Credentialing Plan 2021–2023 Summary of Changes

We review and update our Credentialing Plan at least every two years to maintain compliance with all state and federal regulatory requirements, as well as accreditation requirements of the National Committee for Quality Assurance (NCQA). The 2021–2023 UnitedHealthcare Credentialing Plan will be effective March 1, 2021.

Here are some of the key changes:

  • Updated the definition of Material Restriction to include limitation of practice hours, location of practice or a prohibition on solo practice
  • Updated the definitions of the Regional Peer Review Committee and the National Peer Review and Credentialing Committee
  • Updated the requirement for a current license to address Material Restrictions
  • Added clarification that in some situations an initial credentialing cycle may include the review of Quality of Care concerns
  • The practitioner must have a valid DEA or they must identify a participating practitioner or group practice name with a valid DEA/CDS to prescribe on their behalf
  • Updated Malpractice History review for credentialing and recredentialing to the state that the Credentialing Entity may determine, in its discretion, to review malpractice settlements or judgments for a longer period of time
  • Section 9.0 was amended to reflect the Regional Peer Review’s responsibilities