Behavioral Health Provider Resources
Optima Behavioral Health (OBH) is one of Virginia's largest and most experienced behavioral health managed care organizations, with over 30 years of experience and over 4,000 providers across the state. We have customized provider networks that are carefully selected, fully credentialed, and designed to provide geographically accessible, barrier-free and clinically appropriate care.
This page provides resources that are specific to Optima Behavioral Health providers. For easy access to any additional information, you may need, please refer to Frequently Asked Questions. If you find you still need to reach us directly, please contact Provider Relations.
Behavioral Health News and Updates
Behavioral Health Enhanced Services
Effective July 1, 2021, the Department of Medical Assistance Services (DMAS) will offer a new service, Assertive Community Treatment (ACT), to replace the current program, Intensive Community Treatment (ICT). ACT will include similar services currently offered through ICT, but now expands services to weekends and holidays.
Crisis Stabilization Authorization Changes – Effective July 25, 2021: Comprehensive Needs Assessment (CNA)
The Comprehensive Needs Assessment is the initial face-to-face interaction encounter in which the provider obtains information from the individual, and parent, guardian, or other family members as appropriate about the individual’s mental health status and behaviors. The CNA serves to gather information to assess the needs, strengths, and preferences of the individual.
Medical Necessity Criteria (MNC)
The Comprehensive Needs Assessment must document the need for crisis stabilization services. To qualify for this service, individuals must demonstrate a clinical necessity for the service arising from a condition due to an acute crisis of a psychiatric nature that puts the individual at risk of psychiatric hospitalization.
Provider Connection - Access Behavioral Health Provider Tools
Provider Connection is Optima Health’s suite of online, secure self-service resources for providers. As a registered user, you will have access to:
- Check Member Eligibility and Benefits
- View Claims Status and Details
- View and Download Remits and Pend Reports
To become a participating Optima Behavioral Health Provider, each licensed practitioner or organization must be credentialed by Optima Health as applicable. Please complete and return the appropriate Application Packet below to initiate the credentialing process with Optima Behavioral Health. Please review the credentialing packet in full to ensure acceptance of your application.
For licensed practitioners (in a solo or group practice), Optima Health utilizes the Council for Affordable Quality Healthcare (CAQH) application. Please ensure your CAQH application has been completed (with all supporting documentation attached) before returning the Behavioral Health Provider Application Packet to Optima Health.
Attention: Addiction and Recovery Treatment Services (ARTS) Providers:
Please review the DMAS credentialing requirements document Pathways to Becoming an ARTS Medicaid Provider prior to applying for participation
Provider Changes and Updates
Please notify us of any changes (relocation, joining an additional practice, leaving a practice, etc.) 30 days in advance to avoid interruption or denial of authorizations or claim payments.
Coordination of Care
Billings and Claims
Download the form for requesting a behavioral health claim review for members enrolled in an Optima Health plan.