Credentialing committee decision-making process (non-delegated) - Chapter 15, 2021 UnitedHealthcare Administrative Guide

Determination and notice of approval or denial

After it completes the review and evaluation of all of the credentialing information, the National Credentialing Committee approves or denies participation.

For initial credentialing, all care providers are notified of initial credentialing decisions within 60 calendar days of the National Credentialing Committee’s decision or as required by state law, though we are generally able to notify care providers within 14 days of the National Credentialing Committee’s decision. For recredentialing, we notify care providers if the National Credentialing Committee determines they are no longer eligible to participate in our network within 60 calendar days of the decision or as required by state law. We send written notice of recredentialing approvals to care providers as required by state law.

Right to see members

Approved does not mean “active.” Care providers may not begin seeing our members until both they and we have signed a contract and are in our systems, or they receive the effective date of their “active” status. We send written notice that the contract is active.