Managed Care Organization

How to Get Credentialed with UnitedHealthcare Community Plan in Pennsylvania

Network: Open
CAQH Required

Quick Overview

Timeline

Varies

CAQH

Required

Re-credentialing

Every 3 year(s)

Delegated

No

Pennsylvania-Specific Requirements

UHC Community Plan of Pennsylvania participates in the HealthChoices Physical Health managed care program. Providers must first enroll with Pennsylvania Medicaid through PROMISe, then apply to UHC via CAQH ProView. Active Pennsylvania medical license and NPI are required. Service areas are organized by HealthChoices zones across the state. Behavioral health services are carved out to separate Behavioral Health MCOs in each county/zone.

Step-by-Step Enrollment Process

1

Gather Required Documents

Collect all necessary credentials including your medical license, DEA certificate, malpractice insurance, NPI number, and any state-specific requirements for Pennsylvania.

2

Complete Your CAQH ProView Profile

UnitedHealthcare Community Plan requires a current CAQH ProView profile. Create or update your profile at proview.caqh.org and attest within 120 days.

3

Submit Your Application

Submit your completed enrollment package to UnitedHealthcare Community Plan.

4

Track & Follow Up

Credentialing typically takes 60-90 days. Monitor your application status and respond promptly to requests for additional information.

Required Documents Checklist

Board Certification

Conditional

Required if board certified; highly recommended

CV/Resume

DEA License

Conditional

Required if prescribing controlled substances

Malpractice Insurance

Medical Degree

Medical License

NPI Certificate

Professional Reference

Contact Information

Credentialing

National

Network Enrollment

National

Quick Links

Need Help?

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UnitedHealthcare Community Plan in Other States

Alabama Arizona California Colorado District Of Columbia Florida Georgia Hawaii Iowa Illinois

Other Payers in Pennsylvania

Aetna UnitedHealthcare Cigna Healthcare Anthem / Elevance Health Humana Centene Corporation Molina Healthcare Highmark Blue Cross Blue Shield (Western PA) Independence Blue Cross Pennsylvania Medical Assistance
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