Forms and information to navigate the credentialing process

• Disclosure of ownership and control interest
  Regulatory information requiring facilities and businesses to disclose ownership and control interest prior to payment for any services rendered to Medicare or Medicaid enrollees

• FAQ on Gemini
  

• Joining the UnitedHealthcare Hearing Network
  Learn how simple and easy it is to join our network and complete the credentialing and recredentialing processes

• Practice and provider demographic change form
  

• Provider credentialing 
  Understanding the credentialing and re-credentialing processes

• Change of ownership/tax information change form
  Tax ID forms require a minimum of 30 days advanced notice

• Understanding the credentialing process

• Registration portal attestation access application
  

• Sonova account application
  
  
• Relate^4.0 BTE and Earmold order form

• Relate^4.0 RIC and Custom Ear Piece order form

• Relate^3.1 UP BTE and Earmold order form 

• Relate^3.1 Custom order form

• Relate Loss and Damage Claim form
  
  
• UnitedHealthcare Hearing Prescription form
  Complete this form if a referred patient has a health plan that requires a prescription/written recommendation
  
  
• EPIC Hearing Prescription form
  Complete this form if a referred patient has a health plan that requires a prescription/written recommendation
  

• Release of Information form
  • UnitedHealthcare Hearing Release of Information form (English)
  • UnitedHealthcare Hearing Release of Information form (Spanish)
  • EPIC Hearing Release of Information form

• Virtual Services Consent form
  
  • UnitedHealthcare Hearing Virtual Services Consent form (English)
  • UnitedHealthcare Hearing Virtual Services Consent form (Spanish)
  • EPIC Hearing Virtual Services Consent form (English)
  • EPIC Hearing Virtual Services Consent form (Spanish)

Member opt-out waivers 
Follow the proper opt-out procedure to ensure opt-out waivers are used within acceptable parameters.
Select the correct opt-out waiver based on a member’s plan type and submit.

• UnitedHealthcare Hearing Opt-out member waiver form

• EPIC Hearing Opt-out member waiver form

• AARP UnitedHealthcare Opt-out member waiver form

• Authorization process 
  Discover how the UnitedHealthcare Hearing authorization process works

• Get to know our 2024 hearing programs
  Learn about the different programs and how they set you up for success in 2024
  
  
• Get to know UnitedHealthcare Hearing
  Learn more about who we are and how we work together to meet the hearing health needs of patients

• How UnitedHealthcare Hearing is different from UnitedHealthcare
  Better understanding these 2 entities can make caring for patients and running your practice easier
  
  
• In-person care process and member journey
  Explore the services and process for in-person care

• Provider Portal fact sheet
  Overview of key information and benefits of using the web portal

• UnitedHealthcare Hearing Network Provider quick reference guide

• 2024 UnitedHealthcare Hearing frequently asked questions
  Get answers to the most common questions around program updates, hearing aid benefits, fees and guidelines.

• Acceptable Member Opt-Out Waiver usage
  Learn about the acceptable parameters for submitting a member opt-out waiver

• Electronic Payment Registration Process through PaySpan
  Learn how to register for direct deposit of professional fees from UnitedHealthcare Hearing to reduce costs, speed secondary billings, improve cash flow and reduce paper usage.

• Fee schedule
  

• Hearing tests and unauthorized billing
  A closer look at hearing test requirements and billing parameters with UnitedHealthcare Hearing

• Loss & Damage process 
  Follow this process to help patients manage Loss & Damage claims

• Pediatric program
  Meeting the unique needs of the pediatric population

• Provider practice attestation user guide
  Use this guide to help complete your attestation every 90 days within the UnitedHealthcare Hearing Provider Portal

• Receiving more referrals from UnitedHealthcare Hearing

• Recommended provider status dispute form
  
  
• Regional representatives contact information

• Trial period, returns and exchanges
  Learn about trial periods and how to process a hearing aid return or exchange

• Lifestyle Selection Tool

• Warranty and repair
  Understanding hearing aid warranties and repair details
  
  
• When ordered hearing aids are never fit
  What to do if you are unable to schedule a member’s fitting appointment for hearing aid devices that have been ordered

• 2024 Relate® hearing aids product and software introduction
  Get trained on Relate^4.0 hearing aids and new fitting software

• Office of Inspector General exclusion database search quick reference guide


• Provider Portal training
  Explore this self-paced training course to learn how to navigate the provider portal effectively
  
  
• UnitedHealthcare Hearing – Fraud, Waste and Abuse (FWA) and general compliance training module
  Explore this educational course designed to inform providers about our FWA and compliance programs