Welcome to the Optum Network!
Ohio Provider Resources
Optum Network Manual
Best Practice Guidelines
Coordination of Care (COC)
Health Care Provider Summary Disclosure Form
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.
Ohio Medicaid and MyCare Specific News
- Provider Alert: Ohio ACT and IHBT Prior Authorization Process Change
- Provider Alert: Changes for Out of Network Providers as of 10/01/20
- Provider Alert: Y11 Claims Denial 7/02/18
- Provider Alert: Agency Registration and Affiliation 3/26/18
- Provider Alert: Behavioral Health Redesign Billing 2/21/18
- Provider Alert: Behavioral Health Redesign Billing 2/27/18
- Current OH Global Claim Issues:
- 1. Certain codes are underpaying due to the 08/01/19 fee updates. System corrected as of 10/14/19. Claims rework project in process.
- 2. HCPCS codes H2017 and H2019 with no modifiers billing with Place of Service 11 and 53 are paying inaccurately. System fix in process.
- 3. HCPCS code H0040 denying for No Prior Authorization invalidly. System corrected as of 12/02/19. Claims rework project in process.
- 4. CPT code 96372 is denying as Non-Covered incorrectly. System fixed as of 10/28/19. Claims rework project in process.
- 5. CPT code 99215 for CNP and CNS is paying at a lower rate. System fixed on 08/06/19. Claims rework project in process.
- 6. Claims are denying invalidly for Provider Type 21 is also a Provider Type 84/95 as non-Contracted. System fixed as of 07/15/19. Claims rework project in process.
- 7. Claims denying incorrectly with denial code A17, NPI not billed. System corrected on 01/15/19. Claims rework project in process.
- 8. CPT 90833 is underpaying. System corrected on 10/07/19. Claims rework project is in process.
- 9. CPT 99349 with Place of Service 16 is receiving an A02 No Authorization Denial invalidly. System corrected on 12/20/19. Claims rework project in process.
- 10. Certain Providers are not receiving their Capital Add-On Rate with their APR-DRG rate. System fix in process.
- 11. E&M code 99215 or Telehealth is denying for the GT modifier in some occasions.
- 12. CPT Code H0015 is denying with POS 11.
ODM Behavioral Health Redesign website: http://bh.medicaid.ohio.gov/
UnitedHealthcare Community Plan Provider Administrative Manuals: http://www.uhccommunityplan.com/health-professionals/oh.html
Attention Agencies (CMHCs & AODs):For additional questions on contracting, credentialing, current status, or other items please email: OhioNetworkManagement@Optum.com
Special Note for Ohio Providers who provide Intensive Outpatient (IOP) and/or Partial Hospitalization (PHP). If you are a Provider Type 84/95 designed by the State of Ohio, and you provide PHP and IOP you will need to do the following to ensure you are contracted appropriately for Optum. (If you don’t know if you are a Provider Type 84/95 please click here to verify with the state’s list.
If you provide IOP and/or PHP to Medicaid only members, you will need to complete the Agency Application here.
If you provide IOP and/or PHP to Commercial and/or Medicare members, you will need to complete the Facility Application here.
If you provide IOP and/or PHP to Medicaid, Commercial and/or Medicare members you will need to complete BOTH an Agency Application and a Facility Application. You will need 2 separate contracts with Optum.