Optum Behavioral Health (UnitedHealthcare): Credentialing and Billing for Mental Health Providers

For most UnitedHealthcare plans, mental health is managed by Optum Behavioral Health. To see those members in-network, therapists and psychiatric providers join Optum’s behavioral health network, which is separate from UnitedHealthcare’s medical network. Keep CAQH ProView complete and shared, apply through Optum’s behavioral health provider channels, and bill with the behavioral health claims rules on the member’s card.

This carve-out is the single most common source of “out of network” denials we see for UnitedHealthcare members: the provider is in-network with UnitedHealthcare, just not with the company that actually runs the mental health benefit.

Who manages what

Plan type	Who usually manages the behavioral health benefit
UnitedHealthcare commercial plans	Optum Behavioral Health
UnitedHealthcare Medicare Advantage	Optum Behavioral Health, for many plans
UnitedHealthcare Community Plan (Medicaid)	Varies by state; often Optum, sometimes a state-specific arrangement
Other health plans and employers	Optum also manages behavioral health for some non-UnitedHealthcare plans
Employee assistance programs	Optum EAP, with its own rules

Read the member’s ID card. It usually lists a separate phone number or payer ID for mental health. That is where eligibility, authorization and claims go.

Credentialing with Optum Behavioral Health

1. Prepare the basics: license, individual NPI and correct taxonomy, malpractice coverage, and group NPI if you bill as a group.
2. CAQH ProView: complete, attest and share it with Optum.
3. Request network participation through Optum’s behavioral health provider website. If the network is closed for your area or license type, ask about exceptions and explain what gap you fill.
4. Complete credentialing and sign the agreement. Check which products (commercial, Medicare Advantage, Medicaid) it covers.
5. Confirm your effective date, and set up claims, ERA and EFT for the behavioral health payer ID.

Groups should make sure every clinician is individually credentialed and linked to the group’s agreement before seeing Optum members. See how to get paneled with insurance.

Billing notes for Optum

• Use the behavioral health payer ID and address from the member’s card, not the medical one.
• Verify benefits through Optum’s behavioral health channels, including authorization needs for higher levels of care.
• Document psychotherapy time carefully. Payers review providers with unusually high 90837 use (see 90837 vs 90834).
• Telehealth: follow Optum’s current telehealth policy for place of service and modifiers (see our telehealth billing guide).
• Pre-licensed clinicians: check Optum’s current policy on supervised and associate-level billing before billing their sessions.

Common Optum denials

Denial	Usual cause	Fix
Out of network	In UnitedHealthcare’s medical network, not Optum’s behavioral network	Join the behavioral network; bill the behavioral payer ID
Claim sent to the wrong payer	Medical payer ID used for a behavioral claim	Resubmit to the behavioral health payer ID on the card
Provider not credentialed	New clinician not yet effective or not linked to the group	Confirm credentialing status before scheduling
Records request / audit	High-level codes without supporting documentation	Start and stop times, clear clinical rationale

See denial codes explained for the codes on the remittance.

We are an independent billing and credentialing company, not affiliated with Optum or UnitedHealthcare. Payer processes change, so confirm current requirements on Optum’s provider site. Our mental health credentialing team handles Optum applications and follow-up, with weekly status updates.

Frequently asked questions