Last update: April 1, 2020, 1:15 p.m. CDT
Effective immediately, UnitedHealthcare is temporarily updating our credentialing policies to implement provisional credentialing for out-of-network care providers who are licensed independent practitioners and want to participate in one or more of our networks.
For providers who are already credentialed, we will not require additional credentialing to practice in a new location. Additionally, we’re waiving site visit requirements for health care practitioners and facilities.
PLEASE NOTE: This information is applicable only during the period of the COVID-19 public health emergency and is subject to change. Please check back often for updates.
In accordance with guidelines from the National Committee for Quality Assurance (NCQA), we’re implementing provisional credentialing for out-of-network care providers who are licensed independent practitioners and want to participate in one or more of our networks. We’ll then complete the full credentialing process within 180 calendar days from when provisional credentialing is granted.
Here’s how to obtain provisional credentialing:
- Submit a completed and signed application and attestation through CAQH ProView® or a state-mandated application. Please be sure to select UnitedHealthcare as an approved health plan, so we can quickly receive your application.
- Submit a request for participation to UnitedHealthcare so we can start the provisional credentialing process. You can submit your request for participation in one of three ways:
- Call us at 877-842-3210 and enter the practitioner’s tax identification number (TIN). Then, select Credentialing > Medical > Join the Network.
- Email us at email@example.com. Include the practitioner’s full name, National Provider Identifier (NPI) number, TIN, CAQH ID and a brief description of the request.
- Use our online Request for Participation form (for licensed practitioners only).
What happens next?
We’ll review the application to ensure it meets the provisional credentialing requirements. We’ll verify a current, valid license to practice, review malpractice claims history and verify that you have adequate malpractice coverage. We’ll notify you once this review is complete. To check the status of your credentialing application, please email us at firstname.lastname@example.org.
If you practice in one of the following specialties, you’ll need to contact a partner who handles credentialing and contracting on behalf of UnitedHealthcare. They’ll help you begin the request for participation:
- Optometrists: Go to spectera.com or call 800-638-3120.
- Mental Health or Substance Abuse Practitioners: Go to providerexpress.com or call 800-817-4705.
- Dental Care Providers: Go to dbp.optum.com or call 800-822-5353.
- Chiropractor, Outpatient Therapy Provider/Clinic (Physical/Occupational/Speech) or Alternative Medicine Providers: Go to MyOptumHealthPhysicalHealth.com or call 800-873-4575.
If a provider is licensed but has not yet completed their residency, they may be provisionally credentialed. Completion of residency within the 180-day period would then be required for the provider to be fully credentialed.
Please note that we do not require board certification in order for providers to be credentialed. However, we do require completion of residency in their practicing specialty.
Providers coming out of retirement to assist practices or facilities during this national health emergency will need to complete the provisional credentialing process. To get started, please follow the steps outlined in the provisional credentialing section.
For providers who are already credentialed, we will not require additional credentialing to practice in a new location or to practice across state lines. This is subject to change as required by federal/state requirements.
Note the following additional guidance:
- Care providers are required to check with the applicable professional licensing boards for guidelines on where they are able to practice during the COVID-19 health emergency.
- For credentialed practitioners, new locations do not need to be credentialed because credentialing occurs at a practitioner level and not at a location level.
- For participating facilities that open a new site, we will not require additional credentialing.
- For non-participating facilities seeking participation, we require credentialing but will waive a site visit, if required.
- Additionally, providers who are acting as Locum Tenens or practicing solely in a hospital setting do not require credentialing.
Site visit requirements for health care practitioners and facilities will be waived during the COVID-19 public health emergency. This is in accordance with Centers for Medicare & Medicaid Services (CMS) guidelines and federal and local restrictions on travel and face-to-face meetings. The site visit waiver will be reevaluated once federal restrictions are lifted. We’ll track all practitioners and facilities that are approved without a site visit to determine whether a visit will be required at a later time.
We’re committed to keeping you up to date on COVID-19 – we’re monitoring your inquiries and working hard to answer your questions. Let us know how we’re doing.
We’ll be making daily updates to this site. Be sure to check back often for the latest information.
The benefits described on this website describe federal requirements and UnitedHealthcare national policy. Additional benefits may be available in some states and under some plans.