2026 Gold Card Spring Expansion: Streamlining Prior Authorizations for Providers

Highmark continues to expand its Enterprise Gold Carding Program, which expedites prior authorization for clinicians who have demonstrated historical adherence to clinical criteria. Gold Carded providers are recognized for achieving authorization approval rates of 99% or higher for select modalities.

New Modalities Added This Spring

In addition to the current offerings, this expansion occurring March 1, 2026, includes expedited authorizations for the following modalities:

• Bariatric Surgery
• Cataract Surgery
• Foot Surgery
• Neurostimulators
• Reconstructive Surgery
• Varicose Vein Treatment

This expansion adds 139 CPT codes, bringing the total Gold Card-enabled codes to 728.

Note: Effective March 1, 2026, your Gold Card Clinician status may be subject to change. To review any updates to your privileges, consult the Master Gold Card Clinician Roster located on the Gold Carding Program page of our Provider Resource Center (PRC).

How the Enterprise Gold Card Program Works

Highmark automatically enrolls clinicians, bi-annually, when eligibility criteria are met. Once Gold Carded, clinicians will enter the appropriate information for the Highmark member and, upon submission, will receive an immediate authorization number to attach to any subsequent claims. Where possible, clinicians can schedule follow-up services for patients before they leave the office. This helps patients get the care they need without delays.

Verifying Gold Card Status

You can view the current list of Gold Carded clinicians by visiting the PRC's Gold Carding Program page to verify if you are Gold Carded or your practice has Gold Carded clinicians. You can also review the Gold Card Prenotification Process for authorizations and eligibility criteria.

Maintaining Your Gold Card Status: Importance of Audits

Highmark conducts monthly random (statistically significant sample) and targeted auditing based on utilization. These audits ensure clinicians are acting in accordance with medical policy and medical necessity requirements. A lack of response or concurrent audit failures can result in removal from the program.

Note: Audits have no impact on Gold Carded authorizations that have already been approved. More information is available on the PRC's Gold Carding Program page.

For questions about the Gold Card Program, please email goldcardinquiries@highmark.com.