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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

Project BRAVO Phase II — Implementation Check-In

The Virginia Department of Medical Assistance Services (DMAS) implemented seven (7) new behavioral health services and billing codes, which became effective on December 1, 2021.

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

Register Now

Learn More


Provider Credentialing

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. 
  • Access the CAQH ProView Application
  • Neuropsychological Testing Privileges Application (LCPs)
  • Psychological Testing Privileges Application (LPCs)

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 with Optima Health. (For additional information on ARTS, please visit www.dmas.virginia.gov/#/behavioralhome)

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.

  • Provider Update Form
  • Substitute W-9 Form (W9)

Coordination of Care

  • Confidential Exchange of Healthcare Information Form

Billings and Claims

Download the form for requesting a behavioral health claim review for members enrolled in an Optima Health plan.
  • Behavioral Health Provider Reconsideration Form

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Sentara Health Plans and Optima Health are trade names of Sentara Health Plans, Sentara Health Insurance Company, Sentara Health Administration, Inc., and Sentara Behavioral Health Services, Inc. Optima Health Insurance Company is an additional trade name for Sentara Health Insurance Company. Virginia Premier Health Plan is an additional trade name for Sentara Health Plans. Optima Behavioral Health is an additional trade name for Sentara Behavioral Health Services, Inc. Optima Health Maintenance Organization (HMO) products, and Point-of-Service (POS) products, are issued and underwritten by Sentara Health Plans. Optima Preferred Provider Organization (PPO) products are issued and underwritten by Sentara Health Insurance Company. Sentara Health Administration, Inc. provides administrative services to group and individual health plans but does not underwrite benefits. All Optima Health plans have benefit exclusions and limitations and terms under which the policy may be continued in force or discontinued. Medicare products are administered under an agreement with Sentara Health Plans and the Centers for Medicare and Medicaid Services (CMS.) Medicaid and FAMIS products are administered under an agreement with Sentara Health Plans and the Virginia Department of Medical Assistance Services (DMAS.)