Gold Carding: ​From Compliance Mandate to Competitive Advantage​

Utilization Management (UM) has long been a point of tension between payers and providers. But with new regulations and a national spotlight on administrative burden, gold carding is evolving from policy push to strategic priority. 

States like Arkansas, Louisiana, Michigan, Texas, Vermont, West Virginia and Wyoming have already enacted gold carding legislation, with more expected to follow. At the federal level, CMS is urging gold carding as a key lever to reduce friction and improve access to care.

The message is clear: 

Gold carding isn't just about checking a compliance box—it's a high-impact strategy to modernize UM.

Forward-thinking payers are using gold carding to drive real results: reducing costs, strengthening provider relationships, and creating a more agile, trusted UM function. Just as important, they’re positioning themselves for success as mandates multiply. 

Elevate gold carding from compliance to a core capability 

Design for scale and sustainability

Create a program that adapts to provider behavior, care trends, and policy changes.

 

Drive cross-functional ownership

Ensure collaboration across medial policy, IT, provider relations, and operations.

Automate with intelligence

Implement real-time decision support with full traceability.

Build for trust

Define consistent rules, eligibility logic, and audit-ready transparency.

Why Predictal™ is your partner for gold carding success 

Predictal™ offers a powerful, comprehensive platform built to make gold carding faster, smarter, and easier to manage. From configuration to execution, we empower payers to deliver both compliance and strategic value. 

“As of September 2024, we’ve grown the program to more than 21,000 gold carded providers. In the last 12 months, we’ve had over 400,000 authorizations notifications submitted by our gold carded clinicians. We’ve reduced our cost to process an authorization significantly, allowing us to manage more and pass savings to members.” 

 - CMO, Large Regional HealthPlan

Here's what sets Predictal apart:

Predictal gold carding capabilities at a glance 

Configurable Rules Engine 

Tailor GoldCarding logic by CPT code, provider tier, specialty, or geography—aligned to your clinical strategy.

 

Self-service Control 

Business users can adjust thresholds or eligibility criteria without IT support, enabling faster execution. 

 

Provider Transparency 

Real-time notifications at submissions let providers know when requests qualify.  

 

Analytics-Ready & Data-Agnostic 

Ingest claims, UM, and external data to adapt Goldcard status over time. 

 

Integrated Monitoring

Track provider performance, compliance, and program impact in a single dashboard. 

 

Full Auditability 

Every rule change and provider interaction are tracked – making compliance easy and defensible. 

Configurable Rules Engine

Tailor gold carding logic by CPT code, provider tier, specialty, or geography—aligned to your clinical strategy.

Self-service control

Business users can adjust thresholds or eligibility criteria without IT support, enabling faster execution.

Provider transparency

Real-time notifications at submissions let providers know when requests qualify.

Analytics-ready & data-agnostic

Ingest claims, UM, and external data to adapt gold card status over time.

Integrated monitoring

Track provider performance, compliance, and program impact in a single dashboard.

Full auditability

Every rule change and provider interaction are tracked – making compliance easy and defensible.

Let's talk.

Predictal can help you modernize UM and drive measurable results with gold carding.  

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