Welcome Indiana Behavioral Health Providers
Optum Network Manual
Best Practice Guidelines
Autism/Applied Behavior Analysis
InterQual Level of Care Guidelines are used and criteria can be provided upon request for specific cases.
ASAM Level of Care Guidelines are used for Substance Use Disorder (SUD).
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.
Indiana Medicaid Network Participation
How to Submit an Optum Participation Request:
- Go to Join Our Network and click on the button associated with your provider type (e.g., Individual Clinician, Agency, Facility, Autism/ABA)
- Provider Network Participation Process Definitions and the Summary of IN Medicaid Provider Credentialing Policy are listed under “Important Materials regarding joining the network” below
Individual Clinician Requirements:
- Indiana Approved License Information
- Link to Create or Update your CAQH Application
- Link to One Healthcare ID login. Click here to login and to check the status of your network participation application
- Common Issues During the Application Process
Individual Clinician Step by Step Guides:
- Provider Guide to Start the Application Process
- Step by Step Guide to Complete the Individual Application Form
Agency Requirements:
- Requirements, Required Documentation, Common Issues
- Step by Step Guide to Complete the Agency Application Form
Facility Requirements:
- Requirements, Required Documentation, Common Issues
- Step by Step Guide to Complete the Facility Application Form
Autism/Applied Behavior Analysis:
- Indiana Medicaid ABA Program Specific Information
- Requirements to participate
- General Requirements and the Link to the BCBA Application Forms
- Step by Step Guide to Complete the BCBA Individual Application
- Step by Step Guide to Complete the BCBA Agency Application
Submitting Additional Supporting Documentation:
- Required Documents are attached within the on-line applications. If additional documents are required, contact your Provider Relations Advocate. Turn-around-time for a response from Provider Relations is within 2 business days.
** If you do not meet the requirements as outlined above, you cannot be credentialed with Optum.
Important Materials regarding joining the network
Network Participation Process Definitions
- Enrollment - The process of loading a contracted and credentialed provider to all MCE internal systems, loading for claims payment, and loading to the provider directory (if applicable).
- Credentialing - The process of reviewing the qualifications and appropriateness of a provider to join the health plan's network. Credentialing requirements and processes will follow NCQA guidelines.
- Contracting/Negotiating – The process of the provider and MCE formally executing an agreement for the provider to deliver medical services that outlines reimbursement rates, scope of services, etc.
Step-by-step Guides to Complete the Application
- Guide to Complete the Individual App Form
- Guide to Complete the Agency App Form
- Guide to Complete the Facility App Form
- Guide to Complete the BCBA Individual App
- Guide to Complete the BCBA Agency App
Upcoming Webinars
Provider Communications and General Resources
- Behavioral Health Provider Directory
- CommunityCare Provider Portal User Guide
- HIPAA and 42 CFR Part 2 Privacy Policy and Procedures
- Indiana Medicaid: Members: How a return to normal will impact some Indiana Medicaid members
- Indiana Medicaid: Providers: FAQs – Top 10 Questions
- Indiana Medicaid Website
- Individual Health Record™ User Guide
- Provider Policy and Procedure Manual and Associated Forms
- Quarterly Provider Newsletter
Prior Authorization and Appeals
For BH prior authorization, please submit the Universal PA form to 844-897-6514.
- Universal Prior Authorization Form
- Substance Use Disorder (SUD) Universal Prior Authorization Form
- IHCP SUD Admission Assessment Form
- IHCP SUD Reassessment Form
- Psych-Neuropsych Prior Authorization Request Form
- United Healthcare Community Plan of Indiana Hoosier Care Connect Behavioral Health Prior Authorization List
For appeals information: uhcprovider.com/Indiana
Claims
UnitedHealthcare Community Plan
P.O. Box 5240
Kingston, NY 12402-5240
Contacts
Contact Us
For Treatment/Authorizations, Benefits/Eligibility, Claims, Appeals or any other member-related issue, access the Secure Transactions on Provider Express or call the Customer Service number on the back of the member's ID card.
Provider Relations Advocate
Paulette Means (Northern Indiana Counties)
Main Number: (612) 476-6567
Fax Number: (855) 572-3643
Northern Indiana Counties: Adams, Allen, Benton, Blackford, Carroll, Cass, Clinton, DeKalb, Elkhart, Fulton, Grant, Howard, Huntington, Jasper, Jay, Kosciusko, LaPorte, LaGrange, Lake, Marshall, Miami, Newton, Noble, Porter, Pulaski, St Joseph, Starke, Steuben, Tippecanoe, Tipton, Wabash, Warren, Wells, White, Whitley
Kristin Johnson (Southern Indiana Counties)
Senior Provider Relations Advocate
Main Number: (763) 330-4335
Fax Number: (855) 572-3643
Southern Indiana Counties: Bartholomew, Boone, Brown, Clark, Clay, Crawford, Daviess, Dearborn, Decatur, Delaware, Dubois, Fayette, Floyd, Fountain, Franklin, Gibson, Greene, Hamilton, Hancock, Harrison, Hendricks, Henry, Jackson, Jefferson, Jennings, Johnson, Knox, Lawrence, Madison, Marion, Martin, Monroe, Montgomery, Morgan, Ohio, Orange, Owen, Parke, Perry, Pike, Posey, Putnam, Randolph, Ripley, Rush, Scott, Shelby, Spencer, Sullivan, Switzerland, Union, Vanderburgh, Vermillion, Vigo, Warrick, Washington, Wayne
Indiana Autism/ABA Network Management
Olivia Smith
Main Number: (715) 833-6538
Fax Number: (855) 572-3643