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Name of the billing provider or facility as it will appear on the claim form 2. Federal tax ID TIN of entity in box 1 MD/DO 4 OT 5 Both PT and OT 6 Home Care 7 ATC DC 3 PT 8 MT 9 Other 3. Name and credentials of the individual performing the service s 4. Alternate name if any of entity in box 1 6. Phone number 5. NPI of entity in box 1 8. City 7. Address of the billing provider or facility indicated in box 1 Provider Completes This Section Cause of Current Episode Patient Type 1 Traumatic 4 Pos ...

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Versions	Form popularity	Fillable & printable
2015	4.9 Satisfied (471 Votes)
2013	3.9 Satisfied (42 Votes)
2009	3.9 Satisfied (41 Votes)

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What kind of company is Optum?

Optum, Inc. is an American pharmacy benefit manager and health care provider. It is a subsidiary of UnitedHealth Group since 2011. UHG formed Optum by merging its existing pharmacy and care delivery services into the single Optum brand, comprising three main businesses: OptumHealth, OptumInsight and OptumRx.

What exactly does Optum do?

About Optum Optum Health provides care directly through local medical groups and ambulatory care systems, including primary, specialty, urgent and surgical care to 101 million consumers.

Are Optum and UnitedHealthcare the same?

UnitedHealth Group has two distinct business platforms: Optum and UnitedHealthcare. This cohesive partnership offers an array of health services and health benefits.

What are Optum forms?

The OptumHealth Care Solutions, LLC (OptumHealth) forms are communication tools. They are the vehicle by which a provider reports critical case elements and communicates these and the treatment plan for a patient to OptumHealth. The change in a patient's status as a result of treatment is the outcome from treatment.

Why is Optum calling me?

If your injuries possibly give rise to a personal injury claim or a potential lawsuit (for example, a car accident, a work injury, a slip-and-fall accident, etc.), Optum wants to know, because it's their job to find out if your health insurance company might have a right to be reimbursed out of your settlement.

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What does clinical submission mean?

An established patient presents, but a clinical submission has not been previously sent. \u2022 An established patient presents with treatment needs (time period and/or visits and/or specific services) that go beyond those levels indicated in your most recent clinical submission response.

What is a patient summary form?

The Patient Summary Form was created for certain UHC plans to provide the insurance company with an explanation for the patient's visit and confirm the need for treatment.

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