UMR Insurance Credentialing – The Process

Let’s understand how UMR Insurance credentialing works.

UMR is known as the largest third-party administrator in the United States today. UMR provides a variety of healthcare management plans such as claim processing and administration services for self-funded medical, dental, vision, and disability plans.

The other services that UMR offers are integrated care management, pharmacy benefits administration,
and other ancillary services such as claim recovery management, reinsurance products, and services, claim repricing, and provider data management software and services.

UMR as of today is part of the popular United Healthcare Company. United healthcare themselves provide an array of health benefit plans and services to their clients. The company is responsible for 25
million American consumers having access to quality, affordable healthcare services.

Currently, United Healthcare has 560000 Physicians, and 4100 hospitals under its umbrella nationwide.
With all its merits, it would be a shame if a provider skips getting credentialed with UMR. UMR insurance credentialing is essential if a provider seeks to tap into the client base held by United Healthcare throughout America. To apply for UMR insurance credentialing, you have to apply to the United Healthcare Network.

So let’s check out the process for UMR Insurance Provider Credentialing

1. Pre Application

Before applying, United Healthcare requires practitioners to handover some necessary information to confirm that the applying practitioner is meeting basic guidelines of insurance credentialing with UMR. A United Healthcare representative is assigned to the practitioner who informs whether the applying party meets all the mandatory guidelines or not.

2. Submit Your Application

Once the practitioner is deemed compliant of United Healthcare’s guidelines, they send an e-mail
with an application packet containing all the information needed to get started.

If the application information already exists on the CAQH aka Council for Affordable Quality Healthcare then UMR will with the applying parties permission, proceed to access it electronically.

The Following application information is required from the applying party, depending on:

• Basic Personal Information
• Education and Training Information
• Specialties and Board Certification
• Malpractice Insurance Information
• Work History and References
• Disclosure and Malpractice History

Here are some materials you’ll need:

•   CV or Resume
•   Malpractice or Insurance Policies
•   Drug Enforcement Administration Certificate
•   State Licenses
•   W9’S
•   Various applicable ID numbers

3. Follow Up

Once United Healthcare receives the application packet, they will start the credentialing process.The entire process will take 45 to 60 days to complete.

During this time, the applying party will receive e-mails regarding:

•  Confirmation of Application received
•  Request any missing documentation or application information. If any fundamental document or information is found to be absent during the process, United Healthcare will send a notification, notifying about the closure of that particular application.
•  Constant updates about the status of an application, including delays if any.

4. United Healthcare Approval

If United Healthcare approves a particular practitioner’s application, the practitioner becomes an in-network provider with UMR. United Healthcare will update the provider information in their database within the next 10 business days.

Being a United Healthcare in-network provider can be a very long and tedious process. The entire process requires at least 90 – 120 days to be completed and approved. There is a lot of paperwork, which makes the whole process quite frustrating for medical practitioners who want to accept clients with medical insurance. That is where the professional assistance of Denmaar comes into play.

With the help of our insurance credentialing experts, we can walk you through the entire process by accomplishing tasks without any complications and hassle so that you can work on other core areas of your medical practice.