Credentialing with UnitedHealthcare (UHC) is a complex and time-consuming journey. But it is a crucial step for any practitioner or facility aiming to join one of the largest payer networks in the USA. You can expand your patient base and improve your practice’s financial health by gaining access to millions of insured patients.
Thus, if you want to join the UHC network, this guide will become your go-to resource. It will explain UHC credentialing to help you navigate the process with confidence and avoid common pitfalls.
So, without further ado, let’s get started!
A Step-by-Step Guide to UHC Credentialing Application
Visit the ‘Join our network’ page on the UHC official website.
Begin the UHC insurance credentialing process by selecting your entity type:
- Medical providers
- Hospitals and facilities
- Ancillary providers and centers
- Dental, vision, behavioral health, and other
Based on your chosen entity, you will be redirected to the relevant page with specific details about the process and requirements. We will discuss the UHC credentialing requirements in the next section. But before that, let’s take a look at the individual processes:
For Medical Providers
Are you a medical provider? Follow the steps below to get credentialed with UHC:
Step 1: Create One Healthcare ID
Create a One Healthcare ID if you do not already have one.
To sign up, you will need to fill out a simple form with the following fields:
- First name
- Last name
- Email address
- One Healthcare ID username
- Password
- Confirm password
Step 2: Log in to the Onboard Pro Platform
Once you have your One Healthcare ID, start the process of becoming a contracted medical provider by logging into the Onboard Pro platform.
Step 3: Pre-Credentialing Check
Do you want to request participation as a new medical provider? The UHC credentialing application using Onboard Pro will require you to complete the pre-credentialing check.
It has three main stages:
- Finding providers using the current Council for Affordable Quality Healthcare (CAQH) ID
- Setting up the contract information
- Determining whether credentialing is needed
The first two stages involve your input. However, the third stage is system-automated based on the details you provide.
Step 4: Enter Provider Details
After the pre-credentialing check comes the step where you will add the provider details for getting credentialed with UHC.
Step 5: Start Request for Participation
You can click ‘Continue’ to begin the request for participation process. This step involves completing the following:
- Practitioner information
- Locations
- Licenses
- Hospital affiliations
- Insurance policies
- Attachments
- Submission and confirmation
Step 6: Check UHC Credentialing Application Status
From the Onboard Pro platform dashboard, you can easily view your credentialing application status.
For Hospitals and Facilities
Are you a hospital or facility looking to get credentialed with UHC? If yes, the process remains the same. However, at step 4, you will select ‘Facility’ instead of ‘Provider’ to ensure the Onboard Pro platform offers you relevant experience.
For Ancillary Providers and Centers
This category covers all the entities listed below:
- Ambulatory infusion suites (AIS)
- Ambulatory surgery centers (ASC)
- Dialysis center
- Durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS)
- Hemophilia treatment center
- Home and community-based services (HCBS)
- Home health and hospice
- Home infusion/specialty pharmacy
- Imaging, radiology centers, and portable radiology
- Independent diagnostic testing facilities (IDTF)
- Laboratory
- Sleep studies
- Transportation
- Urgent care centers
Note: The UHC credentialing process can seem complex for ancillary providers and centers, as there are two different methods. In this section, we will break down each approach and explain which one applies to your specific entity according to the official UHC guidelines.
Method 1: Credentialing Application Using RFP Process
Follow the steps discussed below for successfully credentialing with UHC if you are an AIS, DMEPOS, hemophilia treatment center, home infusion/ specialty pharmacy, imaging/radiology center, IDTF, HCBS, laboratory, or a sleep study center:
- Step 1: Fill out the digital questionnaire.
- Step 2: Save and download the completed questionnaire.
- Step 3: Connect with a UHC representative via chat for submission instructions.
Method 2: Credentialing Application Using Onboard Pro Platform
If you are an urgent care center, ASC, dialysis center, home health, or hospice, complete the UHC credentialing application using the automated Onboard Pro platform.
For Dental, Vision, Behavioral Health, and Other
If you are a behavioral health or substance abuse provider or facility, contact Optum Behavioral Health Solutions. It handles credentialing and contracting on behalf of UHC for these specialties. You can visit providerexpress.com or call 800-817-4705 to get started.
Are you a chiropractor, outpatient physical therapist, speech-language pathologist, occupational therapist, or an alternative medicine provider? If yes, visit MyOptumHealthPhysicalHealth.com or call 800-873-4575 to start the UHC credentialing process.
Dental care providers can visit UHCdental.com or call 800-822-5353.
Contact UHC at joinus@UHCHearing.com to learn about the credentialing process for hearing care providers. You can also visit uhchearing.com to acquire more information.
Vision care practitioners such as optometrists and ophthalmologists can contract with UHC in either of the two ways:
- For routine vision care services, visit spectera.com or call 800-638-3120.
- For medical services within the scope of your licensure, visit UHCprovider.com/contactus > select state > Network Management.
UHC Provider Credentialing Requirements
Before we discuss the specific requirements for each entity, take a look at some general guidelines for credentialing with UHC below:
- You need to have Provider Portal access using One Healthcare ID.
- If you do not have a One Healthcare ID, you can easily register for one.
- Some specific entity information that you must provide includes contact information, legal name, and tax ID numbers (TINs).
- You must register for CAQH for some states and specialties.
- If CAQH registration is mandatory, ensure documentation and attestations are up-to-date.
For Medical Providers
The following are the key UHC credentialing requirements for medical providers:
- CAQH ID (if applicable)
- Licensing and certification details
- National Provider Identifier (NPI) number
- One Healthcare ID
- Proof of insurance – liability face sheet
- W-9
- Work and education histories
For Hospitals and Facilities
Before starting the UHC insurance credentialing process for hospitals and facilities, ensure that you have the following:
- Email address
- One Healthcare ID
- Physical facility address, including suite number, if applicable
- Proof of malpractice and general liability insurance
- W-9
- ZIP code + 4
For Ancillary Providers and Centers
The table below discusses the key UHC credentialing requirements for various ancillary providers and centers:
| Setting Type | Documentation Requirements |
|---|---|
| AIS | Community Plan (Medicaid) participation requires proof of enrollment by the state.JCAHO, URAC, CHAP, ACHC, or TCT accreditation.Licensure to do business in the participating state(s).Medicare enrollment status.W-9 for each TIN. |
| ASC | Accreditation by an accreditation organization (AO) that is approved by the Centers for Medicare and Medicaid Services (CMS).CMS letter showing your Medicare provider number.Enrollment in the relevant state’s Medicaid plan.Insurance face sheet/certificate for facility.Organizations licensed by the relevant state.Roster of physicians with privileges at the surgery center.W-9 for each TIN. |
| DMEPOS | Approval by an independent national AO for DMEPOS.Evidence of accreditation and good standing by CMS.Proof of enrollment in individual state Medicaid plan(s) (if applicable). |
| Hemophilia Treatment Center | Federally funded covered entity in the 340B Drug Pricing Program.Licensure to do business in the state(s).Medicare enrollment status.Proof of enrollment in individual state Medicaid plan(s).W-9 for each TIN. |
| HCBS | The facility must be enrolled in the individual state Medicaid plan(s) in which it is requesting participation. |
| Home Infusion/Specialty Pharmacy | ACHC, TCT, CHAP, URAC, or JCAHO accreditation for home infusion practitioners.Evidence of enrollment in individual state Medicaid plan(s) (if applicable).Licensure to do business in the state(s).Medicare enrollment status.URAC accreditation for specialty pharmacy providers.W-9 for each TIN. |
| Imaging and Radiology Centers | For advanced radiology services, include an independent accreditation certificate or letter from an accreditation agency (if applicable).Include relevant Medicaid IDs issued by the applicable state. |
| Laboratory | CLIA accreditation or compliance.Clinical Laboratory Evaluation Program (CLEP).College of American Pathologists (CAP).Copies of CLIA, CAP, CLEP, and state-specific certifications.Medicaid certification.Medicaid numbers by state.Medicare certification.Medicare number.NPI number.Professional liability certification.Proof of approval by the Laboratory Services Committee. |
| Transportation | Evidence of accreditation and good standing by the CMS for ground and air ambulances.Include relevant Medicaid IDs issued by the applicable state.Proof of participation in an independent AO for air ambulances. |
Challenges in Getting Credentialed with UHC
Discussed below are some of the common challenges that applying physicians and facilities face while trying to get credentialed with UHC:
Prolonged Processing Time
The UHC credentialing process is lengthy, as it often takes 90 days or longer to receive final approval. This prolonged timeline can significantly impact your revenue health.
In case you are wondering, what makes the credentialing process take so long to complete, there could be two reasons behind this delay:
- A high number of applicants
- The detailed verification process employed by UHC
Documentation Errors
Inaccurate documentation is another common reason for delayed credentialing with UHC. Minor errors, such as an expired document or a missing signature, can lead to delays or outright rejection of the UHC credentialing application.
Complex CAQH Profile Management
If the physician or facility’s CAQH profile is not accurate, up-to-date, or attested to, the credentialing application will not move forward. The reason? UHC relies heavily on the CAQH ProView database.
For the unversed, CAQH has its own guidelines that can be challenging for healthcare providers to manage.
Lack of Communication & Transparency
There is no way to receive real-time updates on the UHC credentialing application status. Thus, applicants requesting participation in UHC are often unaware of what is causing a delay.
Best Practices for UHC Insurance Credentialing
Here are some best practices to help you rise above the common roadblocks surrounding the credentialing process for UHC:
Maintain Your CAQH Profile
Having an up-to-date, accurate, and attested CAQH ProView profile is the most critical step in your credentialing workflow. Therefore, you should update your profile regularly with license renewals, education credits, and professional information. Doing so will help you prevent UHC credentialing application delays and rejection.
Prepare All Documents in Advance
Next, gather and organize all necessary documents for successful credentialing. These include your medical license, board certifications, diplomas, DEA certificate, and professional liability insurance. Do not forget to verify the validity of these documents and their expiration dates to avoid delays.
Double-Check Your Application for Errors
Before submitting the UHC credentialing application, review the application and all supporting documentation. This step may seem like spending extra time, but it can save delays and rejection.
Track Your UHC Credentialing Application Status
Unfortunately, there are no ways to acquire real-time updates on your application. However, this should not stop you from frequently checking your UHC application status. Besides, you should follow up with UHC’s provider relations to confirm receipt and inquire about the next steps.
Streamline Your UHC Credentialing with MediBillMD
In this guide, we tried to cover every aspect of the credentialing process for UHC. However, with so many requirements and a prolonged process, feeling overwhelmed is understandable.
That is why many healthcare providers and facilities partner with one of the reliable medical credentialing companies.
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