Transcription of Provider Guide - Optum Care
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Provider Guide - Optum Care
Provider GuideContents1 Purpose1 Business Overview4 Optum Medical NetworkContact Information7 Patient Enrollment & Assignment7 Health Plan Contact Information8 Health Plan ID Cards9 Optum Medical Network Website10 Optum Medical Network Provider Portal12 Optum Medical Network Customer Service13 Language & Hearing Impaired Assistance13 Eligibility14 Claims15 Electronic Data Interchange (EDI)16 Claim Submission Address17 Billing18 Reading the Provider Remittance Advice (PRA)18 Electronic Fund Transfer (EFT)19 Claims & Encounter Submissions20 Submission Time Frames21 Glossary of Claims Terminology23 Helpful Billing & Claims Hints24 Credentialing & Recredentialing26 Health Improvement27 Quality Improvement29 5-Star Measures30 Medical Records Standards34 Appointment Access Criteria36 Preventive Care Recommendations39 Utilization Management &Prior Authorization41 Prior Authorization Form43
Optum Medical Network contracted providers represent a network of over 350 primary care physicians (PCPs), 1,000 specialists and 15 hospitals serving all of Maricopa County. Optum Medical Network is a fully delegated entity, assuming both institutional and professional fi nancial risk which allows us to enhance the coordinated care model. The
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