Welcome to the Optum Network!
UPDATED 12/12/22
Optum has received updated guidance from the Executive Office of Health and Human Services (EOHHS) dated November 28, 2022, which include three additional codes: H0046-U1, H0046-HO-U1, H0046-HP-U1 (outlined in the table below) that are effective July 1, 2022, for Children’s Medicaid Services.
The three new codes will be configured on Optum’s claim platforms by December 19, 2022. Claims for these services, with dates of service beginning July 1, 2022, can be submitted after December 19, 2022.
UPDATED EFFECTIVE 9.23.22
Attention Optum Providers who have received a recoupment letter related to POS10 vs POS02
The payment recovery request that was initiated due to POS 10 billing rules not being in effect for Optum NHPRI until April 4, 2022 will cease. Any Optum NHPRI claim billed with POS 10 from 01/01/2022 to 03/31/2022 will be processed for payment and all recovery efforts stopped. No additional action is required for providers to receive payment for DOS 01/01/2022 to 03/31/2022.
Rhode Island Provider Resources
21st Century Cures ACT
- The 21st Century Cures Act (Cures Act) 114 P.L. 255 requires all States to screen and enroll all Medicaid providers, both those in Medicaid fee-for-service (FFS) and managed care organizations (MCOs). Medicaid managed care network providers, regardless of specialty, are required to be screened by and enrolled with the State Medicaid Agency. Federal laws enforced by CMS, including the Affordable Care Act and the 21st Century Cures Act, require states to screen and enroll all providers. Providers who do not comply with this requirement risk being removed from the Rhode Island Medicaid managed care network.
- RI Executive Office of Health and Human Services (EOHHS) has begun the screening and enrollment process providing the following FAQ to assist you with your enrollment. If you have additional questions or concerns that are not answered by the EOHHS Provider Enrollment User Guide, please contact our EOHHS Customer Service Help Desk at (401) 784-8100 for in-state and long-distance calls, or 800-964-6211 for in-state toll calls. You may also email RIProviderServices@gainwelltechnologies.com.
Optum Network Manual
Clinical Criteria
Best Practice Guidelines
Coordination of Care (COC)
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.
Rhode Island Resources
Optum BH provider training refresher
- C&S RI Medicaid Prior Auth and Notification Information
- Rhode Island Medicaid Prior Authorization Approval Notice
- RI Telehealth/Virtual Visits Billing Requirements
- Virtual Visit Attestation Information
- Express Access Network
- Optum Networks Overview
- Important Sections on Provider Express
- NPI and Taxonomy requirements on claim submissions information
- RI Provider Appointment Availability
- EOHHS HBTS Multiple Provider addendum effective 060821
- Optum and NHPRI Escalation Process
- Optum and UHC Community & State Escalation Process
- RI COB Provider Training
- Updating Provider Directory Data – Directory Attestation Guide
Neighborhood Health Plan of Rhode Island
If you have questions regarding NHP of Rhode Island directives related to COVID-19, please contact your Provider Relations Advocate.
We are providing links to support required training for providers serving Neighborhood Health Plan of Rhode Island (NHP of RI) INTEGRITY members.
Click here to learn about training and attestation requirements and to access links to training provided by NHP of RI.
After completing the trainings, you will be asked to attest to having completed those and, at that time, will also be asked to attest to information related to these topics:
- Neighborhood Policies and Procedures
- Provider Rights and Responsibilities
- ADA Compliance, Accessibility and Accommodations
- Cultural Competency Training
- INTEGRITY (Medicare-Medicaid Plan) Training