United Behavioral Health, operating under the brand Optum U. S. Behavioral Health Plan, California, doing business as OptumHealth Behavioral Solutions of California Credentialing and Recredentialing of Clinicians with Optum

Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 2 Joining the Optum Network You’ve sent in your request to join the network and have been invited to apply…what next? –Optum evaluates all clinician applicants in a consistent and timely manner –In most states, clinicians complete their application through CAQH, an online data collection source Includes uploading copies of documents such as: –Professional liability insurance –Professional license(s) –W9 form –Once the CAQH application is complete, we will begin the Primary Source Verification process

Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 3 Primary Source Verification We must confirm some components of the application through a “Primary Source”, such as state licensing boards These components may include: –Professional license –Board Certification –Education and training –History of professional liability claim settlements and judgments –Medicare and Medicaid sanction status If any discrepancies are found between the information submitted by the clinician and that gathered through Primary Source Verifications, the applicant is notified and has 10 business days to address the discrepancies

Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 4 Approval Process If all requirements are met and no discrepancies were noted through Primary Source Verification, your application is ready for review by the Medical Director What if you don’t meet the requirements? Does that mean you can’t be in the network? –Our Credentialing Committee reviews “exceptions” to the minimum requirements - For example, a Psychiatrist who is not Board Certified may be allowed in the network based on training and experience –The Credentialing Committee meets at least once per month to review detailed information on the “exception” files and makes decisions based on thorough and standardized review of each case

Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 5 The Credentialing Committee A standing committee comprised of: –Network clinicians (the majority of the Committee) Not employees of Optum Represent behavioral health disciplines including: –Psychiatrists –Nurses –Psychologists –Master’s Level clinicians –Licensed Optum staff (the minority of the Committee) Chaired by Optum Medical Director (licensed Psychiatrist) Decisions & actions of the Committee are: –Non-discriminatory –Guided by consideration of each applicant’s potential contribution to providing effective, efficient health care services for the individuals we serve –Based on Optum’s need for clinicians in the service area

Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 6 Your effective date in the network Your effective date with Optum is the date that you are approved for participation by the Medical Director or the Credentialing Committee You will be notified when your application is approved or, if your application is not approved, you will receive a notice advising you of that decision You may begin seeing members as a contracted Optum clinician concurrent with your effective date There are many resources and tools available to you through the “Welcome to the network” section of Provider Express (select “Our Network”, then “Welcome to the network” and select your state)

Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 7 Recredentialing Optum recredentials clinicians at least once every 36 months: –State law or client requirements may require a different recredentialing cycle (MA – MDs – 2 years) Optum generally uses CAQH for recredentialing and the process is very similar to initial credentialing, including Primary Source Verifications and notification to you of any discrepancies found during the process It is important that you maintain current demographic information with Optum and update credentialing information with CAQH regularly Remember, making changes in CAQH does not automatically update to your Optum record; you must notify both Optum and CAQH when you make demographic changes To update Optum, use the Provider Express secure Transactions feature “My Practice Info” or contact your Network Manager

Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 8 Approvals and Notifications As with initial credentialing, recredentialing approval may come from: –The Optum Medical Director (when all credentialing criteria are met) –The Credentialing Committee (when there is an “exception” to the credentialing criteria requiring review) You will be notified of the approval or denial of your recredentialing application

Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 9 Important reminders Between credentialing cycles, please remember to: –Update CAQH with any changes to your demographic information such as: Name Tax ID number Changes or renewals of licenses or insurance –Update Optum with those same changes and/or renewals –Notify Optum if you are unable to take new referrals (full practice, leave of absence, etc.) –Notify Optum of any action that could potentially result in the suspension, sanction, revocation or restriction of your license

Thank You. Rev 2/2015