Recredentialing Process - Chapter 14, 2018 UnitedHealthcare Administrative Guide

We perform recredentialing of network care providers at least every 36 months. The process finds and evaluates changes in the care provider’s:

  • License
  • Training
  • Experience
  • Competence
  • Health status

This helps to determine the care provider’s ability to deliver healthcare services.

Recredentialing Application Form

We send letters to each care provider who falls within the scope of this policy. The letter includes:

  • CAQH care provider identification number,
  • Specific CAQH application status, and
  • Instructions on what the next steps are.

If you attest to all the data in your CAQH ProView application every 120 days and maintain a complete and current application with supporting documentation, you do not need to do anything. If CAQH information is not current, you must complete a re-credentialing application form on their website. This includes the Attestation and Release and all information requested on the application. If a care provider does not return the requested information in the established timeframe we may elect to terminate their participation agreement with us.

Collection and Verification of Information

Once we receive a completed recredentialing application, we re-verify your professional credentials and qualifications through the primary sources. Then we submit the application and profile to a credentialing committee. The committee reviews and determines your eligibility.