Wellness Assessment - Frequently Asked Questions

• The one-page Wellness Assessment (WA) is offered to the member at multiple points during each episode of care to identify targeted risks
  and to measure treatment progress.
• Clinicians provide the WA to each new Optum member (or to the parent/guardian of a child or adolescent) at session one or,
  if the member is in crisis,
  at the second session.
• Former clients returning to treatment for a new episode of care (typically billed with CPT code 90791 or 90792) should also complete
  the WA at session one of the new episode-of-care.
• A second WA is administered at session 3, 4 or 5.
• Care Advocates receive algorithm results based on member responses to the WA and may contact clinicians to conduct a brief clinical review
  and to assist in coordinating additional services, when indicated.
• You may receive a letter alerting you to a targeted risk which has been identified. This letter does not require a call back to Optum;
  however, if you need additional resources, you may call a Optum Care Advocate for assistance.
• Some targeted risk factors identified after the review of the second WA may result in a clinician being asked
  to administer a third WA at a later point.
• If a member did not complete the WA at session one and does not return for a second session, please complete the client
  and clinician demographic sections located at the top of the WA, fill in the “MRef” bubble, and return it to Optum.

It is important to print clearly, using all capital letters. When reviewing with the member, please ensure the circles are shaded completely and that only one answer is provided per question. Any stray marks or comments are not interpreted during automated processing. For complete instructions, please refer to the Wellness Assessment Instructions page.

To print forms with clinician and client demographic information already entered, simply log into the secured transaction pages at www.providerexpress.com. After logging in, click on More > Wellness Assessment from the main menu.

Wellness Assessments are available for download in both English and Spanish on the Forms page. Optum recommends downloading forms regularly because routine photocopying may diminish the quality of the form, potentially rendering it unreadable to the automated scanning process. 

Please submit the Wellness Assessment by fax to 1-800-985-6894 for efficient processing. We suggest that you check your fax confirmation page to verify receipt of the fax and to ensure a proper connection to Optum.

You may also submit the Wellness Assessment by mail to:

Optum/OHBSC
Attn: Wellness Assessments
PO Box 30780
Salt Lake City, UT 84130-0780

All members, including those who initiate services under their EAP benefit prior to transition to Mental Health/Substance Abuse (MH/SA) benefits (see EAP Procedures) should be offered a Wellness Assessment. Many, but not all, UnitedHealthcare members have mental health benefits administered by Optum. In addition, Optum is the MH/SA carrier for many regional and national employers. It is important for clinicians to call the number on the back of the Member’s insurance card or check member benefit on Provider Express to determine benefits.

The return to treatment begins a new episode of care, requiring the completion of a new Wellness Assessment with the filing of a 90791 or 90792 CPT code. So, a Wellness Assessment is offered in that first or second session and then again at either session 3, 4 or 5 of the new episode of care.

No. The member for whom you file claims should complete the one-page Wellness Assessment. If the member is a minor (except for minors who are emancipated or able to consent to their own treatment under the laws of your state), the parent or guardian should be asked to complete the Wellness Assessment – Youth form, answering the questions as they relate to the identified patient.

No. The member should then be offered the Wellness Assessment at the beginning of treatment with you. Fill in the session bubble marked “3 to 5.” If you are not sure whether the Wellness Assessment had been offered at the first or second session, then fill in the bubble marked “other” instead.

Completion of the one-page Wellness Assessment is voluntary for the member. If a member declines to complete the Wellness Assessment, complete the demographic sections located toward the top portion of the Wellness Assessment, fill in the bubble labeled “MRef” (indicating member refusal) and return it to Optum. Network clinicians are expected to facilitate member completion of the Wellness Assessment. In our experience, member refusal is rare when the Wellness Assessment is presented in the context of being actively engaged in the treatment. For information to assist with client education and to help answer questions that members may have about the WA, click on the WA Forms and Handouts link on the ALERT page. An individual member’s decision not to participate does not negatively impact measures of your participation.

In these circumstances, you should only complete the demographic sections located at the top of the Wellness Assessment, fill in the “MRef” bubble and return it to Optum. This ensures that a follow-up assessment will not be sent to the adolescent’s home thereby protecting their confidentiality.

No. Information contained in the Wellness Assessment is confidential and held to the same standards of protection as any other written or verbal communication. Optum safeguards member Protected Health Information (PHI) in observance of HIPAA guidelines. More information about Optum Privacy is available on Provider Express. members with additional concerns are welcome to contact Optum directly to speak with a Care Advocate.

Participation in utilization management process, including submission of the Wellness Assessment and responding to requests for clinical reviews, is a required part of Optum clinical management and quality improvement programs.

• All members should be asked to complete the one-page Wellness Assessments (WA)
• If a member reports he or she has already completed a WA with the EAP clinician, it is not necessary to have them complete an initial session WA; however, a second WA should be offered at session 3, 4 or 5

Care Advocates are all licensed clinicians with prior clinical experience working in the private, non-profit, and/or public sectors.

When calling to complete a review, please have the member’s chart available. The review will consist of a brief clinical update including ICD 10 diagnosis, current symptoms, services provided including frequency and duration, goals, interventions, progress to date, and estimated length of continued treatment.