Provider Manual - optumpnw.com

Optum Care Network Provider Manual 2021 1 Table of Contents Welcome Letter .. 3 Provider Manual Overview .. 4 Delegation Defined .. 4 Contact Information .. 5 Practice Engagement .. 6 Summary .. 6 Practice Advocate Responsibilities .. 6 Credentialing .. 6 Providers Joining Your Practice .. 7 Types of Providers Credentialed .. 7 Facilities Adding Location(s) .. 7 Types of Facilities Credentialed .. 7 Sub-Delegation of Credentialing .. 8 recredentialing .. 8 Corrective Action .. 8 Provider /Facility Rights .. 8 Changes to Your Practice/Facility .. 9 Termination of Participation .. 9 Closing your Practice .. 9 Contracting .. 10 Delegation by Plan .. 10 Claims .. 10 Claims Submission .. 11 Reimbursement .. 11 Electronic Funds Transfer .. 12 Charging Members .. 12 Clinical Claims Review.

The recredentialing cycle occurs every three (3) years for providers and facilities. Non-response or failure to return a completed recredentialing application(s) and supporting documentation may be considered a voluntary termination of participation unless otherwise determined by the Chief Medical Officer and/or

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  Applications, Recredentialing, Recredentialing application

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