Get United Healthcare Pcp Change Form

Changing your primary care provider with United Healthcare is a straightforward process when you complete the PCP Change Form online. This guide will walk you through each section of the form to ensure everything is filled out accurately and completely.

Follow the steps to complete your PCP change form online.

1. Press the ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by filling out the Member Information section. Include the member's full name, birth date, phone number, member ID number, and address, ensuring that each field is completed.
3. In the Member Information section, sign the form where indicated. If applicable, include the printed name of the authorized or responsible party beside their signature.
4. Next, complete the PCP Information section by providing the current PCP's name. Select the reason for the change by checking the appropriate box.
5. Now, move to the New PCP Information section. Indicate if the new provider is part of a Federally Qualified Health Center (FQHC) or Rural Health Center (RHC) by selecting 'Yes' or 'No.' If 'Yes,' be aware that the assignment will be made to the group.
6. Provide the new provider's name, National Provider Identifier (NPI), and their service address including city, state, and ZIP code.
7. Indicate whether the new PCP will be an established patient or a new patient. This will determine the effective date of the change.
8. Fill out the Office Contact Name and Phone number as well as the contact's signature and date to finalize this part of the form.
9. Once all sections are complete, review the form for any errors or missing information. Save your changes and proceed to download, print, or share the completed form as needed.

Complete your PCP change form online today for a seamless transition to your new healthcare provider.