Today UnitedHealthcare (UHC) launched a “prior notification” process for non-screening endoscopy services. UHC announced late yesterday its decision to temporarily restructure its prior authorization program into a process that allows physicians to provide data to UHC which UHC states it will use to “accelerate gold carding for eligible physician groups in early 2024.”

For more than two months the ASGE fought back against UHC’s prior authorization program for endoscopy services and made multiple requests for UHC-specific data that showed inappropriate use and geographic variation of endoscopy services. It is clear that UHC did not have specific data within its own system to justify its prior authorization program and is now strong-arming physicians into providing information without our knowing exactly how that data will be used.  

On May 30, the GI societies sent a letter to UHC underscoring that UHC was not justified in moving forward with implementing either the prior authorization or prior notification programs.  Instead, we asked UHC to commit resources and to work through our societies on educational programs with the goal of improving patient care and outcomes.

UHC has not presented a specific timeline for implementation of its Gold Card program except to say it will be launched in “early 2024” and has not shared any information about the criteria by which gastroenterologists and other physicians who perform endoscopy services will be evaluated for gold carding eligibility. During a monthly meeting with medical association stakeholders, UHC representatives stated their expectation that approximately 10 percent of physicians would be eligible for endoscopy gold carding.

Without knowing gold carding eligibility details, physicians who choose to turn over their data on endoscopy services to UHC are not guaranteed they will be granted gold card status when UHC launches a Gold Card program, which means that physicians who do submit to the prior notification program could still be subjected to prior authorization requirements at a later date.

ASGE refuses to capitulate to UHC’s coercive tactics to collect data from physicians that could be used to justify a future prior authorization program, and we will continue our calls for more transparency from UHC and other payers that are moving an increasing number of services through prior authorization without proof of justification.

For more information about the advance notification program, read UHC’s FAQ.