Univera Healthcare welcomes health care providers to participate in our network. We contract with physicians, facilities and other health care professionals to form provider networks essential for the delivery of quality, accessible and affordable health care services to our members.
Univera Healthcare does not exclude from participation in its network or otherwise discriminate against providers on the basis of race, color, national origin, sex, age or disability of individuals with whom the providers have a relationship.
Credentialing / Contracting
- Complete the enrollment form. We will review your request, determine whether credentialing is required and send the appropriate Participating Agreement. (View which provider types require credentialing and agreements).
- Providers must self-register on the Council for Affordable Quality Health Care (CAQH) website (www.caqh.org).
- Credentialing applications are usually processed within 90 days of receipt. Please ensure that applications are completed in their entirety, signed, and all supporting documentation included. Incomplete applications will delay processing time.
- Some states require that out-of-state providers enroll in their state's Medicaid program in order to be reimbursed. Some of these states may accept a provider's Medicaid enrollment in the state where they practice to fulfill this requirement.
- The applicant has the right upon request to be informed of the status of their application for credentialing. They also have the right to review their submitted information for credentialing and correct erroneous information, upon request. The method of communication used by the applicant will determine the method of response (e.g. a phone inquiry will receive a phone response, a letter inquiry will receive a response by letter). The Plan will share current status, date of the next committee meeting, as well as identify the missing items necessary to complete the file for presentation to the Credentialing Committee.
- Important Tips:
- Make sure CAQH is updated and completed.
- All fields on the application forms are filled in, especially the required fields, Social Security number and Taxonomy code.
- Submit the application with the necessary documentation to the address or fax number listed.
When seeking health care services, our members often rely upon the information in our online Find A Doctor tool. This is just one of the reasons why it’s very important that you inform Univera Healthcare whenever any of your practice information changes. If you are a participating provider with Univera Healthcare, you may request most changes online
or by completing the Practitioner Demographic Change form
. If you are not yet a participating provider and would like to contract with Univera Healthcare, complete an enrollment form
- Terminating a Licensed Physician: Any nurse practitioner (NP), physician assistant (PA), or certified behavior analyst assistant that has a collaborating relationship with the terminated licensed physician must complete an Application for Non-Physician Health Care Practitioner to be reassigned.