Platinum Recognition for Facility-Based Programs

Special Note to Facilites - All Levels of Care 

It's critically important that you inform Optum at the time of member discharge or step-down to a lower level of care. Failure to do so will result in delays of reimbursement, and very possibly denial of submitted claims. Reporting member discharge is consistent for all levels of  care, including acute inpatient, residential and partial hospitalization. Additionally, facilities may be contacted by Optum for intervention or review on an as needed basis, for admissions demonstrating significant complexity and/or recent chronicity.  

Reviews Are Done on an Annual Basis 

Data on all Platinum Recognition Programs is completed on a 12-month look-back cycle each spring. When the data run is completed, Optum will notify facilities of their status via letter instructing them to go to Provider Express to view their data.

The purpose of the Platinum Recognition Program  is to recognize and reward facilities for delivering effective and efficient care

The Platinum Recognition Program endeavors to evaluate facilities based upon trends in health care, as well as the feedback we garner from our network providers and facilities. Listening to what you have to say presents Optum with a fantastic opportunity to incorporate your thoughts and innovations into an evaluation program that is better for you, our members and the behavioral health community at large. Using unbiased data that is quantified and compared to regional program benchmarks, Platinum excels at utilizing data to measure variations in practice patterns, which drive increased costs and poor clinical outcomes.

The Platinum Recognition Program provides an evaluation of facility performance and is based on an annual, data-driven assessment. We use benchmarks that are developed from similar patient cohorts by Level of Care, Condition Category, and Product Type.

Platinum Recognition Program allows for more specific comparisons of facility-based behavioral health programs. We will identify Platinum programs within the three condition categories: General Mental Health, Substance Use Disorders and Eating Disorders.  And in addition, we monitor performance separately in three levels of care: Inpatient, Residential, and Partial Hospitalization.