UnitedHealthcare credentialing: how to join UHC and Optum

Medical or behavioral health: which route is yours

The two are separate. Joining Optum for behavioral health doesn't give you a UnitedHealthcare medical contract, and the reverse is also true. If you're already in Optum's behavioral network and want a medical contract too, UnitedHealthcare asks you to contact its network team.

UnitedHealthcare is usually one of several insurers a practice joins, alongside your state's Blue Cross Blue Shield plan. Our guide on how to get credentialed with insurance companies covers the full order.

Before you start

• NPI, and group NPI if you bill as a practice
• Tax ID and W-9
• CAQH ID, with the profile attested
• UnitedHealthcare authorized in CAQH
• One Healthcare ID for the provider portal
• Practice locations exactly as on your NPI record

UnitedHealthcare says CAQH is required for most states and specialties. Onboard Pro pulls most of your demographic and credentialing information from it automatically and flags anything missing. A complete profile is the difference between a request that moves and one that waits. Our CAQH guide walks through setup and authorization.

Applying through Onboard Pro, step by step

Step 1: Sign in to the Provider Portal

Create a One Healthcare ID if you don't have one, then sign in to the UnitedHealthcare Provider Portal and open Onboard Pro. Onboard Pro replaced UnitedHealthcare's older "request for participation" form for medical providers in 2023.

Step 2: Start a request for one state

Onboard Pro handles one state per request. If you practice in two states, submit two requests. Choose whether you're joining as an individual or under a group, and use the Tax ID you'll actually bill under.

Step 3: Fill the gaps

Onboard Pro fills in what it can from CAQH and shows what's missing. Answer those items and upload anything it asks for. If it can't find your CAQH data, check that UnitedHealthcare is authorized in your profile and that your attestation is current.

Step 4: Track credentialing and contracting

Your Onboard Pro dashboard shows projected completion dates for credentialing and for contracting. They are two tracks: credentialing confirms your qualifications, and contracting sets your agreement and fee schedule. You need both before you're in-network.

Step 5: Sign and confirm your effective date

Review the agreement before signing, especially which plans and locations it covers. Don't bill UnitedHealthcare members as in-network until you have your effective date in writing.

Commercial, Medicare Advantage and Medicaid

UnitedHealthcare runs several lines of business: employer and individual plans, Medicare Advantage, and Medicaid through UnitedHealthcare Community Plan in many states. Participation can differ by line and by state, so ask which ones your agreement includes. For practices with many patients over 65, the Medicare Advantage network often matters most. It's separate from traditional Medicare, which you join through PECOS.

How long UnitedHealthcare credentialing takes

Your Onboard Pro dashboard shows projected dates for your own request, and that's the best estimate. As a planning range, allow 60 to 120 days from a complete request. Requests slow down when CAQH isn't attested or authorized, when the Tax ID or group details don't match, or when the network in your area is closed for your specialty.

After you're in: re-credentialing

UnitedHealthcare re-credentials providers every three years and starts the process itself as the date approaches. It says that if you keep a complete, current CAQH attestation every 120 days, nothing more is needed. If the attestation lapses, re-credentialing can't finish, which puts your participation at risk. Our recredentialing guide covers every insurer's cycle, plus Medicare and Medicaid.

Getting help from UnitedHealthcare

UnitedHealthcare offers credentialing help by chat at UHCprovider.com/networkhelp, 7 a.m. to 7 p.m. Central Time. Have your NPI, Tax ID and request details ready.

Common mistakes

• CAQH not authorized for UnitedHealthcare, so Onboard Pro can't pull your data.
• Applying through UnitedHealthcare for behavioral health instead of Optum, or the reverse.
• One request for several states. Each state needs its own.
• Wrong Tax ID: joining as an individual when you'll bill under a group.
• Assuming one agreement covers every line of business, such as Medicare Advantage or Community Plan.

Common questions