Provider Alert: Authorizations Temporarily Not Viewable- Date Span Correction and Medicaid Authorizations UpdateOptima Health is undergoing a system conversion for our Medicaid line of business. Authorization requests submitted between November 22, 2023 to December 6, 2023, may not show in the provider portal, but this does not indicate that the plan has not received or reviewed them.
Provider Alert: Payment Policies and SHP UpdatesAs of November 1, 2023, Optima Health payment policies are accessible through Provider Connection, our secure portal. The policies, stored in Compliance 360, explain acceptable billing and coding practices to equip you for accurate claims submission. We will inform you as new policies are published.
Provider Alert: Sentara Health Plans, Cardinal Care Updates, and MoreAt the end of 2023, the Optima Health and Virginia Premier brands will retire and unify under Sentara Health Plans. Our growth affords us the opportunity to innovate and adapt to align with best practices in the industry, as well as partner with you to ensure our shared customers receive the care they need, when they need it.
Provider Alert: New CMR ProcessAs valued partners in healthcare, we are excited to share upcoming changes that are geared towards enhancing the quality of care for our shared patients.
providerNEWS 4th Quarter 2023Featuring: Introducing Sentara Health Plans, Coming Soon: Sentara Health Plans Partners With Availity; Member Accommodations and Communication Service, Welcoming Baby Program, Focus HEDIS Measures, Authorization Requirements, and more.
Provider Alert: DMAS Issues PRSS GuidelinesVirginia’s Department of Medical Assistance Services (DMAS) has shared information regarding Provider Services Solution (PRSS) guidelines for subunits.
Provider Alert: Authorization Updates and MorePositive and/or lateral prior authorization updates, effective October 2, 2023, will be listed on optimahealth.com on Thursday, October 5, 2023.
Provider Alert: Important Reminders and MoreThis week, we are sharing the following provider updates — see below to learn more. Inappropriate Use of Modifier 57 • Attention: OB/GYN Providers - Doula Balance Billing • Imaging and Cardiac Services Program • Medicare Data and Eligibility Verification Outage • New Password Requirements
Provider Alert: New Password Requirements and UpdatesAs of September 13, 2023, we will move from an 8-character network password to a 12-character network password policy. The policy will take effect on the user’s next required password rotation and includes Provider Connection, our secure portal.
12 Character Password RequiredIn an effort to protect the Sentara Health enterprise and our consumers from cyber security threats, we are continually evaluating opportunities to advance our internal and external cyber security capabilities.
Provider Alert: Merge Webinars and Provider SurveysAdditional webinars have been scheduled for September 13 and 20 at 10 a.m. Register now for the session most convenient for you, or learn at your own pace by viewing the slide presentation.
providerNEWS 3rd Quarter 2023Featuring: Optima Health Welcomes Former Virginia Premier Providers, Optima Health Appointment Standards, Where To Go for Urgent Care Needs, Pharmacy Travel Essentials, Statin Use in Persons With Diabetes (SUPD), COVID-19 Updates and more.
Benefit Flexibilities Post Public Health Emergency (PHE)Changes in the Medicare Part B program will improve access to high quality, affordable biosimilars for people with Medicare as well as impose a $35 per month cost-sharing cap on insulin used in DME pumps.
CMS - External Infusion Pumps PolicyChanges in the Medicare Part B program will improve access to high quality, affordable biosimilars for people with Medicare as well as impose a $35 per month cost-sharing cap on insulin used in DME pumps.
New Claims PlatformOptima Health launched its new claims platform on May 1, 2023, for Medicare claims only at this time. As part of this change, providers will have all EFT/ERA issued through PaySpan®.
Provider Manual UpdatesAn updated Optima Health Provider Manual will be released later this month.
New Clinical Policy InformationOptima Health has a new repository for clinical policies.
Exciting News!Optima Health Plan will assume agreements with Virginia Premier Providers on July 1.
New Medicare Claims Platform - An UpdateAdditional information to help you prepare for upcoming changes.
New Medicare Claims Platform Launches May 1On February 1, we notified you of a change to the system we use to process Medicare claims. To ensure a smooth transition for all our providers, we have extended our implementation date from April 1, 2023, to May 1, 2023. Please see details below to learn more.
Authorization Required for Outpatient Services—Implementation Rescheduled for May 1We previously announced that, effective April 1, 2023, we would no longer require an authorization for the first 15 visits for outpatient physical therapy (PT), occupational therapy (OT), and speech therapy (ST) for MAPD and DSNP members.
Ensure Your Online Provider Directory Information Is AccurateOptima Health partners with LexisNexis. Unverified provider information cannot be included in our online directory.
Encourage Your Patients to Renew Their Medicaid CoverageStarting in March 2023, Virginia will begin reviewing members’ health coverage to make sure they still qualify; however, members will not lose coverage prior to April 30, 2023.
New Vision Partner Effective January 1st, 2023Optima 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.
Optima Health Will Temporarily Relax Authorization RequirementsEffective January 13, 2023, discharge to Optima Health in-network post-acute facilities will not require prior authorization.
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 TodayAs an Optima Health participating provider, you must take immediate action to initiate enrollment through the new PRSS (Provider Services Solution) enrollment wizard.
Attention Medicare Providers: Action Needed to Avoid Claims Submission DenialsOptima Health discovered an error with Medicare ID cards distributed to members for 2023.
Optima Health to Implement New PBMEffective 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 AgreementAs we prepare to transition to Cardinal Care in 2023, we recently announced amended provider information.
providerNEWS 4th Quarter 2022Featuring: 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 2022Featuring: 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.
Self-Service Password Resets Now Available for Provider Connection UsersIf 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.