Simplifying Enrollment, Contracting, and Compliance for AARP Medicare Advantage Providers
AARP Medicare Provider Enrollment
Preferred MB partners with physicians, nurse practitioners, therapists, facilities, and ancillary providers to complete AARP Medicare provider enrollment quickly and accurately. Our experts manage data gathering, application preparation, contracting, and electronic setup so you can join AARP’s Medicare Advantage networks with confidence and start billing without delays.
What Is AARP Medicare Provider Enrollment?
“AARP Medicare” refers to Medicare Advantage plans offered through UnitedHealthcare (UHC) under the AARP brand. These are some of the most popular Medicare Advantage products nationwide. To see patients in-network, providers must complete the enrollment and credentialing process, which includes:
- Submitting applications through UHC’s portals
- Maintaining an updated CAQH profile
- Providing licensure, malpractice, and practice documentation
- Undergoing primary source verification and compliance checks
- Executing a participation agreement (contract)
- Activating EFT/ERA for payment
Why AARP Medicare Enrollment Matters
Large market share
AARP/UHC Medicare Advantage serves over 7 million enrollees (2024 CMS data).
High patient demand
Many seniors specifically seek AARP-branded plans, so enrollment directly impacts your referral volume.
Revenue opportunity
Participation ensures reimbursement for covered Medicare services under AARP MA plans.
Compliance requirement
CMS and NCQA standards mandate credentialing before claims can be processed.
How AARP Medicare Enrollment Works (Step by Step)
Pre-Check Eligibility: Confirm Medicare PTAN/NPI, state licensure, malpractice coverage, CAQH attestation.
Application Submission: Submit through UHC’s provider portal (the gateway for AARP MA).
Primary Source Verification: UHC verifies licenses, education, board status, malpractice history, sanctions.
Contract Execution: Once approved, providers sign participation agreements outlining reimbursement and rules.
Directory Load: Provider details are published in AARP/UHC directories.
EDI/EFT Activation: Claims (837), remits (835), eligibility (270/271), and payments (ACH) are configured.
Go-Live & Ongoing Compliance: Providers can begin billing; Preferred MB manages recredentialing and updates.
How Preferred MB Simplifies Enrollment
| Enrollment Challenge | How Preferred MB Helps |
|---|---|
| Confusing online portals | We manage portal submissions directly |
| CAQH mismatches | Full CAQH scrub + 120-day attestation reminders |
| Application rejections | Pre-check for data accuracy across NPPES, W-9, CAQH |
| Long wait times (90–120 days) | Proactive follow-ups with UHC/AARP provider relations |
| Missed recredentialing deadlines | Preferred MB maintains calendars & reminders |
| EFT/ERA setup errors | Direct support with banking, 835/837 tests |
How to Know If You’re Eligible for Enrollment
AARP Medicare enrollment has prerequisites. Providers must already be eligible for Medicare participation and meet UHC/AARP’s network requirements.
Typical Requirements
Individual Providers
- NPI-1, Medicare PTAN
- Active state license(s)
- CAQH profile (attested, references, malpractice, training)
- DEA & State Controlled Substance license (if prescribing)
- Malpractice insurance certificate and claims history
- CV with month/year chronology
Groups/Facilities
- NPI-2, TIN, W-9
- Entity malpractice/GL coverage
- Ownership disclosures (percentages, SSNs)
- Locations, hours, accessibility status
- Rosters of affiliated providers
- CLIA/accreditation (as applicable)
How Individual vs. Group Enrollment Works
| Scenario | Required Forms/Steps | Outcome |
|---|---|---|
| Solo physician/NP | CAQH, UHC portal application, malpractice, DEA, PTAN | Enrolled as individual with direct payment |
| Group practice | Entity application + NPI-2, roster submission | Group contracts, reassigns benefits from individuals |
| Adding providers | Roster updates + CAQH validation | New clinicians linked to existing group contract |
| Facility/ancillary | Accreditation/CLIA, entity docs, service scope | Facility listed as in-network site |
How Contracting Works With AARP Medicare
Reimbursement rates (often Medicare fee schedule-based benchmarks)
Timely filing limits (usually 90–180 days)
Prior authorization rules (especially for specialty and ancillary services)
Directory compliance (CMS requires up-to-date info; noncompliance risks suspension)
Delegation options (large groups may be delegated for credentialing/claims)
Appeals/grievances process (structured, CMS-aligned timelines)
Preferred MB reviews contracts for alignment, negotiates where possible, and ensures you understand the financial/operational commitments.
For More information
How Long Does Enrollment Take?
| Stage | Timeline | Notes |
|---|---|---|
| Intake & Application Prep | 5–10 business days | Faster with complete docs |
| Credentialing / PSV | 30–60 days | UHC runs NCQA-based checks |
| Contracting | 2–4 weeks | Can overlap with PSV |
| Directory Load | 10–30 days post-approval | May vary by region |
| EDI / EFT Activation | 2–3 weeks | Preferred MB sets up 837/835/270/271 |
How Preferred MB Protects Revenue From Day One
Enrollment is worthless without cash flow. Our credentialing team:
Activate EFT/ERA so payments and remittances flow electronically.
Test 837 claim files with clearinghouses.
Validate eligibility (270/271) and claim status (276/277).
Load fee schedules into your RCM/PM system.
Train staff on AARP MA denial codes and appeal packet templates.
How to Maintain Compliance After Enrollment
Directory updates: Must be reported within 30 days (addresses, hours, accepting-patients status).
Annual FWA training: Required for all staff billing MA plans.
OIG/SAM exclusion checks: Must be run at hire and ongoing.
Recredentialing: Typically every 36 months; Preferred MB preps early.
Prior auth updates: Keep staff informed of changing lists.
Claims monitoring: Regular denial tracking, appeals oversight.
How Preferred MB Communicates During Enrollment
At Preferred MB our credentialing team provide:
Weekly status updates (what’s with UHC, what’s pending with you)
Escalation ladder (credentialing → contracting → provider relations)
Secure document tracking
Shared recredentialing calendar