Clinical Reference

Laboratory Benefit Management
Optima Health is proud to announce our new collaboration with Avalon Healthcare Solutions (Avalon) on a new laboratory benefit management program. Avalon will be providing Routine Testing Management (RTM) services to Optima Health. RTM, an automated review of high-volume, low-cost laboratory tests, provides consistent application of laboratory policies while remaining provider and member friendly.

Documents and Forms

Advanced Care Planning
Information for providers regarding Advance Care Planning.

Clinical Guidelines
Clinical guidelines for health professionals in an easy-to-download format.

Immunization Schedules
View and print immunization schedules for children, adolescents, and adults.

Well Child Forms
Well Child forms are available for download.

Health Programs

Avoidance of Antibiotic Use
Information for providers about antibiotic use.

Get Off Your Butt: Stay Smokeless for Life
Smoking is the leading cause of preventable illness and death in the United States. When you stop smoking, you lengthen your life. It is always the right time to stop.

Optum Managed Transplant Program
Optima Health will utilize Optum’s Managed Transplant Program (MTP) of care management services for all organ and blood/marrow transplants for Optima Health Commercial and Optima Family Care plans.

Pediatric Obesity Prevention and Treatment Toolkit
Valuable information for children, parents and health professionals on growth management. BMI tools, Optima Health Clinical Guidelines, and educational resources are included in this online toolkit.


HEDIS®* Measures
A quick and easy reference containing the most current information, measure descriptions, and tips to help improve rates of compliance.

*HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA)

Required Education

Model of Care
Optima Health has defined and developed a Model of Care to coordinate the delivery of care for D-SNP beneficiaries based on data driven outcomes and benchmarks. We measure the effectiveness of the Care Coordination program to ensure beneficiaries’ healthcare needs, preferences for health services, and information sharing across healthcare staff and facilities are met over time.