Effective for dates of service on or after September 1, 2025, Neighborhood will begin directly managing all behavioral health services for members in all lines of business. Please note that Optum, our current behavioral health vendor, will continue to support Neighborhood with behavioral health services for all dates of service through August 31, 2025. There is no change to processes or benefits currently accessed via Optum prior to September 1, 2025. Providers should continue to contact Optum for any questions by visiting their website, Provider Express site or calling Optum’s Provider Services at 1-877-614-0484.
Behavioral health providers who are interested in continuing to provide services to Neighborhood members after September 1, 2025, must complete an application to join our network, which will begin the contracting process. Any contracts that you currently have with Optum are not transferred to Neighborhood. Behavioral health providers will need to directly contract with Neighborhood to continue serving Neighborhood members after September 1, 2025.
For more information on this transition, please refer to the below FAQ’s.
Behavioral Health FAQ’s
- What is changing about how Neighborhood is managing behavioral health services?
Beginning September 1, 2025, Neighborhood will be ending its relationship with Optum and directly managing behavioral health services.
- Why is Neighborhood changing how it manages behavioral health services?
Neighborhood is committed to providing the best care and service possible to members. By managing behavioral health services, Neighborhood creates additional opportunities for integration between medical and behavioral providers.
- Where should members go if they have questions about how Neighborhood manages behavioral health services?
Members should call Member Services at 1-855-321-9244.
- Will behavioral health member benefits change?
There will be no changes to member behavioral health benefits.
- Will behavioral health services require a referral?
Neighborhood does not require referrals to access behavioral health services.
- Will behavioral health services require a prior authorization?
The only services that require prior authorization are non-covered and out-of-network services.
- Can providers continue to see Neighborhood members prior to September 1, 2025?
Yes, behavioral health providers can continue to provide services to Neighborhood members. There is no change to processes or benefits currently accessed via Optum prior to September 1, 2025. Providers should continue to contact Optum for any questions by visiting their website, Provider Express site or calling Optum’s Provider Services at 1-877-614-0484. Neighborhood will not be able to answer questions about services provided prior to September 1, 2025.
- How do providers become contracted with Neighborhood?
To join the Neighborhood network, behavioral health providers must submit an application through the Join Our Network Page. That application will start the contracting and credentialing processes.
- For providers currently seeing Neighborhood members through a contract with Optum but who have chosen not to contract with Neighborhood, what steps are necessary to continue providing care for these patients?
Members have a continuity of care period enabling them to continue seeing a non-contracted provider for a specified period of time. Providers who continue to treat members while they are not contracted with Neighborhood may be subject to applicable non-participating provider requirements. To ensure providers can continue providing care to their patients, they should contract directly with Neighborhood.
- Once providers become contracted with Neighborhood, how do they receive training about doing business with Neighborhood?
Providers will receive a welcome letter with information about upcoming provider orientation sessions and training materials. Neighborhood will ensure providers have all the resources necessary to care for our members.
- What is the credentialing process for existing providers in Optum’s network who are now contracted with Neighborhood?
Providers credentialed through Optum can continue to treat Neighborhood members while undergoing Neighborhood’s credentialing process if they have completed an application and signed a contract with Neighborhood. While the Neighborhood contract will be effective on September 1, 2025, providers can continue to see members while the credentialing is in process which may take up until February 28, 2026.
- What is the credentialing process for new providers (not currently in Optum’s network)?
In order to participate with Neighborhood, providers not currently in Optum’s network must complete an application, sign a contract, and be approved by Neighborhood’s Credentialing Committee. To initiate the process, please go to Neighborhood’s Join Our Network page.
The process includes validation of provider training, licensure, and/or certification to provide services in the specialty of practice.
Please refer to Section 9, Credentialing and Standards of Care of the Provider Manual, for the definition of a completed application as well as additional details of the credentialing process.
- Does the provider’s Council for Affordable Quality Healthcare (CAQH) status need to be current to credential with Neighborhood?
CAQH status must be current when the credentialing decision is rendered. Neighborhood uses the CAQH application to credential providers.
- How will reimbursement work throughout the transition?
Providers will be reimbursed as per their Optum agreement through August 31, 2025. Effective September 1, 2025, providers will be reimbursed as per their Neighborhood agreement.
- How do providers receive reimbursement through Neighborhood?
Providers enrolled with an electronic funds transfer (EFT) will be paid electronically.
- How do providers check eligibility and claim status after September 1, 2025?
Providers can check both eligibility and claim status by contacting Provider Services or logging into the provider portal. More information on this process will be made available during provider orientation.
- What are the timely filing limits with Neighborhood?
Complete claims must be received by Neighborhood within one hundred eighty (180) days from the date of service.
- Will the explanation of payment/remittance advice (EOP/RA) include both behavioral health and medical claims?
Yes. If the provider renders both types of services, they will receive an EOP/RA which includes both behavioral health and medical claims (i.e., all finalized claims within a payment cycle).
Provider Orientations
To support your integration into our network, we have scheduled orientation webinars for newly contracted providers on the following dates:
Please register for the webinar that best fits your schedule by clicking on the corresponding date above. We encourage you to share these registration links with anyone if your office that could benefit, such as practice managers, billing personnel, etc. These sessions will provide an overview of key processes, including claims submission, member eligibility, policy guidelines and how to access provider resources. Providers are welcome to submit questions and topics for discussion in advance by sending an email to: providercomms@nhpri.org.
Register Your Email
Email is the primary way Neighborhood communicates important updates to providers, including policy changes, training opportunities, and network updates. To ensure your office stays informed, including practice managers and billing staff, sign up for email updates today.