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 updated 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.

A few important notes:

Use the online form when you need to notify Optima Health of the following changes at your practice:

  1. Adding a new provider to your practice
  2. Accepting new patients (panel status)
  3. Contact information updates (address, phone, email, website, etc. – for all locations)
  4. Provider relocating or joining additional practice
  5. Practitioner name change
  6. Provider termination (Practitioner leaving practice/retired/deceased)

Upon submission you will receive an email confirming receipt of your request which will include a copy of the original submission and a Request Instance ID number. We recommend that you flag nintex@workflowcloud.com as a safe email address (ex. save to your contact list) to ensure receipt of confirmation email correspondence.

Online form may be used to submit medical and behavioral health groups, solo provider and non-CMHRS ancillary provider changes.

Delegated providers will continue to submit rosters to add, update or terminate via email to delegateroster@optimahealth.com.

Facility providers, CMHRS providers, as well as any contract related updates (Tax ID, Legal Name Change, product/reimbursement updates) should continue to be submitted directly to your contract manager.