NON-CREDENTIALED PRACTITIONER ADD/CHANGE FORM  
 

• Add, terminate or change demographic data for non-credentialed practitioners and specialists such as anesthesiologists, audiologists, CRNAs, dietitians, ER physicians, occupational therapists, physical therapists, speech therapists, pathologists and radiologists. Check with the facility if unsure if a practitioner is a non-credentialed type.
• Please allow 30 business days for your request to be reviewed and completed.
• For status checks, please contact UCare's Provider Assistance Center at 612-676-3300 or toll free at 1-888-531-1493.
• For questions with filling out the form, please contact UCare's Provider Demographic Support Line at 612-676-8959.