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Details: Welcome to Provider Express. This is the provider website designed for behavioral health providers for Optum and its affiliates. Please select an icon below to go to the Regional site where you are located.

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Optum ID-One Healthcare ID

Details: Increases security: improves compliance with Health Insurance Portability and Accountability Act (HIPAA) Streamlines access: allows users to update profiles once for use by multiple applications; Resources. One Healthcare ID - Frequently Asked Questions ; Creating your One Healthcare ID (video runtime: 4:17) Quick Reference Guide

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Eligibility and Benefits

Details: Checking a Member’s eligibility for services and the available benefits is a crucial step in beginning to provide clinical services to Members.

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COVID-19 Telehealth Policies for Assessment Services

Details: Optum is taking action to ensure health plan members affected by COVID-19 (coronavirus) have the support and resources they need. Optum recognizes that assessment (psychological and neuropsychological testing) plays an important role in the provision of mental health and substance use disorder treatment.

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Health & Behavior Assessment and Intervention Medicare

Details: Health & Behavior (H&B) assessment and intervention procedures are used to identify and address psychological, behavioral, emotional, cognitive, and social factors important to the prevention, treatment, or management of physical health problems. The focus is not on mental health, but on the

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Level of Care Guidelines

Details: Co-occurring behavioral health and medical conditions can be safely and effectively managed in the proposed level of care. AND 2Services are medically necessary defined as: o Consistent with generally accepted standards of clinical practice;

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UBH Waived Cost-Sharing for Members for in-network non

Details: health plan at the time of service due to the rapidly changing situation. Optum continues to take actions and provide resources to support members and providers during this challenging time. Any changes to this or other temporary policies related to the health care emergency will be communicated through our COVID-19

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LEVEL OF CARE GUIDELINES: MENTAL HEALTH CONDITIONS

Details: for behavioral health benefit plans th at are managed by Optum and U.S. Behavioral Health Plan, California (doing business as OptumHealth Behavioral Solutions of California (“Optum -CA”)). The . Level of Care Guidelines. is derived from generally accepted standards of behavioral health practice . These

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Optum Reimbursement Policies

Details: Facility-Based Behavioral Health Program Professional Fees Reimbursement Policy. Facility-Based Behavioral Health Program Reimbursement Policy. Health and Behavior Assessment and Intervention Reimbursement Policy Commercial & Medicare. Inappropriate Primary Diagnosis Codes Reimbursement Policy. Incident to Billing Reimbursement Policy

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LEVEL OF CARE GUIDELINES: MENTAL HEALTH CONDITIONS

Details: recovery, resiliency, and wellbeing1 for behavioral health benefit plans that are managed by Optum and U.S. Behavioral Health Plan, California (doing business as OptumHealth Behavioral Solutions of California (“Optum-CA”)). The Level of Care Guidelines is derived from generally accepted standards of behavioral health practice. These

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Outpatient Psychiatric and Psychological Services

Details: approved providers of mental health services, the state licensure or authorization must specify that the provider’s scope of practice includes the provision of clinical psychotherapy for the treatment of mental illness. Psychiatrists are physicians (MDs and Dos) trained in mental health disorders and may provide all services described in this

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Health Care for Individuals with Intellectual and

Details: Developmental Disabilities Health Care E-Toolkit Resources 3. The links below highlight just a few of the helpful resources available from the Vanderbilt Kennedy Center e-toolkit for Primary Care Providers: Health Care for Adults with Intellectual and Developmental Disorders.

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COVID-19 Provider Updates

Details: The health of our members and the safety of those who deliver care are our top priorities. We’re taking action and providing resources to support our members and providers during this challenging time. United Behavioral Health (dba Optum Behavioral Health) and EAP are taking action to ensure health plan members affected by COVID-19

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Home Health Psychiatric Care: Medicare Coverage Summary

Details: 2. Services must be provided under a Home Health Plan of Care approved and signed by the treating physician. 3. Nursing services provided must meet the part-time or intermittent requirements for home health services. "In most instances, this definition will be met if a patient requires a skilled nursing service at least every 60 days." 4.

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Psychiatric Partial Hospitalization: Medicare Coverage Summary

Details: furnished by a hospital or community mental health center (CMHC) to patients with acute mental illness in order to avoid inpatient care through this type of ambulatory care. The Medicare psychiatric partial hospitalization benefit was established and is intended to furnish services in lieu of inpatient

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Claim Entry on Provider Express

Details: Provider Express Claim Entry is available to Optum network clinicians and group practices free of charge, 24/7, for outpatient behavioral health and EAP claims. The claim entry form is intuitive and easy-to-use – it allows you to data enter the required info and submit in real-time for quick processing.

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United Behavioral Health Credentialing Plan 2021 – 2022

Details: BH2948_01/2021 United Behavioral Health and United Behavioral Health of New York, I.P.A., Inc. operating under the brand Optum • “Credentialing Decision Date” is the date on which the Credentialing Committee makes its

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OH Public Health Care Program (OHPHCP)

Details: UnitedHealthcare Community Plan is a selected managed care administrator for Ohio Public Health Care Program (OHPHCP) members. Optum has been selected by UnitedHealthcare Community Plan to manage the Applied Behavior Analysis (ABA) program for OHPHCP members with an Autism Spectrum Disorder diagnosis.

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Guidelines/Policies/Manuals

Details: Optum behavioral health may develop Clinical Criteria that describe the generally accepted standards of practice evidence, prevailing standards and guidance supporting determinations made regarding specific services. When deciding coverage, the member’s specific benefits must be referenced. All reviewers must first identify member eligibility

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COVID-19 IOP-PHP Telehealth Policies

Details: For example, please review this COVID-19 Public Health Emergency Response and 42 CFR Part 2 Guidance. During the COVID-19 nationwide public health emergency, IOP/PHP providers should provide telehealth services in accordance with the OCR Notice.

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Home [www.providerexpress.com]

Details: This is the provider website designed for behavioral health providers for Optum and its affiliates. This page is new. Please select an icon below to go to the Regional site where you are located.

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Waiver of In-Network Outpatient Cost-Share for Essential

Details: mental health services provided on or after May 2, 2020, even if the course of treatment began prior to that date. Therefore, prior to collecting any cost-share amount, providers should ask the member whether they are or were employed as an essential worker at any time during the …

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Telemental Health Services Reimbursement Policy

Details: 1624a_Telemental Health Medicaid_04/2020 5 United Behavioral Health operating under the brand Optum U.S. Behavioral Health Plan, California doing business as OptumHealth Behavioral Solutions of California modifier for Ohio Medicaid and Ohio MME • CPT codes 90792, 90833, 90836 and 90838 are

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Welcome Louisiana

Details: For the latest Health Plan Advisories related to the COVID-19 crisis and related changes to the offering of services, please visit the links below. UHC guidance is reflective of the HPAs unless you have been otherwise notified. State-Level Resources. Louisiana Department of Health’s COVID-19 Website; Medicaid Updates for Providers; Louisiana

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Adoption of LOCUS/CASII/ECSII for Level of Care Guidance

Details: Effective management of behavioral health services: Three main concepts need to be considered and balanced in effectively managing behavioral health services: (1) Use of wrap-around services; (2) tailored to specific age of the member; and, (3) adopts a system of care approach. The L/C/E criteria best meet all three of these concepts.

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Introducing All Savers Plan Administered by UnitedHealthcare

Details: Use myAllSaversProvider.com to Check Member Eligibility and Claims Status. If you have a patient enrolled in an All Savers Plan administered by UnitedHealthcare, use myAllSaversProvider.com to check member eligibility and claims status. If you have not yet registered on this site, you may do so under “Register Now” of the All Savers home page.

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Welcome Massachusetts

Details: AllWays Health Partners. AllWays Health Partners Website Adverse Incident Reporting Forms ALERT Performance Specifications Provider Manual Addendum Serious Reportable Events Training Materials Massachusetts Medicaid. Medication-Assisted Treatment (MAT) MA – One Care Provider FAQs Harvard Pilgrim Health Plan

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Telemental Health Services Reimbursement Policy

Details: BH1624b_Telemental Health Services Commercial_06/2020 United Behavioral Health operating under the brand Optum U.S. Behavioral Health Plan, California doing business as OptumHealth Behavioral Solutions of California 2 same site. Examples of such services are those that are delivered via the internet or using other communication devices. For

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Optum Behavioral Health: COVID-19 updates to telehealth

Details: Health and Human Services (Notice), on a temporary basis, health care providers, qualified and licensed in accordance with applicable regulations to provide ABA services, may use audio or video communications technology immediately to deliver telephonic and telehealth care to Optum Behavioral Health plan members in

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IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY

Details: United Behavioral Health operating under the brand Optum U.S. Behavioral Health Plan, California doing business as OptumHealth Behavioral Solutions of California 2 For the Purpose of this reimbursement policy “facility-based behavioral health program” refers to the following levels of care: Mental Health:

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UnitedHealthcare Community Plan Behavioral Health Billing

Details: • Louisiana Community Health Plan requires that you initially submit your claim within 365 days of the date of service • When a provider is contracted as a group, the payment is made to the group, not to an individual • Resubmissions and Corrected Claims should be submitted within 365 days of the DOS or you risk Timely Filing denials.

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Transcranial Magnetic Stimulation

Details: Behavioral Clinical Policies are a set of objective and evidence-based behavioral health criteria used by medical necessity plans to standardize coverage determinations, promote evidence-based practices, and support members’ recovery, resiliency, and wellbeing for behavioral health benefit plans that are managed by Optum®1.

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Supplemental Clinical Criteria: Applied Behavior Analysis

Details: health benefit plans that are managed by Optum®1. This guideline is used to make coverage determinations as well as to inform discussions about evidence-based practices and discharge planning for behavioral health benefit plans managed by Optum. When deciding coverage, the member’s specific benefits must be referenced.

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State of Maryland Medical Necessity Criteria

Details: mental health disorder, except for excluded diagnoses which are appended. An RTC is defined as a psychiatric institution that provides campus-based intensive and extensive evaluation and treatment of children and adolescents with severe and chronic emotional disturbances who require a self-contained

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IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY

Details: also applicable to behavioral health benefit plans administered by OptumHealth Behavioral Solutions of California. Our behavioral health reimbursement policies may use Current Procedural Terminology (CPT®*), Centers for Medicare and Medicaid Services (CMS) or other procedure coding guidelines.

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UnitedHealthcare Community Plan Behavioral Health

Details: Behavioral Health Providers. Enter the name, licensure and NPI number who is directly rendering services when required: Box 24J: NPI number of Behavioral Health Provider Box 31: Name and Licensure of Behavioral Health Provider Box 33: Agency Name, address, and phone number Box 33a: Agency NPI number *

› Verified 3 days ago

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Applied Behavior Analysis (ABA) Treatment Approvals Via

Details: BH887_rev102019 United Behavioral Health and United Behavioral Health of New York, I.P.A., Inc. operating under the branOptum U.S. Behavioral Health Plan, California doing business as OptumHealth Behavioral Solutions of California 97154 Group adaptive behavior treatment by …

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UHC Appeals and Provider Disputes Contact Information

Details: UnitedHealthcare Community Plan . Appeals and Provider Disputes Contact Information. Please note the following fax number, addresses, and phone numbers to be used when seeking an Appeal

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IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY

Details: United Behavioral Health operating under the brand Optum U.S. Behavioral Health Plan, California doing business as OptumHealth Behavioral Solutions of California 2 reimbursement, in which case they will be reimbursed pursuant to this policy. For information about the health care-related

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Autism/Applied Behavior Analysis (ABA) Using CPT Codes FAQs

Details: BH2803a_06202 United Behavioral Health and United Behavioral Health of New York, I.P.A., Inc. operating under thebrand Optum U.S. Behavioral Health Plan, California doing business as OptumHealth Behavioral Solutions of California 2

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