UnitedHealthcare Hearing disclosure of ownership and control interest
Federal Requirement
In accordance with 42 CFR, Part 455, Subpart B, and as required by CMS, facilities and businesses must disclose ownership and control interest prior to payment for any services rendered to Medicare or Medicaid enrollees.
Action Required
UnitedHealthcare Hearing requires disclosure forms from these states only:
- Louisiana
- Massachusetts
- Minnesota
- New Jersey
- New Mexico
- New York
All other states require disclosure forms be submitted directly to the state. It’s your responsibility as a contracted provider with UnitedHealthcare Hearing to ensure your disclosure of ownership and control interest forms are updated any time there are changes to information previously provided. Updated disclosure forms are generally required every 3 years.
Please complete the appropriate disclosure form for your respective state based on the type of ownership applicable to your practice. Submit your completed and signed disclosure of ownership and control interest form as a case here: DOO Form Case.
Provider resources
State-specific Disclosure of Ownership forms
In order to comply with federal regulations, we may be required to suspend payment to providers who fail to comply and not submit a valid, completed disclosure form to UnitedHealthcare Hearing.