OptumHealth Care Solutions - Complex Medical Conditions Client User Access Request

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Optum offers products for complex medical conditions such as:

Bariatric

Cancer

Chronic Kidney Disease

Congenital Heart Disease

Orthopedics

Transplantation

VAD

Women's Health Services

- Neonatology

- Pregnancy

To submit a request for access to the OptumHealth Client website, you must complete all fields in the form below. Upon approval of your request, we will forward you the OptumID registration link to create your userid and password.

All fields below that are bolded and marked with an asterisk (*) are required fields.

Company Name*:

Site Location*:

Company Type*:

Broker/Producer

HMO

Indemnity

MGU

Reinsurance

Self Insured

Stop-Loss

TPA

Other

First Name*:

Last Name*:

Email*:

Professional Title: (e.g. RN, MD, CCM)

Position Title: (role in your organization)

Address 1*:

Address 2:

Address 3:

City*:

State*:

Zip*:

Phone Number*:

Extension:

Fax Number:

The following role applies to my interaction with OptumHealth Care Solutions - Complex Medical Conditions*:

Role	Provides Access To:
Broker/Producer	Access to tools to assist you in the sale of OptumHealth products and services.
Case Manager	PHI, Facility Search, Facility Contract Information, Facility Rates, Steerage Tools, Volume/Outcome Data, Online NF, Utilization Review Reports, Claims Status
Claims	PHI, Claims Status, Facility Rates, Facility Search, Facility Contract Information, Volume/Outcome Data
Claims Portal	Download Claims, Repriced Claims, Claim Detail Report, Daily Email Feed
Executive	Utilization Review Reports, Facility Search, Facility Contract Information, Facility Rates, Steerage Tools, Volume/Outcome Data
General	Facility Search, Facility Contract Information, Facility Rates, Volume/Outcome Data
Medical Director	PHI, Facility Search, Facility Contract Information, Facility Rates, Steerage Tools, Volume/Outcome Data
Supporting Organization	Facility Search, Facility Contract Information, Volume/Outcome Data

Enter the name of the group you would like to access on the website*:

Comments

PHI = Personal Health Information at Patient Level

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