Provider Training Opportunity: Home Sleep Study Authorizations via CareCentrix

By now, you should have received communications from Optima Health and CareCentrix® notifying you about the relationship between our organizations that will take effect on March 1, 2023 for sleep testing services (HST) provided to Optima Health members covered under commercial plans in Virginia.

Optima Health Will Temporarily Relax Authorization Requirements

Effective January 13, 2023, discharge to Optima Health in-network post-acute facilities will not require prior authorization.

New Vision Vendor Announcement

Optima Health is pleased to announce the selection of VSP®️ Vision Care to manage routine eye exams and materials benefits for commercial, Medicare, and Medicaid product lines, beginning January 1, 2023.

Sentara Healthcare Acquires AvMed, Inc.

Sentara Healthcare, one of the largest not-for-profit integrated health care delivery systems in the U.S. Mid-Atlantic region, has finalized the transaction with SantaFe HealthCare, Inc., for ownership of AvMed, Inc., a not-for-profit health plan in Florida.

Immediate Action Needed: Enroll in PRSS Today

As an Optima Health participating provider, you must take immediate action to initiate enrollment through the new PRSS (Provider Services Solution) enrollment wizard.

Temporary Action Needed by Medicare Providers to Avoid Claims Submission Denials

Optima Health discovered an error with Medicare ID cards distributed to members for 2023.

Optima Health to Implement New PBM

Effective January 1, 2023, Optima Health will change our pharmacy benefit manager (PBM) from OptumRx®️ to Express Scripts®️ for commercial, Medicare, and Medicaid plans.

Cardinal Care: Provider Agreement

As we prepare to transition to Cardinal Care in 2023, we recently announced amended provider information.

providerNEWS 4th Quarter 2022

Featuring: Virginia Medicaid Policy Updates – Cardinal Care, PRSS Enrollment Reminder, Help Close Care Gaps, Optima Medicare Advantage and Optima D-SNP Updates, New PBM, and More.

providerNEWS 3rd Quarter 2022

Featuring: COVID-19 Featuring: COVID-19 Coverage Extension Update, Jiva Update, Zelis Claims Review Implemented, Inova is Joining our Network, Dario Partnership Supports Members with Diabetes, Partners in Pregnancy Referral Program, Avalon Genetic Testing Implementation Delayed to 2023, Ensure Your Online Provider Directory Information is Updated, New Sleep Testing Services Program: Launch Date Postponed and more.

New Sleep Testing Services Program Rescheduled

Our new sleep diagnostic testing partnership with CareCentrix,®️ previously announced for implementation on October 1, has been postponed.

Self-Service Password Resets Now Available for Provider Connection Users

If you are an active Provider Connection user, you can save valuable time by enrolling in the self-service password reset process. Set up is easy and only requires two steps.

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.

providerNEWS 2nd Quarter 2022

Featuring: COVID-19 Coverage Extension Update, Optima Health Launching Doula Benefit for Pregnant Members, Let's Talk About Advance Care Planning With Our Patients, Avalon Genetic Testing Implementation Begins This Summer, and more.

Claims Clinic Brush Up Registration

This month will consist of upcoming Authorizations Claim Clinic Brush-Up, introducing “How to create and view Authorizations Online Submission” revised Job Aid, and JIVA Resources and tutorial.

Jiva Provider Tutorial and Quarterly Provider Webinar

New learning opportunities! Review the Jiva platform tutorial and register for the next Quarterly Provider Webinar for medical or behavioral health updates.

Population Care Update for Providers 2022

Optima Health strives to have healthy members as part of our quality improvement initiatives. Learn more about four annual campaigns that support better health for your patients.

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.