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.

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

Claims Submission

Claims for your UnitedHealthcare Medicare Advantage members for Dates of Service January 1, 2015 going forward should be submitted with the Payer ID: LIFE1 through Optum Medical Network’s preferred method of electronic claim submission 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 AskOMNUT@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!