Marlien / Payer guides / UHC
UnitedHealthcare / Optum
UnitedHealth Group — UnitedHealthcare; Optum for behavioral health
- GA
- TX
- Commercial
- Medicare Advantage
- Medicaid / CHIP (MCO)
- Behavioral health (Optum BH)
Checked against this payer's own pages on 2026-11-04. Next review 2027-02-02.
This guide, as a document
Everything on this page, laid out to print. Use your browser's print or save-as-PDF. No email, no sign-up.
- Every line of business, with what to watch for on each.
- What we checked, and what we could not verify.
- Kept current: it is the same catalogue we work from.
It opens in a new tab. Then use your browser's print or save-as-PDF to keep a copy with your file.
The checklist is the work
This page is the map: the channel, the order it happens in, the traps, what the payer publishes about time, and what we could not verify. It is not the checklist.
We do not publish the itemised list of documents and conditions for each line of business. You will not find it on this page, and you will not find it by reading. We hand it over instead: resolved for the line you are actually filing, and written down against your own file. It is the part that takes the work, and it is the part that goes wrong when nobody has done it.
The first step is $250: we read your documents against what UHC asks for and tell you in writing what is missing, before anything is filed. It is credited in full against any engagement.
Get the UHC checklist
Tell us who you are and we will send you the whole file: the conditions that must be true before you file, and every document the payer asks for, line by line. It costs nothing and commits you to nothing.
Where you file
- How you apply
- UHC provider onboarding portal
- The path
- onboard-pro.uhcprovider.com — request participation, then Credentialing → Contracting → Connecting
- What access you need
- One Healthcare ID required to register.
- Who verifies
- UHC performs its own PSV
- Worth knowing
- Behavioral health is a parallel path with its own portal and its own NPRF workflow, ending in its own system-loading step.
CAQH
- Required
- A DataSpring (CAQH) registration ID is required at the participation request — you cannot complete the request form without it.
- Authorise this payer
- UnitedHealthcare
Lines of business
Each line is its own application, with its own checklist, its own effective date and its own contract. Filing one does not file the others. What follows is what this payer asks for, line by line.
Commercial
Standard UnitedHealthcare commercial book. Onboard Pro pulls what DataSpring already holds, so you do not re-key it.
Medicare Advantage (MA)Medicare Advantage
Backdating under 42 CFR 424.521 may apply. UHC MA uses the same three-stage flow as commercial.
Medicaid / CHIP — GeorgiaGA
Georgia Medicaid credentialing is decided by the DCH Centralized CVO, not by UHC. UHC still runs its own contracting. IMPORTANT: UHC is an apparent successful health plan for the Georgia Families 360° contract (Notice of Intent to Award, 2 December 2024), but DCH has NOT issued a Notice of Award and has published no implementation date — so there is no Georgia Medicaid network to join yet and no contract to file for. Treat this line as a watch item.
What to watch for on this line
- Must be trueGeorgia Medicaid: DCH has not issued a Notice of Award — UHC cannot contract a Georgia Medicaid provider yetOur own bar, not a published payer rejection rule. DCH's own update (23 April 2026) says the CMO procurement is in the protest phase pending the Notice of Award, and that no implementation timeline has been published. UHC is an apparent successful health plan for Georgia Families 360° with no Georgia Medicaid network to join. Do not spend filing effort on this line until the Notice of Award is issued — and record the date and the source when it is.
Medicaid / CHIP — TexasTX
Texas Medicaid credentialing runs through the TAHP CVO layer (Verisys). UHC still runs its own contracting.
Behavioral health — Optum BH
Completely separate track: Provider Express, its own NPRF workflow, and 5–30 additional business days of loading after approval.
What the payer publishes about time
These are the payer's own published figures. They are not our commitment, and they are not a promise about when you can bill.
- Completeness review
- notVerified
- Decision
- up to 45 calendar days from a completed application
- Committee
- Medical Director may approve files meeting all Credentialing Criteria; otherwise the standing National Credentialing Committee decides
- Contract
- contract mailed within 5 business days of the request
- What the numbers mean
- Three sequential stages, two of which sit AFTER approval. A client told "approved" may still wait up to 60 days to bill.
Deadlines that start a clock
These run against a filing. Miss one and the filing stops, or restarts.
Complete data + attestation90 calendar days
counted from the effective date
Recredentialing
- Cycle
- 3 years
- What it hangs on
- automatic
- Worth knowing
- Complete data with attestation every 90 days.
The effective date
Approval is not the date. These are the markers that make a date real.
- How it is established
- No standalone effective-date letter is published. Billing begins when the provider profile is created and network assignment lands in the UHC Provider Portal after contract load.
- What proves it
- UHC Provider Portal profile with provider number and network assignment
- Contract date
- This is not the same as the contract effective date. Track both.
- Worth knowing
- Approval and contract signing are both early. The real gate is system load + network assignment — up to 60 days of dead time after the contract is signed.
Backdating: 30 daysMedicare Advantage (MA)
42 CFR 424.521(a)(1) — retrospective billing is permitted for up to 30 days before the effective date ONLY where circumstances precluded enrollment in advance of providing services, and only for services provided at the ENROLLED PRACTICE LOCATION. 90 days is available where a Presidentially-declared Stafford Act disaster precluded advance enrollment. It is a DETERMINATION, not an entitlement.
Federal rule, not confirmed in UHC's own material. Applies to the MA line only. Commercial and Medicaid: no backdating authority identified.
This is a federal rule. This payer's own material does not confirm it, so we do not promise it. We tell the payer what the circumstances were and let the payer decide.
What we checked, and what we did not
Read this before relying on anything else on this page.
Channel, Onboard Pro path, stage structure, 45-day decision, 60-day system load, BH loading window, 3-year cycle, 90-day attestation and all four links confirmed 2026-11-02. Appeal window NOT verified. Contract-mailing window conflicts between two UHC sources (5 vs 10 business days) — assume 10.
The payer's own pages
Where to file
- Join our network — medical providersUnitedHealthcare Provider Portal › Onboard Pro › request participationYou need a One Healthcare ID, the NPI, a W-9, work and education history, a liability face sheet, and a DataSpring/CAQH registration ID. UHC will email you a reference number.
- UnitedHealthcare Provider Portal (Onboard Pro)Sign in with your One Healthcare ID. The dashboard shows the live status of every enrollment request.
- CAQH / DataSpring — register and authorize UnitedHealthcareProView › Authorization tab › UnitedHealthcareDataSpring is required in some states and specialties. Keep attestations current.
- Optum Behavioral Health — Provider ExpressBehavioral health uses Provider Express, not Onboard ProA completely separate path: own portal, own NPRF workflow, own loading queue.
Information and forms
- Join our network — full library (medical, facilities, ancillary, behavioral)Select your entity type to get the right workflow.
- UHC Credentialing & Recredentialing FAQ (PDF)Industry standards, credentialing organizations and what to have ready.
- UHC provider contact pageProvider Services 877-842-3210; chat 24/7 in the portal.
Who to contact
- UHC Provider ServicesGeneral provider assistance877-842-3210Chat 24/7 in the UnitedHealthcare Provider Portal.
- Optum Behavioral HealthBehavioral health enrollment and credentialing877-614-0484The Credentialing FAQ PDF also lists 800-817-4705.
- Provider advocateAssigned chat agent in the UHC Provider PortalLive chat 7 a.m.–7 p.m. CT from the portal.
These are the payer's own pages. If a link stops working, tell us and we will re-check it. Links we could not verify are not published here.
Want this done for you?
Marlien assembles the core file, gets the authorisations, files every door on this page, and follows up until each payer records a decision and a written effective date. The price is written down before the work starts.
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