UnitedHealth care (UHC) is a healthcare company that has a large network of physicians, healthcare specialists, and facilities. To become a UnitedHealth care provider, health care professionals must apply and have their UnitedHealthCare (UHC) credentials validated. Applicants begin the application process by visiting UnitedHealthcare’s website.
Enrollment in UnitedHealth care Providers
Enrolling as a UnitedHealth care provider is a four-step procedure. You must first submit a participation request, and then you must go through an experience and expertise verification process. After that, you sign a participation agreement and set up online tools.
To allow UnitedHealth care to access account data, you must provide you’re:
- Tax identification number (TIN)
- As well as an up-to-date and authorized Council for Affordable Quality Healthcare (CAQH) ProView account number.
Submit a Request for Participation
Depending on whether you are a hospital and health care institution, optometrist, mental health or substance abuse practitioner, dental care provider, chiropractor, outpatient therapy provider, or alternative medicine provider, the method for submitting a request for participation differs. Non-mentioned care providers have their own process of application as well.
Hospitals and health care institutions can request participation by sending
- An email with their name
- Tax ID
- Service addresses
- National Provider Identifier (NPI)
A representative contacts you after you send the email. Some medical specialties are required to go through a third party that handles credentialing and contracting on UnitedHealth care’s behalf. The website contains a list of these third parties. All other care providers must make a request for participation through UnitedHealth care’s Request for Participation (RFP) portal.
Credentialing by United Healthcare
After you have submitted and accepted the form, you can proceed with the UnitedHealth care credentialing process. During this process, your credentials are evaluated to see if they fit the requirements.
The credentialing criteria of UnitedHealth care are in accordance with the National Committee on Quality Assurance (NCQA). They provide a foundation of best practices for organizations such as UnitedHealth care, according to the NCQA. When evaluating a medical professional’s experience and legitimacy, the NCQA assures that a standard is used.
Training and education, license and certification, employment history, insurance, and other background checks and state rules are all evaluated during the credentialing process. Complete the state-appropriate certification form, which will be reviewed by a state board and a committee of peers.
What’s you have to provide for Credentialing
United-Healthcare’s credentialing standards are fully submissive with the National Committee on Quality Assurance [NCQA] as well as state and federal laws.
Requirement
Training & Schooling
- Post-graduate education or practice, as well as a practitioner degree [MD/DO/DPM]
- Information on medical or professional education and training
- Fulfillment of a residency plan in the preferred specialty
Authorizing and Certification
- Current permit or certification in the country in which the care provider will be practicing
- National Provider Identification [NPI] number
- DEA no./ CDS document
- Medicare certification
Previous Employment Details
- 5-year work history
- Description of work conditions, license account and permissions
- [W-9] report
- Hospital staff prerogatives
Insurance
- Active negligence insurance or a government alternatives
- History of misconduct
To be eligible for credentials, every facility should meet specific criteria:
- Current necessary license(s)
- General/full liability insurance
- Errors and imperfections (negligence) insurance
- Proof of Medicare/Medicaid plan participation qualification
- Proper accreditation by a recognized firm, or satisfying alternative, Centers for Medicare & Medicaid Services (CMS) certification.
Verify your credential
After we get your certificate of completion from CAQH, we will evaluate your application and confirm your credentials. We will contact the state licensing board for your license and, among other things, evaluate your educational practice. This primary source analysis of United Health Care’s direction is carried out by Aperture. A panel of your peers reviews your request to see whether you meet United Health Care’s credentialing standards. This peer-review procedure could add 20-25 days to the deadline.
Creating Online Tools
After your credentials have been verified and contracts have been signed, you will proceed to the final stage: setting up online tools. As a UnitedHealth care provider, you should be permitted to see patients at this stage. Begin by validating your demographic and tax identification details. This makes it easier for members to locate you in the gateway. Create a One Healthcare ID and a United Healthcare Provider Portal Profile next. You can evaluate member eligibility, benefits, and claims using the site.
Set up electronic funds transfer and electronic data interchange connections after creating a profile by clicking the link on the Get Connected page. Finally, sign up for network updates via an electronic newsletter and complete the new provider orientation course. The website contains a UnitedHealth care administrative handbook, which you and other staff members can use to review administrative policies.
Depending on the state where you practice, you may also be required to fill out a government credentialing application. This is possible with a CAQH account. While your credentials are being reviewed, you can start the procurement methods by creating a new contract or joining an existing group contract if you are joining an already approved medical group.