A Guide to Provider Credentialing with UnitedHealth

Essential Documentation Checklist

Let’s start with what you’ll need to have ready:

• Current medical license(s)
• DEA registration (if applicable)
• Board certification(s)
• Professional liability insurance
• Work history (past 5 years)
• Education and training history
• Hospital privileges documentation
• COVID-19 vaccination status
• Current CV
• Government-issued ID
• Social Security number
• NPI number
• CAQH ProView profile (more on this in a bit)
  

Here’s what you need to know:

Getting Started with CAQH

• Register at proview.caqh.org if you haven’t already
• Complete ALL sections (yes, even the ones that seem redundant)
• Keep it updated (set a quarterly reminder)
• Authorize UnitedHealth to access your profile

Common CAQH Pitfalls to Avoid

• Letting your attestation expire (it needs to be re-attested every 120 days)
• Missing sections (incomplete profiles are a major headache)
• Outdated information (especially insurance certificates)
• Inconsistent data across different sections
  

Step 1: Initial Application

First things first – head to UnitedHealth’s provider portal (uhcprovider.com) and:

1. Create an account if you don’t have one
2. Navigate to the credentialing section
3. Choose “New Provider Credentialing Application”
4. Enter your basic information and NPI

Step 2: Primary Source Verification

This is where UnitedHealth does their homework.

They’ll verify:

• Your education
• License status
• Board certifications
• Work history
• Malpractice history
• Hospital privileges

Timeline: Usually takes 2-6 weeks

Step 3: Committee Review

Your application goes to UnitedHealth’s credentialing committee, who reviews:

• Your qualifications
• Practice patterns
• Any red flags from verification
• Compliance with UnitedHealth standards

Step 4: Final Decision

You’ll receive one of three outcomes:

1. Approved
2. Denied (rare if you’ve prepared well)
3. Additional information requested (pretty common)
   

Stay Organized

Create a credentialing folder (digital or physical) with:

• Copies of all submitted documents
• Timeline of submissions
• Contact information for your UnitedHealth rep
• Notes from any conversations
• Follow-up deadlines

Be Proactive

• Don’t wait for them to contact you
• Follow up every 2-3 weeks
• Keep a log of all communications
• Save email confirmations

Common Pitfalls to Avoid

• Incomplete applications
• Expired documents
• Inconsistent information
• Missing deadlines
• Not following up
  

Adding a New Location

If you’re already credentialed but adding a location:

1. Log into the provider portal
2. Submit a location add request
3. Provide updated practice information
4. Include any new tax ID information

Group Practice Considerations

For group practices:

• Each provider needs individual credentialing
• Group tax ID must be credentialed
• Consider delegated credentialing for large groups

Recredentialing

Mark your calendar! Recredentialing happens every 3 years.

Start preparing:

• 6 months before expiration
• Update all documentation
• Check for any new requirements
  

Here’s how to handle common issues:

When to Worry

• No response after 30 days
• Multiple requests for the same information
• Contradictory information from different reps

How to Escalate

1. Contact your provider advocate
2. Document all communications
3. Be polite but persistent
4. Use the provider portal messaging system
5. Consider reaching out to your local UnitedHealth network manager
   

Documentation Pro Tips

• Keep a master credentialing file
• Set up auto-reminders for expirations
• Use consistent dates and information formats
• Save everything as PDFs
• Name files clearly and consistently

Communication Strategies

• Get names and contact info for everyone you speak with
• Follow up emails with phone calls
• Keep communications clear and concise
• Document EVERYTHING
  

Once You’re Credentialed

1. Set up your online profile completely
2. Learn the claims submission process
3. Understand the appeal process
4. Know your contract terms
5. Keep up with UnitedHealth updates

Maintaining Your Credentials

• Track expiration dates
• Update information promptly
• Maintain accurate CAQH profile
• Stay compliant with continuing education
• Monitor UnitedHealth newsletters for requirement changes
  

Useful Contacts

• Provider Services: [Number varies by region]
• Credentialing Department: [General contact]
• Network Management: [Regional contacts]

Online Resources

• UnitedHealth Provider Portal
• CAQH ProView
• State Medical Board websites
• National Provider Identifier registry
  

When in doubt:

• Document everything
• Follow up regularly
• Stay professional
• Keep copies of everything
• Don’t be afraid to ask questions
  

If you encounter these common issues:

Application Stuck in Process

1. Check your CAQH attestation
2. Verify all documents are current
3. Contact your provider advocate
4. Escalate if necessary

Missing Information Requests

1. Respond within 48 hours
2. Send information through proper channels
3. Follow up to confirm receipt
4. Keep copies of everything sent

System Access Issues

1. Clear browser cache
2. Use recommended browsers
3. Contact technical support
4. Document error messages