Optum

Overview

Behavioral-health network (UHC subsidiary). Primary enrollment channel for commercial BH coverage; interacts heavily with state Medicaid programs.

Commercial BH enrollments for PM Pediatrics — ongoing. NY + NJ focus. Expect 30–45 day processing per payer confirmation.
Delegated arrangement with Confluent — covers (at least) the Commonwealth Hand Therapy and Advanced brands. Post-cred-approval flow: providers move into Confluent’s “existing payers” roster, no individual enrollment request is needed. QC team surfaced lines with active enrollment requests on these delegated brands in the 4/15 weekly — being reconciled against the project plan and removed.

Medicaid-first dependency hold (BH) — Optum is holding multiple PM Pediatrics BH providers pending NY Medicaid enrollment approval first, even for providers who already hold active NY Medicaid numbers (Angela Heppner, Josephine Pimentel). Janet Kahn-Scolaro (PMP BH lead) has asked Medallion to review all processing Optum lines and release the dependency for providers who already have Medicaid. Amy Barfield committed 2026-04-16 to push Medallion’s Provider Enrollment team to release commercial-only (Jamie Morzowski, Jessica Williams, Josephine Pimentel).
DOO + amendment form errors (PMP) — multiple Optum enrollments for PMP had DOOs filled out incorrectly (wrong owner-as-provider, wrong NPI). Root cause partially mis-routed: Medallion was sending DOOs to providers; Janette prefers owner-signed DOOs she handles herself. See PM Pediatrics for details.
Completeness errors on amendments — Angela Heppner’s NY location-add amendment was returned because a page was left blank (provider name, title, signature, org name missing).

Processing time per Optum rep (NY medicaid enrollment review): 30–45 days.
For Optum BH in NJ: all providers must be credentialed through NJ Medicaid regardless of license type (LMHC, LCSW, psych).

PM Pediatrics
Confluent — delegated credentialing (Commonwealth Hand Therapy, Advanced brands)