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Welcome to the Optum Network!

Optum Network Manual

Best Practice Guidelines

Autism/Applied Behavior Analysis

InterQual Level of Care Guidelines are used and criteria can be provided upon request for specific cases.

ASAM Level of Care Guidelines are used for Substance Use Disorder (SUD).

Additional information and forms are available, including psych/neuropsych testing guidelines, credentialing plans, and Disability Solutions Manual, on the Provider Express Guidelines/Policies & Manuals and Optum Forms pages.

 

Indiana Medicaid Network Participation

How to Submit an Optum Participation Request:

  • Go to Join Our Network and click on the button associated with your provider type (e.g., Individual Clinician, Agency, Facility, Autism/ABA)
  • Provider Network Participation Process Definitions and the Summary of IN Medicaid Provider Credentialing Policy are listed under “Important Materials regarding joining the network” below

Individual Clinician Requirements:

Individual Clinician Step by Step Guides:

Agency Requirements:

Facility Requirements:

Autism/Applied Behavior Analysis:

Submitting Additional Supporting Documentation:

  • Required Documents are attached within the on-line applications. If additional documents are required, contact your Provider Relations Advocate.  Turn-around-time for a response from Provider Relations is within 2 business days.

** If you do not meet the requirements as outlined above, you cannot be credentialed with Optum.

Indiana Medicaid-Specific Resources

Provider Communications and General Resources
Important Materials regarding joining the network

Network Participation Process Definitions

  • Enrollment - The process of loading a contracted and credentialed provider to all MCE internal systems, loading for claims payment, and loading to the provider directory (if applicable).
  • Credentialing - The process of reviewing the qualifications and appropriateness of a provider to join the health plan's network. Credentialing requirements and processes will follow NCQA guidelines.
  • Contracting/Negotiating – The process of the provider and MCE formally executing an agreement for the provider to deliver medical services that outlines reimbursement rates, scope of services, etc.

 

Step-by-step Guides to Complete the Application

 

Network Effective Policy Summary 

Claims

UnitedHealthcare Community Plan
P.O. Box 5240
Kingston, NY 12402-5240

  1. Claims, Appeals/Disputes and Payments;
  2. Eligibility and Benefits

 

Prior Authorization and Appeals

For BH prior authorization, please submit the Universal PA form to 844-897-6514.


For appeals information: uhcprovider.com/Indiana

Training Resources

Indiana Hoosier Care Connect Behavioral Health Provider Training

IN Medicaid Tips

E4 Center – Rush Center for Excellence in Behavioral Health Disparities in Aging

Contacts

Provider Relations Advocate

Belen Stewart (Northern Indiana Counties)

Main Number: (612) 632-5962

Fax Number: (855) 572-3643

Northern Indiana Counties: Adams, Allen, Benton, Blackford, Carroll, Cass, Clinton, DeKalb, Elkhart, Fulton, Grant, Howard, Huntington, Jasper, Jay, Kosciusko, LaPorte, LaGrange, Lake, Marshall, Miami, Newton, Noble, Porter, Pulaski, St Joseph, Starke, Steuben, Tippecanoe, Tipton, Wabash, Warren, Wells, White, Whitley

 

David Hoover (Southern Indiana Counties)

Senior Provider Relations Advocate

Main Number: (763) 330-7588

Fax Number: (855) 572-3643

Southern Indiana Counties: Bartholomew, Boone, Brown, Clark, Clay, Crawford, Daviess, Dearborn, Decatur, Delaware, Dubois, Fayette, Floyd, Fountain, Franklin, Gibson, Greene, Hamilton, Hancock, Harrison, Hendricks, Henry, Jackson, Jefferson, Jennings, Johnson, Knox, Lawrence, Madison, Marion, Martin, Monroe, Montgomery, Morgan, Ohio, Orange, Owen, Parke, Perry, Pike, Posey, Putnam, Randolph, Ripley, Rush, Scott, Shelby, Spencer, Sullivan, Switzerland, Union, Vanderburgh, Vermillion, Vigo, Warrick, Washington, Wayne

Indiana Autism/ABA Network Management
(877) 614-0484