Provider Data Information

This indicates whether a physician is receiving new patients into his/her practice. Physicians self-report to UnitedHealthcare whether they are accepting new patients.

Board certification provides a trusted credential that is important to patients and relevant to physician practice. Physicians are Board certified if, after completing residency training in a specialty, they pass an exam and meet requirements established by their Board. Board certification is voluntary. UnitedHealthcare verifies this information with the American Board of Medical Specialties or the American Osteopathic Association when the physician first joins UnitedHealthcare's network and at least every three years thereafter. You can see a physician´s current Board status by visiting American Board of Medical SpecialtiesOpens a new window or American Osteopathic AssociationOpens a new window.

Except as noted below, physicians and health care professionals self-report and update upon UnitedHealthcare's request the demographic information (name, address, phone number, gender, languages spoken, medical group affiliation, hospital affiliation, accepting current patients) displayed in the directory. UnitedHealthcare reviews all of this information at least every three years at the time of credentialing and recredentialing.

Hospital affiliation refers to a hospital where a particular physician may treat patients. Hospital affiliation is reported to UnitedHealthcare by the physician at the time of credentialing and recredentialing. A physician may notify UnitedHealthcare of changes at any time.

UnitedHealthcare collects information about hospital names, locations, phone numbers, and accreditation before contracting with a hospital and at least every three years after recredentialing the hospital. All hospitals in UnitedHealthcare's network must have met UnitedHealthcare's Facility Site Visit Criteria and also must either have accreditation or have met the certification standards from the Centers for Medicare and Medicaid Services (CMS). Accreditation means a hospital has undergone review by an external agency and met established standards. CMS Certification means a hospital has undergone review by CMS and met applicable certification standards. You can check the current accreditation status of hospitals by visiting the following sites:

• Quality Check
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• Healthcare Facilities Accreditation Program
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• DNV GL Healthcare
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• Center for Improvement in Healthcare QualityOpens a new window

This refers to the language(s) other than English that a physician or his/her clinical staff can speak to those needing medical care. This information is voluntarily reported by the physician to UnitedHealthcare at the time of the credentialing and recredentialing. A physician may notify UnitedHealthcare of changes at any time.

This refers to the name of the physician's practice. It may be a group practice with other doctors.

A specialty is the medical field in which a physician has training, such as orthopedics or cardiology. Physicians self-report their specialties, which UnitedHealthcare then verifies with external sources at the time of credentialing, recredentialing, and whenever a physician notifies UnitedHealthcare of a change.

Tiered Benefit plan designs offer two network benefit levels and optional non-network benefits:

• Tier 1 network providers
  • Members receive the highest level of benefits for using Tier 1 providers.
  • Log in at myuhc.com to see blue Tier 1 dots next to the providers’ names.
• Network providers
  • Members receive benefits for using network providers
• Non-network providers (if non-network coverage is included)
  • Members receive the lowest level of benefits for using non-network providers

Tier 1 providers may include:

• Premium Care Physicians – in certain markets where the UnitedHealth Premium Designation program is available
• Oncologists
• Lower cost hospitals – in specific geographic markets as defined by the Hospital Tiering benefit -  AL, AR, CT, FL, GA, LA, MS, NC, OH, RI, SC and TN
• Spine & Joint Solution (Centers of Excellence) – for large, self-insured National Accounts employers
• Accountable Care Organizations – available only in certain markets