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- 1. How do I sign on to Optum Referrals Portal?
To sign up you must be a contracted provider and have received approved authorizations from Optum. On this website you will see a menu across the top - click on Optum Referrals Portal. Locate where it says "Not a member? Sign Up Here and Get Access Now" - then follow the sign up instructions.
- 2. Who do I contact if I have question about the status of my referral?
Contact your Regional Care Management Department. If you are on Optum Referrals Portal - you can access the system directly and look up the referral.
- 3. How do I get a member's address corrected in Optum Referrals Portal?
On the Home page in Optum Referrals Portal go to Eligibility Search or Referral Submission, find your member, click on their name and go to member update for address/phone number change.
- 4. What can I expect for a turnaround time or review of my request?
5 business days for a routine request, 72 hours for a non-routine (expedited) request.
- 5. What qualifies as an urgent/emergent referral?
CMS defines expedited as: Time sensitive situations in which the standard time frame for issuing determinations could seriously jeopardize the life or health of the member, or the member's ability to regain maximum function.
- 6. What do I do if I cannot find the specialist/facility that I want to refer to?
Complete your request and click on the magnifying glass icon in the "requested provider spec" or "facility" field. Go to "Not listed" and enter who you want to refer to. Please note in the Clinical Problem box why there is a need to utilize this specialist over one that is listed.
- 7. Who do I contact to discuss a medical necessity denial?
Contact the Physician Reviewer at the phone number listed under the denial reason.
- 8. How do I handle a retro request for a service done last week in my office?
Final retrospective review of your request may be obtained by mailing the request to Optum IMCS Retro Review Department at 19191 S. Vermont Suite 700, Torrance, CA 90502. Please include the completed request for service and relevant clinical information and an explanation of why authorization was not obtained earlier. Alternatively, you may submit a claim for the services with relevant clinical information, following the usual claims submission process.
- 9. How do I handle a retro request for a procedure on someone that I just saw in my office?
If you are a user of Optum Referrals Portal - please submit request through the portal. If not please follow the procedure for signing on the Optum Referrals Portal.
- 10. How do I obtain additional training on Referral Management System for my staff?
Please contact your clinician liaison or your regional Care Management Department.
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