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March 1, 2011 On February 16, 2011, New Mexico ordered OptumNew Mexico to suspend a January 1, 2011, change to its claims system that imposed clinical review triggers on substance abuse and mental health treatment services that resulted in claim denials. In Optum’s response disputing the Collaborative’s sanction, Carole Levine, OptumHealth New Mexico’s interim chief executive officer said the company believes it is not in violation of federal or state regulations requiring the consultation or involvement of board-certified contracting health care provider organizations in connection with the BMS and PSR clinical guidelines. The guidelines were developed . . .

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Market Intelligence Resource | March 1, 2011

OptumHealth New Mexico Response to Collaborative, Dispute of Sanction

March 1, 2011 On February 16, 2011, New Mexico ordered OptumNew Mexico to suspend a January 1, 2011, change to its claims system that imposed clinical review triggers on substance abuse and mental health treatment services that resulted in claim denials. In Optum’s response disputing the Collaborative’s sanction, Carole Levine, OptumHealth New Mexico’s interim chief executive officer said the company believes it is not in violation of federal or state regulations requiring the consultation or involvement of board-certified contracting health care provider organizations in connection with the BMS and PSR clinical guidelines. The guidelines were developed . . .

Want To Read More? Log In Or Become A Paid Member
Resource Available For Paid OPEN MINDS Circle Members Only
Not a paid member? Don't miss out! Sign up today and receive unlimited organizational access to all OPEN MINDS strategic advice, market intelligence, and management best practices – over 250,000 resources!
Log In
If you are already a paid member, log in to your account to access this resource and more. If you are a free member, you will need to upgrade to a paid membership before accessing this resource.

Become A Paid Member
If you are not yet a paid member, learn more about the OPEN MINDS Circle Market Intelligence Service Membership on our website, reach out to our team at info@openminds.com, or call us at 877-350-6463.