Optum/UHC referrals allow eligible clinicians to receive appointment requests through the Optum provider directory.
Note: Depending on your credentialing or contract, you may see references to either Optum or UnitedHealthcare (UHC).
Once enabled for Optum referrals, your existing new client availability can appear to members searching for care through the provider directory.
In this guide, we’ll cover:
- Activating Optum referrals
- Managing Optum referral availability
- Customizing the default service for in-network referrals
- Managing appointment requests from Optum
Note: To learn more about managing in-network referrals in your SimplePractice account, see Managing in-network referral availability and requests.
Activating Optum referrals
To determine whether you’re eligible to receive in-network referrals, see Eligibility requirements for in-network referrals.
If you're in-network with Optum and interested in receiving referrals, contact SimplePractice Support to request activation.
Once Optum referrals have been activated, you'll see Optum as a referral source in Marketing > In-Network Referrals, where you can manage your referral availability and referral request settings.
Note: To stop receiving Optum referrals, see Turning in-network referral requests on or off.
Managing Optum referral availability
Once enabled for Optum referrals, your availability allows new clients to see when you're available for services and submit appointment requests through the Optum provider directory.
To update your availability to receive appointment requests, follow the steps in Managing in-network referral availability and requests.
After adding availability for Optum referrals, you can increase the likelihood of receiving referrals by verifying that the following is reflected in your Provider Express account:
- Your information in your Provider Express account is up to date
- Optum requires verification of your information every 90 days
- Your Telehealth indicator is enabled, if you offer Telehealth appointments
- Your Accepting New Clients indicator is enabled
For assistance with making updates in your Provider Express account, please reach out to Optum's provider services.
Customizing the default service for in-network referrals
You can change the default service offered for Optum in-network appointment requests to another service, such as an initial consultation service. This way, these requests will reflect the duration and rate you typically offer for initial consultations. To do this:
- Navigate to Marketing > In-Network Referrals
- Under Initial service, select Change
- Choose the initial consultation service from the dropdown menu
- Click Save
Note: If you don’t see an initial consultation service in the dropdown menu, make sure the service is added in Settings > Services and products > Services, and that Allow online appointment requests and Allow requests from new clients are checked for the service. To do this, see Adding a service code.
Moving forward, any new client appointments requested through Optum’s member portal will default to this service.
Managing appointment requests from Optum
When you receive appointment requests from Optum, you can navigate to the Requests page to accept or decline an appointment request. You can also send intakes to the client through the Requests page.
To learn more, see Managing in-network referral appointment requests.
Before taking any of the actions above, you can view additional health plan information for the client. To do this:
- Click the prescreener icon next to the client’s name from the Requests page
- View the:
- Client name
- Date of birth
- Reason for visit
- Insurance plan
- Member ID
- Group ID
Tip: This client and health plan information will also be saved as a prescreener on the referred client’s Overview page.
You’ll also see a link to Provider Express, which will take you directly to Optum’s provider portal.
Although referred clients are confirmed to qualify for an appointment, you can review this client and health plan information to confirm eligibility and benefits before their first appointment.
Note: For assistance with Provider Express, please reach out to your group practice administrator or the Provider Express support team directly.