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AUTHORIZATIONS
Drug Authorizations. Prescription drug authorizations listed by plan type. Medical Authorizations. Prior authorization forms, the reconsideration form, and policy information. Coronavirus Self EVENTS | OPTIMA HEALTH Tags: Guest, Members, Medicaid, Optima Family Care, Optima HealthCommunity Care
PRIOR AUTHORIZATION FORMS Behavioral Health Outpatient Authorization Request. Electroconvulsive Therapy (ECT) Authorization Request. Transcranial Magnetic Stimulation (rTMS) Authorization Request Form. Community Mental Health RecoveryServices (CMHRS)
CLINICAL GUIDELINES
Preventive Health Guidelines. 2021 Immunization Schedule. Adult Health Maintenance. Guidelines for Childhood Lead Poisoning Testing. Pediatric Health Maintenance. Tobacco Cessation. DRUG AUTHORIZATION FORMS Drug Authorization Forms. Luxturna (Medical) (Medication should ONLY be administered in a surgical suite under controlled aseptic conditions by a surgeon experienced in intraocular surgery.) Trogarzo IV (Medical) (Medication will be provided by the Physician's office.) Vimizim IV (Medical) (IV Infusion performed ONLY at Sentara InfusionCenters.)
OPTIMA HEALTH TREATMENT COST CALCULATOR The Treatment Cost Calculator uses actual health insurance claims history data to provide accurate, real-time estimates for more than 300 procedures. Get estimates for common procedures like X-rays, advanced imaging, outpatient surgery, office visits, labs, immunizations, inpatient admissions, and more! Cost estimates can betailored to your
UPDATE YOUR INFORMATION Update Your Information. In order to better serve you, it is important that we have updated information about your practice. If any information related to your practice's operations or provider roster have changed, please complete the Optima Health Provider Update Form and submit to the email address shown on the front of the form. MEDICARE DOCUMENTS AND FORMS Documents and Forms for Medicare Plans. Enter your ZIP code to ensure we provide you with the right plan information for your coverage area. DIABETES | OPTIMA HEALTH Diabetes. Optima Health can help you, or a loved one manage diabetes. Diabetes is a serious disease that can lead to potentially life-threatening complications such as heart disease, stroke, kidney disease, blindness, and amputation. Diabetes-related complications may be prevented, but only if long-term lifestyle changes are made. PROVIDERS | OPTIMA HEALTHAUTHORIZATIONSPHARMACYBILLING AND CLAIMSCLINICAL REFERENCEPROVIDER SUPPORTNEWS Optima Health Providers. Pharmacy. Covered drug search, formularies and order forms. Authorizations. Prescription drug and medical authorization forms. Billing & Claims. Billing services form instructions, EDI transaction overview and more. Clinical Reference. Immunization schedules, clinical guidelines and more.AUTHORIZATIONS
Drug Authorizations. Prescription drug authorizations listed by plan type. Medical Authorizations. Prior authorization forms, the reconsideration form, and policy information. Coronavirus Self EVENTS | OPTIMA HEALTH Tags: Guest, Members, Medicaid, Optima Family Care, Optima HealthCommunity Care
PRIOR AUTHORIZATION FORMS Behavioral Health Outpatient Authorization Request. Electroconvulsive Therapy (ECT) Authorization Request. Transcranial Magnetic Stimulation (rTMS) Authorization Request Form. Community Mental Health RecoveryServices (CMHRS)
CLINICAL GUIDELINES
Preventive Health Guidelines. 2021 Immunization Schedule. Adult Health Maintenance. Guidelines for Childhood Lead Poisoning Testing. Pediatric Health Maintenance. Tobacco Cessation. DRUG AUTHORIZATION FORMS Drug Authorization Forms. Luxturna (Medical) (Medication should ONLY be administered in a surgical suite under controlled aseptic conditions by a surgeon experienced in intraocular surgery.) Trogarzo IV (Medical) (Medication will be provided by the Physician's office.) Vimizim IV (Medical) (IV Infusion performed ONLY at Sentara InfusionCenters.)
OPTIMA HEALTH TREATMENT COST CALCULATOR The Treatment Cost Calculator uses actual health insurance claims history data to provide accurate, real-time estimates for more than 300 procedures. Get estimates for common procedures like X-rays, advanced imaging, outpatient surgery, office visits, labs, immunizations, inpatient admissions, and more! Cost estimates can betailored to your
UPDATE YOUR INFORMATION Update Your Information. In order to better serve you, it is important that we have updated information about your practice. If any information related to your practice's operations or provider roster have changed, please complete the Optima Health Provider Update Form and submit to the email address shown on the front of the form. MEDICARE DOCUMENTS AND FORMS Documents and Forms for Medicare Plans. Enter your ZIP code to ensure we provide you with the right plan information for your coverage area. DIABETES | OPTIMA HEALTH Diabetes. Optima Health can help you, or a loved one manage diabetes. Diabetes is a serious disease that can lead to potentially life-threatening complications such as heart disease, stroke, kidney disease, blindness, and amputation. Diabetes-related complications may be prevented, but only if long-term lifestyle changes are made. HOME | OPTIMA HEALTH Welcome Members. Thank you for choosing Optima Health. We'd like to welcome you with information to help you start using your new health plan. Get Started. Get On-the-Go Access. Get the Optima Health mobile app to access member ID cards, schedule virtual care appointments, find doctors, check claims and more. Get the App. PROVIDERS | OPTIMA HEALTH Optima Health Providers. Pharmacy. Covered drug search, formularies and order forms. Authorizations. Prescription drug and medical authorization forms. Billing & Claims. Billing services form instructions, EDI transaction overview and more. Clinical Reference. Immunization schedules, clinical guidelines and more.AUTHORIZATIONS
Drug Authorizations. Prescription drug authorizations listed by plan type. Medical Authorizations. Prior authorization forms, the reconsideration form, and policy information. Coronavirus Self OPTIMA EMPLOYEE ASSISTANCE PROGRAM Optima Employee Assistance Program (EAP) During this stressful time, it’s normal to feel worried, frustrated, or isolated. We care about your well–being. Groups with the Optima EAP benefit can talk to a counselor by calling 1–800–899–8174. This benefit also includes online resources on optimaeap.com. COVID-19 100% COVERAGE ENDING JUNE 30 Thank you for choosing Optima Health. As you know, in an effort to support our clients and members, Optima Health began providing 100% coverage for many services related to the COVID-19 pandemic. We previously announced that we would extend coverage through May 31, 2021 for select services and have decided to extend coverage throughJune 30, 2021.
OPTIMA COMMUNITY COMPLETE (HMO D-SNP) Optima Community Complete (HMO D-SNP) is a Medicare Dual Special Needs Plan (D-SNP). If you currently receive Commonwealth Coordinated Care Plus (CCC Plus) Medicaid benefits and are also eligible for Medicare, you may want to consider enrolling in Optima Community Complete.CLINICAL GUIDELINES
Preventive Health Guidelines. 2021 Immunization Schedule. Adult Health Maintenance. Guidelines for Childhood Lead Poisoning Testing. Pediatric Health Maintenance. Tobacco Cessation. OPTIMA HEALTH TREATMENT COST CALCULATOR The Treatment Cost Calculator uses actual health insurance claims history data to provide accurate, real-time estimates for more than 300 procedures. Get estimates for common procedures like X-rays, advanced imaging, outpatient surgery, office visits, labs, immunizations, inpatient admissions, and more! Cost estimates can betailored to your
MEDICARE DOCUMENTS AND FORMS Documents and Forms for Medicare Plans. Enter your ZIP code to ensure we provide you with the right plan information for your coverage area. HEARING CARE AND HEARING AID DISCOUNT PROGRAM The new program provides coordinated care, fixed and reduced costs and provides a broader network to those hearing related-services and treatments not currently covered under your medical plan, Medicare or Medicaid (ages 21 and over). The program covers you and your extended family (spouse, grandparents, aunts, uncles, children and friends). HOME | OPTIMA HEALTHSIGN INSHOP FOR INSURANCEHEALTH INSURANCE 101FIND DOCTORS, DRUGS AND FACILITIES Optima Health offers health insurance coverage for individuals, families, and employers that includes wellness programs, online resources, extra savings and discounts and more. SIGN IN | OPTIMA HEALTH Sign in to your OptimaHealth.com account. © Optima Health 2021, 4417 Corporation Lane, Virginia Beach, VA 23462-3162AUTHORIZATIONS
Drug Authorizations. Prescription drug authorizations listed by plan type. Medical Authorizations. Prior authorization forms, the reconsideration form, and policy information PRIOR AUTHORIZATION FORMS Pre-authorization fax numbers are specific to the type of authorization request. Please submit your request to the fax number listed on the request form with the fax coversheet.. Pre-authorization reconsideration request? UPDATE YOUR INFORMATION Update Your Information. In order to better serve you, it is important that we have updated information about your practice. If any information related to your practice's operations or provider roster have changed, please complete the Optima Health Provider Update Form and submit to the email address shown on the front of the form. DIABETES | OPTIMA HEALTH Optima Health can help you, or a loved one manage diabetes. Diabetes is a serious disease that can lead to potentially life-threatening complications such as heart disease, stroke, kidney disease,blindness, and
BEHAVIORAL HEALTH PROVIDER RESOURCES FORMULARIES AND DRUG LISTS Formularies and Drug Lists. Prescription drug lists and formularies for all Optima Health plans. Alternatively you can use our online search tool for the most up-to-date information*.. Commercial PlansCLINICAL GUIDELINES
Clinical guidelines for health professionals in an easy-to-downloadformat.
MEDICAL LOSS RATIO REBATES Resources for Filing Your Annual Income Tax Return. When you are ready to file your tax return and want to learn more about the rebate you received and how it may affect your tax filing, you can find information below about the Medical Loss Ratio (MLR) rebates and if they are taxable, or not. HOME | OPTIMA HEALTHSIGN INSHOP FOR INSURANCEHEALTH INSURANCE 101FIND DOCTORS, DRUGS AND FACILITIES Optima Health offers health insurance coverage for individuals, families, and employers that includes wellness programs, online resources, extra savings and discounts and more. SIGN IN | OPTIMA HEALTH Sign in to your OptimaHealth.com account. © Optima Health 2021, 4417 Corporation Lane, Virginia Beach, VA 23462-3162AUTHORIZATIONS
Drug Authorizations. Prescription drug authorizations listed by plan type. Medical Authorizations. Prior authorization forms, the reconsideration form, and policy information PRIOR AUTHORIZATION FORMS Pre-authorization fax numbers are specific to the type of authorization request. Please submit your request to the fax number listed on the request form with the fax coversheet.. Pre-authorization reconsideration request? UPDATE YOUR INFORMATION Update Your Information. In order to better serve you, it is important that we have updated information about your practice. If any information related to your practice's operations or provider roster have changed, please complete the Optima Health Provider Update Form and submit to the email address shown on the front of the form. DIABETES | OPTIMA HEALTH Optima Health can help you, or a loved one manage diabetes. Diabetes is a serious disease that can lead to potentially life-threatening complications such as heart disease, stroke, kidney disease,blindness, and
BEHAVIORAL HEALTH PROVIDER RESOURCES FORMULARIES AND DRUG LISTS Formularies and Drug Lists. Prescription drug lists and formularies for all Optima Health plans. Alternatively you can use our online search tool for the most up-to-date information*.. Commercial PlansCLINICAL GUIDELINES
Clinical guidelines for health professionals in an easy-to-downloadformat.
MEDICAL LOSS RATIO REBATES Resources for Filing Your Annual Income Tax Return. When you are ready to file your tax return and want to learn more about the rebate you received and how it may affect your tax filing, you can find information below about the Medical Loss Ratio (MLR) rebates and if they are taxable, or not. PROVIDERS | OPTIMA HEALTH Pharmacy. Covered drug search, formularies and order forms. Authorizations. Prescription drug and medical authorization forms. Billing & Claims. Billing services COVID-19 100% COVERAGE ENDING JUNE 30 Thank you for choosing Optima Health. As you know, in an effort to support our clients and members, Optima Health began providing 100% coverage for many services related to the COVID-19 pandemic. We previously announced that we would extend coverage through May 31, 2021 for select services and have decided to extend coverage throughJune 30, 2021.
OPTIMA MEDICARE HMO
Optima Medicare HMO Plans. Our affordable Medicare Advantage (Part C) plans provide comprehensive coverage, all backed by the support of our high-quality network of experts.. With a $0 monthly premium option, low out-of-pocket maximums, and special allowances, you can enjoy better value at more predictable costs. RESOURCES | PROVIDERS | OPTIMA HEALTH HEDIS ® Measures for Measurement Years (MY) 2020 and 2021. Use this quick and easy reference as a guide to improve Optima Health members’ quality of care. This guide includes specific gap closure tips and reminders such as:AUTHORIZATIONS
Drug Authorizations. Prescription drug authorizations listed by plan type. Medical Authorizations. Prior authorization forms, the reconsideration form, and policy informationOPTIMA FAMILY CARE
Open enrollment in Optima Family Care will be available for Medallion 4.0 Non-Expansion members in the following regions: . Central: April 19, 2021 – June 30, 2021; Northern/Winchester: June 19, 2021 – August 31, 2021; View schedule FIND DOCTORS DENTISTS AND MEDICATIONS Find Doctors, Dentists and Medications. Our network features more than 35,000 1 providers, major hospital systems, and access to Sentara Medical Group (SMG), Sentara Quality Care Network (SQCN), Riverside Health System, Tidewater Physician Multispecialty Group FORMULARIES AND DRUG LISTS Formularies and Drug Lists. Prescription drug lists and formularies for all Optima Health plans. Alternatively you can use our online search tool for the most up-to-date information*.. Commercial Plans DRUG AUTHORIZATION FORMS Forms to download and submit for drug authorizations through OptimaHealth.
CLINICAL GUIDELINES
Clinical guidelines for health professionals in an easy-to-downloadformat.
HOME | OPTIMA HEALTHSIGN INSHOP FOR INSURANCEHEALTH INSURANCE 101FIND DOCTORS, DRUGS AND FACILITIES Welcome Members. Thank you for choosing Optima Health. We'd like to welcome you with information to help you start using your new health plan. Get Started. Get On-the-Go Access. Get the Optima Health mobile app to access member ID cards, schedule virtual care appointments, find doctors, check claims and more. Get the App. SIGN IN | OPTIMA HEALTH Sign in to your OptimaHealth.com account. © Optima Health 2021, 4417 Corporation Lane, Virginia Beach, VA 23462-3162 PROVIDERS | OPTIMA HEALTH Optima Health Providers. Pharmacy. Covered drug search, formularies and order forms. Authorizations. Prescription drug and medical authorization forms. Billing & Claims. Billing services form instructions, EDI transaction overview and more. Clinical Reference. Immunization schedules, clinical guidelines and more. PRIOR AUTHORIZATION FORMS Behavioral Health Outpatient Authorization Request. Electroconvulsive Therapy (ECT) Authorization Request. Transcranial Magnetic Stimulation (rTMS) Authorization Request Form. Community Mental Health RecoveryServices (CMHRS)
CLINICAL GUIDELINES
Preventive Health Guidelines. 2021 Immunization Schedule. Adult Health Maintenance. Guidelines for Childhood Lead Poisoning Testing. Pediatric Health Maintenance. Tobacco Cessation. FORMULARIES AND DRUG LISTS Formularies and Drug Lists. Prescription drug lists and formularies for all Optima Health plans. Alternatively you can use our online search tool for the most up-to-date information*.. Commercial Plans BEHAVIORAL HEALTH PROVIDER RESOURCES DIABETES | OPTIMA HEALTH Diabetes. Optima Health can help you, or a loved one manage diabetes. Diabetes is a serious disease that can lead to potentially life-threatening complications such as heart disease, stroke, kidney disease, blindness, and amputation. Diabetes-related complications may be prevented, but only if long-term lifestyle changes are made. MEDICAL LOSS RATIO REBATES Learn more about the Medical Loss Ratio (MLR) rebate you received and how it may affect your tax filing. Update May 1, 2021. Optima Health recently issued additional rebate checks to eligible Individual & Family plan policyholders who paid premium in 2018. If you received a check or have questions about the rebate, please view our Member DRUG AUTHORIZATION FORMS Drug Authorization Forms. Luxturna (Medical) (Medication should ONLY be administered in a surgical suite under controlled aseptic conditions by a surgeon experienced in intraocular surgery.) Trogarzo IV (Medical) (Medication will be provided by the Physician's office.) Vimizim IV (Medical) (IV Infusion performed ONLY at Sentara InfusionCenters.)
HOME | OPTIMA HEALTHSIGN INSHOP FOR INSURANCEHEALTH INSURANCE 101FIND DOCTORS, DRUGS AND FACILITIES Welcome Members. Thank you for choosing Optima Health. We'd like to welcome you with information to help you start using your new health plan. Get Started. Get On-the-Go Access. Get the Optima Health mobile app to access member ID cards, schedule virtual care appointments, find doctors, check claims and more. Get the App. SIGN IN | OPTIMA HEALTH Sign in to your OptimaHealth.com account. © Optima Health 2021, 4417 Corporation Lane, Virginia Beach, VA 23462-3162 PROVIDERS | OPTIMA HEALTH Optima Health Providers. Pharmacy. Covered drug search, formularies and order forms. Authorizations. Prescription drug and medical authorization forms. Billing & Claims. Billing services form instructions, EDI transaction overview and more. Clinical Reference. Immunization schedules, clinical guidelines and more. PRIOR AUTHORIZATION FORMS Behavioral Health Outpatient Authorization Request. Electroconvulsive Therapy (ECT) Authorization Request. Transcranial Magnetic Stimulation (rTMS) Authorization Request Form. Community Mental Health RecoveryServices (CMHRS)
CLINICAL GUIDELINES
Preventive Health Guidelines. 2021 Immunization Schedule. Adult Health Maintenance. Guidelines for Childhood Lead Poisoning Testing. Pediatric Health Maintenance. Tobacco Cessation. FORMULARIES AND DRUG LISTS Formularies and Drug Lists. Prescription drug lists and formularies for all Optima Health plans. Alternatively you can use our online search tool for the most up-to-date information*.. Commercial Plans BEHAVIORAL HEALTH PROVIDER RESOURCES DIABETES | OPTIMA HEALTH Diabetes. Optima Health can help you, or a loved one manage diabetes. Diabetes is a serious disease that can lead to potentially life-threatening complications such as heart disease, stroke, kidney disease, blindness, and amputation. Diabetes-related complications may be prevented, but only if long-term lifestyle changes are made. MEDICAL LOSS RATIO REBATES Learn more about the Medical Loss Ratio (MLR) rebate you received and how it may affect your tax filing. Update May 1, 2021. Optima Health recently issued additional rebate checks to eligible Individual & Family plan policyholders who paid premium in 2018. If you received a check or have questions about the rebate, please view our Member DRUG AUTHORIZATION FORMS Drug Authorization Forms. Luxturna (Medical) (Medication should ONLY be administered in a surgical suite under controlled aseptic conditions by a surgeon experienced in intraocular surgery.) Trogarzo IV (Medical) (Medication will be provided by the Physician's office.) Vimizim IV (Medical) (IV Infusion performed ONLY at Sentara InfusionCenters.)
PROVIDERS | OPTIMA HEALTH Optima Health Providers. Pharmacy. Covered drug search, formularies and order forms. Authorizations. Prescription drug and medical authorization forms. Billing & Claims. Billing services form instructions, EDI transaction overview and more. Clinical Reference. Immunization schedules, clinical guidelines and more.AUTHORIZATIONS
Drug Authorizations. Prescription drug authorizations listed by plan type. Medical Authorizations. Prior authorization forms, the reconsideration form, and policy information. Coronavirus Self RESOURCES | PROVIDERS | OPTIMA HEALTH The free Optima Health FIT (Fecal Immunochemical Test) campaign occurs year–round with an annual push of over 30,000 kits every summer. Please familiarize yourself with the campaign flyer. Feel free to print and share with eligible Optima Health members. You may also review the sample results letter that we mail to providers. DRUG AUTHORIZATION FORMS Drug Authorization Forms. Luxturna (Medical) (Medication should ONLY be administered in a surgical suite under controlled aseptic conditions by a surgeon experienced in intraocular surgery.) Trogarzo IV (Medical) (Medication will be provided by the Physician's office.) Vimizim IV (Medical) (IV Infusion performed ONLY at Sentara InfusionCenters.)
OPTIMA HEALTH TREATMENT COST CALCULATOR The Treatment Cost Calculator uses actual health insurance claims history data to provide accurate, real-time estimates for more than 300 procedures. Get estimates for common procedures like X-rays, advanced imaging, outpatient surgery, office visits, labs, immunizations, inpatient admissions, and more! Cost estimates can betailored to your
PROVIDER TOOLKIT
Navigate the AIM ProviderPortal PDF, 741 KB. Last Updated: 3/10/2021. Register for Provider Connection PDF, 347 KB. Last Updated: 4/27/2021. View and Create Pre-authorizations PDF, 470 KB. Last Updated: 4/27/2021. View Claims Status and Submit Reconsideration PDF, 519 KB. Last Updated: 4/27/2021. Avoid Common Claim Submission Errors PDF, 272KB.
PROVIDER MANUALS AND DIRECTORIES Provider Manual Supplements. Optima Family Care FAMIS/FAMIS Moms - Medallion 4.0 - Provider Manual Supplement PDF, 414 KB. Last Updated: 12/15/2020. Optima Medicare (HMO) - Provider Manual Supplement PDF, 533 KB. Last Updated: 12/15/2020. Optima Community Complete (HMO D-SNP) - Provider Manual Supplement PDF, 296 KB. Last Updated:12/8/2020.
YOU AND YOUR PRIMARY CARE PHYSICIAN When you establish a relationship with a PCP, you develop continuity of care with someone who gets to know you and your health goals, and helps you manage your overall progress, which adds up to better health. Your PCP will provide routine and preventive care services such as annual physicals, exams, and treatment for colds and flu. COVERAGE DECISIONS AND APPEALS Coverage Decisions and Appeals. Download the form for requesting a claim review for members enrolled in an Optima Health plan. Download the form for requesting a behavioral health claim review for members enrolled in an Optima Health plan. Non–contracted providers who have had a Medicare claim denied for payment and want to appeal, must FIND DOCTORS DENTISTS AND MEDICATIONS Find Doctors, Dentists and Medications. Our network features more than 35,000 1 providers, major hospital systems, and access to Sentara Medical Group (SMG), Sentara Quality Care Network (SQCN), Riverside Health System, Tidewater Physician Multispecialty Group PROVIDERS | OPTIMA HEALTHAUTHORIZATIONSPHARMACYBILLING AND CLAIMSCLINICAL REFERENCEPROVIDER SUPPORTNEWS Pharmacy. Covered drug search, formularies and order forms. Authorizations. Prescription drug and medical authorization forms. Billing & Claims. Billing services EVENTS | OPTIMA HEALTH Tags: Guest, Members, Medicaid, Optima Family Care, Optima HealthCommunity Care
AUTHORIZATIONS
Drug Authorizations. Prescription drug authorizations listed by plan type. Medical Authorizations. Prior authorization forms, the reconsideration form, and policy information PRIOR AUTHORIZATION FORMS Pre-authorization fax numbers are specific to the type of authorization request. Please submit your request to the fax number listed on the request form with the fax coversheet.. Pre-authorization reconsideration request? OPTIMA HEALTH TREATMENT COST CALCULATOR The information provided by this site is only an estimate. While every effort has been made to provide you with the most accurate information, in some instances the actual charges from your provider may be different than the historical averages reported by the Treatment Cost Calculator. DIABETES | OPTIMA HEALTH Optima Health can help you, or a loved one manage diabetes. Diabetes is a serious disease that can lead to potentially life-threatening complications such as heart disease, stroke, kidney disease,blindness, and
UPDATE YOUR INFORMATION Update Your Information. In order to better serve you, it is important that we have updated information about your practice. If any information related to your practice's operations or provider roster have changed, please complete the Optima Health Provider Update Form and submit to the email address shown on the front of the form. DRUG AUTHORIZATION FORMS Forms to download and submit for drug authorizations through OptimaHealth.
CLINICAL GUIDELINES
Clinical guidelines for health professionals in an easy-to-downloadformat.
MEDICAL LOSS RATIO REBATES Resources for Filing Your Annual Income Tax Return. When you are ready to file your tax return and want to learn more about the rebate you received and how it may affect your tax filing, you can find information below about the Medical Loss Ratio (MLR) rebates and if they are taxable, or not. PROVIDERS | OPTIMA HEALTHAUTHORIZATIONSPHARMACYBILLING AND CLAIMSCLINICAL REFERENCEPROVIDER SUPPORTNEWS Pharmacy. Covered drug search, formularies and order forms. Authorizations. Prescription drug and medical authorization forms. Billing & Claims. Billing services EVENTS | OPTIMA HEALTH Tags: Guest, Members, Medicaid, Optima Family Care, Optima HealthCommunity Care
AUTHORIZATIONS
Drug Authorizations. Prescription drug authorizations listed by plan type. Medical Authorizations. Prior authorization forms, the reconsideration form, and policy information PRIOR AUTHORIZATION FORMS Pre-authorization fax numbers are specific to the type of authorization request. Please submit your request to the fax number listed on the request form with the fax coversheet.. Pre-authorization reconsideration request? OPTIMA HEALTH TREATMENT COST CALCULATOR The information provided by this site is only an estimate. While every effort has been made to provide you with the most accurate information, in some instances the actual charges from your provider may be different than the historical averages reported by the Treatment Cost Calculator. DIABETES | OPTIMA HEALTH Optima Health can help you, or a loved one manage diabetes. Diabetes is a serious disease that can lead to potentially life-threatening complications such as heart disease, stroke, kidney disease,blindness, and
UPDATE YOUR INFORMATION Update Your Information. In order to better serve you, it is important that we have updated information about your practice. If any information related to your practice's operations or provider roster have changed, please complete the Optima Health Provider Update Form and submit to the email address shown on the front of the form. DRUG AUTHORIZATION FORMS Forms to download and submit for drug authorizations through OptimaHealth.
CLINICAL GUIDELINES
Clinical guidelines for health professionals in an easy-to-downloadformat.
MEDICAL LOSS RATIO REBATES Resources for Filing Your Annual Income Tax Return. When you are ready to file your tax return and want to learn more about the rebate you received and how it may affect your tax filing, you can find information below about the Medical Loss Ratio (MLR) rebates and if they are taxable, or not. HOME | OPTIMA HEALTH Optima Health offers health insurance coverage for individuals, families, and employers that includes wellness programs, online resources, extra savings and discounts and more. OPTIMA EMPLOYEE ASSISTANCE PROGRAM Optima Employee Assistance Program (EAP) During this stressful time, it’s normal to feel worried, frustrated, or isolated. We care aboutyour well–being.
OPTIMA COMMUNITY COMPLETE (HMO D-SNP) Optima Community Complete (HMO D-SNP) is a Medicare Dual Special Needs Plan (D-SNP). If you currently receive Commonwealth Coordinated Care Plus (CCC Plus) Medicaid benefits and are also eligible for Medicare, you may want to consider enrolling in Optima Community Complete.AUTHORIZATIONS
Drug Authorizations. Prescription drug authorizations listed by plan type. Medical Authorizations. Prior authorization forms, the reconsideration form, and policy information MEDICARE DOCUMENTS AND FORMS Documents and Forms for Medicare Plans. Enter your ZIP code to ensure we provide you with the right plan information for your coverage area. UPDATE YOUR INFORMATION Update Your Information. In order to better serve you, it is important that we have updated information about your practice. If any information related to your practice's operations or provider roster have changed, please complete the Optima Health Provider Update Form and submit to the email address shown on the front of the form. DRUG AUTHORIZATION FORMS Forms to download and submit for drug authorizations through OptimaHealth.
CLINICAL GUIDELINES
Clinical guidelines for health professionals in an easy-to-downloadformat.
PROVIDER MANUALS AND DIRECTORIES Provider Manuals and Directories Manuals. Optima Health Provider Manual; Provider Manual Supplements. Optima Family Care FAMIS/FAMIS Moms - Medallion 4.0 - FIND DOCTORS DENTISTS AND MEDICATIONS Find Doctors, Dentists and Medications. Our network features more than 35,000 1 providers, major hospital systems, and access to Sentara Medical Group (SMG), Sentara Quality Care Network (SQCN), Riverside Health System, Tidewater Physician Multispecialty Group HOME | OPTIMA HEALTHSIGN INSHOP FOR INSURANCEHEALTH INSURANCE 101FIND DOCTORS, DRUGS AND FACILITIES Welcome Members. Thank you for choosing Optima Health. We'd like to welcome you with information to help you start using your new health plan. Get Started. Get On-the-Go Access. Get the Optima Health mobile app to access member ID cards, schedule virtual care appointments, find doctors, check claims and more. Get the App. PROVIDERS | OPTIMA HEALTHAUTHORIZATIONSPHARMACYBILLING AND CLAIMSCLINICAL REFERENCEPROVIDER SUPPORTNEWS Optima Health Providers. Pharmacy. Covered drug search, formularies and order forms. Authorizations. Prescription drug and medical authorization forms. Billing & Claims. Billing services form instructions, EDI transaction overview and more. Clinical Reference. Immunization schedules, clinical guidelines and more. EVENTS | OPTIMA HEALTHOPTIMA HEALTH FORMSOPTIMA HEALTH IN VIRGINIAOPTIMA HEALTH INSURANCE CAREERSOPTIMA HEALTH INSURANCE VIRGINIAOPTIMA HEALTH PROVIDER PORTALOPTIMA HEALTH PROVIDER LOG IN Tags: Guest, Members, Medicaid, Optima Family Care, Optima HealthCommunity Care
OPTIMA EMPLOYEE ASSISTANCE PROGRAM Optima Employee Assistance Program (EAP) During this stressful time, it’s normal to feel worried, frustrated, or isolated. We care about your well–being. Groups with the Optima EAP benefit can talk to a counselor by calling 1–800–899–8174. This benefit also includes online resources on optimaeap.com. PRIOR AUTHORIZATION FORMS Behavioral Health Outpatient Authorization Request. Electroconvulsive Therapy (ECT) Authorization Request. Transcranial Magnetic Stimulation (rTMS) Authorization Request Form. Community Mental Health RecoveryServices (CMHRS)
CLINICAL GUIDELINES
Preventive Health Guidelines. 2021 Immunization Schedule. Adult Health Maintenance. Guidelines for Childhood Lead Poisoning Testing. Pediatric Health Maintenance. Tobacco Cessation. OPTIMA HEALTH PLAN HOMEPAGE FOR COVA EMPLOYEES Optima Health Vantage HMO Plan for Commonwealth of Virginia (COVA) and The Local Choice (TLC) Employees. The Optima Health Vantage HMO Plan is a plan choice in the Greater Hampton Roads area available to Commonwealth of Virginia and The Local Choice employees where an employer has selected Optima Health as a plan offering. OPTIMA HEALTH TREATMENT COST CALCULATOR The Treatment Cost Calculator uses actual health insurance claims history data to provide accurate, real-time estimates for more than 300 procedures. Get estimates for common procedures like X-rays, advanced imaging, outpatient surgery, office visits, labs, immunizations, inpatient admissions, and more! Cost estimates can betailored to your
BEHAVIORAL HEALTH PROVIDER RESOURCES FORMULARIES AND DRUG LISTS Formularies and Drug Lists. Prescription drug lists and formularies for all Optima Health plans. Alternatively you can use our online search tool for the most up HOME | OPTIMA HEALTHSIGN INSHOP FOR INSURANCEHEALTH INSURANCE 101FIND DOCTORS, DRUGS AND FACILITIES Welcome Members. Thank you for choosing Optima Health. We'd like to welcome you with information to help you start using your new health plan. Get Started. Get On-the-Go Access. Get the Optima Health mobile app to access member ID cards, schedule virtual care appointments, find doctors, check claims and more. Get the App. PROVIDERS | OPTIMA HEALTHAUTHORIZATIONSPHARMACYBILLING AND CLAIMSCLINICAL REFERENCEPROVIDER SUPPORTNEWS Optima Health Providers. Pharmacy. Covered drug search, formularies and order forms. Authorizations. Prescription drug and medical authorization forms. Billing & Claims. Billing services form instructions, EDI transaction overview and more. Clinical Reference. Immunization schedules, clinical guidelines and more. EVENTS | OPTIMA HEALTHOPTIMA HEALTH FORMSOPTIMA HEALTH IN VIRGINIAOPTIMA HEALTH INSURANCE CAREERSOPTIMA HEALTH INSURANCE VIRGINIAOPTIMA HEALTH PROVIDER PORTALOPTIMA HEALTH PROVIDER LOG IN Tags: Guest, Members, Medicaid, Optima Family Care, Optima HealthCommunity Care
OPTIMA EMPLOYEE ASSISTANCE PROGRAM Optima Employee Assistance Program (EAP) During this stressful time, it’s normal to feel worried, frustrated, or isolated. We care about your well–being. Groups with the Optima EAP benefit can talk to a counselor by calling 1–800–899–8174. This benefit also includes online resources on optimaeap.com. PRIOR AUTHORIZATION FORMS Behavioral Health Outpatient Authorization Request. Electroconvulsive Therapy (ECT) Authorization Request. Transcranial Magnetic Stimulation (rTMS) Authorization Request Form. Community Mental Health RecoveryServices (CMHRS)
CLINICAL GUIDELINES
Preventive Health Guidelines. 2021 Immunization Schedule. Adult Health Maintenance. Guidelines for Childhood Lead Poisoning Testing. Pediatric Health Maintenance. Tobacco Cessation. OPTIMA HEALTH PLAN HOMEPAGE FOR COVA EMPLOYEES Optima Health Vantage HMO Plan for Commonwealth of Virginia (COVA) and The Local Choice (TLC) Employees. The Optima Health Vantage HMO Plan is a plan choice in the Greater Hampton Roads area available to Commonwealth of Virginia and The Local Choice employees where an employer has selected Optima Health as a plan offering. OPTIMA HEALTH TREATMENT COST CALCULATOR The Treatment Cost Calculator uses actual health insurance claims history data to provide accurate, real-time estimates for more than 300 procedures. Get estimates for common procedures like X-rays, advanced imaging, outpatient surgery, office visits, labs, immunizations, inpatient admissions, and more! Cost estimates can betailored to your
BEHAVIORAL HEALTH PROVIDER RESOURCES FORMULARIES AND DRUG LISTS Formularies and Drug Lists. Prescription drug lists and formularies for all Optima Health plans. Alternatively you can use our online search tool for the most upAUTHORIZATIONS
Drug Authorizations. Prescription drug authorizations listed by plan type. Medical Authorizations. Prior authorization forms, the reconsideration form, and policy information. Coronavirus Self OPTIMA EMPLOYEE ASSISTANCE PROGRAM Optima Employee Assistance Program (EAP) During this stressful time, it’s normal to feel worried, frustrated, or isolated. We care about your well–being. Groups with the Optima EAP benefit can talk to a counselor by calling 1–800–899–8174. This benefit also includes online resources on optimaeap.com. FIND A DOCTOR OR HOSPITAL Find a Doctor. Align your health with a team committed to providing quality care. The Optima Medicare HMO network is made up of board-certified doctors and specialty providers committed to developing a relationship with you. Your extended care team includes nurse practitioners and physician assistants to help ensure you arereceiving the best
PROVIDER MANUALS AND DIRECTORIES Provider Manual Supplements. Optima Family Care FAMIS/FAMIS Moms - Medallion 4.0 - Provider Manual Supplement PDF, 414 KB. Last Updated: 12/15/2020. Optima Medicare (HMO) - Provider Manual Supplement PDF, 533 KB. Last Updated: 12/15/2020. Optima Community Complete (HMO D-SNP) - Provider Manual Supplement PDF, 296 KB. Last Updated:12/8/2020.
OPTIMA HEALTH ANNOUNCES PAYMENT POLICY CHANGES EFFECTIVE Optima Health wants to make you aware of changes to our provider payment policies, effective August 1, 2021. Please review the list of updates carefully to ensure you understand the changes and any potential impact to your practice/facility and your patients.. If you have any questions about these changes, please contact your network educator or your contract manager at 877-865-9075. OPTIMA HEALTH TREATMENT COST CALCULATOR The Treatment Cost Calculator uses actual health insurance claims history data to provide accurate, real-time estimates for more than 300 procedures. Get estimates for common procedures like X-rays, advanced imaging, outpatient surgery, office visits, labs, immunizations, inpatient admissions, and more! Cost estimates can betailored to your
FEDERAL EMPLOYEES
Important Information for Federal Employees. We have been helping Federal Employees with coverage for over 20 years. We are delighted to be back in 2021 and offering quality coverage, exceptional service and offer you to be part of one of the nation's top-ranked integratedhealth systems.
PRESCRIPTION DRUG LISTS Prescription Drug Lists and Formularies. Prescription drug lists and formularies for all Optima Health plans. Alternatively you can use our online search tool. Opens a new window or tab. for the most up-to-date information*. Employer Plans. OptimaFit Individual & Family Plans. DIABETES | OPTIMA HEALTH Diabetes. Optima Health can help you, or a loved one manage diabetes. Diabetes is a serious disease that can lead to potentially life-threatening complications such as heart disease, stroke, kidney disease, blindness, and amputation. Diabetes-related complications may be prevented, but only if long-term lifestyle changes are made.CDHP RESOURCES
Optima Equity Resources (HSA) Optima Equity Advantages PDF, 355 KB. Last Updated: 10/29/2020. HSA Cost Savings Modeling Tool - Standard Assumptions (.xls) XLS, 156 KB. Last Updated: 12/16/2019. HSA Cost Savings Modeling Tool - Adjustable Assumptions (.xls) XLS, 164 KB. Last Updated: 12/16/2019. HSA Enrollment Form PDF, 97 KB. HOME | OPTIMA HEALTHSIGN INSHOP FOR INSURANCEHEALTH INSURANCE 101FIND DOCTORS, DRUGS AND FACILITIES Optima Health offers health insurance coverage for individuals, families, and employers that includes wellness programs, online resources, extra savings and discounts and more. PROVIDERS | OPTIMA HEALTHAUTHORIZATIONSPHARMACYBILLING AND CLAIMSCLINICAL REFERENCEPROVIDER SUPPORTNEWS Pharmacy. Covered drug search, formularies and order forms. Authorizations. Prescription drug and medical authorization forms. Billing & Claims. Billing services EVENTS | OPTIMA HEALTHOPTIMA HEALTH FORMSOPTIMA HEALTH IN VIRGINIAOPTIMA HEALTH INSURANCE CAREERSOPTIMA HEALTH INSURANCE VIRGINIAOPTIMA HEALTH PROVIDER PORTALOPTIMA HEALTH PROVIDER LOG IN Tags: Guest, Members, Medicaid, Optima Family Care, Optima HealthCommunity Care
OPTIMA EMPLOYEE ASSISTANCE PROGRAM Optima Employee Assistance Program (EAP) During this stressful time, it’s normal to feel worried, frustrated, or isolated. We care aboutyour well–being.
PRIOR AUTHORIZATION FORMS Pre-authorization fax numbers are specific to the type of authorization request. Please submit your request to the fax number listed on the request form with the fax coversheet.. Pre-authorization reconsideration request? OPTIMA HEALTH PLAN HOMEPAGE FOR COVA EMPLOYEES Optima Health Vantage HMO Plan for Commonwealth of Virginia (COVA) and The Local Choice (TLC) Employees. The Optima Health Vantage HMO Plan is a plan choice in the Greater Hampton Roads area available to Commonwealth of Virginia and The Local Choice employees where an employer has selected Optima Health as a plan offering. OPTIMA HEALTH TREATMENT COST CALCULATOR The information provided by this site is only an estimate. While every effort has been made to provide you with the most accurate information, in some instances the actual charges from your provider may be different than the historical averages reported by the Treatment Cost Calculator. BEHAVIORAL HEALTH PROVIDER RESOURCES FORMULARIES AND DRUG LISTS Formularies and Drug Lists. Prescription drug lists and formularies for all Optima Health plans. Alternatively you can use our online search tool for the most upCLINICAL GUIDELINES
Clinical guidelines for health professionals in an easy-to-downloadformat.
HOME | OPTIMA HEALTHSIGN INSHOP FOR INSURANCEHEALTH INSURANCE 101FIND DOCTORS, DRUGS AND FACILITIES Optima Health offers health insurance coverage for individuals, families, and employers that includes wellness programs, online resources, extra savings and discounts and more. PROVIDERS | OPTIMA HEALTHAUTHORIZATIONSPHARMACYBILLING AND CLAIMSCLINICAL REFERENCEPROVIDER SUPPORTNEWS Pharmacy. Covered drug search, formularies and order forms. Authorizations. Prescription drug and medical authorization forms. Billing & Claims. Billing services EVENTS | OPTIMA HEALTHOPTIMA HEALTH FORMSOPTIMA HEALTH IN VIRGINIAOPTIMA HEALTH INSURANCE CAREERSOPTIMA HEALTH INSURANCE VIRGINIAOPTIMA HEALTH PROVIDER PORTALOPTIMA HEALTH PROVIDER LOG IN Tags: Guest, Members, Medicaid, Optima Family Care, Optima HealthCommunity Care
OPTIMA EMPLOYEE ASSISTANCE PROGRAM Optima Employee Assistance Program (EAP) During this stressful time, it’s normal to feel worried, frustrated, or isolated. We care aboutyour well–being.
PRIOR AUTHORIZATION FORMS Pre-authorization fax numbers are specific to the type of authorization request. Please submit your request to the fax number listed on the request form with the fax coversheet.. Pre-authorization reconsideration request? OPTIMA HEALTH PLAN HOMEPAGE FOR COVA EMPLOYEES Optima Health Vantage HMO Plan for Commonwealth of Virginia (COVA) and The Local Choice (TLC) Employees. The Optima Health Vantage HMO Plan is a plan choice in the Greater Hampton Roads area available to Commonwealth of Virginia and The Local Choice employees where an employer has selected Optima Health as a plan offering. OPTIMA HEALTH TREATMENT COST CALCULATOR The information provided by this site is only an estimate. While every effort has been made to provide you with the most accurate information, in some instances the actual charges from your provider may be different than the historical averages reported by the Treatment Cost Calculator. BEHAVIORAL HEALTH PROVIDER RESOURCES FORMULARIES AND DRUG LISTS Formularies and Drug Lists. Prescription drug lists and formularies for all Optima Health plans. Alternatively you can use our online search tool for the most upCLINICAL GUIDELINES
Clinical guidelines for health professionals in an easy-to-downloadformat.
FIND A DOCTOR OR HOSPITAL Optima Medicare HMO provides access to an extensive network of hospitals with nationally recognized clinical programs, up-to-date preventive care and safety protocols, as well as the latest medical procedures and technologies. OPTIMA EMPLOYEE ASSISTANCE PROGRAM Optima Employee Assistance Program (EAP) During this stressful time, it’s normal to feel worried, frustrated, or isolated. We care aboutyour well–being.
AUTHORIZATIONS
Drug Authorizations. Prescription drug authorizations listed by plan type. Medical Authorizations. Prior authorization forms, the reconsideration form, and policy information OPTIMA HEALTH TREATMENT COST CALCULATOR The information provided by this site is only an estimate. While every effort has been made to provide you with the most accurate information, in some instances the actual charges from your provider may be different than the historical averages reported by the Treatment Cost Calculator. OPTIMA HEALTH ANNOUNCES PAYMENT POLICY CHANGES EFFECTIVE Optima Health wants to make you aware of changes to our provider payment policies, effective August 1, 2021. Please review the list of updates carefully to ensure you understand the changes and any potential impact to your practice/facility and your patients.. If you have any questions about these changes, please contact your network educator or your contract manager at 877-865-9075.FEDERAL EMPLOYEES
Important Information for Federal Employees. We have been helping Federal Employees with coverage for over 20 years. We are delighted to be back in 2021 and offering quality coverage, exceptional service and offer you to be part of one of the nation's top-ranked integratedhealth systems.
PRESCRIPTION DRUG LISTS Prescription Drug Lists and Formularies. Prescription drug lists and formularies for all Optima Health plans. Alternatively you can use our online search tool for the most upCLINICAL GUIDELINES
Clinical guidelines for health professionals in an easy-to-downloadformat.
UPDATE YOUR INFORMATION Update Your Information. In order to better serve you, it is important that we have updated information about your practice. If any information related to your practice's operations or provider roster have changed, please complete the Optima Health Provider Update Form and submit to the email address shown on the front of the form. PROVIDER MANUALS AND DIRECTORIES Provider Manuals and Directories Manuals. Optima Health Provider Manual; Provider Manual Supplements. Optima Family Care FAMIS/FAMIS Moms - Medallion 4.0 -Skip to content
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Coverage for people with low incomes and disabilities ARE YOU NOW ELIGIBLE FOR MEDICAID? As of January 1, 2019, thousands of Virginians between the ages of 19-64 are now able to get the health care they need at little to no cost under the Virginia Medicaid expansion. If you haven't qualified for Medicaid before, you may qualify now. Discover more about your Medicaid eligibility. QUESTIONS ABOUT HEALTH INSURANCE? We have answers. Check out our helpful videos, glossary, explanation of acronyms, specific answers to common questions and more. Visit Health Insurance 101 GET HEALTHY, STAY HEALTHY Free programs and online tools to help you get healthy and stayhealthy.
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Optima Health 2019, 4417 Corporation Lane, Virginia Beach, VA23462-3162
Optima Health is the trade name of Optima Health Plan, Optima Health Insurance Company, Optima Health Group, Inc., and Sentara Health Plans, Inc. Optima Health Maintenance Organization (HMO) products, and Point-of-Service (POS) products, are issued and underwritten by Optima Health Plan. Optima Preferred Provider Organization (PPO) products are issued and underwritten by Optima Health Insurance Company. Sentara Health Plans, Inc. provides administrative services to group and individual health plans but does not underwrite benefits.Details
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