New Online Requirement for Optum Health Networks Utilization Management
Starting December 1, 2024, in Colorado, Nevada, and New Mexico, Optum Health Networks will receive prior authorization requests and inpatient notifications only through a secure online electronic system. This is just one way this change should enhance efficiency over fax submissions in general and allow for much more prompt response times over paper submissions.
This requirement will apply to all healthcare providers who have patients within the states that have their network management under Optum. Patients eligible to access this network will have member ID cards with the payer ID "LIFE1." Providers are encouraged to scrutinize patient ID cards in order to determine a patient's eligibility for use of this new online-only submission process.
Health professionals who already possess an Optum Pro account login using One Healthcare ID and their password and go to the Medical Management tab within the Optum Pro portal. For unregistered providers, they can easily register for an Optum Pro portal website, or even just get a One Healthcare ID from identity.onehealthcareid.com.
This will decommission several fax numbers that had been used for submissions and notices across the three states. The fax numbers available for prior authorizations have been 888-992-2809, whereas for Medicare Part B 855-221-1978 will no longer be available. Other specific fax numbers in Nevada, New Mexico, and Colorado for inpatient notifications, clinical information, and appeals will no longer be available.
Optum has stated that there is a requirement for notification of admission within one business day, and notices of Medicare Non-Coverage should adhere to the new online submission guidelines. Exceptions to this online mandate apply only where legally required to accept faxed documents.
This update is in line with the larger digital-first initiative at Optum for enhanced efficiency through healthcare networks. Learn more here: optumproportal.com.
