Optum and UnitedHealthcare

Key Requirements for Joining the UnitedHealthcare (including Optum) Network in Texas:

• Use of CAQH ProView: UnitedHealthcare, including Optum networks, requires physicians and many other healthcare professionals in Texas to complete and maintain their information in the Council for Affordable Quality Healthcare (CAQH) ProView database. You will need to grant UnitedHealthcare access to your CAQH profile. Ensure all sections are complete and up to date.  
• Texas License: A current and unrestricted license to practice in Texas is mandatory. The license must be in good standing with the relevant Texas licensing board.
• Professional Liability Insurance: You will need to provide proof of current professional liability insurance that meets UnitedHealthcare’s minimum requirements for your specialty and the state of Texas. Specific limits may apply.
• Work History: Expect to provide a detailed work history for the past five years, with explanations for any gaps longer than six months.  
• Education and Training: Verification of your medical education, residency, fellowships, and other relevant training will be required.
• Board Certification: Information on your board certifications, if applicable to your specialty, will be necessary.
• Hospital Privileges: For physicians, information regarding current hospital privileges or admitting arrangements with participating hospitals may be required.
• DEA/CDS Certificate: If you prescribe controlled substances, you’ll need to provide your current DEA (Drug Enforcement Administration) and Texas CDS (Controlled Dangerous Substances) certificates.
• NPI (National Provider Identifier): You must have a valid NPI to participate in the network.
• Tax Identification Number (TIN): Your TIN is required for contracting and payment purposes.
• W-9 Form: You’ll likely need to submit a completed W-9 form.
• Practice Information: Details about your practice location(s), including addresses, phone numbers, and contact information.
• Attestation: You will need to attest to the accuracy of the information provided in your application.
• Background Check: A criminal background check is typically part of the credentialing process.
• Completion of UnitedHealthcare Application: While CAQH is a primary source of information, you will also need to complete UnitedHealthcare’s specific network participation request through their provider portal, Provider Express.

Steps to Credential with UnitedHealthcare (including Optum) in Texas:

1. Register with CAQH: If you are not already registered, go to the CAQH ProView website (www.caqh.org) and complete your profile. Ensure all information is accurate and up to date. https://proview.caqh.org/Login/Index?ReturnUrl=%2f
2. Access Provider Express: Go to the UnitedHealthcare Provider Portal (https://www.uhcprovider.com/) and register for or log in with your One Healthcare ID.  
3. Complete the Network Participation Request: Navigate to the “Join Our Network” or credentialing section and complete the online application. You will need to provide your demographic information, specialty, service locations, and other required details.
4. Authorize CAQH Access: Within the UnitedHealthcare application, you will need to authorize UnitedHealthcare to access your CAQH ProView profile.  
5. Submit Supporting Documentation: Upload any required supporting documents, such as copies of your Texas license, DEA/CDS certificates, liability insurance face sheet, board certifications, and W-9 form, through the Provider Express portal or as instructed.
6. Primary Source Verification: UnitedHealthcare will verify your credentials with the primary sources (licensing boards, educational institutions, etc.).
7. Credentialing Committee Review: Your application and verified information will be reviewed by UnitedHealthcare’s credentialing committee.  
8. Notification: You will be notified in writing of the committee’s decision regarding your participation in the network.
9. Contracting: If approved for credentialing, you will then proceed with the contracting phase to finalize your agreement with UnitedHealthcare.

Important Points:

• Provider Express: This is the primary online portal for UnitedHealthcare providers to manage their information, including the credentialing process.
• Timelines: The credentialing process can take time, typically 45 calendar days or more from when a complete application and all required information are received. Primary source verification timelines depend on the responsiveness of the verifying entities.
• Recredentialing: UnitedHealthcare requires recredentialing every three years. Maintaining an up-to-date CAQH profile and attesting to its accuracy every 90 days can streamline this process.
• Specific Requirements: Requirements can vary slightly based on your provider type (physician, allied health professional, facility, etc.) and specialty. Always refer to the official UnitedHealthcare provider website and relevant provider manuals for the most accurate and detailed information.
• Optum Specifics: If you are specifically joining an Optum network (e.g., Optum Behavioral Health, Optum Physical Health), the initial steps will likely still involve CAQH and the UnitedHealthcare Provider Portal. However, there might be specific application pathways or additional requirements depending on the Optum line of business. It’s best to clarify this during the initial application process.

Recommendation:

The most reliable way to understand the exact and current credentialing requirements for Optum/UnitedHealthcare in Texas is to:

1. Visit the UnitedHealthcare Provider Portal (https://www.uhcprovider.com/).  
2. Navigate to the “Join Our Network” or “Credentialing” sections.
3. Review the specific requirements and steps outlined for your provider type and specialty in Texas.
4. Contact United Healthcare Provider Services directly if you have specific questions.

By following these steps, you can ensure you have the most accurate and up-to-date information for a successful credentialing process with Optum and UnitedHealthcare in Texas as of May 7, 2025.

Summary Table: Optum Credentialing Steps in Texas