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UnitedHealthcare (UHC / Optum) Credentialing Guide
National Commercial, Medicare Advantage & Optum Behavioral Health Guidelines · Verified August 2026
Observed Window60–120 DaysNational Average: 95 Days
Submission RouteCAQH ProViewPayer Code: 87726
Retroactive PolicyStrict (No Retro)Claims billable only post-approval
Committee MeetingBi-MonthlyCutoff: 15th of each month
Mandatory Documentation Checklist for UnitedHealthcare
- Active CAQH ProView Profile attested within the last 90 calendar days.
- State Medical / APRN / LCSW License with zero pending investigations.
- DEA Registration Certificate matching practice primary physical location.
- Malpractice Certificate of Insurance ($1M/$3M limits) showing active policy dates.
- Hospital Admitting Privileges verification letter (or signed admitting arrangement).
- 5-Year Continuous Work History with written explanations for any gap exceeding 30 days.
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