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UnitedHealthcare Community Plan Provider Manual Reminders

Last update: October 2, 2020

As a reminder, providers need to comply with UnitedHealthcare Community Plan and payer protocols, including those contained in the AZ Care Provider Manual. Providers must provide official notice of the following things within 10 calendar days of any of the following events:

  1. Bankruptcy or insolvency
  2. Indictment, arrest, felony conviction or any criminal charge related to your practice or profession
  3. Suspension, exclusion, debarment or other sanction from a state or federally funded health care program
  4. Loss or suspension of your license to practice
  5. Departure from your practice for any reason
  6. Closure of practice

In addition, Medical Group Agreements also have a clause similar to the one below:

5.5 Licensure. Medical Group and Medical Group Professionals will maintain, without material restriction, such licensure, registration and permits as are necessary to enable Medical Group and Medical Group Professionals to lawfully perform under this Agreement.

  • Notices by Medical Group. Medical Group will give notice to UnitedHealthcare within 10 days after any event that causes Medical Group to be out of compliance with section 5.5 or 5.6 of this Agreement. Medical Group will give notice to UnitedHealthcare at least 30 days prior to any change in Medical Group’s name, ownership, control, National Provider Identifier (NPI) number or tax identification number (TIN).

In addition, Medical Group will give written notice to UnitedHealthcare within 10 days after it learns of any of the following:

  • Any suspension, revocation, condition, limitation, qualification or other material restriction on a Medical Group Professional’s licenses, certifications and permits by any government agency under which a Medical Group Professional is authorized to provide health care services
  • Any suspension, revocation, condition, limitation, qualification or other material restriction of a Medical Group Physician's staff privileges at any hospital, nursing home or other facility at which a Medical Group Physician has staff privileges during the term of this Agreement;
  • An indictment, arrest or conviction of a Medical Group Professional for a felony, or for any criminal charge related to the practice of the Medical Group Professional’s profession;
  • The departure of any Medical Group Professional from Medical Group

You may use the Physician/Provider Demographic Update Fax form for demographic changes or update NPI information for care providers in your office. This form is located at  UHCprovider.com > Menu > Find a Care Provider > View More Demographic Information Update Resources > Care Provider Paper Demographic Information Update Form. You can also update your demographic and practice data information in the My Practice Profile app. Find more information at UHCprovider.com.

The Arizona Medical Board also provides information regarding the closure of a practice, medical records, reportable misdemeanors and the physician health program. The Physician Health Program is an Arizona Medical Board-sponsored program for physicians and physician assistants who may suffer from substance use, medical, psychiatric or behavioral disorders that may affect their ability to safely practice medicine or perform health care tasks. You can view this information at azmd.gov/Regulation/Regulation#