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Guidelines/Policies for Providers Spring 2020

Mar 09, 2020
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Credentialing Reminders

When new physicians join a practice location, we recommend beginning the credentialing process as soon as possible to avoid delays. This will minimize disruptions to the practice and Members’ claims. You can help the process run smoothly by doing the following:

  • Include a current copy of the provider’s Certificate of Insurance with the Provider Add/Change form and send both to
  • Ensure that the new Provider’s CAQH number is included, and that their information and attestation in the CAQH system are current upon submission of the credentialing request.

Questions about credentialing should be submitted to

Health Options Paper Claims Policy

Our Provider Relations team frequently responds to questions about Health Options’ Paper Claims Policy. You can access a copy of that policy here

Itemized Bill Submission Reminder

Institutional inpatient and outpatient claims of $20,000 or more must include an itemized bill to be considered for payment. You can avoid processing delays by emailing the itemized bill to on the same day the associated claim is submitted. We may also request itemized bills on claims identified for further review. The Itemized Bill Submission Policy is available here.   

For additional information on these, or other guidelines and policies, contact Health Options’ Provider Relations Team at (207) 402-3347.


Group Administrators can now rely on our Group Administrator Portal User Guide for help with employer portal functionality. It contains instructions for setting up a portal account, managing employee enrollment, and viewing and paying invoices online. You can access the guide at Please inform your Health Options employer groups about this document’s availability.