What is Optum Physical Health?

What is Optum Physical Health? 🤝

Optum is a subsidiary of UnitedHealth Group, offering a wide spectrum of services, from pharmacy benefit management to direct care under Optum Health. Their Physical Health division connects independent practitioners (e.g., PT/OT, MD/DO, therapists) with patients through insurance networks, enhancing access to quality care.

Why Credential with Optum?

• Assured quality standards: The credentialing process confirms that providers meet rigorous benchmarks in licensure, training, malpractice coverage, and more.
• Network access: Once approved, providers can treat and bill Optum/UnitedHealth patients, expanding catchment and revenue.
• Recredentialing: Occurs every 36 months or per state rules to maintain up-to-date qualifications.

Step-by-Step Credentialing Journey

a. Letter of Interest & Signing

Begin by submitting a Letter of Interest to OptumHealth Physical Health. After signing the Participating Provider Agreement (PPA), you’re eligible to apply.

b. Application Submission

Create a One Healthcare ID to access the provider portal. Complete the credentialing application fully—including personal and practice details, malpractice policy, NPI, and Medicare/Medicaid if applicable. Submit your application electronically via the Provider Credentialing System (PCS).

c. Primary Source Verification & Committee Review

Optum (with partner Aperture) performs thorough verification of credentials, licensure, education, training, insurance, and claims history. A peer Credentialing Committee then reviews and votes on your application.

d. Approval, Denial, & Appeals

Approved applicants receive the executed PPA and a welcome packet listing the effective date. If denied, Optum issues a notice including appeal rights—typically within 30 days—and you may reapply after 24 months.

Timeline & Common Delays

Standard timeframe: Expect credentialing to take up to 60 days if complete—but industry delays of 90–180 days are common.

Common bottlenecks include:

• Incomplete applications
• Slow response times
• Required supplemental audits (especially in behavioral health)

From r/therapists: “The process is slow AF… Up to 180 days isn’t out of the norm honestly.”

Helpful Tips for a Smoother Process

• Keep CAQH updated (re-attest every 90 days) — Optum and others pull info from it
• Ensure consistent info across documents (name, address, TIN/NPI) to avoid rejections
• Organize digital files (licenses, insurance, board certs) so attachments are ready
• Stay on top of follow‑up — call, document conversations, escalate if needed
• Know audit requirements, especially for ABA or behavioral health — Optum may require upfront documentation

Recredentialing & Ongoing Compliance

Every 36 months, or as state law dictates, providers undergo recredentialing, which checks current licensure, insurance, claims, and board status. Annual compliance training (fraud/waste/abuse, HIPAA, plan-specific) may also be required.

Putting It All Together

Here’s a snapshot journey:

Final Takeaways

• Plan ahead: Start credentialing early—factoring in possible delays.
• Stay organized: CAQH, your portal, and document management are critical.
• Be proactive: Regular follow-ups can help avoid stalls.
• Understand your rights: Know appeal timelines and renewal requirements.

Bottom line: Optum Physical Health credentialing is a structured yet sometimes slow process that ensures quality and network integrity. With diligence and organization, providers can effectively navigate this journey and join a robust care delivery network.