ProviderCredRequest - Provider Portal

Thank you for your interest in OptumHealth Physical Health. We welcome your questions and comments about our company.

E-mail Subject:

I would like more information about OptumHealth Physical Health's products, services, and data analysis capabilities.
I am a health care provider and would like information about joining an OptumHealth Physical Health network.
I am a new therapist joining an existing Optum contracted group.
- Online Process
  Thank you for your interest in OptumHealth Physical Health. We welcome your questions and comments about our company.
- Offline Process
  This is current process that will get removed in coming months.
I am a health care provider and would like to become a Managed Physical Network Provider (The Empire Plan), ONLY.

NOTE: If you are an individual with a question about your health care benefits, please call the number on the back of your membership card. If you are an existing customer, with questions about your current account, please contact your account manager.

UnitedHealthCare Community Plan of Indiana

The following applies to providers interested in participating with Optum and does not apply to those providers interested in becoming Managed Physical Network Providers:

In an effort to determine if your business should contract with Optum, please review the following:

Optum contracts with chiropractors and outpatient physical, occupational and speech therapy providers/clinics.
Optum also contracts with complementary and alternative medicine providers (CAM) such as acupuncturists, naturopaths and massage therapists.

Optum does not contract with:

MDs, DOs or other sub-specialties.
Therapy Provider practices that share a Tax Identification Number (TIN) with an MD, DO, PhD, or DDS.
Providers who share a TIN with a hospital based entity.
Home health agencies or therapists who perform home visits.
Physical and occupational therapy assistants.

Comments*

First Name*

Last Name*

Organization*

Address*

City*

Zip*

Phone*

Email*

How did you hear about OptumHealth Physical Health?

Brochure

Phone Call from OptumHealth Physical Health

Recommended by Other Provider

Patient Request

Fax Blast

Other

Provider Information
Specialty*

First Name*

Last Name*

TIN*

NPI*

Clinical/Facility Information

Name

Service Address*

City*

State*

Zip*

Phone*

Fax*

Email*

Contact Name*

Therapy Providers

1. Does your clinic/facility employ multi-disciplinary medical based providers (e.g. MD's, DO's, NP's, RT's, RN's, etc.) that will bill the same Tax ID number as PT, OT, ST providers under your employment?*

Yes

2. Does a hospital based or skilled nursing facility share the same TAX ID number as your clinic/facility?*

Yes

3. Does your clinic/facility currently bill using a CMS-1500 claim form?*

Yes

Provider Information
Specialty*

TIN*

NPI*

Clinical/Facility Information

Name

Service Address*

City*

State*

Zip*

Phone*

Fax*

Email*

Contact Name*