Forms and documents

In compliance with the Texas legislature’s "Gold-Card" law, Nationwide does not require a physician or provider to obtain pre-authorization for a particular health care service if, in the most recent 6-month evaluation period, we have approved no less than 90 percent of the requests submitted.

How does an exemption work?

• If a physician or provider is eligible, they will receive an approval letter detailing this information and any further action steps.
• Once approved, we may not deny or reduce payment to a provider for a health care service for which the provider has qualified for the exemption.
• In order for a physician to qualify, there has to be at minimum 5 pre-authorization requests for that particular health care service with a 90% rate of approval.
• The provider’s exemption from pre-authorization requirements remains in effect until the 30th day after the date we notify the provider of our determination to rescind the exemption.

If the exemption is rescinded?

• This would mean we made a decision — on the basis of a retrospective review of a random sample of not fewer than 5 and no more than 20 claims submitted by the provider during the most recent evaluation period — that less than 90 percent of the claims for the particular health care service met the medical necessity criteria that would have been used by us when conducting pre-authorization review for the particular health care service during the relevant evaluation period.
• A provider has the right to an independent review of our determination conducted by an independent review organization regarding the pre-authorization exemption.
• A provider can request that the independent review organization consider another random sample of not less than 5 and no more than 20 claims submitted to us by the provider during the relevant evaluation period for the relevant health care service as part of its review.

Check your exemption status

There are no providers that qualify for an exemption at this time. Please check back in March 2026 for an updated list.

Plan Year 2025 Prior Authorization Statistics for policies issued within Texas (January – June)

• Total number of medical prior authorizations requested: 52
• Total number of medical prior authorizations approved: 52
• Total number of medical prior authorizations denied: 0
  • Reasons for denial: N/A
  • Denials overturned or internal appeal: N/A
  • Denials overturned by an independent review organization: N/A
  • Denials overturned by an independent review organization: N/A

This law is applicable only to the state of Texas at this time.

For any additional questions, please contact the TDI (Texas Department of Insurance) at LHLMgmt@tdi.texas.gov or please visit their website at tdi.texas.gov.