Teaser - October 14th: Payor Behavior Update: Optum and ASAM 4th Edition & Ambetter Claims Cadence Changes
What’s Changing: Optum and ASAM 4.0 & Ambetter
Payor Behavior Update: Optum and ASAM 4th Edition & Ambetter Claims Cadence Changes
Behavioral health providers are facing upcoming shifts in payer behavior and billing requirements. OPTUM is transitioning to new revenue codes to align with the ASAM 4th Edition, while Ambetter now requires claims to be submitted from admission to discharge, where interim billing is not allowed.
Join us on Tuesday, October 14th, with Linda Shulman, Director of Payor Relations and Advocacy at Hansei Solutions, for an insightful discussion on what these payor changes mean for your organization, how to stay compliant, and strategies to protect your revenue.
We’ll cover:
OPTUM’s shift to new revenue codes and billing rules under the ASAM 4th Edition.
Ambetter’s no-interim-billing policy and its impact on billing cadence and cash flow.
California Providers: Why investing in your CARF accreditation is now critical to get ASAM levels of care accredited—an upfront cost that can save you money long-term.
Linda Shulman
Director of Payor Relations and Advocacy
As the Director of Payor Relations and Advocacy, Linda brings her deep knowledge
and expertise to advance the organization’s mission. Linda is dedicated to
transforming how behavioral health services are reimbursed by engaging with
customers and insurance companies. She aims to develop inclusive, comprehensive
programming that shifts away from traditional, day-to-day utilization review (UR)
processes. Instead, she seeks to establish contracts focused on outcomes and
quality standards, helping to reduce readmissions, lower administrative costs, and
create meaningful, long-term care solutions for those in need. By advocating for
innovative reimbursement models, Linda is committed to making sustainable,
high-quality behavioral health services more accessible and impactful.
Linda Shulman, a licensed Marriage and Family Therapist with over 40 years of
experience, has held key roles, including the Director of Ventura County’s Behavioral
Health Department. She later moved into Utilization Management, providing UM
services remotely and founding a consulting business to support facilities with
accreditation and managed care. Her payor industry experience includes positions
at Aetna, Carelon, and Anthem, where she led the development of the Substance
Use Disorder Clinical UM Team.
Based in San Diego, Linda Shulman is a devoted single mother to her two adopted
children, a role she considers her full-time job. She’s an avid NFL fan and sports
enthusiast interested in travel, concerts, and movies.