December 2025 Top of Mind

Optum no longer managing behavioral health benefits for Sutter Health Plan in 2026

This change in benefits administration is effective Jan. 1, 2026, and applies to Sutter Health Plan Commercial members. As a participating provider, your existing Provider Participation Agreement requires no action.

What this means for you

• For claims, reconsiderations and appeals for dates of service prior to 2026: Optum will allow claim(s) run out for one year, with all timeframes outlined in your Participation Agreement.
• Claims for dates of service starting Jan. 1, 2026: You will need to send these claims to the member’s new plan.

Continuity of care

• For Sutter members in active treatment on Jan. 1, 2026: Continuity of care or authorizations should be directed to the member’s new plan.
• Utilization management activities: Utilization management will discontinue as of Dec. 31, 2025, with the exception of members admitted as inpatient by midnight on Dec. 31, 2025. Optum will continue to provide utilization management services through the end of the service authorization period or March 31, 2026, whichever is earlier.

Sutter members will also need to call the number on the back of their ID card for details about transitioning to the new plan.

Questions about your network participation?
Please call Provider Services at 1-877-614-0484.