Provider Contracting

Provider applications to participate in any U of U Health Plan network are considered based on the following:

• Business needs
• The credentialing process

All providers must be approved through our credentialing process before they may participate in any network.

Business needs may include and are not limited to:

• Network adequacy requirements based on state and/or federal guidelines
• Network adequacy requirements based on the current or expected population of a given geographic area (usually defined by county or zip code)
• Network adequacy requirements based on provider type and/or specialty
• Network composition based on scope of services required by payer such as employer, health plan, union/trust, government entity, etc.
• Network performance requirements in terms of cost/utilization, quality measures, outcomes, access, and/or patient or physician satisfaction
• Demographic needs including but not limited to languages spoken
• Existing, non-compensated, referral patterns with current network providers and/or U of U Health Plans members

Benefits of participating with a U of U Health Plan network include:

• Claim payments made to you directly on a weekly basis
• Provider Relations representatives are available to help you and your staff
• Inclusion in our on-line and printed provider directories made available to brokers,employers and members for the applicable products
• Member benefits are designed to encourage use of network providers
• Eligibility to register for Provider Portal, our online tool to verify eligibility, check claims status, submit inquiries, and more

Note: We are no longer accepting applications for Durable Medical Equipment/Medical Supplies providers, Laboratory/Pathology providers, Infusion Suites, or General Dentists (Oral Surgeons are accepted).

To apply, complete the Provider Application Form below.

Our Contracting Committee reviews applications within 15 to 20 business days.

• If the application is approved, one of our Contracting Executives will extend a contract to you. When we receive the signed contract back from you, we will initiate credentialing of all providers listed in Exhibit B.
• If the application is denied, you will be notified.

Credentialing typically takes 6-8 weeks to complete following receipt of the signed contract. The Credentialing Committee makes the final determination as to whether the provider meets our credentialing criteria. This committee meets the first Monday of each month, excluding holidays. Once credentialed, providers can begin to see members.

If you need to make an update to your practice, use the Provider Information Update Form, not a new Application.

Note: Adding a New Provider

If you already have a contract and are adding a new provider, follow instructions under Practitioner Credentialing.

Note: Provider Business Updates

If you need to update your existing location or business information, complete and submit the Provider Information Update Form.