Follow the steps to complete the application effectively.

1. Click ‘Get Form’ button to obtain the CA OptumHealth Facility Application and open it in your preferred editing tool.
2. Begin by providing the organizational facility identifying information. Include the legal name of the facility, parent company name (if applicable), and the address information. Ensure that all fields are completed with current and accurate details.
3. Identify the levels of care your facility wishes to contract with. Carefully select each applicable level of care, indicating options such as substance abuse, psychiatric, and specific programs offered by your facility.
4. Fill out the practice location details for each level of care checked in the previous step. Include relevant contact numbers and indicate the age category or population served.
5. Provide the organizational provider contact information. List names, roles, and contact details of key personnel authorized to handle the application and communications related to credentialing.
6. Complete the accreditation section by listing all current accreditations your facility holds, including issue and expiration dates.
7. Fill in the licensure and certification details as required, ensuring that you attach relevant documents if applicable, such as state audits.
8. In the Medicare/Medicaid/NPI section, provide the necessary IDs and issue dates as needed, making sure to validate any Medicare or Medicaid numbers with the required documents.
9. Complete the general/professional liability information, ensuring that you attach proof of insurance coverage that meets the required minimums.
10. Answer the legal status questions fully and attach any explanations for incidents as required.
11. Detail the location accessibilities and ensure to address all relevant conditions regarding accessibility.
12. Sign and date the application at the designated area, certifying that all information is complete and accurate.
13. Review the preparation checklist before submission to ensure that all necessary supporting documents and certifications are included.
14. Once all steps are completed, save changes to the document, and download or print the application for your records.
15. Submit the application as per the outlined instructions, sharing it via the appropriate channels.

Complete your CA OptumHealth Facility Application online today to ensure a smooth credentialing process.