Hey Alfredo!  We are also having issues with UHC/Optum and trying to figure out how to navigate the problems.  It seems like the reps are not familiar with their own policies. We have gotten different answers from different reps.  When we look up coverage for tms for specific members it always says that it is covered and no prior auth is needed even when we list a PMHNP as the provider. This is very misleading since they apparently won't pay when billed under a PMHNP.  Have you made any progress since your post here?  

Hi Colby, we have proceeded to have a psychiatrist conduct a face to face "evaluation for tms" which is uploaded in the Provider Express portal AND the TMS sessions are billed under our psychiatrist who oversees the treatment, is readily available and I or another NP is in the building. No denials and always approved when meeting criteria. Every now and then some UHC insurances tell us no authorization is required and all we do is document caller, date and time as no auth number is provided and "authorization or verbal discussions do not guarantee payment."  I wish UHC would follow other commercial payors, Triwest, Tricare and allow PMHNP to obtain authorization and payment. Best regards, Alfredo