Not all Member benefit packages are the same - Always check what benefits are available for each member

Members have a variety of benefits available to them, but not all Members have the same benefit package. That's why it's very important to determine what benefits are available to the particular Member you are seeing.

To help further your understanding and clarification for what benefit(s) a Member is and is not covered, Optum’s Coverage Determination Guidelines can help you navigate covered benefits. These guidelines seek to explain the terms of a Member’s benefit package including terms of coverage, benefit exclusions and limitations.

You will find our Coverage Determination Guidelines by going to:
providerexpress.com >> Clinical Resources >> Guidelines/Policies/Manuals  >> Click open the twirl-down button as shown below:

Find the Coverage Determination Guidelines on the Guidelines/Policies & Manual Page