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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 Pri

operations. The network is a health care innovator, with a track record for quality, fi nancial stability and extraordinary services. We are well positioned to continually invest in new infrastructure and systems for the benefi t of our contracted physicians and to accommodate the impending changes of health care reform.

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