Chemical Dependency and Mental Health Claims
Submission Guidelines
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