UnitedHealthcare Announces Updates to Credentialing Plan for 2025–2027
01/13/2025
Beginning March 1, 2025, UnitedHealthcare's updated Credentialing Plan for 2025–2027 will be available for review. The plan, revised biennially, ensures compliance with state and federal regulations as well as accreditation standards established by the National Committee for Quality Assurance (NCQA).
What Providers Need to Know
The updated Credentialing Plan introduces several key changes designed to enhance compliance and streamline credentialing processes. These updates go into effect on March 1, 2025.
Key Updates for the 2025–2027 Plan
- Credentialing Requirements Expanded:
- Network covering practitioners (e.g., locum tenens) and telemedicine practitioners must complete credentialing if they have signed a participation agreement with UnitedHealthcare.
- Revised Time Frames:
- Applications or attestations must be submitted within 180 days of their completion.
- Primary source verifications should be no older than 120 days to meet new NCQA standards.
- Verification of State Medicaid Exclusions:
- A new requirement ensures state Medicaid exclusions are verified, when applicable.
- Updated Wording for Delegated Credentialing:
- In Section 11, the term “credentialing system controls” has been updated to “credentialing information integrity” to better reflect the focus on data accuracy and reliability.
Why This Matters
These updates are designed to strengthen the credentialing process and ensure ongoing compliance with regulatory and accreditation requirements. Providers should familiarize themselves with the changes and prepare to align their credentialing practices with the new plan.
Next Steps for Providers
- Review the updated Credentialing Plan before it takes effect on March 1, 2025.
- Ensure all credentialing documentation and processes adhere to the revised requirements.
- For questions or assistance, contact your UnitedHealthcare representative.
Source: UnitedHealthcare