Q: Can you verify the number used to send in Critical Incident Reports? I have fax: (844) 552-7508, but we are unable to send anything to this number.
A: (844) 552-7508
Q: The sound was fuzzy when you said something about reporting harm to you?? So if a client harms our tech we report it to you?
A: Yes. You should. We do not believe that is the essence behind the form but you can and should use this to report instances so that we can work with you to ensure these situations are addressed for our Providers safety as well as our Members.
Q: If that client is Dual Eligible/DSNP, will the Optima card look different or how will we be able to differentiate?
A: A dual member will receive a separate card for their services. That card will be Optima Community Complete.
Q: The payer ID for availity is different from payerpath, is this correct?
A: Existing Providers can continue to use the same payer IDs. New providers should use 54154 or 5415M for CMHRs services billed through any clearinghouse, other than availity. Providers only using Availity must use 5415M.
Q: When do you anticipate being able to accept, process, and respond to Service Authorization Requests electronically?
A: Our IT teams are engaged and working on the additional CMHRS service type options needed. We hope to have this update made very soon but do not have a definitive date just yet. We will communicate as soon as it is complete via the Friday DMAS CMHRS calls, as well as to this attendee listing via email.
Q: We use Trizetto as our clearinghouse, is there an ID number we can use with them?
A: Trizetto would need to pass the claims through Payerpath/AllScripts using Optima Health Payer ID
Q: We have submitted CCCPlus paper claims to Optima since 1/1/18 and we have not received any payment yet.
A: Please contact Provider Relations
Q: Our billing system will not enter taxonomy in that space. (referencing slide 32 Field 24J)
A: We understand that the CMS1500 does not make field 24J required. It is encouraged that providers use 261QM0801X for CMHRS services to drive an auto assignment to the correct system record. Not using that field on the 24J does not impede your claims, it just speeds up our processes.
Q: Can you go back over the continuity of care for continued stay auths. DMAS rules indicate we must submit continued stay authorizations for April 1st through December 31st 2017 (that are currently in place) by March 22nd 2018 (your 7 day window). Are you saying this is not the case/a requirement? The slide made it look like authorizations will be extended for a period after the continuity of care. This seems contradictory. Please clarify.
A: Any current authorization, under this COC period that extend beyond March 31, we will honor. If we need any additional clinical explanation of why the care needs to extend farther than March 31, we will be reaching out to you directly.
Q: How do you obtain a username and password to the provider remit website? My provider connection username and password does not work.
A: You can obtain remits through Report to Web, inside of our Provider Connection Portal. You will need your vendor Id to register for both of these. If you are experiencing issues with
Q: Can you explain whether providers need to send claims for Dual Eligibles to Medicare first before forwarding claims for CMHRS to you?
A: No. Bill CMHRS services directly to Optima Health.
Q: For individual/sole providers in practice and looking to be credentialed with Optima, do you have any recommendations about finding a covering provider who is in network with Optima? Do you find that this is a barrier for individuals in private practice who want to get in-network but may not know another individual who participates with Optima and could cover for them?
A: We recommend you use our online directory tool to find like providers near you to network covering vendors. This is found on optimahealth.com/providers, Find a Doctor, Behavioral Health Search.
Q: We were told that Mental Health Case Management H H0023 does not require a registration but on the slide you just displayed it indicated that is does for both initial and extended stay.
A: Both initial and extended stay require registration.
Q: Where/who will we send updates to our license to? For an added location, what form is supposed to be filled out in addition to showing proof of the updated license?
A: or your Network Educator directly.
Q: You kept mentioning "ABA Providers" instead of Licensed Behavior Analysts. Does that mean you will also credential Licensed Assistant Behavior Analysts separately? How about RBTs or QMHPs?
A: We will credential Licensed Behavior Analyst and Licensed Assistant Behavior Analyst. We will not credential RBTs nor QMHPs.
Q: Do we need to have the authorization # on the claims?
A: No
Q: We are currently receiving authorizations for members, but we are receiving two and three authorizations per member with different authorization numbers and start and end dates, which authorizations should we go with.
A: Please send these examples to
Q: Per Medicaid guidelines can we bill for unlicensed providers, (license eligible) as long as the licensed and credentialed provider signs off on the service.
A: Yes, under either the organizational NPI or the licensed and credentialed practitioners NPI.
Q: Is it true that individuals in any given area of VA might have multiple care coordinators working with those folks? We have not heard from care coordinators to speak with our case managers regarding members.
A: A member will only have 1 OHCC Care Coordinator.
Q: We currently submit Optima claims directly versus through a clearing house, can we continue this process? If so, do we need to change the payer ID #?
A: Yes. Using the same payer ID you do today.
Q: Is it the same # for the Gateway clearing house?
A: Yes. Any clearinghouse you use that is able to send your claims through payerpath/allscripts will use the payer IDs as listed above or in the slide materials.
Q: We are still seeing claim denials on service code H2012 (Intensive In Home Services). The denial reason reads "DENY-non allowed expense billed by provider. Provider resp." It looks like service code H2012 is linked to Anesthesia? Has this been corrected?
A: Please send these examples to via secure email.
Q: So, since we are credentialed with you, an auth magellan previously approved through, say November, will definitely be approved for services through then UNLESS you reach out to us for additional information? Is this correct?
A: Correct
Q: How long are registrations for Case Mgt services being authorized for, historically it has been for one year however we have been getting approval for 2 or 3 months at a time
A: Should be for 1 year. Please send examples to
Q: We question the approved auth based on what Magellan has approved. I know specific situations are not being addressed, but we are getting letters about needing auths for differing dates and not accepting something prior to then... i.e. letter received from you for an auth good through only feb, so when we submit new continued stay because of the letter sent by Optima, we then get denied for the new date (Optima says an auth was already in place as of January through end of March). So, two different letters for same individuals.
A: Please send examples to
Q: Sorry, but I didn't get a full answer to my questions about Licensed ASSISTANT Behavior Analysts. They are licensed but need to be supervised by a Licensed Behavior Analyst. Will you credential them separately?
A: No. Licensed ASSISTANT Behavior Analysts will bill through the supervising Licensed Behavior Analyst therefore do not need to go through credentialing.
Q: With the continued stay for TDT. There is not a line to request for summer vs school. Do we need to specify or just check the tdt box?
A: Just check the tdt box, unless the form changes.
Q: Can residents and supervisees bill under a licensed mental health professional for outpatient therapy?
A: All licensed mental health professionals must be credentialed in order to bill under their type 1 NPI. Under any Medicaid services, residents and supervisees, must bill under a licensed and credentialing mental health professional.