Optum credentialing and provider enrollment run through separate networks, so the first job is working out which one your application belongs in. Optum Behavioral Health, Optum Physical Health, and the other Optum networks each have their own entry point, their own application types, and their own contacts.
This guide sorts out which Optum track applies to you, what to prepare, how CAQH fits in, how to check on a file that has gone quiet, and when recredentialing comes due.
Key Takeaways
- Behavioral health applications start at Provider Express. Physical therapy, occupational therapy, speech, and chiropractic applications start with Optum Physical Health.
- Optum Behavioral Health offers five application types, so pick the one that matches how you practice before you submit anything.
- Optum decides whether it wants to add you to the network before credentialing begins, so a clean application can still be declined for network need.
- CAQH participation is required in most states for behavioral health, and Optum has to be authorized to view your profile.
- Individual clinicians check status inside Provider Express. Groups, facilities, and autism providers call Network Management at (877) 614-0484.
- Recredentialing comes around about every three years.
Which Optum Network Are You Joining?
Optum belongs to UnitedHealth Group, the same parent company as UnitedHealthcare, and it runs a family of networks that each credential on their own. Match your discipline to the track before you open an application.
Optum Behavioral Health covers mental health, substance use disorder, and autism and ABA services. Applications start on the Provider Express network page.- Optum Physical Health covers physical therapy, occupational therapy, speech, and chiropractic care. New providers and groups submit a request on the Optum Physical Health site, or call 1-800-873-4575.
- Medical providers who want the UnitedHealthcare medical network apply through UnitedHealthcare’s Onboard Pro tool. Our guide to credentialing with UnitedHealthcare covers that side, and UnitedHealthcare’s medical provider page points behavioral health applicants back to Provider Express.
Optum Behavioral Health covers mental health, substance use disorder, and autism and ABA services. Applications start on the Optum also runs other networks, such as workers’ compensation, with separate recruitment contacts. Those fall outside this guide. If you are new to the process, our overview of medical credentialing shows what happens behind each step.
How Optum Behavioral Health Credentialing Works
Optum Behavioral Health sorts applicants into five application types. Choose the one that matches your practice.
- Individually credentialed clinicians, meaning solo clinicians and clinicians in a group that has no Optum group agreement.
- Groups with individually credentialed providers, meaning groups that already hold a group agreement with Optum.
- Groups with agency credentialed providers, such as community mental health centers, federally qualified health centers, rural health clinics, and opioid treatment programs.
- Facilities and hospital-based programs offering inpatient, residential, partial hospitalization, or intensive outpatient care for mental health or substance use.
- Autism, ABA, and BCBA providers, including solo BCBA practices and agencies delivering intensive ABA.
After you apply, Optum makes a preliminary decision on whether it wants to contract with you. Credentialing then follows Optum’s national credentialing plan, or its California plan for California providers, which covers initial credentialing, recredentialing, and ongoing monitoring. A practice can finish every field correctly and still hear that Optum is not adding providers in that specialty or area, so ask your network contact about need early.
State Medicaid programs can change the order and timing of these steps, and Provider Express keeps separate state pages for them. Check yours before you start. Once you are in network, our pages on behavioral health and psychiatry billing cover what comes next.
Optum Physical Health Credentialing
Optum Physical Health runs its own network for rehabilitation and chiropractic providers. A new provider or group starts by submitting a request on the Optum Physical Health site or calling 1-800-873-4575. The same contact line answers questions about where your request stands.
Credentialing for this network repeats every three years from your initial credentialing date unless your state sets a different cycle. If your practice falls in one of these disciplines, our pages on physical therapy, occupational therapy, and chiropractic billing cover the payer side after you are in network.
Documents to Have Ready for an Optum Application
Optum’s requirements shift a little by network and state, but most files draw on the same records.
- Current state license for every state where you will see Optum members
- NPI and W-9 for the individual or group
- DEA certificate, if you prescribe controlled substances
- Malpractice insurance face sheet with current effective and expiration dates
- Board certification and education and training records
- Work history with any gap explained
- BCBA certification for autism and ABA applicants
- CAQH ID with a current attestation
Using CAQH for Optum Credentialing
Optum Behavioral Health requires CAQH participation in most states. Where your state requires it, you enter your CAQH ID on the application and authorize United Behavioral Health, the Optum Behavioral Health entity, to view your profile.
Two CAQH problems account for many stalled files. Optum may not be authorized to see the profile, or the profile may hold outdated practice details, license dates, or malpractice dates. Review the authorization section in your CAQH account, keep every date current, and attest on schedule, which is every 120 days. CAQH now sits under DataSpring, so you may see both names. If you want background, start with what CAQH is and why it matters.
How Long Optum Credentialing Takes
Optum’s network pages do not give one overall timeline for credentialing and contracting, and the figures that circulate online usually come from third parties. Facilities and agencies carry more documentation than solo clinicians, so expect them to run longer.
Our average credentialing turnaround across payers is about 85 days from submission, and that clock starts only after every required document is gathered and sent. Missing items and mismatched details are the usual reasons a file runs past that average.
Checking Your Optum Credentialing Status and Phone Numbers
Where you look depends on the application type.
- Individual clinicians use the Initial Credentialing Status Toolbar inside the secure area of Provider Express. The path runs through My Practice Info, then My Network Status, then Check Initial Credentialing Status.
- Agency and group applicants, facilities, and autism and ABA providers call Network Management at (877) 614-0484.
- Physical health applicants call 1-800-873-4575.
Check your CAQH profile before you call, since it shows whether Optum is authorized and whether your attestation is current. Then follow up every two to three weeks, and write down the date, the person you reached, and what they said.
Common Delays and How to Avoid Them
Most stalled Optum applications trace back to a short list of causes. Our post on why credentialing gets delayed covers the general causes, and these are the ones specific to Optum.
- The wrong application type. A clinician in a group without an Optum group agreement applies as an individual, and a group that holds an agreement uses the group path.
- The wrong network. A physical therapist who applies through Provider Express has started in the wrong place.
- An unauthorized or stale CAQH profile. Confirm Optum is authorized and the attestation is current.
- Expired documents. Track license, DEA, board, and malpractice dates, and renew early.
- No network need. Ask your contact whether Optum is accepting your specialty in your area before you invest weeks in the file.
Recredentialing with Optum
Optum recredentials about every three years, in line with NCQA standards, unless your state sets another cycle. Behavioral health providers stay under Optum’s national or California credentialing plan, which also covers ongoing monitoring between cycles. Our guide to provider recredentialing covers the full cycle.
Start about six months before your due date. Update your documents, re-attest in CAQH, and resolve any quality or compliance concerns you already know about. Calendar the date the day you are approved.
Optum Credentialing FAQ
What is Optum credentialing?
Optum credentialing is the review Optum uses to verify a provider’s qualifications before the provider joins one of its networks. Each Optum network, including Optum Behavioral Health and Optum Physical Health, runs its own application and credentialing process.
Is Optum credentialing the same as UnitedHealthcare credentialing?
No. UnitedHealthcare credentials medical providers through its Onboard Pro tool. Behavioral health providers apply through Optum Behavioral Health at Provider Express, and physical therapy, occupational therapy, speech, and chiropractic providers apply through Optum Physical Health.
How do I apply to the Optum Behavioral Health network?
Go to the Our Network page on Provider Express and choose the application type that fits your practice. The options are individually credentialed clinician, group with individually credentialed providers, group with agency credentialed providers, facility or hospital-based program, and autism, ABA, or BCBA provider.
Does Optum require CAQH?
Optum Behavioral Health requires CAQH participation in most states. Where it applies, you enter your CAQH ID on the application and authorize United Behavioral Health to view your profile, and you keep the profile attested every 120 days.
How long does Optum credentialing take?
Optum does not publish one overall timeline. Medwave’s average credentialing turnaround across payers is about 85 days from submission, and facilities and agencies usually take longer than solo clinicians.
How do I check my Optum credentialing status?
Individual clinicians use the Initial Credentialing Status Toolbar in the secure area of Provider Express. Agency and group applicants, facilities, and autism and ABA providers call Network Management at (877) 614-0484. Optum Physical Health applicants call 1-800-873-4575.
How often does Optum recredential providers?
About every three years, unless the state sets a different cycle. Providers should start preparing about six months ahead.
Can Medwave handle Optum credentialing for my practice?
Yes. Medwave handles credentialing, payer contracting, and medical billing for practices, and has supported 15,000+ providers.
Getting Optum Applications Off Your Desk
The first decision, which Optum network and which application type, shapes everything after it. Medwave makes that call up front, builds and attests the CAQH profile, submits the application, and stays with the file through credentialing and the contract. The contract is where payer contracting work decides what each claim pays, and our medical billing team picks up from there.
Send us your NPI and the Optum network you are targeting through the form below, and we will map the application before anything is submitted.
Co-Founder and COO of Medwave, bringing more than 25 years of hands-on experience in healthcare revenue cycle management, payer contracting, and medical credentialing.