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 Hospital Admission Notification45 Coordination of Benefits (COB)& Third Party Liability (TPL)46 Provider Dispute Resolution Process47 Provider Dispute Resolution Request 48 care Management Overview52 Referral Form for Member Programs54 Medicare Risk Adjustment54 CMS Hierarchical ConditionCategories (HCC) Model56 Annual Wellness Visits2 Provider Guide1 Provider Guide PurposeThe purpose of this manual is to provide key information to our contracted network providers and support you in delivering effective care for mutual patients in accordance with Optum Medical Network and indu
To improve lives by transforming health care in Phoenix: one patient, one family, one community at a time. Values Integrity. Compassion. ... If an Emergency Arises: ... urgent care locations, skilled nursing facilities and more
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