Optum Idaho Provider Manual
Optum Idaho Provider Manual
June 2019 Edition
November 2018_updated June 2019 BH2127a_06/2019
United Behavioral Health operating under the brand Optum
Table of Contents
Resource Guide
3
Introduction / About United Behavioral Health (UBH), Optum and Optum Idaho
10
Glossary of Terms
13
Network Requirements
24
Idaho Behavioral Health Plan (IBHP) Benefits, Authorization Requirements and
32
Access to Care
Utilization Management Guidelines
70
Treatment Philosophy
75
Treatment Record Documentation Requirements
81
Privacy Practices
86
Quality Improvement
88
Achievements in Clinical Excellence (ACE) Clinicians
93
Compensation and Claims Processing
95
Anti - Fraud, Waste and Abuse
100
Appeal and Provider Dispute Resolution
104
Manual Updates and Governing Law
109
Member Rights and Responsibilities
110
Youth Empowerment Services (YES) System of Care
113
Youth Empowerment Services Program Definitions: Glossary of Terms
114
Youth Empowerment Services Program: Benefits, Authorization Requirements and
117
Access to Care
November 2018_updated June 2019 BH2127a_06/2019
United Behavioral Health operating under the brand Optum
Resource Guide
Optum Idaho Network Management
Your Optum Idaho Network Management team is here to support you in the provision of quality care to all Idaho Behavioral Health Plan (IBHP) Members. The team consists of seven fulltime employees dedicated to ensuring the Optum Idaho network meets the needs of the IBHP membership statewide. Their primary location of operations is at the Optum Idaho office in the Boise area at:
Optum Idaho 205 East Watertower Street Meridian, ID 83642
Network Director ? responsible for overseeing the development and management of the Optum Idaho network to ensure that the IBHP membership has optimal access to quality care for all IBHP covered services.
Regional Network Manager ? responsible for ongoing development and management of the Optum Idaho network in Regions 1 & 2.
Regional Network Manager ? responsible for ongoing development and management of the Optum Idaho network in Regions 3, 4 & 5.
Regional Network Manager ? responsible for ongoing development and management of the Optum Idaho network in Regions 6 & 7.
Network Associate ? responsible for providing administrative support to the Optum Idaho network team Members.
Community Agency Liaisons ? responsible for coordinating the interface between the Optum Idaho clinical team and all IDHW partners (including the courts, juvenile justice, department of corrections, as well as child and family services).
This team can be reached during regular business hours by calling the Optum Idaho Provider Services line at 1-855-202-0983.
Websites
Optum Idaho Providers have access to a host of web-based information and resources through our Idaho website , which is designed to reduce their administrative burden and increase their effectiveness. The foundation of this is easily accessible information such as Provider forms, Provider manuals, Level of Care Guidelines, policies and procedures, relevant
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United Behavioral Health operating under the brand Optum
news articles, and on-line training, including Continuing Education Units (CEUs) to maintain licensure. We provide secure tools to reduce the administrative tasks, such as online verification of Member eligibility and benefits, treatment authorization request and verification, submission of behavioral health claims online, EDI support so that Providers can easily get their claims processed, status of submitted claims (in accordance with national standards), and the ability to register online to receive electronic payments directly into their bank account.
Resources available on include: ? Optum Idaho Provider Manual
? Optum Idaho Level of Care Guidelines
? Link to Online Verification of Member Eligibility and Benefits
? Link to Online Treatment Authorization Request and Verification
? Link to Online EDI Support
? Link to additional Provider training resources: ? Relias Learning at ? OptumHealth Education at
? Access to Standard Screening Tools for primary care physicians
The portal contains direct links to all resources available on the Optum primary Provider portal at .
Our industry-leading Provider website includes both public and secure pages. Public pages include general updates and useful information. Secure pages are available only to network Providers and require registration. The password-protected "secure Transactions" gives you access to Member and Provider-specific information.
To Register for Access: Select the "First-time User" link in the upper right hand corner of the home page and follow the prompts.
Secure Transactions: ? Check eligibility and authorization or notification of benefits requirements
? Obtain initial authorization or notification requests, if applicable
? Create and maintain My Patients list
? Submit professional claims and view claim status
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United Behavioral Health operating under the brand Optum
? Make claim adjustment requests
? Register for Electronic Payments and Statements (EPS), including Electronic Funds Transfer (EFT)
? Update practice information: ? Add NPI ? Add Taxonomy Code(s) ? Update Languages Spoken ? Update email address ? Update gender ? Add Medicaid/Medicare Numbers ? Update expertise ? Update ethnicity ? Manage address locations, including practice, remit, and credentialing ? Admitting privileges ? Update phone and fax numbers ? Availability status ? Accessibility-practice hours, wheelchair accessibility, public transportation, etc.
? View Achievements in Clinical Excellence (ACE) and ALERT Online Scorecards
? Obtain pre-populated Wellness Assessments
? Link to Clinician version of to get patient education resources in English and Spanish (see below)
Public Pages
The home page includes "Quick Links" to our most frequently accessed pages as well as recent news and updates:
? Access the latest information about ALERT?
? Obtain ACE program updates
? Download standard forms
? Find staff contacts
? Review clinical guidelines
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