|FAQ - Clinical Support and Submissions|
Where may I obtain additional information about
the Clinical Support Program?
You may obtain additional information regarding the Clinical Support Program by accessing your:
• Plan Summary
• WebAssist, www.myoptumhealthphysicalhealth.com
• Operations Manual
• Service representatives for administrative inquiries
• Support clinician for clinical inquiries
Who is my support clinician and how do I reach him/her to discuss clinical issues?
OptumHealth has clinicians located throughout the United States. Each state has a designated support clinician(s). A service representative may connect you with your assigned support clinician. Additionally, your support clinician’s name is listed on the Response to Submission you receive when you submit a Patient Summary Form.
I am frequently encouraged to use the “online format” for Patient Summary Form submissions. Why should I submit a Patient Summary Form online rather than submit it via fax?
One of the benefits of electronic Patient Summary Form filing is that the system will not accept the Patient Summary Form unless it is filled in completely. This will immediately reduce errors and process delays. Facsimile submission of incomplete Patient Summary Forms can increase processing time. Another benefit to submitting a Patient Summary Form online is that once the Patient Summary Form is successfully submitted, you will receive a confirmation number. You may print out the confirmation page or copy down the confirmation number. Receipt of the confirmation number lets you know that your Patient Summary Form has been received. When you submit your Patient Summary Form online, you have the added ability to view the status of your online submission.
How do I know if a patient requires a clinical submission?
There are two separate processes that must be completed to determine if a patient has benefits and if they require clinical submission. First, you must call the carrier at the number on the back of the patient’s ID card to verify with the carrier that the patient has benefits. Second, you must either call the OptumHealth Care Solutions, LLC. Quick Group Check line at (888) 329-5182 or log onto www.myoptumhealthphysicalhealth.com and use the Quick Group Check utility located in the Tools & Resources section. This final check will let you know if a clinical submission is required.
Why is my Patient Summary Form submission returned as “late”?
A Patient Summary Form submission is considered “late” if it is received later than the timely filing requirements. Please refer to your Plan Summary for specific guidelines.
I am treating a patient with two different conditions. When I submit a second Patient Summary Form for the second condition, the first Patient Summary Response is changed to reflect inclusion of the second condition. Why can’t I have a different Patient Summary Response for each condition treated?
OptumHealth expects providers to treat all conditions identified judiciously and simultaneously. If treatment begins for one condition within a given timeframe and OptumHealth then receives a new Patient Summary Form with a new condition identified, the subsequent response to submission will be considered to extend the overall treatment timeframe to include the new condition(s). When sending this subsequent submission for the new condition, be sure to address all conditions on the new clinical submission.
I have faxed over my Patient Summary Form multiple times and there is still no record of the submission. Is there only one fax number available for fax submissions or are there multiple fax lines set-up for CSP submissions?
OptumHealth has different fax lines set up based on health plan and region. Refer to the Plan Summary to determine the best fax number.
Why does my Response to Submission confirmation number contain letters in addition to the usual number-only confirmation?
A Patient Summary Response number that contains letters as a part of the confirmation number indicates that a change in the original Patient Summary Response has occurred. These types of changes typically occur as a result of additional information provided by your office. Examples of when you may see this are as follows:
• Change/update in conditions treated
• Change/update in visit value
• Change/update in visit end date value
OptumHealth does not require that I record functional outcome measures with each Patient Summary Form submission. Why should I implement functional outcome assessment in my clinic and why should I submit functional outcome scores on the Patient Summary Form?
Using functional outcome tools in your clinic provides you with ongoing assessment of patient progress with the established treatment plan. Sharing these outcomes with your patient is an opportunity for firsthand continuous feedback. This also provides the strongest documentation for the ongoing need for skilled care. All outcome assessment tools, templates, scoring how-to’s, and interpretative education materials are available at www.myoptumhealthphysicalhealth.com.
Should I review the “Patient Completes This Section” with my patients?
Absolutely. When you review this information with your patients, you improve patient/provider communication, goal setting, and barrier recognition. The increase in communication can yield a more positive treatment outcome.
Why should I include information about my patient’s surgical procedure and the date of surgical procedure on the Patient Summary Form?
Your designated support clinician reviews all relevant information in order to apply an appropriate Recovery Milestone Value to the Response to Submission. Surgical procedure and date of surgical procedure information are important components of a patient’s health record. Recording these applicable components ensures that your support clinician has a full appreciation of the case and all the complexities that may exist due to surgical intervention.
My office staff received a Patient Summary Response that reads “stationary” or “ineffective”? As the treating provider, should I discuss this transitional type response with my patients?
A “stationary” or “ineffective” transitional response on the Response to Submission reflects a determination in which a lack of progress is appreciated based on the submitted documentation. These response types should be shared with the treating provider, and they in turn provide an ideal opportunity for patient/practitioner discussion about treatment plan, goals, and barriers toward progress. Additionally, should you recognize unique barriers to improvement, you should feel free to contact your assigned support clinician for discussion.
I keep hearing about “Recovery Milestones” from the Member and Provider Services Representatives and my Support Clinician; what are they?
A recovery milestone is a marker at which to assess the patient’s ongoing care and to ascertain whether:
• Ongoing care is appropriate
• A change in care plan is required
• Co-management is needed
• A referral is possibly indicated
The recovery milestone may also indicate a typical recovery pattern for the condition indicated in the clinical submission.
A recovery milestone is NOT:
• Based on a prescription for care, i.e. physician prescription
• Based on a treatment protocol and typical scheduling pattern
• The medically necessary number of visits
• An authorization of the appropriate amount of care