May 19, 2022

UnitedHealthcare Community Plan: What to expect during a site visit

Health care professionals who wish to contract with UnitedHealthcare Community Plan may need a site visit as part of the credentialing process. Requirements for site visits are determined by state Medicaid contracts and by NCQA and Centers for Medicare & Medicaid Services (CMS) requirements for facilities.

Site visit requirements are outlined in the UnitedHealthcare Credentialing Plan and State and Federal Regulatory Addendum.

Who requires a site visit?
As part of the credentialing process, site visit requirements for health care professionals vary depending on the state and specialty. Some states require visits for initial credentialing only, and others require them for recredentialing as well (every 36 months). 

Here are the requirements for Arizona, Florida, Indiana, Maryland, Mississippi, New Jersey and Pennsylvania:

  • Arizona – initial credentialing only
    • Health care professional types/specialties that require a site visit: family practice, geriatric medicine, internal medicine, pediatrics, general practice, obstetrics and gynecology, nurse practitioner, physician assistant
    • Note: nurse practitioners and physician assistants will only need a site visit if they work in a primary care physician (PCP) or obstetrics and gynecology office
  • Florida – initial and recredentialing
    • Health care professional types/specialties that require a site visit: family practice, geriatric medicine, internal medicine, pediatrics, general practice
  • Indiana – initial and recredentialing
    • Health care professional types/specialties that require a site visit: family practice, geriatric medicine, internal medicine, pediatrics, general practice, obstetrics and gynecology, nurse practitioner, physician assistant, certified nurse midwife
  • Maryland – initial credentialing only
    • Health care professional types/specialties that require a site visit: family practice, geriatric medicine, internal medicine, pediatrics, general practice
  • Mississippi – initial credentialing only
    • Health care professional types/specialties that require a site visit: family practice, geriatric medicine, internal medicine, pediatrics, general practice, adolescent medicine, obstetrics and gynecology 
    • Note: nurse practitioners will only need a site visit if they’ve indicated on the application that they are acting as a PCP
  • New Jersey – initial and recredentialing
    • Health care professional types/specialties that require a site visit: family practice, geriatric medicine, internal medicine, pediatrics, general practice, obstetrics and gynecology
  • Pennsylvania – initial credentialing only
    • Health care professional types/specialties that require a site visit: family practice, geriatric medicine, internal medicine, pediatrics, general practice, dentist 
    • Note: site visits include verifying that the facility complies with Americans with Disabilities Act requirements

What are the site visit requirements for facilities?
There are different site visit requirements for facilities. If the facility is not accredited or certified by a recognized agency, a site visit is required. A site visit is not required if CMS or state quality review was conducted within the last 3 years.

What can I expect during the site visit?
Site visits are conducted by United Language Group (ULG), a third-party vendor. ULG will call you to schedule the visit. Please ensure the contact information in your application is accurate. Once the visit has been scheduled, ULG will send you a confirmation email and an auditor from ULG will arrive to conduct the visit. 

When the auditor arrives, they’ll use a check list to determine whether your facility complies. Items on the check list include – but are not limited to – physical accessibility, appearance, waiting and examining room cleanliness, record keeping, and policies and procedures.

Questions?

PCA-1-22-01297-PO-News