Section 7.0 - Credentialing and Recredentialing of Facilities
Step Two: Complete a Credentialing Application
Completing a CAQH Provider Data Portal application is a fast and easy way to securely submit credentialing information. You enter information just once and it’s available to multiple health insurers at no cost to you.
For providers in Hawaii: If you are joining a Medicare or commercial plan, or a combination of Medicare, Medicaid and commercial, you will begin the credentialing process by working with MDW Hawaii. Contact MDX at 808-532-6989, option 2. If you are only joining a Medicaid (Community) plan, please follow the instructions detailed under "For all others" below.
If you have a CAQH Provider ID number and are registered with CAQH Provider Data Portal, here’s what you need to do:
Check to make sure the account is up to date and complete. Your application will not be released to UnitedHealthcare until CAQH verifies that your application is complete.
Authorize UnitedHealthcare to access your data (either by selecting global authorization or manually authorizing UnitedHealthcare).
Need to complete the CAQH application?
Here’s what you need to do:
Go to CAQH.org to set up an account and complete an application.
If you don’t fully complete the application or if more information is needed, someone from CAQH will contact you.
Please respond to any requests from CAQH promptly so that you can complete your application in a timely manner.
CAQH will notify you when your application is complete.
What happens next?
CAQH will send you a quarterly reminder to review and update your information – keeping your application up to date makes it easier to credential with other insurers and speeds up the recredentialing process.
Step Three: Get Your Credentialing Approved
Once we receive your completed application from CAQH, we’ll review your application and verify your credentials. Specifically:
Verifying credentials – We’ll contact the state board for your license and verify your professional training/education, etc. This primary source verification is conducted by Aperture on behalf of UnitedHealthcare.
Application review – Your application will be presented to a committee of your peers to determine if you meet UnitedHealthcare’s credentialing requirements. This peer review can take up to 25 calendar days
Check your status
To check the status of your credentialing application, Sign In with your One Healthcare ID. This allows you to access self-service tools or connect to a chat advocate for support.
Please have the care provider’s full name, Tax ID, and National Provider Identifier (NPI) available.
The Credentialing Program has been developed in accordance with state and federal requirements and accreditation guidelines. In accordance with those standards, UnitedHealthcare members will not be referred and/or assigned to you until the credentialing process and contracting process have been completed.