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Optimahealthcommunitycareprovidermanual

MedicalProviderServiceRepresentatives757-552-7474or1-800-229-88228a.m.to5p.m.MondaythroughFridayFax:757-552-7316ProviderRelat[email protected]CardinalCareMedicaidMemberHandbookPDF,1MBLastUpdated:11/09/20232023OptimaCommunityCare(FAMIS)ComprehensiveFormularyPDF,2MBLastUpdated:

09/29/20232023OptimaCommunityCarePrescriptionDrugFormularyPDF,2MBLastUpdated:09/29/20232023OptimaCommunityCarePrescriptionDrugFormulary-JSONFormatJSON,1MBLastUpdated:09/29/20232023OptimaHealthMedicaidFormularyChanges-EffectiveJuly1,2023PDF,425KBLastUpdated:07/25/20232024Sentara

CommunityCare(FAMIS)ComprehensiveFormularyPDF,2MBLastUpdated:09/29/20232024SentaraCommunityCarePrescriptionDrugFormularyPDF,2MBLastUpdated:09/29/2023EPAMDocumentDrugList.pdfPDF,20KBLastUpdated:10/27/2023MedicalBenefitOncologyDrugs-MedicaidCoverage(OptimaCommunityCare)-NotManaged

byCarelon-ReferredBacktoOptimaHealthPDF,175KBLastUpdated:06/02/2023OptimaHealthCommunityCareNON-PART-DCOVEREDDRUGSLISTPDF,1MBLastUpdated:08/11/2023SHPAmbulatorySurgeryGrouper,October1,2023XLSX,211KBLastUpdated:10/04/2023SHPAmbulatorySurgeryGrouper,July1,2023XLSX,210KBLast

Updated:07/13/2023SHPAmbulatorySurgeryGrouper,April1,2023XLSX,209KBLastUpdated:06/30/2023SHPAmbulatorySurgeryGrouper,January01,2023XLSX,213KBLastUpdated:03/28/2023SHPAmbulatorySurgeryGrouper,October1,2022XLSX,200KBLastUpdated:03/28/2023SHPAmbulatorySurgeryGrouper,July1,2022XLSX,200

KBLastUpdated:03/28/2023Pleasejoinusforavarietyofinformativewebinarsthatwillhelpmakeiteasytoworkwithus.ParticipatingProviders:Haveyouhadachangetoyourpracticeinformationorproviderroster?KeepingOptimaHealthinformedofchangesisanimportantsteptoensuringaccurateclaimspaymentandpatientsatisfaction.If

OptimaHealthInsuranceCompanyisanadditionaltradenameforSentaraHealthInsuranceCompany.VirginiaPremierHealthPlanisanadditionaltradenameforSentaraHealthPlans.OptimaBehavioralHealthisanadditionaltradenameforSentaraBehavioralHealthServices,Inc.OptimaHealthMaintenanceOrganization(HMO)products,and

Point-of-Service(POS)products,areissuedandunderwrittenbySentaraHealthPlans.bijokeOptimaPreferredProviderOrganization(PPO)productsareissuedandunderwrittenbySentaraHealthInsuranceCompany.

OptimaHealthMaintenanceOrganization(HMO)products,andPoint-of-Service(POS)products,areissuedandunderwrittenbySentaraHealthPlans.OptimaPreferredProviderOrganization(PPO)productsareissuedandunderwrittenbySentaraHealthInsuranceCompany.zowenobahotapiSentaraHealthAdministration,Inc.provides

administrativeservicestogroupandindividualhealthplansbutdoesnotunderwritebenefits.AllOptimaHealthplanshavebenefitexclusionsandlimitationsandtermsunderwhichthepolicymaybecontinuedinforceordiscontinued.noyuvu

OptimaPreferredProviderOrganization(PPO)productsareissuedandunderwrittenbySentaraHealthInsuranceCompany.SentaraHealthAdministration,Inc.providesadministrativeservicestogroupandindividualhealthplansbutdoesnotunderwritebenefits.AllOptimaHealthplanshavebenefitexclusionsandlimitationsandtermsunderwhich

thepolicymaybecontinuedinforceordiscontinued.MedicareproductsareadministeredunderanagreementwithSentaraHealthPlansandtheCentersforMedicareandMedicaidServices(CMS.)MedicaidandFAMISproductsareadministeredunderanagreementwithSentaraHealthPlansandtheVirginiaDepartmentofMedicalAssistance

Services(DMAS.)©OptimaHealth2023,POBox66189,VirginiaBeach,Virginia23466SentaraHealthPlansandOptimaHealtharetradenamesofSentaraHealthPlans,SentaraHealthInsuranceCompany,SentaraHealthAdministration,Inc.,andSentaraBehavioralHealthServices,Inc.OptimaHealthInsuranceCompanyisanadditionaltrade

nameforSentaraHealthInsuranceCompany.VirginiaPremierHealthPlanisanadditionaltradenameforSentaraHealthPlans.OptimaBehavioralHealthisanadditionaltradenameforSentaraBehavioralHealthServices,Inc.

OptimaPreferredProviderOrganization(PPO)productsareissuedandunderwrittenbySentaraHealthInsuranceCompany.SentaraHealthAdministration,Inc.kesetixutulifuprovidesadministrativeservicestogroupandindividualhealthplansbutdoesnotunderwritebenefits.AllOptimaHealthplanshavebenefitexclusionsandlimitationsand

termsunderwhichthepolicymaybecontinuedinforceordiscontinued.

continuedinforceordiscontinued.MedicareproductsareadministeredunderanagreementwithSentaraHealthPlansandtheCentersforMedicareandMedicaidServices(CMS.)MedicaidandFAMISproductsareadministeredunderanagreementwithSentaraHealthPlansandtheVirginiaDepartmentofMedicalAssistanceServices(DMAS.)