providerNEWS 1st Quarter 2022

Featuring: Free stress management resources available to healthcare providers, COVID-19 coverage extension update, clinical documentation platform migration delays, Optima Medicare Advantage/Optima Dual-Eligible Special Needs Plan (D-SNP) contract update, Influenza vaccine coverage for members, DMAS announces April launch for PRSS system, service facilitation authorization changes, Project Bravo Phase II: New Behavioral Health Services launched December 1st, and more.

Coverage of At-Home Over-the-Counter COVID-19 Test Kits

Beginning January 15, 2022, Optima Health expanded coverage for certain over-the-counter COVID-19 diagnostic tests for commercial group and Individual & Family Plan members.

Services Facilitation Authorization Changes

Optima Health wants to make you aware of upcoming changes to the authorization process for a variety of services.

Project Bravo Phase II

On December 1, 2021, seven (7) new enhanced behavioral health services will become effective.

A Free Stress Management Resource Available to Healthcare Providers

We know medical professionals face daily occupational stressors, recognized for quite some time and exacerbated in the past year and a half by the pandemic. Sentara Healthcare is committed to helping our community physicians and providers with positive solutions to improve emotional wellbeing.

Close Quality Gaps in Care

Optima Health recently implemented a campaign to close quality gaps in care. We improve health every day by making it easy for our members, your patients, to get the care they need when they need it.

What’s New at Optima Health

Join us from the convenience of your office to learn what’s new at Optima Health. You’ll receive refreshers on how to successfully do business with us, as well as have your questions answered.

providerNEWS 3rd Quarter 2021

Featuring: COVID-19 coverage extension update, HEDIS measures, CAHPS survey tips, changes to the peer-to-peer reconsideration process and more

Population Care Update for Providers: New Initiatives Support Member Health

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.

CareCentrix Post-Acute Care Services

Optima Health has contracted with CareCentrix to manage post-acute care services for our commercial members in Virginia, effective October 1, 2021 (previously scheduled to start on August 1).

New Online Provider Update Form

We are excited to announce the implementation of the new online Provider Update Form on our website! Network providers will now submit update requests electronically, replacing the use of the PDF document/submission process by email for most requests. This is a more convenient and efficient process, which will result in faster processing by the health plan. Effective 9/6/21, paper/PDF provider update forms submitted by email will no longer be accepted.

Collaboration with Avalon Healthcare Solutions

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.

Peer to Peer Provider Notification Changes

Effective 10/1/2021, Optima Health will implement the following changes to the provider peer to peer and reconsideration process.

Quarterly Provider Webinars August 2021

Join our network educators on August 4th at 10:00 a.m. or August 11th at 1:00 p.m. from the convenience of your office to learn what’s new at Optima Health, receive refreshers on how to successfully do business with us as well as have your questions answered.

providerNEWS 2nd Quarter 2021

Featuring: COVID-19 coverage extension update, post-acute care services for commercial members, Virginia regulatory changes for motor vehicle accident litigants and more.

DMAS Announces Enhanced Dental Benefits to Adult Members

After July 1, 2021, Optima Family Care will no longer offer enhanced dental benefits to Medicaid and FAMIS members. Beginning July 1, 2021, the Virginia Department of Medical Assistance Services (DMAS) will offer comprehensive dental services for 750,000 adult Medicaid and FAMIS members 21 and older.

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.

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.

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.

Is Your Provider Directory Status Current?

It is important to routinely review and update your status on the Optima Health Online Provider Directory. This ensures members know your correct status, allowing them to make the best choices for their families. You may also confirm your status by calling provider relations.