Welcome to the Optum Network!

At least annually, the Health Plan will remind all physical health and behavioral health, providers of their role in providing comprehensive health care and the importance of integrated physical and behavioral health, especially for people experiencing chronic physical and/or behavioral health issues. In this reminder, PCPs will be encouraged to use State-approved screening tools and other resources to facilitate early identification of behavioral health needs.

Optum Network Manual

• Network Manual

Clinical Criteria

• Standard Clinical Criteria

Best Practice Guidelines

• BP Guidelines

• ABA

Coordination of Care (COC)

• COC Flyer
• COC Checklist

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.

Optum and UnitedHealthcare Community Plan

KY Medicaid Behavioral Health Prior Authorization List

Behavioral Rehabilitative Services Request Form

Medicaid Certification of Need For Inpatient Psychiatric Services For Individuals Under Age 21 (MAP)

Optum has adopted the InterQual® Care Guidelines for guidance on clinical criteria decisions for the treatment of behavioral health conditions for Kentucky Medicaid membership.  The InterQual® criteria Care Guidelines are proprietary to InterQual® and are not published on this website.

Kentucky Health Information Exchange

If you have questions about KHIE or want to begin the connection process, please email KHIE@ky.gov, Call 502-564-7992 EXT 2800 or online via https://khie.ky.gov/Pages/index.aspx