CommercialPrior AuthMedium impact
Gold Card Fall Expansion: More than 24,000 Providers Now in the Program
Highmark·PA, NY, DE · Vascular Surgery, Radiology, Nuclear Medicine·Prior Authorization
Effective date
Sep 1, 2026
We identified it
Aug 28, 2026
Summary
Highmark's Gold Card Program has expanded to include more than 24,000 providers as of September 1, 2026. However, Nuclear Medicine and Varicose Veins Treatment modalities are being removed from the program effective immediately. Practices must verify their Gold Card status and remove these two modalities from Gold Card pre-notification workflows.
Action Required
By September 1, 2026: (1) Billing and clinical teams must verify current Gold Card status by consulting the Master Gold Card Clinician Roster on Highmark's Provider Resource Center (PRC); (2) Remove Nuclear Medicine and Varicose Veins Treatment from all Gold Card pre-notification workflows in billing systems and encounter forms; (3) For Nuclear Medicine claims, note that prior authorization is no longer required as of July 1, 2026; (4) For Varicose Vein Treatment, revert to standard prior authorization process pending Highmark's reassessment. Update provider education materials to reflect these modality removals. Failure to remove these modalities from Gold Card workflows may result in incorrect pre-notification submissions and claim processing delays.