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You could earn more on top of your contract fees

NAVIGATING OPTUM

Welcome

An Optum overview

First time logging into Provider Express

What is a Provider Advocate (formerly Network Manager)

How to contact Optum

AUTHORIZATIONS & BENEFITS

Covered Benefits for Members

Eligibility and Benefits

Prior Authorization of Service

Coordination of Care

 

 

 

BILLING & CLAIMS

File your claims electronically

Provider Express claim entry

Electronic Data Interchange (EDI)

Claim tips

Get paid faster

Claim Inquiry and Adjustments

 

DATA VERIFICATION

Updating your practice information

HELP IMPROVE MEMBER ACCESS

Join the Express Access Network

Easy to offer Telemental Health Services

Keep your practice information current on Provider Express

PROVIDER RESOURCES

Optum Video Channel

Earn up to 3% more than contracted fee schedules

ALERT

Achievements in Clinical Excellence

Frequently Accessed Forms

Guidelines/Policies & Manuals

Provider Express Support

Autism/Applied Behavior Analysis

Navigating Optum Webinar Deck

NAVIGATING OPTUM ON-DEMAND

View pre-recorded webinar here

Navigating Optum FAQs

Navigating Optum Webinar Deck

Autism/Applied Behavior Analysis

It starts by submitting more Wellness Assessments

When you become an Platinum provider, as evaluated by the Achievements in Clinical Excellence (ACE) program, you may become eligible for all sorts of fantastic perks, such as:

*Due to state regulatory requirements, California, Colorado, Maryland, Missouri, New York and Texas provider tiering will not be displayed on clinician search results pages. If your practice resides in one of the excluded states, it’s very important that you continue submitting ALERT Wellness Assessments. Your data will continue to be evaluated, and you or your group’s data can still qualify for ACE perks such as free CEUs and the twelve-month fee increase.

In order to be eligible for all these benefits, you need to submit more Wellness Assessments (WA). As you may know, ALERT is built on a confidential, reliable and validated means of identifying targeted risk issues through a review of Wellness Assessment and claims data.  In addition, it provides a baseline measure of member functioning combined with later measures to reflect change in member functioning over time.

  • The WA is a one page assessment tool that you ask the member to complete at the first visit (or prior to the first visit) and then review with the member before faxing to Optum
  • The WA is administered again by you and completed by the member on session 3, 4 or 5 and again reviewed by you and faxed to Optum
  • Clinician participation rates in administering the Wellness Assessment are included in evaluation in the ACE program
  • The more WAs that are submitted, the better cases can be tracked, and the more Member outcomes will be reported back to you in aggregate

For more information on the ACE Clinicians program, click here.