Credentialing Overhaul: Key Changes in UnitedHealthcare’s 2025–2027 Plan
06/09/2025
UnitedHealthcare Updates Credentialing Plan for 2025–2027
UnitedHealthcare has released its Credentialing Plan for 2025–2027, effective Mar. 1, 2025. Reviewed every two years, the plan ensures adherence to state, federal, and NCQA accreditation standards. The updated plan introduces several changes designed to streamline processes and meet current regulatory requirements.
Key Changes to the Credentialing Plan
1. Expanded Credentialing Scope
The updated plan now requires credentialing for additional practitioners, including network covering providers (such as locum tenens) and telemedicine practitioners who have signed participation agreements with UnitedHealthcare. This change reflects the growing role of diverse provider types in healthcare delivery.
2. Stricter Credentialing Time Frames
- To align with NCQA standards, UnitedHealthcare has revised its time frames for credentialing documentation:
- Provider applications or attestations must be no older than 180 days.
- Primary source verifications must be completed within 120 days.
- These tightened deadlines aim to ensure the accuracy and relevance of provider information.
3. New Medicaid Exclusion Verification
A new requirement mandates verification of state Medicaid exclusions, where applicable, to enhance compliance with regulatory standards and safeguard network integrity.
4. Updated Terminology
In Section 11 of the Delegated Credentialing portion, the term “credentialing system controls” has been replaced with “credentialing information integrity.” This change clarifies the focus on maintaining accurate and reliable credentialing data.
What Providers Should Do Next
Providers are encouraged to review the full 2025–2027 Credentialing Plan to familiarize themselves with these updates. The plan will be available for review starting Mar. 1, 2025. By preparing for these changes, practitioners can ensure a smooth transition and continued compliance with UnitedHealthcare’s credentialing requirements.
For more details, visit UnitedHealthcare’s official website or contact their provider support team.
Source: UnitedHealthcare