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



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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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