January/February 2025 

National

New year, new National Network Manual

How you request IOP services is changing

What's new for Platinum in 2025?

Oxford behavioral membership has a new home

Northeast

MA: Professional development at your fingertips

NY: New! Child Health Plus adds benefits in 2025

NY: Updated reimbursement rates for Commercial plans

NY: Take two of these for better health

NY: Partner with us to support HARP members in recovery

VA: How you submit prior authorizations is changing

Southeast

GA: Welcome XO Health

TN: Attention out-of-network providers: Commercial Prior Authorization request submission change

Central

KY: Look out 2025 – We're ready to grow

MN and TX: Welcome XO Health

NM: Turquoise Care members get a lift

NM and TX: Providence Employee Health Plan change

West

AK, CA, MT and WA: Providence Employee Health Plan change

CA: Don't delay! Respond quickly to records requests

Announcements

CPT code 96146 has been added to the National Gold Card code exemption list

The STAR submission tool is available to all – training is now optional

Training

Join Us at the ATTACh Conference April 3-5

March 2025 

National

Digital ABA Authorization Saves Time

Closing gaps: HEDIS measure updates

Annual wellness visits: Spring is the time to plant healthy habits

Northeast

MA: Gender affirming care

Southeast

FL: Caregivers get some care now, too

FL: Medicaid now covers alternative services 

Central

KY: Community-based support is available

West

CA: Gender affirming care 

CA: New California network manual

April 2025 

National and Announcements 

April 24:  Two-factor authentication is required to access the Provider Express secure portal

Learn how Emotional Wellbeing Solutions can expand patient relationships and your business

Make it easy for members to find you:  update your provider data today

Northeast

MA: Removal of restrictions for certain Community Support Programs requires using updated billing codes

NY: How to increase patient engagement to improve outcomes

Southeast

New to Optum? Attend a Navigating Optum session to discover tools and resources you’ll use when working with us

VA: ​Billing update for outpatient services delivered under supervision​

Central

TX: Texas Medicaid now covers Certified Family Partner support for caregivers of children and youth

New to Optum? Attend a Navigating Optum session to discover tools and resources you’ll use when working with us

West

CA: New state regulations require at least one mental health screening during pregnancy and postpartum

May 2025 

National and Announcements 

You can now check status and submit medical records for payment reviews online 24/7

Review this quick reference guide for key 2025 American Medical Association CPT code updates

There's no need to call us to report discharges — you can now use the secure provider portal

Northeast

MA: Review the MassHealth requirements for post-hospital discharge planning and tracking homelessness.

NJ: Review the UnitedHealthcare Community Plan of New Jersey requirements for member access to care

RI: As of Sept. 1, 2025, Optum will no longer manage behavioral health benefits for Rhode Island members

Southeast

VA: ​DMAS enrollment required to provide and get paid for services to Virginia Medicaid members​

Central

IN: Learn how the Outpatient Care Engagement program streamlines care delivery while improving outcomes

June 2025 

National and Training

This month, the Provider Express homepage will have a new look for easier navigation

The 2025 Platinum results are in: See if your facility is a top performer and how facility programs earned this distinct designation

Are you new to the Optum network? Attend a Navigating Optum session to discover tools and resources you’ll use when working with us

Northeast

NY: Starting July 1, providers must bill with modifier 93 for Medicaid audio-only telehealth claims

NY: Plan now for required audits

PA: Coverage for Children’s Health Insurance Program enrollees expands to 12 more counties June 16

Central

KY: Medicaid prior authorizations are back

MN: Start early to submit claims for dates of service through Dec. 31, 2024 before the June 30 deadline

West

CA: Support for providers affected by the southern CA wildfires available until Sept. 15, 2025

July 2025 

National and Training

Level of care updates in 4th Edition Criteria affect national authorization exemptions for SUD PHP

Northeast

NY: Do your HCBS referrals and authorizations comply with the new guidelines?

Southeast

FL: ​Criminal Justice and Crisis Intervention Programs help Medicaid members recently incarcerated or in crisis find and obtain mental health services

VA: ​Medicaid MHS authorization process change: Starting Sept. 4, 2025, you can submit and view Medicaid MHS prior authorizations via Provider Express

Central

WI: Forward Health Medicaid: Check out these tips to reduce common claim denials for timelier claim payments

West

CA: Just In: MY2024 Appointment Availability Survey results are now available

CO: Rocky Mountain Health Plans providers — update your email so you don’t miss key alerts

August 2025 

National

Check your Gold Card waiver status starting Sept. 1

National Network updates: effective Oct. 1, 2025

Timely Appointment Standards for Individual and Family Plan Members

The importance of metabolic testing for patients with severe mental illness

Northeast

NH: Confused about Behavioral Health Integration and collaborative care billing?

NY: Medicaid providers: OASAS outpatient rehab billing code changes

Central

OH: Prevent Medicaid claim edits and get paid faster

West

CA: California Network Manual updates

CA: The annual Provider Appointment Availability Survey begins this month

September 2025

National and Announcements

Don’t forget the rendering provider NPI on claims

Meet Medallion: Our new credentialing partner

Boost your bottom line

Did you earn a National Gold Card prior authorization waiver?

Effective Sept. 1, 2025: Optum ABA Supplemental Clinical Criteria has been updated

Northeast

NY: Are your patients engaged?

Central

MO: Are you showing up in member searches?

NE: Don’t stall; update your license today

Southeast

LA: Make sure you're on time

October 2025

National and Announcements

Who doesn’t love efficiency?

Testing 1-2-3

Psychotherapy and E/M billing: As easy as 1-2-3

Updated National Network Manual 

Training

NJ: Got questions about NJ FamilyCare?

Northeast

MA: MGBHP expands D-SNP plans in 8 counties

MA: Be Seen: Update AOE in the portal

NY: Medicaid OASAS billing changes coming

Central

MI: LOCUS and MichiCANs screenings required

MN: Provide care to those who care for us

Multiple: Medica to exit select markets in 2026

Southeast

LA: Important opioid treatment changes

West

AZ: Welcoming 2,000 seniors by year-end 2026

CA: Required annual articles are here

November 2025

National and Announcements

New year, extended telehealth benefits

Important IOP and PHP billing changes

Training

NORTHEAST: Get ready for 2 new MGBHP D-SNP plans

Northeast

MA: Need a prior auth? Use the new digital process

NY: TMS treatment available for NY Medicaid

Central

CO: Plan ahead and help members find you in 2026

MN: Prior authorization changes coming

Southeast

FL: Ultimate Health Plans members move to Optum

West

CA: Welcoming 3,500 Medicare Advantage members

December 2025

National and Announcements

Want to expand your network?

Tick Tock: Time to use the new ABA form

Training

NORTHEAST: Don’t miss out on MGBHP D-SNP training!

Northeast

MA: Inpatient prior auth process update

MA: Medicaid urgent care billing code updates

MA: Changes coming for CANS assessment

West

CA: Resources and tools for California providers

CA: Keep a Sharp lookout in 2026!

CA: Change in Sutter Health Plan administration

CO: Western Colorado area plan changes coming

July 2024 

National 

Want to Provide Intensive Outpatient Services to Medicare Members?

New areas of expertise show providers’ military affiliations 

Merchant ID needed to process Care Cash debit cards

Updated National Network Manual now available

Transition to ASAM 4th Edition criteria underway

Central

NE: Claims being denied for one of these common reasons? 

Training

Diversify Your Business With EAP Referrals 

Announcements

It’s Now Easier to Find Prior Authorization Information on Provider Express

Update your communication preferences in My Practice Profile

August 2024 

National

UnitedHealthcare launches national Gold Card Program

Join Us at the ATTACh Conference Sept. 12-14

Gain access to important medical info for your clients 

Billing Guidelines Updated for DSNP Members

Claims for Peer Support Services Being Denied?

Avoid claim denials or delays with these tips

Improve care and equity with OutCare’s LGBTQ+ courses

September 2024 

National 

Go for the Gold Card - check your waiver status today

Central 

Texas: Texas moms need you. Help them find you by identifying as a maternal mental health provider.   

Northeast 

Connecticut: Numbers don’t lie. Except on outdated ID cards

Massachusetts: Time is on Your Side Thanks to a new online ABA prior authorization submission process

New York: Notification required for SUD complex care

Rhode Island: Enroll with Medicaid to prevent claim denials

October 2024 

National 

Medicare prior authorization list is now online

National Gold card waivers effective Oct. 1

Free, live, accredited webcast Nov 6: Lethal Means Saftey: Critical focus in suicide prevention 

2023 claim audits coming for Oscar Health Plan members

Feel the need for speed? The Provider Express secure portal delivers!

Central 

Minnesota: Avoid claim denials if you're contracted with a Medicaid MCO or have recently billed as an MCO network provider

Northeast 

New York: Foster care provider education updated

West

Arizona: New appointment availability training required for Medicare providers

California: You'll start seeing the standard Optum logo on provider and member communications

November 2024 

National 

Connecting care, mind and body - the benefits of value-based care

Updated state-specific mobile crisis listings now available

Attend a free webinar on Nov. 21 and learn about the Surest health plan

Help more patients find your SUD programs

More convenience ahead for the online STAR prior authorization tool

Does the HIPAA privacy rule always rule?

Central 

Register for a free webinar on Dec. 4 and get answers on how to support Minnesota firefighters through Optum EWS 

Change to UnitedHealthcare Community Plan of Minnesota Medicaid coverage for 2025

Northeast 

Pennsylvania: Now you can submit prior authorization requests online any time

Rhode Island: Neighborhood Health Plan of Rhode Island will no longer require prior authorization for in-network services

New Hampshire: Optum will no longer manage behavioral health benefits for Harvard Pilgrim Stride

West

CA: Key reminders for providers

WA: Benefits administration change for Premera Blue Cross Medicare Advantage

Highlight your trauma expertise in the Optum provider directory so members can find you at a glance

Southeast

Florida: New Areas of Attested Expertise Available to you in 2025 

Louisiana: Learn what you need to do so you can assist those in crisis

Louisiana: Submitting Commercial prior authorization requests is easier with a new online process

Mississippi: Submit your prior authorization requests online any time