COVID-19 Credentialing Updates

UnitedHealthcare is following National Committee for Quality Assurance (NCQA) guidelines and is extending the care provider recredentialing cycle by two months, to 38 months. This will allow care provider offices additional time to respond to recredentialing requests. UnitedHealthcare will continue to initiate the recredentialing requests for information based on standard timeframes and will complete all that are received prior to the 38 months. 

In accordance with guidelines from the National Committee for Quality Assurance (NCQA), we’re implementing provisional credentialing for out-of-network care providers who are licensed independent practitioners and want to participate in one or more of our networks. We’ll then complete the full credentialing process within 180 calendar days from when provisional credentialing is granted.

Please note: All credentialing applications will be evaluated to determine if UnitedHealthcare is currently accepting applications in specific geographic areas or for a designated specialty.

Here’s how to obtain provisional credentialing:

1. Submit a completed and signed application and attestation through CAQH ProView^® or a state-mandated application. Please be sure to select UnitedHealthcare as an approved health plan, so we can quickly receive your application.
2. Submit a request for participation to UnitedHealthcare so we can start the provisional credentialing process. You can submit your request for participation in one of three ways:
   • Call us at 877-842-3210 and enter the practitioner’s tax identification number (TIN). Then, select Credentialing > Medical > Join the Network.
   • Email us at swproviderservices@uhc.com. Include the practitioner’s full name, National Provider Identifier (NPI) number, TIN, CAQH ID and a brief description of the request.
   • Use our online Request for Participation form (for licensed practitioners only).

What happens next?

We’ll review the application to ensure it meets the provisional credentialing requirements. We’ll verify a current, valid license to practice, review malpractice claims history and verify that you have adequate malpractice coverage. We’ll notify you once this review is complete. To check the status of your credentialing application, please email us at swproviderservices@uhc.com.

Specialty Credentialing

If you practice in one of the following specialties, you’ll need to contact a partner who handles credentialing and contracting on behalf of UnitedHealthcare. They’ll help you begin the request for participation:

• Optometrists: Go to spectera.com or call 800-638-3120.
• Mental Health or Substance Abuse Practitioners: Go to providerexpress.com or call 800-817-4705.
• Dental Care Providers: Go to dbp.optum.com or call 800-822-5353.
• Chiropractor, Outpatient Therapy Provider/Clinic (Physical/Occupational/Speech) or Alternative Medicine Providers: Go to MyOptumHealthPhysicalHealth.com or call 800-873-4575.

Resident Physicians

If a provider is licensed but has not yet completed their residency, they may be provisionally credentialed. Completion of residency within the 180-day period would then be required for the provider to be fully credentialed.   

Board Certification

Please note that we do not require board certification in order for providers to be credentialed. However, we do require completion of residency in their practicing specialty.

From March 19, 2020 until June 18, 2020, UnitedHealthcare has revised our credentialing policies, consistent with National Council on Quality Assurance (NCQA) standards, to temporarily implement provisional credentialing. This process applies to out-of-network care providers who are licensed independent practitioners and want to participate in one or more of our networks. We may also extend completion of annual assessments, if requested by a Delegated Credentialing Entity, dependent on our evaluation of their current circumstances.

PLEASE NOTE: The provisional credentialing process described below and the potential annual assessment extensions only apply during the COVID-19 national public health emergency period and are subject to change. Please check back often for updates.

Credentialing Delegates may:

• Extend the practitioner and provider re-credentialing cycle from 36 months to 38 months
• Extend provisional credentialing status from 60 days to180 days

Provisional Credentialing

Delegated Credentialing Entities are strongly encouraged to implement a provisional credentialing process. UnitedHealthcare has temporarily adopted the standards set forth by NCQA in order to expedite member’s access to care providers during the COVID-19 national public health emergency period. Our provisional credentialing process includes:

• Receipt of a completed application with a current attestation
• Primary source verification of a current, valid license to practice
• Review of malpractice history
• Evidence of adequate professional liability insurance
• Completion of the full credentialing process within 180 calendar days from when provisional credentialing is granted
  

For providers who are already credentialed, we will not require additional credentialing to practice in a new location. Additionally, we’re temporarily waiving site visit requirements for health care practitioners and facilities. This is in accordance with Centers for Medicare & Medicaid Services (CMS) guidelines and federal, state and local restrictions on travel and face-to-face meetings.

Reminder: Delegates must monitor the directives of each state’s regulations and licensing board for any additional requirements that may apply. Delegates must also document all exceptions within their emergency plan for the period of the COVID-19 public health emergency.

Completing Annual Assessments and Improvement Action Plans

Please contact a UnitedHealthcare Delegation Oversight team member or network liaison to request any of these accommodations or to report extenuating circumstances:

• Annual Assessments
  We understand that normal operations have been disrupted in many communities, which could affect a Delegated Credentialing Entity’s ability to participate in the annual assessment process. From March 1, 2020 until September 1, 2020, the following provisions are in effect:
  • All planned on-sites must be performed virtually. For the safety and wellbeing of our Delegated Credentialing Entities and our employees, the UnitedHealthcare Delegation Oversight team has eliminated all non-essential travel.
    
  • Delegated Credentialing Entities can request an extension of the annual assessment grace period of up to 2 months. This would allow 16 months (instead of the normal 14 months) for completion of the annual assessment process for delegation oversight, if necessary.
  • Delegated Credentialing Entities must document the national emergency plans implemented for delegated functions.
• Improvement Action Plans
  Improvement Action Plans (IAPs) should be remediated, as scheduled, by the Delegated Credentialing Entity and the  UnitedHealthcare Delegation Oversight Team. In extenuating situations where the IAP extends beyond the remediation due date, the Delegated Credentialing Entity will make every effort to remediate as soon as reasonably possible and will regularly communicate progress toward remediation. The UnitedHealthcare Delegation Oversight team will document circumstances of the delay and validate findings once remediation is reported.

Temporary Service Address and Closings

Please refer to the Practice Administration section for instructions on how to notify UnitedHealthcare about temporary service address changes and temporary practice or facility closures. 

For providers who are already credentialed, we will not require additional credentialing to practice in a new location or to practice across state lines. This is subject to change as required by federal/state requirements.

Note the following additional guidance:

• Care providers are required to check with the applicable professional licensing boards for guidelines on where they are able to practice during the COVID-19 health emergency.
• For credentialed practitioners, new locations do not need to be credentialed because credentialing occurs at a practitioner level and not at a location level.
• For participating facilities that open a new site, we will not require additional credentialing.
• For non-participating facilities seeking participation, we require credentialing but will waive a site visit, if required.
• Additionally, providers who are acting as Locum Tenens or practicing solely in a hospital setting do not require credentialing. 

Providers coming out of retirement to assist practices or facilities during the national public health emergency period will need to complete the provisional credentialing process. To get started, please follow the steps outlined in the provisional credentialing section.

Site visit requirements for health care practitioners and facilities will be waived during the COVID-19 national public health emergency period. This is in accordance with Centers for Medicare & Medicaid Services (CMS) guidelines and federal and local restrictions on travel and face-to-face meetings. The site visit waiver will be reevaluated once federal restrictions are lifted. We’ll track all practitioners and facilities that are approved without a site visit to determine whether a visit will be required at a later time.