|
  Providers Serving OhioHealthy
Ohio Providers

Provider Connection

Provider Connection is Optima Health's secure, self-service online provider tool. Registered Providers and office staff can verify member eligibility and benefits, view claim and authorization status, view remits and reports, and more! Provider Connection is available 24 hours a day.

Watch the Provider Connection demo.

Learn more about Provider Connection secure tools.

Medical Authorizations

Pre-Authorization for all services is managed by Optima Health Clinical Care Services. All reviews and determinations are based on medical necessity as supported by sound medical criteria and standards of care.

Access more information about Medical Authorizations

Pharmacy

The Optima Health Pharmacy and Therapeutics Committee, composed of physicians and pharmacists, determine if utilization management tools are necessary for some drugs. This includes prior authorization criteria, step-edit criteria, and quantity limits. Please refer to the Provider Manual for the complete pharmacy policy including a list of benefit exclusions.

Access Pharmacy Resources

Claims and Reimbursement

Electronic Funds Transfer (EFT)

Optima Health offers direct deposit of payments through Electronic Funds Transfer (EFT). EFT is a safer, more secure, and more efficient method of claims payment. Clean claims are processed and paid within an average of seven days when submitted electronically and payment made through EFT.

Take advantage of the benefits of EFT - Enroll today!
Electronic Payment/Remittance Authorization Agreement

Electronic claims submission is the most efficient and timely method for processing and payment of claims.

Access more information about Claims and Reimbursement

Clinical Reference

Important clinical reference materials including immunization schedules and clinical guidelines.

Access Clinical Reference materials

Provider Manual

Need to review an Optima Health policy? Want to learn more about claims processing or view a sample member ID card? The Provider Reference Manual is available to view and print.

Access the Ohio Provider Manual

Access the Ohio Facilities and Ancillaries Manual

Contact Us

Optima Health Provider Services
Phone: 1-844-853-4060
Fax: 1-877-822-7503
Monday - Friday, 8 a.m. to 5 p.m. EST
Email: providerservicesOH@optimahealth.com

Access additional contact information for Ohio Health providers