Salesforce
What should your 253 date match?
The Complete Application Received Date
Which state requires a copy of all PSVs?
Florida
Do you split a file you are denying for the specific exception reason of Miscellaneous Medicaid Exclusions?
No
In NDB on the IDC, what date do we use for the 405 code?
30 days from the current date.
What is the current credentialing committee date?
February 18, 2026 (2/18/2026)
Is E&I the highest level of credentialing?
Credentialing Hierarchy:
Which website can you use to verify a mid-level provider’s education?
The Clearinghouse website (National Student Clearinghouse).
If you made outreach to obtain the provider’s license and never received a response, which exception reason (specific) would you use?
Unable to Verify License
Explanation:
A provider license is a PSV (Primary Source Verification) element, and “Non‑Response” is never used for license verification.
On what screen in NDB do we enter AOE codes
I-X-C
How often are committee dates updated?
Usually every two weeks.
Which element is required for a pharmacist—DEA or hospital privileges?
Neither.
What is the look‑back period for malpractice reviews?
You made outreach because you were unable to verify the state license. The credentialing contact responds and advises that the provider no longer wishes to participate. What exception reasons would you choose under the General and Specific sections?
Exception Reason (General):
Multiple Issues
Exception Reason (Specific):
Important Note:
“Provider No Longer Wishes to Participate” should only be used in addition to another issue and should never be used as a standalone exception reason.
What should be in the BC field for mid‑level providers?
X
What was the last ALL Teams meeting about?
You have a CC for all LOBs in Indiana, and you made two outreach attempts to the hospital to verify admitting privileges but never received a reply. How would you handle this file?
You would split the file.
Indiana (IN) and New Mexico (NM) rule:
The state requires the health plan to verify directly with the hospital that the information provided by the provider on the application is accurate and valid. This requirement applies only to Community and State line of business (C&S) requests.
In the state of New Jersey (NJ), a provider does not have active hospital privileges or an admitting arrangement. Do you deny the CC for all products, or do you split the cycle and deny only for C&S?
Deny for all products.
Which exception reason code would you use for a provider whose training is not in the designated specialty?
What does I-5-Z screen do?
If you need to correct codes in NDB but your cycle has already been completed, what would you do?
On the IDC screen, use Function D.
What hospital admitting privileges are required for Texas (TX)?
FYI: This is being asked because TX and AZ C&S will soon be moving from Classic to SFL
The state requires the health plan to verify that the hospital or covering provider has active Community & State (C&S) contracts.
The health plan does not need to contact the hospital directly to verify that the provider’s admitting privileges are accurate and valid.
In which states do site visits expire?
Site visits expire only in the following states: New Jersey (NJ), Florida (FL), and Indiana (IN).
For a CC you are denying for multiple issues, under Exception Reason (General) you will list Multiple Issues. How do you list the Exception Reason (Specific) issues?
On the State & Federal grid, under the Exception Reason tab, list the high‑level issues in alphabetical order, separated by commas.
Which screen in NDB do we use to confirm a provider’s participation status for C&S products?
I-4-Z
Where can you find the UnitedHealthcare Credentialing Plan (2025–2027)?
The UnitedHealthcare Credentialing Plan (2025–2027) is available on UHCprovider.com under Join the Network.
It has also been communicated that the document is available on the NCC SharePoint; however, I has not been located there yet.