PayFlow (Direct) setting orders to On Hold

We've been using PayFlow Pro Direct Payments on our 1.4.0.1 site for several years. All of a sudden we've been getting all orders placed through there with a status of "On Hold" and this message on the order:
Payflow PNREF: #999999999999. Amount of $99.99 pending approval on gateway.

Thi sis how I have it setup:
Attachment 827

What is wrong?

Note, please don't tell me to upgrade, this install was done by contractors that severely customized it by not following standard principles, mainly by editing core source, and so we will not be able to upgrade. This installation is also tightly coupled with an ExpressionEngine CMS and later versions of Magento do not work well with it.