Chemical Dependency and Mental Health Claims

Effective for services rendered on or after January 1, 2012, Chemical Dependency and Mental Health Claims should be filed in the same manner as Professional Claims. For more information, please refer to the Fall 2011 issue of Spotlight on Benefits. For services rendered prior to January 1, 2012, please follow the instructions below.

Submission Guidelines (visits that take place prior to 1/1/12)

A claim for chemical dependency for mental health benefits should be filed with the Health Plan's chemical dependency and mental health benefit manager, OptumHealth, following the instructions below:

• Download and print the CMS-1500 Form (Adobe Acrobat reader required, click here for free download).
• Complete the form in its entirety and submit it along with your provider's bill (including itemized diagnoses and payment sheets) to OptumHealth at following address:
• OptumHealth
• P.O. Box 31053
• Laguna Hills, CA 92654