UPDATE – Johnson & Johnson COVID-19 vaccine news
As of April 13, 2021, the FDA and CDC are recommending a pause in the use of the Johnson & Johnson (Janssen) COVID-19 vaccine due to a very rare and severe blood clot in some individuals who received it. Safety is a top priority for the CDC, and the use of this vaccine is on hold until these cases and analysis can be further reviewed and assessed later this week. Review this update for more information and how claims will be handled during this time.
COVID-19 billing and temporary provision updates
Last update: January 14, 2021, 1:15 p.m. CT
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 from March 19, 2020 through June 30, 2021 and is subject to change. Please check back often for updates.
For providers who are due for re-credentialing from March 1, 2020 through June 30, 2021, UnitedHealthcare is following National Committee for Quality Assurance (NCQA) guidelines and is extending the care provider recredentialing cycle by 2 months, to 38 months. This will allow care provider offices additional time to respond to recredentialing requests. UnitedHealthcare will continue to initiate the recredentialing requests for information based on standard timeframes and will complete all that are received prior to the 38 months.
From March 19, 2020 through June 30, 2021, 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.
Please note: All credentialing applications will be evaluated to determine if UnitedHealthcare is currently accepting applications in specific geographic areas or for a designated specialty.
Here’s how to obtain provisional credentialing:
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:
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.
From March 19, 2020 through June 30, 2021, UnitedHealthcare has revised our credentialing policies, consistent with National Council on Quality Assurance (NCQA) standards, to temporarily implement provisional credentialing. This process applies to out-of-network care providers who are licensed independent practitioners and want to participate in one or more of our networks. We may also extend completion of annual assessments, if requested by a Delegated Credentialing Entity, dependent on our evaluation of their current circumstances.
PLEASE NOTE: The provisional credentialing process described below and the potential annual assessment extensions only apply during the COVID-19 national public health emergency period and are subject to change. Please check back often for updates.
Credentialing Delegates may:
Delegated Credentialing Entities are strongly encouraged to implement a provisional credentialing process. UnitedHealthcare has temporarily adopted the standards set forth by NCQA in order to expedite member’s access to care providers during the COVID-19 national public health emergency period. Our provisional credentialing process includes:
For providers who are already credentialed, we will not require additional credentialing to practice in a new location. Additionally, we’re temporarily waiving site visit requirements for health care practitioners and facilities. This is in accordance with Centers for Medicare & Medicaid Services (CMS) guidelines and federal, state and local restrictions on travel and face-to-face meetings.
Reminder: Delegates must monitor the directives of each state’s regulations and licensing board for any additional requirements that may apply. Delegates must also document all exceptions within their emergency plan for the period of the COVID-19 public health emergency.
Completing Annual Assessments and Improvement Action Plans
Please contact a UnitedHealthcare Delegation Oversight team member or network liaison to request any of these accommodations or to report extenuating circumstances:
Temporary Service Address and Closings
Please refer to the Practice Administration section for instructions on how to notify UnitedHealthcare about temporary service address changes and temporary practice or facility closures.
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:
Providers coming out of retirement to assist practices or facilities during the national public health emergency period will need to complete the provisional credentialing process. To get started, please follow the steps outlined in the provisional credentialing section.
Site visit requirements for health care practitioners and facilities will be waived during the COVID-19 national public health emergency period. 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 and processes described on this website apply pursuant to federal requirements and UnitedHealthcare national policy during the national emergency. Additional benefits or limitations may apply in some states and under some plans during this time.
We will adjudicate benefits in accordance with the member’s health plan.
Medicaid Providers: UnitedHealthcare will reimburse out-of-network providers for COVID-19 testing-related visits and COVID-19 related treatment or services according to the rates outlined in the Medicaid Fee Schedule.