August 2025 Top of Mind

Updated California Network Manual now available

Mid-year updates have been added to the California Network Manual for Optum Behavioral Health providers.  And remember to replace previous downloaded versions with the updated manual.

Check out some of the key changes:

New items

• Added Individual and Family Plan (Exchange) appointment wait time standards
• Added guidance on discharge planning for inpatient psychiatric facilities and units
• Expanded information and guidance for the HEDIS measures on follow-up care after an emergency room visit or hospitalization for behavioral health, including the timeline for outpatient follow-up appointments after discharge
• Changed claims payment time from 45 to 30 calendar days for commercial and Medicaid business only (effective Jan. 1, 2026)

Updated information

• Clarified reimbursement for outpatient behavioral health services rendered by unlicensed practitioners working towards clinical licensure or other practitioners not eligible to practice independently
• Updated contact information for the Optum Provider and Network Integrity department
• Added more details around collaboration and utilization management in the Outpatient Care Engagement program
• Expanded guidance around discharge planning from inpatient psychiatric hospitals, including the requirement to provide notice of anticipated discharge 24 hours in advance, and the need to have follow-up appointments scheduled prior to discharge and for the appointments to be within 7 days of discharge

See the Change Index on page 4 of the manual for details.

Questions? 

Call Provider Services at 1-877-614-0484