In the News!

Phoenix news stations KPHO and KTVK covers how Optum Medical Network expanding its programs, improving patient health and helping costs.

Optum Medical Network in Phoenix continues to expand their network with more providers and services to help anticipate patient needs before there is a health problem. It starts with the primary care physician and a community that cares.

EFT

Optum offers Electronic Funds Transfers (EFT) through Emdeon to provide payer remittance data and direct deposit. This can drastically reduce expense, streamline workflow and shorten reimbursement cycle. You may call Emdeon at (866) 506-2830 and select option 1 or sign up by visiting emdeon.com/eft.

Optum Client: #3059
Payer ID:LIFE1

Our Name has Changed

Lifeprint is now Optum Medical Network.

We are excited to announce that Lifeprint is now Optum Medical Network. While our name is changing, you will still receive the same level of personalized service you expect from us.


This exciting transition will be reflected in our branding. For your convenience, we’ve created Optum Medical Network branded materials, forms and job aides just for you.
 
We look forward to sharing more updates with you, including additional details about the new relationship between Optum Medical Network and SCAN® Health Plan. Beginning on January 1, 2015, Optum Medical Network can manage your patients who are enrolled in the SCAN® Classic Medicare Advantage plan. We will continue to manage your patients who have UnitedHealthcare® Group Medicare Advantage or AARP® MedicareComplete® (HMO). With the addition of the SCAN plan, more of your patients will have the opportunity to participate in the Optum Medical Network.
 
What this means for your practice is a new opportunity to have more of your patients managed through a network that makes your claims submission and payment process as efficient and easy as possible. Other benefits include:

  • 1. Customized assistance to help you thrive independently by supporting the entire spectrum of your operations and patient relationships.
  • 2. Concierge service that offers additional in-practice staff and defined best practices to support your business goals.
  • 3. A flexible, easy to work with team that takes a unique approach to your practice
  • 4. Educational support to help plan for the future and close quality gaps by redesigning workflow, making your practice run more efficiently.
  • 5. Interdisciplinary care management process and care coordination support to help manage complex patient population.
  • 6. Knowledgeable service center that responds quickly, resolving all issues in the most efficient way.e
 
We want to make the brand transition as smooth as possible for you. If you have any other questions related to new options for your SCAN patients, or anything else, please don’t hesitate to contact us at 877-370-2845.

Claims Submission

Did you know that Optum Medical Network’s preferred method of claim submission is electronic, known as Electronic Data Interchange (EDI)? EDI is the computer-to-computer transfer of data transactions and information between trading partners (payers and providers). EDI is a fast, inexpensive and safe method for automating the business practices that take place on a daily basis. There is no charge for submitting claims electronically to Optum Medical Network.

Electronic claims submission allows the provider to eliminate the hassle and expense of printing, stuffing and mailing your claims to Optum Medical Network. It substantially reduces the delivery, processing and payment time of claims. There is no charge for submitting claims electronically. Providers are able to use any major clearinghouse.

Attestation Forms

Do you have question about Attestation Forms or HCC codes? We are creating more resources to help providers get answers to questions they may have about attestation forms, starting with a new email answer box. If you have any questions about filling out Attestation Forms, or HCC codes, just send them to optum.coder@optum.com.

The box is checked daily by a CPC or RN, CPC so you can always expect a quick response.

Examples of the types of questions you can submit include:

  • 1. The BMI is on the progress note but the attestation sheet is asking for the primary diagnosis. Also 278.01 is documented in the note but the attestation sheet is asking for the diagnosis descriptor. I do not understand what this means?
  • 2. In my note, I have listed DM with renal manifestations and CKD. Now I’m being told they are not linked. Why do they have to be linked?
  • 3. I faxed in the attestation and progress note and now I’m getting back that the progress note is not there. What happened to the progress note?
  • 4. Is hypertension a code that has an HCC?
  • 5. My patient had a RAF score last year of 2.0 and this year only has a potential of 1.5. What happened to that .5?

These are just a few examples of the types of questions our team can help answer. We urge you to stay in communication about your questions through this new resource!

Prior Authorization List

Optum Medical Network has posted a list of procedures that require prior authorization. This is not an all-inclusive list and is subject to change. Please note that inclusion of items or services in this list does not indicate benefit coverage. You should verify benefits prior to requesting authorization.

Payment for authorized services is contingent upon verification of eligibility for benefits, the benefits available in the member’s plan, the applicable contractual limitations, restrictions and exclusions.

Prior Authorization is not required for emergency or urgently needed services.

Click here to view a list of Prior Authorizations

Clinical Guidelines

Disease specific clinical guidelines have been added to the website for the following diagnoses: HTN, Cholesterol, COPD, Heart Failure and Diabetes. We recommend using these best practice guidelines to assist in the management of your patients. These guidelines are nationally approved for the management of patients.

Information on Utilization Management

Affirmative Statement Regarding Incentives

OptumTM Medical Network’s core values of integrity and compassion dictate that we deliver the most effective care possible to every patient. This principle should be the guiding force behind all the decisions we make when it comes to patient care, including those surrounding utilization management.

Therefore, we are sharing this Affirmative Statement about incentives (specifically relating to Utilization Management).