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Notification of Practice or Demographic Changes (Applies to Commercial Benefit Plans in California) - Chapter 2, 2019 UnitedHealthcare Administrative Guide

Notification of Practice or Demographic Changes (Applies to Commercial Benefit Plans in California)

California Senate Bill 137 requires us to perform ongoing updates to our care provider directories, both online and hardcopy. As a participating medical group, IPA or independent physician, you are required to update UnitedHealthcare within five business days if there are any changes to your ability to accept new patients.

As a participating medical group, IPA or independent physician, if a member or potential enrollee seeking to become a patient contacts you, and you are no longer accepting new patients, you must direct them to report any inaccuracy in our provider directory to both:

  • UnitedHealthcare for additional assistance in finding a care provider, and, as applicable,
  • Either the California Department of Managed Health Care or the California Department of Insurance.

You shall cooperate with and provide the necessary information to us so we may meet the requirements of Senate Bill 137. We are required to contact all participating care providers, including but not limited to contracted medical groups or IPAs, on an annual basis, and independent physicians, every six months. This outreach includes a summary of the information that we have on record and requires you to respond by either confirming your information is accurate, or providing us with applicable changes.

If we do not receive a response from you within 30 business days, either confirming that the information on file is correct, or providing us with the necessary updates, we have an additional 15 business days to make attempts for you to verify the information. If these attempts are unsuccessful, we will notify you that, if you continue to be nonresponsive, we will remove you from our provider directory after 10 business days.

If the final 10-business day period lapses with no response from you, we may remove you from the directory. If we receive notification that the provider directory information is inaccurate, the provider group, IPA, or physician may be subject to corrective action.

In addition to outreach for annual or bi-annual attestations, we are required to make outreach if we receive a report of inaccuracy for any provider data in the directories. We are required to confirm your information is correct. If we attempt to contact you and do not receive a response, we will provide you a 10 business-day notice that we will suppress your information from our provider directory.

Medical groups, IPAs, or independent physicians can submit applicable changes to:

For Delegated Providers: Email changes to Pacific_DelProv@uhc.com or delprov@uhc.com.

For Non-Delegated Providers: Visit the Demographics and Profiles section for the Provider Demographic Change Submission Form and further instructions.