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Pre-approved through ValuePoint, Optum Provider Management Services offers a self-service gateway and support system to enroll, credential and verify providers. States can also choose additional options, including full-service, outsourced, end-to-end provider services.

Our core offering includes:

  • Provider enrollment and self-service portal
  • Provider database
  • Verification workbench

The solution also includes remote mail office, enterprise content management, and provider and staff training.

Additional options:

Option A enhances self-service capabilities for your providers. Additional system functionality includes:

  • Real-time member eligibility and claim status inquiries
  • Warrant and remittance advice inquiries
  • Claims-based medical history feature
  • Batch eligibility inquiry and response of HIPAA-compliant health care transactions
  • Online provider appeal request
  • Primary care case management (PCCM) inquiry tool
  • Online direct entry claims for all claim types, including corrections, voids and replacement claims

Option B offers full-service, outsourced, end-to-end provider management services, including:

  • Provider enrollment portal and enhancements
  • Supporting operations
  • Call center
  • Training of providers and provider site visits to train and support your network

Read the full MA

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