About Provider Data
All practitioners and hospitals who are part of UnitedHealthcare networks must meet credentialing requirements. These requirements comply with National Committee for Quality Assurance credentialing standards. UnitedHealthcare reviews credentialing information provided by practitioners and hospitals before they become part of UnitedHealthcare's network. Every three years, UnitedHealthcare's practitioners and hospitals must supply updated information to UnitedHealthcare, which UnitedHealthcare reviews again. UnitedHealthcare verifies information that is supplied, such as where a physician received training and if the physician has a current license to practice. UnitedHealthcare instructs providers to notify UnitedHealthcare with updates at any time.
If you have any questions about your participating providers, please feel free to contact UnitedHealthcare Member Services or the provider directly.
Demographic Information
Except as noted below, physicians and health care professionals self-report and update upon UnitedHealthcare's request the demographic information (name, address, phone number, gender, languages spoken, medical group affiliation, hospital affiliation, accepting current patients) displayed in the directory. UnitedHealthcare reviews all of this information at least every three years at the time of credentialing and recredentialing.
Specialty
A specialty is the medical field in which a physician has training, such as orthopedics or cardiology. Physicians self-report their specialties, which UnitedHealthcare then verifies with external sources at the time of credentialing, recredentialing, and whenever a physician notifies UnitedHealthcare of a change.
Medical Group Affiliation
This refers to the name of the physician's practice. It may be a group practice with other doctors.
Language
This refers to the language(s) other than English that a physician or his/her clinical staff can speak to those needing medical care. This information is voluntarily reported by the physician to UnitedHealthcare at the time of the credentialing and recredentialing. A physician may notify UnitedHealthcare of changes at any time.
Board Certification
Board certification provides a trusted credential that is important to patients and relevant to physician practice. Physicians are Board certified if, after completing residency training in a specialty, they pass an exam and meet requirements established by their Board. Board certification is voluntary. UnitedHealthcare verifies this information with the American Board of Medical Specialties or the American Osteopathic Association when the physician first joins UnitedHealthcare's network and at least every three years thereafter. You can see a physician´s current Board status by visiting www.abms.org or http://www.osteopathic.org.
Acceptance of New Patients
This indicates whether a physician is receiving new patients into his/her practice. Physicians self-report to UnitedHealthcare whether they are accepting new patients.
Hospital Affiliation
Hospital affiliation refers to a hospital where a particular physician may treat patients. Hospital affiliation is reported to UnitedHealthcare by the physician at the time of credentialing and recredentialing. A physician may notify UnitedHealthcare of changes at any time.
Hospital Information
UnitedHealthcare collects information about hospital names, locations, phone numbers, and accreditation before contracting with a hospital and at least every three years after recredentialing the hospital. All hospitals in UnitedHealthcare's network must have met UnitedHealthcare's Facility Site Visit Criteria and also must either have accreditation or have met the certification standards from the Centers for Medicare and Medicaid Services (CMS). Accreditation means a hospital has undergone review by an external agency and met established standards. CMS Certification means a hospital has undergone review by CMS and met applicable certification standards. You can check the current accreditation status of hospitals by visiting the following sites: