/year/diagnosis for endometriosis and benign tumor (fibroid). Achieved a weighted score of 85% pass of markers at or below 75th percentile based on national metrics.
At risk: While your group is currently approved for preauthorization leniency, you are at risk of losing your Gold Card status. Less than 10 measured markers each with less than 10 episodes/year/diagnosis for endometriosis and benign tumor (fibroid). Have not achieved a weighted score of 85% pass of markers at or below 75th percentile based on national metrics.
On track: While your group is not currently approved for preauthorization leniency, you are on track for Gold Card status. At least 10 measured markers each with a minimum of 10 episodes/year/diagnosis for endometriosis and benign tumor (fibroid). Achieved a weighted score of 85% pass of markers at or below 75th percentile based on national metrics.
Off track: Your group is not currently approved for preauthorization leniency and you are off track for Gold Card status. Less than 10 measured markers each with less than 10 episodes/year/diagnosis for endometriosis and benign tumor (fibroid). Have not achieved a weighted score of 85% pass of markers at or below 75th percentile based on national metrics.
Gold Card Program reporting (Colorado only)
View quarterly reports for the Colorado GCP (first report will be loaded after Q1 2026).
Year
Q1
Q2
Q3
Q4
Annual
2026
Frequently asked questions
Yes. There are a few exclusions that you need to be aware of:
GCP only applies to otherwise-covered services. Some services are excluded by specific plans and would still not be covered.
Cosmetic procedures will continue to be denied as a plan exclusion, and unspecified codes will continue to be reviewed.
The Gold Card Program uses Cave Consulting Group software to analyze practice patterns against national benchmarks for various condition-specific care measures.
This allows Select Health to develop specialty-specific physician effectiveness scores based on this analysis. These scores will compare individual physician effectiveness against peer group effectiveness and relevant best-practice guidelines for their specialty.
For specialists: To measure effectiveness, the Cave software assigns nearly all claim lines to a medical condition of episode of care, resulting in accurate capture and assignment of costs. These episodes are:
Assigned to providers with >20% of professional allowed charges
Grouped by medical condition associated with a clinical measure
Compared with protocol ranges based on nationwide utilization and published evidence-based care models
Select Health measures performance on a group level based on a provider’s primary clinic in our records. This is impacted by several factors, including:
Attribution if a provider practices in multiple clinics
Severity of illness
Definition of diagnosis
Attribution of tests
Select Health reviews the data at least twice a year with changes made to the preauthorization leniency list yearly. In some cases, the current threshold for preauthorization leniency is still inconsistent with national standards. Because of this, these thresholds will be adjusted over time to become more consistent with the national benchmarks. Select Health will provide ongoing feedback on medical condition practice patterns in comparison to peers within the region and nationally.
For questions about the Gold Card Program please contact:
Colorado: Krista.Schonrock@selecthealth.org