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Welcome to the Optum Network!

Optum Network Manual

Best Practice Guidelines

Autism/Applied Behavior Analysis

InterQual Level of Care Guidelines are used and criteria can be provided upon request for specific cases.

ASAM Level of Care Guidelines are used for Substance Use Disorder (SUD).

Additional information and forms are available, including psych/neuropsych testing guidelines, credentialing plans, and Disability Solutions Manual, on the Provider Express Guidelines/Policies & Manuals and Optum Forms pages.

 

Indiana Medicaid Network Participation

How to Submit an Optum Participation Request:

  • Go to Join Our Network and click on the button associated with your provider type (e.g., Individual Clinician, Agency, Facility, Autism/ABA)
  • Provider Network Participation Process Definitions and the Summary of IN Medicaid Provider Credentialing Policy are listed under “Important Materials regarding joining the network” below

Individual Clinician Requirements:

Individual Clinician Step by Step Guides:

Agency Requirements:

Facility Requirements:

Autism/Applied Behavior Analysis:

Submitting Additional Supporting Documentation:

  • Required Documents are attached within the on-line applications. If additional documents are required, contact your Provider Relations Advocate.  Turn-around-time for a response from Provider Relations is within 2 business days.

** If you do not meet the requirements as outlined above, you cannot be credentialed with Optum.

Important Materials regarding joining the network

Network Participation Process Definitions

  • Enrollment - The process of loading a contracted and credentialed provider to all MCE internal systems, loading for claims payment, and loading to the provider directory (if applicable).
  • Credentialing - The process of reviewing the qualifications and appropriateness of a provider to join the health plan's network. Credentialing requirements and processes will follow NCQA guidelines.
  • Contracting/Negotiating – The process of the provider and MCE formally executing an agreement for the provider to deliver medical services that outlines reimbursement rates, scope of services, etc.

 

Step-by-step Guides to Complete the Application

 

Network Effective Policy Summary

UHC Provider Portal 

Indiana Medicaid-Specific Resources

Claims

UnitedHealthcare Community Plan
P.O. Box 5240
Kingston, NY 12402-5240

  1. Claims, Appeals/Disputes and Payments;
  2. Eligibility and Benefits

 

Contacts

Contact Us

For Treatment/Authorizations, Benefits/Eligibility, Claims, Appeals or any other member-related issue, access the Secure Transactions on Provider Express or call the Customer Service number on the back of the member's ID card.

Provider Relations Advocate

Paulette Means (Northern Indiana Counties)
Main Number: (612) 476-6567
Fax Number: (855) 572-3643

Northern Indiana Counties: Adams, Allen, Benton, Blackford, Carroll, Cass, Clinton, DeKalb, Elkhart, Fulton, Grant, Howard, Huntington, Jasper, Jay, Kosciusko, LaPorte, LaGrange, Lake, Marshall, Miami, Newton, Noble, Porter, Pulaski, St Joseph, Starke, Steuben, Tippecanoe, Tipton, Wabash, Warren, Wells, White, Whitley

 

Kristin Johnson (Southern Indiana Counties)

Senior Provider Relations Advocate
Main Number: (763) 330-4335
Fax Number: (855) 572-3643

Southern Indiana Counties: Bartholomew, Boone, Brown, Clark, Clay, Crawford, Daviess, Dearborn, Decatur, Delaware, Dubois, Fayette, Floyd, Fountain, Franklin, Gibson, Greene, Hamilton, Hancock, Harrison, Hendricks, Henry, Jackson, Jefferson, Jennings, Johnson, Knox, Lawrence, Madison, Marion, Martin, Monroe, Montgomery, Morgan, Ohio, Orange, Owen, Parke, Perry, Pike, Posey, Putnam, Randolph, Ripley, Rush, Scott, Shelby, Spencer, Sullivan, Switzerland, Union, Vanderburgh, Vermillion, Vigo, Warrick, Washington, Wayne

 

Indiana Autism/ABA Network Management

Olivia Smith 
Main Number: (715) 833-6538
Fax Number: (855) 572-3643