UNITED PHYSICIANS IS A ONE STOP SHOP FOR
CREDENTIALING & PLAN ENROLLMENT
UP credentials and recredentials its members. Practitioners must be board certified or board-eligible (certified within five years of completion of training in their practicing specialty) to apply. Once credentialed, each practitioner is expected to adhere to UP’s policies and standards.
Also, UP will enroll you with the health plans and offer support when issues and questions arise. UP has contracts with over 15 health plans, including BCN, HAP, Meridian and Molina.
UP’s Credentialing Department:
- Handles physician credentialing and recredentialing for all plans contracted with United Physicians
- Facilitates enrollment in contracted plans
- Tracks physician credentials and provides notification of expiring credentials to ensure continued compliance with contractual requirements
- Facilitates notification of provider change information to all contracted plans.
Recredentialing
UP recrendentials physician members every three years. Physicians will be notified that they are approaching their three year recrendentialing due date and will be asked to ensure that their
CAQH (Council for Affordable Quality Healthcare) application has a current attestation date and that all information on the application is current. The Credentialing Department will then access the application from the CAQH website and begin the process. The completed recredentialing application will be submitted to the Credentials Committee for approval. Upon approval, a letter will be mailed to the physician informing them of the committee’s decision.
If you have any questions or need additional information, please contact the Client Services Department at 248-593-0100 / clientservices@updoctors.com.
The UP credentialing team is accredited by the National Committee for Quality Assurance (NCQA), an organization that works to improve health care quality through the administration of evidence-based standards, measures, programs, and accreditation. Credentialing to join UP and health plan enrollment are separate processes, and timelines vary from provider to provider.
United Physicians facilitates contracts with health plans characterized by equitable reimbursements, lower settlement withholds, and reliable distribution of risk plan settlements and performance incentives to physician members. United Physicians currently participates in the following health plans:
PPO:
- Aetna All Products PPO
- Cofinity
- HAP Preferred/Alliance Health & Life PPO
- McLaren Health Plan PPO
- Multiplan/PHCS PPO
- Priority Health PPO
Managed Care Plans (HMO):
- Blue Care Network (BCN) HMO – MCG Affiliation Acknowledgement
(Provider must self-enroll in BCBSM to participate.)
- HAP Commercial HMO
- Humana HMOx (Detroit/MI HMOx)
- McLaren Health Plan HMO
- Meridian Choice Commercial HMO
- Priority Health HMO
- Total Health Care Commercial HMO
Medicare Advantage:
- BCN Medicare Advantage HMO
- HAP Medicare Advantage HMO
- HAP Medicare Advantage PPO
- HAP Empowered
- Humana Medicare Advantage PPO, PFFS, POS
- Humana Gold Choice HMO (Medicare Advantage)
- McLaren Medicare Advantage HMO
- Meridian Medicare Advantage (SNP & Prime HMO)
- Priority Health Medicare HMO
Medicaid:
- Aetna Better Health Medicaid HMO
- Blue Cross Complete Medicaid HMO
- HAP Empowered
- McLaren Health Plan Medicaid HMO
- Meridian Health Plan of Michigan Medicaid HMO
- Total Health Care Medicaid HMO
Medicare-Medicaid Dual Eligible:
- Aetna Better Health Medicare-Medicaid Dual Eligible
- HAP Empowered
All Products Agreement:
- Molina Healthcare of Michigan, Inc. (includes Medicaid, MA-SNP, Medicare-Medicaid Dual Eligible, Exchange Product)
UP serves as your liaison to the health plans, handles your initial membership application and facilitates health plan enrollment. If you have any questions or need additional information about any of the plans listed above, please contact Client Services at 248-593-0100 or clientservices@updoctors.com.
