Welcome to the Optum Idaho web site. The services we offer on this site will support providers in assisting consumers, their loved ones and their families to achieve and maintain recovery. We understand and applaud your commitment to the behavioral needs of Idaho residents and families. Optum will help you ensure positive outcomes and well-being in individuals.
Working together, we'll provide information and methodology to help our members successfully navigate though the complex treatment process from the point of diagnosis. We will identify each member's unique behavioral health needs. Connect them to the right services to address those needs. Deliver the right care, at the right pace, at the right time. This includes helping people manage their behavioral health and wellness challenges. We believe people with behavioral health challenges are able to live, work and participate productively in their communities. We believe they are able to do this despite the challenges. We also believe people are resilient and able to rebound from trauma, stigma and other stresses.
With more resources, come more opportunities to contribute to the richness of lives of Idahoans. We would like to hear from you. Please use our Contact Us page to share your thoughts and opinions.
When we have important information or updates to share, we may post Provider Alert notices to this section of the web site.
Relias Learning provider training announcement (02/24/14)
Optum Holiday Closures announcement (02/12/14)
ALERT Program provider training announcement (02/12/14)
Please read about Prior Authorization Improvements (01/30/14)
Relias Learning provider training announcement (01/29/14)
Please read about Contacting Optum to Report a Critical Incident (01/24/14)
Medical Necessity and Transformation of the Idaho Treatment System- Training dates/locations (1/14/14)
Peer Support Service Overview - Training Dates (1-3-14)
Please read about our Peer Support Services Implementation - coming soon! (12-17-13)
Please use the "Contact Us" form for providing feedback to Optum. (11-22-13)
For Clinical Authorization Review please use the Clinical Authorization Review form. (12-15-13)
Billing, Checkwrite and Training updates (10-2-13)
Claim Notification Letters (10-15-13)
Using the current Idaho Medicaid network as the foundation, Optum is building a unique Optum Idaho provider network to serve the IBHP population. Optum Idaho will be working closely with the Idaho Department of Health and Welfare and the Idaho provider community to build a network that is effective in promoting and realizing the best outcomes possible for each IBHP member, in keeping with the goal of gradually transforming the provider network into one that consists of Comprehensive Behavioral Health Centers throughout the state of Idaho.
Read our FAQs for additional information. The FAQs are updated and re-posted weekly on Wednesday.
Idaho Clinical Model
In collaboration with IDHW, members and providers Optum is developing, implementing and maintaining a utilization management program for the Idaho Behavioral Health Plan to monitor the appropriate utilization of covered services. Please reference the Idaho Clinical Model (updated) for more detail.
The Optum Wellness Assessment is an integral part of the Idaho Clinical Model. Analyses demonstrate that the Wellness Assessment scales, comprised of items from well-validated public domain scales, are both valid and reliable. Both have been independently validated to ensure psychometric integrity as an outcome tool and to affirm the tool's use as an objective assessment tool with external credibility. Please reference a more detailed discussion of the Global Distress Scale, its reliability and validity for additional detail.
Please join us for an ALERT Program review. Training sessions will be held on March 11th through March 13th, 2014. Please register for one of these trainings sessions.
Medical Necessity and Transformation of the Idaho Treatment System provider forums were held February 3rd through the February12, 2014. View the Medical Necessity and System Transformation presentation shown during these sessions.
Peer Support Services Requirement overview sessions were held January 15th through January 17th, 2014. View the Peer Support Services Requirement presentation shown during these sessions.
Provider claims training sessions were held on October 2nd through October 4th, 2013. View the Claims Training Presentation shown during these sessions.
IDHW Medicaid Eligibility Program's training sessions were held on October 9th. View the Eligibility Training Presentation shown during this session.
ID Provider Express Eligibility training sessions were held on October 10th and 11th. View the PE Eligibility Training Presentation shown during these sessions.
ID Provider Express Long Form Claim training sessions were held on October 16th through 18th. View the PE Long Form Claim Training Presentation shown during these sessions.
Take a guided tour to learn about the secure transactions offered to registered users. Also included is information regarding upcoming training regarding how to use Provider Express, and other important topics that are valuable to your practice.
Information concerning your Provider Orientation can be viewed in this presentation.
Guidelines & Policies
- Provider Manual - updated 10/09/2013
- Level of Care Guidelines
- Optum Best Practice Guidelines
- Coverage Determination Guidelines
- Optum Idaho has five audit tools used during site visits. A description of these is in the Audit Tool Review . The tools are:
- Treatment Record Review Form
- Organizational Provider Tool
- Adult:: Community Based Rehabilitations Services (CBRS) Treatment Record Review Form
- Youth: Community Based Rehabilitations Services (CBRS) Treatment Record Review Form
- Clinician Site Audit Tool
- Peer Support Record Audit Tool
- Peer Support Site Audit Tool
- ID Testing Request Form (Optum Idaho Psychological and Neuropsychological Testing Guidelines)
- ALERT-WA Form
- Idaho Outpatient Treatment Report (OTR)
- Idaho Community Based Rehabilitation Treatment Report (CBRS)
- EPSDT Request Form
- Agency Roster Update Form
- H0031/H0032 Authorization Request Form (03/03/2014)
- Relias Learning Enrollment Spreadsheet (02/24/14)
OPTUMHealth provides 60 scholarships to certify Family Support Specialists. The CPSP Scholarship application is available for you to download..
Claims or Network Related Questions
Please see our EDI and Clearinghouse document for important information on electronic claims submission.
Paper claims submitted via U.S. Postal Service should be mailed to:
PO Box 30760
Salt Lake City, UT 84130-0760
For information regarding Claims, Network-related questions, or to request a login for Provider Express please Contact Optum