UnitedHealthcare Provider Enrollment: What To Expect

Healthcare organizations must meet the unique provider credentialing and enrollment process requirements for every payer. Completing UnitedHealthcare provider enrollment is no different. Credentialers understand the importance of working with insurance payers to ensure smooth and timely reimbursement. It’s a challenge.

This blog will highlight how credentialers can navigate UnitedHealthcare provider enrollment. We’ll walk you through the steps in enrolling your providers with UnitedHealthcare, the information and documents you need, and the best practices to follow.

Why Is Payer Enrollment Important for Healthcare Providers?

Payer enrollment is a crucial step that allows healthcare providers to participate in the network of a specific insurance payer. By enrolling with individual payers, your organization gains access to a wide range of patients with insurance coverage. In addition, being in-network with specific payers means your facility can provide healthcare services to its members at negotiated rates, leading to more stable revenue streams and better financial stability.

Benefits of Enrolling Your Providers With UnitedHealthcare

Here are some key advantages of becoming an in-network provider with UnitedHealthcare:

• Expanded Revenue Opportunities: UnitedHealthcare is the 4th largest health insurer in the U.S., offering your organization’s providers access to ~27 million UnitedHealthcare members across all 50 states. This will increase the organization’s visibility and strengthen your organization’s and providers’ financial viability.
• Competitive Reimbursement Rates: UnitedHealthcare offers competitive reimbursement rates to in-network providers. Your organization will receive fair compensation for your providers’ services, contributing to organizational revenue growth and stability.
• Patient Trust and Confidence: Being in-network with a reputable insurance payer like UnitedHealthcare can instill trust and confidence in the patients seen by your providers. UnitedHealthcare members are more likely to choose providers within their network, and by being part of that network, your organization can attract and retain more patients – and providers – and the revenue that comes with them.
• Collaboration and Referrals: Enrolling your providers with UnitedHealthcare opens up opportunities for collaboration and referrals with other UnitedHealthcare network organizations. This can lead to mutually beneficial relationships and help grow your organization’s professional network.

Completing provider enrollment with UnitedHealthcare, you can tap into these benefits and position your practice for long-term success.

Understanding The Payer Enrollment Process

Before enrolling healthcare providers with UnitedHealthcare, it’s essential to have a clear understanding of the payer enrollment process. Here are the key steps:

1. Gather Training and Education
2. Gather Licensing and Certification
3. Gather Work History Details
4. Gather Payer-Specific Requirements
5. Following Application Submission

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UnitedHealthcare Provider Enrollment Guidelines

UnitedHealthcare requires that credentialiers ensure all providers meet standard credentialing criteria to become a healthcare professional in its network. Recredentialing is required every three years in most states. The recredentialing process requires meeting the same criteria as during the initial credentialing process.

Here is a list of the information you’ll need to gather for UnitedHealthcare credentialing:

Training and Education

• Practitioner degree (M.D., DO, DPM), post-graduate education or training
• Details of medical or professional education and training
• Completion of a residency program in the designated specialty

Licensing and Certification

• Current license or certification in the state(s) in which the care provider will be practicing (no temporary licenses)
• National Provider Identifier (NPI) number
• Active Drug Enforcement Administration (DEA) number and/or Controlled Dangerous Substances (CDS) certificate or acceptable substitute (if required)
• Medicare/Medicaid participation eligibility or certification (if applicable)

Work History Details

• Five-year work history
  • Explain gaps longer than 6 months
• Statement of work limitations, license history, and sanctions (only required if they apply to join UnitedHealthcare Medicare and Medicaid plans). The statement must include:
  • Any limitations in the ability to perform the functions of the position, with or without accommodation
  • History of loss of license and/or felony convictions
  • History of loss or limitation of privileges or disciplinary activity
• W-9 form
• Hospital staff privileges

Insurance

• Active professional liability (malpractice) insurance (face sheet required) or a state-approved alternative
• Malpractice history (summary of any pending or settled malpractice cases)

Other

• Credentialing contact information or valid email address
• Other credentialing requirements, such as AMA profile or criminal history review, as required by law

Credentialing Authorities

• Notification if this provider has ever been a delegated provider before this credentialing application
• Passing score on state site visit (if required)
• A list of UnitedHealthcare network hospitals where the provider has admitting privileges or the name of a UnitedHealthcare participating care provider who is willing to admit on their behalf

Credentialing for Medicaid and state programs (UnitedHealthcare Community Plan)

• State-specific credentialing and recredentialing information on how to join the UnitedHealthcare Community Plan network can be found in the care provider manual

During the credentialing process, UnitedHealthcare may request more information than what was included on a provider’s application. Requirements may vary based on location, care provider type, or specialty. UnitedHealthcare will supply the required forms and instructions if additional information is requested.

Provider organizations can submit an application and agreement using the Council for Affordable Quality Health Care (CAQH credentialing) Universal Credentialing DataSource application.

The enrollment process generally takes up to 14 calendar days to complete once UnitedHealthcare has a completed application and all required information. After receiving a completed application, the company performs primary source verification before presenting the request for participation to the credentialing committee. Note: The timeline depends on response times from medical schools, residencies, specialty boards, and hospitals.

Enroll Successfully The FIRST Time

MedTrainer Credentialing Software keeps all the necessary information for UnitedHealthcare provider enrollment in one user-friendly place with proven workflows, customizable dashboards, one-click reporting, and automated reminders to keep tasks on track.

Our powerful software offers:

• Enrollment Applications Dashboard: Quickly assess and improve your enrollment process with dynamic graphs that show application age, average time to complete applications, and number of closed applications per credentialer. 
• Built-in Automation: Keep the enrollment process moving forward with automated reminders for providers to send documents, notification of recredentialing deadlines, and license expiration. 
• Highly Customizable Reports: With all credentialing data in one place, it is easy to customize reports for monthly payer submissions so that you can stay on top of due dates and status. Save reports for easy access, and schedule them to be emailed to internal and external recipients. 
• CAQH Profile Management: Streamline your enrollment processes with the most up-to-date provider information at your fingertips. Save time and improve provider onboarding and recredentialing with CAQH profile management. 
• Application Workflow Management: Simplify enrollment processing with a customized workflow, status, process checklist, notes, and task assignments. Easily assign multiple enrollments to staff, update statuses, and prioritize.

Download our guide – Tools to Conquer Provider Enrollment – for valuable tips on speeding up the time from credentialing to enrollment approval. Schedule your demo to see MedTrainer Credentialing Software in action.