UMR Credentialing – Easy tips to get credentialed with UMR

UMR Insurance Credentialing Process- Explained

If you are in the healthcare sector, you may have come across the term UMR Insurance credentialing. Let’s understand what the term means and how the process is carried out.

UMR is the largest third-party administrator in the United States at present. It provides a variety of healthcare management plans like claims processing and administration services for self-funded medical, dental, vision, and disability plans.

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

UMR is a part of the popular United Healthcare insurance (UHC) company. The UHC itself provides an array of health benefit plans and services to its clients and is responsible for 25M American consumers having access to quality affordable healthcare services.

The company has 560,000 physicians and 4100 hospitals under its umbrella across the US. With all its merits, it is a major flaw if a provider skips getting credentialed with the UMR. UMR insurance credentialing is important if a provider seeks to access the client base held by UHC throughout America. And to apply for UMR credentialing, you first have to apply to the UHC.

Here is the process you need to follow.

1. Pre Application

Before applying, the UHC requires the practitioners to submit some important information to confirm that they are meeting the basic guidelines of insurance credentialing. A UHC representative is assigned to the practitioner who informs whether the applying party meets all the mandatory guidelines.

2. Application Submission

Once the practitioner is declared compliant with the UHC guidelines, an email containing important information and instructions is sent over. This information can also be accessed electronically on the CAQH website.

The following is the information that applicants would need.

Demographics, Education and Training particulars, Specialties and Board Certificates, Malpractice Insurance Information, work history, and some references.

Other than the above information, here is some material that they may require.

CV or resume, malpractice or insurance policies, drug enforcement administration certificate, state licenses, W9s, all applicable ID numbers.

3. Follow Up

Once the application is received by UHC, the credentialing process will be initiated. The entire process takes around 45 to 60 days to complete. While the application is reviewed, applicants might receive emails regarding confirmation of application received and requests for missing documentation or information. In cases where some fundamental document is found missing, UHC sends a notification regarding the closure of that particular application.

4. United Healthcare Approval

If the UHC approves an application, the applicant becomes an in-network provider with the UMR. UHC will then be updating this information in their digital database within the shortest period.

The final word

Being in-network with the UHC is a long and tedious process. The entire process may consume some 90-120 days for completion. There is paperwork that makes the process quite frustrating for medical practitioners who wish to attract clients with a medical insurance. And this is exactly where Bikham comes to your help.

With the help of seasoned credentialing experts, we can walk you through the entire process and accomplish tasks in a hassle-free manner, so you can work on what matters the most- patient care.