Payer Processing Issues

Summary

When Optum discovers issues or interruptions to transaction processing, the details will appear below.
If you are looking for a specific payer or specific transaction type, please use ctrl+f to find that term on the page.

*These updates can also be found within Customer Care Hub under Payer Processing Issues: https://customercare.changehealthcare.com/public/home.html

VIEW PAYER LISTS →

Report Generation Delay for CPID 2426 Michigan Blue Care Network

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted since Oct. 9, 2024.

Payer impacted:

  • CPID 2426 Michigan Blue Care Network

Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 801101 10/21/2024

Electronic Routing Change for CPID 5986 CalOptima Long Term Care

Effective immediately, Optum will be reactivating the electronic claims connection and changing the electronic claims routing for the following payer:

Payer Name: CalOptima Long Term Care

Institutional CPID: 5986

Current Edit Master: HE9C060

New Edit Master: HE9T007

Payer-assigned Payer ID: COLTC

Enrollment Requirements:  

Claims:

  • Payer enrollment for electronic claims is required.

  • Providers currently sending electronic claims through Optum must complete a new enrollment form.

  • New providers must complete a new enrollment form.

Report Changes:

You may see some differences in the payer reports you are receiving.  

Action Required: Please make the following changes to accommodate the routing change: 

  • Revalidate unreleased claims to edit correctly under new edit master.  

  • Modify any bridge routines based on edit masters.

  • No Payer Alias changes are required. Payer Name and CPID are not changing.

  • When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.

REF 799552 10/17/2024

Payer Transmit Delay for Multiple CPIDs

Due to a payer system issue, a delay occurred in the transmissions to the following payer since Oct. 16, 2024.

Payer impacted:

  • CPID 5575 New Jersey Charity Care Inpatient

  • CPID 5576 New Jersey Charity Care Outpatient

Optum is working with the payer to resolve this issue. We will notify you as soon as additional information becomes available.

This delay affected claims released to Optum since 3 p.m. ET on Oct. 15, 2024.

Action Required: Be aware of the transmit delay above.

REF 799700 10/17/2024

Report Generation Delay for CPID 1120 Community Eye Care

A payer is experiencing issues affecting Professional report generation for some claims submitted since Oct. 11, 2024.

Payer impacted:

  • CPID 1120 Community Eye Care

Optum is working diligently with the payer to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 799702 10/17/2024

Optum Alert: Update: Report Generation Delay for Multiple CPIDs

Update: The payer intermediary has been unable to generate and deliver the reports for some claims submitted between Oct. 1, 2024, and Oct. 10, 2024.

Action Required: Please resubmit claims if payment has not been received.

Original notify sent Oct. 14, 2024:

A payer is experiencing issues affecting Institutional and Professional report generation for some claims submitted since Oct. 1, 2024.

Payer impacted:

  • CPID 7071 Anthem Ohio Medicaid

  • CPID 9458 CareSource Ohio Medicaid

  • CPID 2481 Ohio Medicaid

  • CPID 3509 Ohio Medicaid

Optum is working diligently with the payer to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF799701 10/17/2024

Real time Payer Transaction for Alohacare, ALOHA

Effective Aug. 8, 2024, Optum is pleased to announce the availability of Real-time (Eligibility Inquiry and Response 270/271) transactions for the Real Time ID below:

  • ALOHA

Action Required by customer:

Please update your system to take advantage of these payer transactions. For assistance with submitting Real-Time transactions, please contact your Practice Management System Vendor or open a Optum Customer Care Hub ticket

Updated Payer Lists may be obtained from your software vendor or Payer Lists | Change Healthcare.  

REF 797952 10/17/2024

Electronic Routing Change for CPIDs 9517 and 1110 Innovative Integrated Health, Inc.

Effective immediately, Optum will be changing electronic claims routing for the following payer:

Payer Name: Innovative Integrated Health, Inc.

Professional CPID: 1110

Current Edit Master: PE_E049

New Edit Master: PE_T007

Institutional CPID: 9517

Current Edit Master: HE9E049

New Edit Master: HE9T007

Current Payer-assigned Payer ID: 99660

New Payer-assigned Payer ID: IIHPO

Enrollment Requirements:

  • Claims: Payer enrollment for electronic claims is not required.

  • Report Changes: You may see some differences in the payer reports you are receiving.

Action Required: Please make the following changes to accommodate the routing change:

  • Revalidate unreleased claims to edit correctly under new edit master.

  • Modify any bridge routines based on edit masters

  • No Payer Alias changes are required. Payer name and CPIDs are not changing.

  • When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.

REF 799551 10/17/2024

Remittance Reactivation for CPIDs 8651, 3295 Cedars Sinai Medical Network

Optum recently restored electronic remittance connectivity for the following payer: 

Payer Name: Cedars Sinai Medical Network 

Professional CPID: 3295 

Institutional CPID: 8651 

Industry Payer ID: 95166 

Remittance Enrollment Requirements: 

  • Payer enrollment for electronic remittance is required:  

  • Providers currently receiving electronic remittance for this payer do not need to complete a new enrollment form. 

  • Providers who moved their enrollment to another clearinghouse or have not received remittance will need to re-enroll to receive remittance for this payer from Optum (Change Healthcare). 

  • New providers must complete a new enrollment form. 

Action Required: 

Please consider the following to allow transactions to process properly due to the above changes:  

  • Make any necessary system changes. 

  • When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.

REF799601 10/17/2024

Remittance Reactivation for CPID 6195 Superior Vision Services

Optum recently restored electronic remittance connectivity for the following payer:

Payer Name: Superior Vision Services

Professional CPID: 6195

Industry Payer ID: 41352

Remittance Enrollment Requirements:

  • Payer enrollment for electronic remittance is required:

  • Providers currently receiving electronic remittance for this payer do not need to complete a new enrollment form.

  • Providers who moved their enrollment to another clearinghouse or have not received remittance will need to re-enroll to receive remittance for this payer from Optum (Change Healthcare).

  • New providers must complete a new enrollment form.

Action Required: Please consider the following to allow transactions to process properly due to the above changes: 

  • Make any necessary system changes.

  • When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.

REF 799600 10/17/2024

Electronic Routing Change for CPIDs 9517 and 1110 Innovative Integrated Health, Inc.

Effective immediately, Optum will be changing electronic claims routing for the following payer:

Payer Name: Innovative Integrated Health, Inc.

Professional CPID: 1110

Institutional CPID: 9517

Current Payer-assigned Payer ID: 99660

New Payer-assigned Payer ID: IIHPO

Enrollment Requirements: 

Claims:

Payer enrollment for electronic claims is not required.

Report Changes:

You may see some differences in the payer reports you are receiving. 

Action Required: Please consider the following to allow transactions to process properly due to the above changes:

Make any necessary system changes.

When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.

REF 799550 10/17/2024

Electronic Reactivation and Routing Change for CPID 5986 CalOptima Long Term Care

Effective immediately, Optum is reactivating the electronic claims connection and changing electronic claims routing for the following payer:

Payer Name: CalOptima Long Term Care
Institutional CPID: 5986
Payer-assigned Payer ID: COLTC
Claims Surcharge: $0.10

Enrollment Requirements
Claims:

  • Payer enrollment for electronic claims is required.

  • Providers currently sending electronic claims through Optum must complete a new enrollment form.

  • New providers must complete a new enrollment form.

Report Changes:
You may see some differences in the payer reports you are receiving.

Action Required: Please consider the following to allow transactions to process properly due to the above changes:

  • Make any necessary system changes.

  • When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.

REF 799553  10/17/24

Remittance Reactivation for Dean Health Plan by Medica

Effective immediately, Optum has restored 835 connectivity for the following payer:

Payer Name: Dean Health Plan by Medica
Professional CPID: 1497
Institutional CPID: 3581
Industry Payer ID: 39113

Remittance Enrollment Requirements:

Payer enrollment for electronic remittance is required: 

  • Providers previously enrolled with Optum (Change Healthcare), who did not switch their enrollment away from Optum (Change Healthcare) do not need to re-enroll.   

  • Providers who moved their enrollment to another clearinghouse will need to re-enroll with Optum (Change Healthcare) to receive ERAs for this payer from Optum (Change Healthcare).

  • New providers must complete a new enrollment form.

Action Required: Please consider the following to allow transactions to process properly due to the above changes:

  • Make any necessary system changes.

  • When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.

REF 799207 10/16/2024

Report Generation Delay for CPID 2991 UMWA H & R Funds

A payer intermediary experienced issues affecting Institutional report generation for some claims submitted on Aug. 28, 2024, and Aug. 29, 2024

Payer impacted:

  • CPID 2991 UMWA H & R Funds

The payer intermediary is unable to generate and deliver the reports.

Action Required: None. Please resubmit claims if payment has not been received.

REF 799001 10/16/2024

New Electronic Remittance Connections Available

Optum has new electronic remittance connections available: 

Payer Name: Beam Insurance Administrators
Institutional & Professional CPID: 2782
Payer-assigned Payer ID: BEAM1
Line of Business (LOB) Code: E00
Payer Enrollment Required: Yes
Remittance Fee: N/A

Action Required:  

  • Add the payers to your system to begin using the new payer connection. 

  • Enrollment forms must be submitted and approved to begin receiving electronic remittance through Optum.

REF 797152 10/16/2024

Electronic Claims Connection Suspended

Effective immediately, the payer listed below has/have been temporarily suspended at Optum for claims processing and removed from the payer list.

Payer Name: Associated Hispanic Physicians IPA

CPIDs: 7794, 8554

Payer ID: MPM44

Action Required: Please refrain from submitting claims until further notice.

REF 799300 10/16/2024

Report Generation Delay for CPID 1853 ElderPlan

A payer intermediary experienced issues affecting Professional report generation for some claims submitted Aug. 17, 2024, and Aug. 19, 2024

Payer impacted:

  • CPID 1853 ElderPlan

The payer intermediary is unable to generate and deliver the reports.

Action Required: None. Please resubmit claims if payment has not been received.

REF799000 10/16/2024

Electronic Claims Connection Suspended

Effective immediately, the payer listed below has been temporarily suspended at Optum for claims processing and removed from the payer list.

Payer Name:  TDS/SRRIPA/Clover
CPIDs:  6049 and 9202
Payer ID:  RP012

Action Required: Please refrain from submitting claims until further notice.

REF 798951  10/16/24

Update: Report Generation Delay for CPID 2162 Colorado Medicare

The payer intermediary has been unable to generate and deliver the reports for some claims submitted on Sept. 17, 2024, and Sept. 18, 2024.

Action Required: Please resubmit claims if payment has not been received.

Original message sent Oct. 15, 2024:

A payer intermediary is experiencing issues affecting professional report generation for some claims submitted on Sept. 17, 2024, and Sept. 18, 2024.

Payer impacted:

  • CPID 2162 Colorado Medicare

Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 799100 10/16/2024

New Electronic Remittance Connections Available

Optum has a new electronic remittance connection available:

Payer Name: McLaren Advantage SNP

Institutional CPID: 6637

Professional CPID: 6739

Payer-assigned Payer ID: 3833R

Line of Business (LOB) Code: U9O

Payer Enrollment Required: Yes

Remittance Fee: N/A

Action Required:

  • Add the payers to your system to begin using the new payer connection.

  • Enrollment forms must be submitted and approved to begin receiving electronic remittance through Optum.

REF 798950 10/16/2024

Electronic Claims Connection Suspended

Effective immediately, the payer listed below has been temporarily suspended at Optum for claims processing and removed from the payer list.

Payer Name: AllCare PEBB

CPIDs: 7163, 7696

Payer ID: 26158

Action Required: Please refrain from submitting claims until further notice.

REF 798850 10/16/2024

Report Generation Delay for CPID 2162 Colorado Medicare

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted on Sept. 17, 2024 and Sept. 18, 2024.

Payer impacted:

  • CPID 2162 Colorado Medicare

Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 798201 10/15/2024

Delay in Electronic Remittance Advice (ERA) for Noridian Payers - RESOLVED

This message is intended for Revenue Performance Advisor customers. 

UPDATE: This issue is now resolved. 

Original message sent Sept. 26, 2024: 

Due to a payer issue, there has been a delay in professional and institutional Electronic Remittance Advice (ERA/835) delivery for the following payers beginning on Thursday, Sept. 12, 2024, through present: 

SMAK0 – Alaska Medicare Part B 

12M02 – Arizona Medicare Part A 

SMAZ0 – Arizona Medicare Part B 1

2M64 – California Medicare Part A 

12M64 – Hawaii Medicare Part A 

SMHI0 – Hawaii Medicare Part B 

12M07 – Idaho and Alaska Medicare Part A 

SMID0 – Idaho Medicare Part B 

SKIA0 – Iowa Medicaid 

12M65 – Medicare Part A (CA, HI, NV) Legacy 

12M77 – Montana Medicare Part A 

SMMT0 – Montana Medicare Part B 

12M64 – Nevada Medicare Part A 

SMNV0 – Nevada Medicare Part B 

12M82 – North Dakota Medicare Part A 

SMND0 – North Dakota Medicare Part B 

SMCA1 – Northern California Medicare Part B 

12M41 – Oregon Medicare Part A 

SMOR0 – Oregon Medicare Part B 

12M83 – South Dakota Medicare Part A 

SMSD0 – South Dakota Medicare Part B 

SMCA2 – Southern California Medicare Part B 

12M84 – Utah Medicare Part A 

SMUT0 – Utah Medicare Part B 

12M45 – Washington Medicare Part A 

SMWA0 – Washington Medicare Part B 

12M30 – Wyoming Medicare Part A 

SMWY0 – Wyoming Medicare Part B 

Action Required: Please be aware of a delay in the delivery of ERA for the dates above.

REF 797552 10/15/2024

Meridian Health Plan of Illinois DOS before July 1, 2021, Electronic Claims/Remittance Connection No Longer Available

Effective immediately, the payer listed below will no longer be available at Optum for claims and remittance processing.

Payer Name: Meridian Health Plan of Illinois DOS before July 1, 2021
Claim and Remittance CPIDs: 5916, 4777

Claims and Remittance containing Dates of Service on or after July 1, 2021, must begin using the following:

Payer Name: Meridian Medicare Medicaid Plan
Professional CPID: 9102
Institutional CPID:  5058
Remittance Available: Yes
Payer-assigned Payer ID: MHPIL
Claim Fee: N/A

Enrollment Requirements:
Claims:

  • Payer enrollment for electronic claims is not required.

Remittance:

  • Payer enrollment for electronic remittance is required.

  • Providers currently receiving electronic remittance through Optum for CPIDs 5058, 9102 Meridian Medicare Medicaid Plan do not need to complete a new enrollment form. 

  • Providers not receiving electronic remittance through Optum for CPIDs 5058, 9102 Meridian Medicare Medicaid Plan must complete a new enrollment form.

  • New providers must complete a new enrollment form.

Action Required: 

  • Please be aware of the changes above and make any necessary changes in your system.

  • To access the new enrollment forms, please visit Enrollment Central.

REF 797950 10/15/2024

Payer Deactivation - Summit America Insurance Services

This message is intended for Revenue Performance Advisor customers.

Effective immediately, the payer listed below will no longer be available at Optum for claims, eligibility and claim status inquiry processing:

  • 37301-Summit America Insurance Services

Updated Payer Lists may be obtained from your software vendor or Optum. Optum is removing this payer from the RPA Payer List and any transactions sent using the above payer ID will be rejected.

Action Required:

Please discontinue use of the above payer IDs. Providers should review the patient's current insurance ID card for claim filing information.

REF 798250 10/15/2024

Resolved: Novitas Medicare Electronic Remittance Advice (ERA) - RESOLVED

This message is intended for Revenue Performance Advisor customers.

UPDATE: This issue has been resolved.

Original message sent Sept. 19, 2024:

There were issues that impacted clearinghouse delivery of remits from Novitas Medicare (various payer IDs – see below) issued during the period starting February 19, 2024, through April 19, 2024. Novitas Medicare completed reprocessing remits for this period as of September 16, 2024.

Noridian payers 

RPA Professional, Institutional payer ID

AR|Arkansas Novitas JH

(SMAR0, 12022)

CO|Colorado Novitas JH

(SMCO0, 12M03)

DE|Delaware Novitas JL

(SMDE0, 12M76)

ID|Idaho Novitas JL

(SMID0, 12M07)

LA|Louisiana Novitas JH

(SMLA0, 12M12)

MD|Maryland Novitas JL

(SMMD0, 12010)  

MS|Mississippi Novitas JH

(SMMS0, 12M76)

NJ|New Jersey Novitas JH

(SMNJ0, 12005)

NM|New Mexico Novitas JH

(SMNM0, 12M22)

OK|Oklahoma Novitas JH

(SMOK0, 12M37)

PA|Pennsylvania Novitas JL

(SMPA0, 12M60)

TX|Texas Novitas JH

(SMTX0, 12M53)

Action Required:

If you are missing any remits from Novitas Medicare for the above period, visit the Novitas Medicare website to download them.

REF 797551 10/15/2024

Report Generation Delay for CPIDs 2746 and 7924 SAGE1

A payer is experiencing issues affecting Institutional and Professional report generation for some claims submitted since Sept. 24, 2024.

Payer impacted:

  • CPID 2746 SAGE1 

  • CPID 7924 SAGE1

Optum is working diligently with the payer to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 798200  10/15/24

Meridian Health Plan of Illinois DOS before 07/01/2021 Electronic Claims/Remittance Connection No Longer Available

Effective immediately, the payer listed below will no longer be available at Optum for claims and remittance processing.

  • Payer Name: Meridian Health Plan of Illinois DOS before 07/01/2021

  • Claim CPIDs: CPIDs: 5916, 4777 

  • Remittance LOB: U2M

Claims and Remittance containing Dates of Service on or after July 1, 2021, must begin using the following:

  • Payer Name: Meridian Medicare Medicaid Plan

  • Professional CPID: 9102

  • Professional Edit Master: PE_B800

  • Institutional CPID:  5058

  • Institutional Edit Master: HE9B801

  • Payer-assigned Payer ID:  MHPIL

  • Line of Business Code (LOB):  H85

Enrollment Requirements: 

Claims:

  • Payer enrollment for electronic claims is not required.

Remittance:

  • Payer enrollment for electronic remittance is required.

  • Providers currently receiving electronic remittance through Optum for CPIDs 5058, 9102 Meridian Medicare Medicaid Plan do not need to complete a new enrollment form. 

  • Providers not receiving electronic remittance through Optum for CPIDs 5058, 9102 Meridian Medicare Medicaid Plan must complete a new enrollment form.

  • New providers must complete a new enrollment form.

Action Required:  Please make the following updates to accommodate these payer changes:

  • Revalidate unreleased claims to edit correctly under new edit master. 

  • Modify any bridge routines based on edit masters.

  • Modify related Payer Alias names to the new CPIDs.

  • To access the new enrollment forms, please visit Enrollment Central.

REF 797951 10/15/2024

Report Generation Delay for CPIDs 2502 and 5479 IU Health Plan Medicare Advantage

A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted since Oct. 1, 2024.

Payer impacted:

  • CPID 2502 IU Health Plan Medicare Advantage

  • CPID 5479 IU Health Plan Medicare Advantage

Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 796104 10/14/2024

Remittance Reactivation for CPIDs 3231, 4945 Medical Benefit Administration

Optum recently restored electronic remittance connectivity for the following payer:

Payer Name: Medical Benefit Administration
Professional CPID: 3231
Institutional CPID: 4945
Industry Payer ID: MBA01

Remittance Enrollment Requirements:

  • Payer enrollment for electronic remittance is required:

  • Providers currently receiving electronic remittance for this payer do not need to complete a new enrollment form.

  • Providers who moved their enrollment to another clearinghouse or have not received remittance will need to re-enroll to receive remittance for this payer from Optum (Change Healthcare).

  • New providers must complete a new enrollment form.

Action Required: Please consider the following to allow transactions to process properly due to the above changes:

  • Make any necessary system changes.

  • When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.

REF 797150 10/14/2024

Claim Processing Suspended

Effective immediately, the payer listed below has been temporarily suspended at Optum for claim processing, and has been removed from the payer list.

Payer Name: Vibra Health Plan
CPIDs: 2553, 1181
Payer ID: 15976

Action Required: Please refrain from submitting claims until further notice.

REF 796107 10/14/2024

Electronic Claim Connection Status for Block Vision CPID 3402 and Superior Vision CPID 6195

Effective immediately, the payers listed below are temporarily suspended at Optum for claim processing and have been removed from the payer list. 

Payer Name: Block Vision

CPIDs: 3402

Payer ID: 41352

Payer Name: Superior Vision

CPIDs: 6195

Payer ID: 41352

Action Required: Please do not  submit claims for the payers until further notice.

REF 797650 10/14/2024

Report Generation Delay for CPID 2234 Illinois Health Partners

A payer intermediary is experiencing issues affecting professional report generation for some claims submitted on Oct. 2, 2024.

Payer impacted:

  • CPID 2234 Illinois Health Partners

Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 796105 10/14/2024

Report Generation Delay for CPIDs 1004 and 7829 Passport Advantage

A payer intermediary is experiencing issues affecting institutional and professional report generation for some claims submitted since Sep. 30, 2024.

Payer impacted:

  • CPID 1004 Passport Advantage

  • CPID 7829 Passport Advantage

Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 797201 10/14/2024

Report Generation Delay for CPIDs 5959 and 4258 VNS Health

A payer intermediary is experiencing issues affecting institutional and professional report generation for some claims submitted since Sep. 30, 2024.

Payer impacted:

  • CPID 5959 VNS Health

  • CPID 4258 VNS Health

Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 796102 10/14/2024

Report Generation Delay for CPIDs 6128 and 4616 Gold Coast Health Plan

A payer is experiencing issues affecting Institutional and Professional report generation for some claims submitted since Sept. 23, 2024.

Payer impacted:

  • CPID 6128 Gold Coast Health Plan

  • CPID 4616 Gold Coast Health Plan

Optum is working diligently with the payer to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 797252 10/14/2024

Update: Report Generation Delay for CPIDs 2423 and 5558 Alabama Blue Cross Blue Shield

Update: It has been determined that the report delay below was due to a payer claims processing issue. We have retransmitted the impacted claims to the payer on Oct. 14, 2024. Reports will be delivered once the claims have successfully processed at the payer. 

Action Required: Please be aware of delays. 

Original Notice Sent Oct. 8, 2024:

A payer is experiencing issues affecting Institutional and Professional report generation for some claims submitted on Sept. 27, 2024. 

Payer impacted: 

  • CPID 2423 Alabama Blue Cross Blue Shield 

  • CPID 5558 Alabama Blue Cross Blue Shield

Optum is working diligently with the payer to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF797251 10/14/2024

Report Generation Delay for CPIDs 1592 and 5432 Johns Hopkins Healthcare / Priority Partners

A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted since Sept. 30, 2024.

Payer impacted:

  • CPID 1592 Johns Hopkins Healthcare / Priority Partners

  • CPID 5432 Johns Hopkins Healthcare / Priority Partners

Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 796103 10/14/2024

Report Generation Delay for CPID 2483 Texas Childrens Health Plan (STAR Medicaid)

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted since Oct. 4, 2024.

Payer impacted:

  • CPID 2483 Texas Childrens Health Plan (STAR Medicaid)

Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 796106  10/14/24

Report Generation Delay for CPIDs 2013 and 8146 Care N Care Insurance Co.

A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted since Sept. 30, 2024.

Payer impacted: 

  • CPID 2013 Care N Care Insurance Co.

  • CPID 8146 Care N Care Insurance Co.

Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 797200 10/14/2024

Report Generation Delay for CPIDs 9656 and 7715 Hopkins Health Advantage

A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted since Oct. 1, 2024.

Payer impacted:

  • CPID 9656 Hopkins Health Advantage

  • CPID 7715 Hopkins Health Advantage

Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 797202  10/14/24

Report Generation Delay for Multiple CPIDs

A payer is experiencing issues affecting Institutional and Professional report generation for some claims submitted since Oct. 1, 2024.

Payer impacted:

  • CPID 7071 Anthem Ohio Medicaid

  • CPID 2481 Ohio Medicaid

  • CPID 3509 Ohio Medicaid

Optum is working diligently with the payer to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 797250  10/14/24

UDOH0 - Utah Medicaid Real-Time Payer Transaction

Effective Oct. 11, 2024, Optum is pleased to announce the availability of Real-Time Eligibility transactions for the below payer:  

Payer ID:  UDOH0

Payer name:  Utah Medicaid 

Transaction type:  Eigibility (270/271)

Enrollment Instructions: 

All submitters must complete enrollment instructions prior to submitting transactions.

Action Required by the Customer: 

Please update your system to take advantage of this payer transaction.  For assistance with submitting Real-Time transactions, please contact your Practice Management System Vendor or Optum Customer Care Hub ticket https://customercare.changehealthcare.com/public/home.html.

Updated Payer Lists may be obtained from your software vendor or Payer Lists | Change Healthcare

REF 797050 10/11/2024

MHC01 - Mountain Health CO-OP - real-time payer transaction

Effective October 9, 2024, Optum is pleased to announce the availability of real-time claim status transactions for the below payer: 

Payer id:  MHC01

Payer name:  Mountain Health CO-OP

Transaction type:  Claim Status inquiry (276/277).

Action Required:

Please update your system to take advantage of this payer transaction.  For assistance with submitting real-time transactions, please contact your Practice Management System Vendor or Optum Customer Care Hub.

Updated Payer Lists may be obtained from your software vendor or Payer Lists | Change Healthcare.

REF 796900 10/11/2024

Delay in Electronic Remittance Advice (ERA) for Payer ID 77160, CPIDs 6128 and 4616, Gold Coast Health Plan

Due to a payer processing issue, there has been a delay in professional and institutional Electronic Remittance Advice (ERA) for the following payers for dates of Sept. 3, 2024, through present:

  • 6128 Gold Coast Health Plan

  • 4616 Gold Coast Health Plan

Action Required: Please be aware of a delay in the delivery of ERA for dates above.

REF 796400 10/11/2024

Resolved: Delay in Electronic Remittance Advice (ERA) for Multiple CPIDs , Noridian Payers

This message is intended for Assurance EDI and Assurance Reimbursement Management customers.

This issue has been resolved.

Original message sent Sep. 29, 2024.

Due to a payer processing issue, there has been a delay in professional and institutional Electronic Remittance Advice (ERA) for the following payers for check dates of Sep. 12, 2024, through present:

  • 1456 Arizona Medicare Part B

  • 5546 Arizona Medicare Part A

  • 3508 California Medicare Part A

  • 2467 Hawaii Medicare Part B

  • 5567 Hawaii Medicare Part A

  • 5581 Idaho and Alaska Medicare Part A

  • 2465 Idaho Medicare Part B

  • 1455 Alaska Medicare Part B

  • 5567 J1 Mutual of Omaha, CA, HI, NV

  • 2646 Medicare Part A (CA, HI, NV) Legacy

  • 5584 Montana Medicare Part A

  • 7400 Montana Medicare Part B

  • 1446 Nevada Medicare Part B

  • 5907 Nevada Medicare Part A

  • 2453 North Dakota Medicare Part B

  • 1523 North Dakota Medicare Part A

  • 1436 Northern California Medicare Part B

  • 1459 Oregon Medicare Part B

  • 5515 Oregon Medicare Part A

  • 2454 South Dakota Medicare Part B

  • 5589 South Dakota Medicare Part A

  • 1444 Southern California Medicare Part B

  • 2458 Utah Medicare Part B

  • 1527 Utah Medicare Part A

  • 1462 Washington Medicare Part B

  • 5521 Washington Medicare Part A

  • 2466 Wyoming Medicare Part B

  • 3583 Wyoming Medicare Part A

  • 2571 Iowa Medicaid

  • 1469 Iowa Medicaid

Additional updates will be forwarded as more information becomes available.

Action Required: Please be aware of a delay in the delivery of ERA for check dates above. If you have any questions, feel free to contact your Customer Support Team.

REF 796100 10/11/2024

Claim Processing Suspended for CPIDs 7818, 9516 Change Healthcare Accident Claims Solution

Effective immediately, the payer listed below has been temporarily suspended at Optum for claim processing, and has been removed from the payer list.

Payer Name: Change Healthcare Accident Claims Solution
CPIDs: 7818, 9516
Payer ID: 88446

Action Required: Please refrain from submitting claims until further notice.

REF 795657 10/10/2024

Invalid Error Message for 6631/6732 McLaren Health Plan Medicaid

Due to a payer intermediary processing issue, Professional and Institutional claims for the payer listed below may have received the following invalid error message[s]:

  • A3:249 CLM,ENCNTER BEEN REJECTD AND NOT ENTERD INTO ADJUDICATION SYS.:PLACE OF SERVICE.

  • A3:187 CLM,ENCNTER BEEN REJECTD AND NOT ENTERD INTO ADJUDICATION SYS.:DATE-S OF SERVICE.

  • A3:453 CLM,ENCNTER BEEN REJECTD AND NOT ENTERD INTO ADJUDICATION SYS.:PROCEDURE CODE MODIFIER(S) FOR SERVICE(S) RENDERED

This issue began on Aug. 15, 2024, and was resolved by the payer intermediary on Oct. 9, 2024. Claims will require resubmission.

Payers impacted: 

  • CPID 6631 McLaren Health Plan Medicaid

  • CPID 6732 McLaren Health Plan Medicaid

Action Required: Please resubmit any impacted claims.

REF 795552 10/10/2024

Electronic Routing Change for CPIDs 8642 and 7225 Sharp Community Medical Group

Effective Oct. 10, 2024, Optum will be changing electronic claims and remittance routing for the following payer:

Payer Name: Sharp Community Medical Group
Professional CPID: 7225
Institutional CPID: 8642
Payer-assigned Payer ID: SCMG1
Payer Surcharge: $0.10

Enrollment Requirements:
Claims:

  • Payer enrollment for electronic claims is not required.

Remittance:

  • Payer enrollment for electronic remittance is required.

  • Providers currently receiving electronic remittance through Optum must complete a new enrollment form.

  • New providers must complete a new enrollment form.

Report Changes:
You may see some differences in the payer reports you are receiving.

Action Required:

Please consider the following to allow transactions to process properly due to the above changes:

  • Make any necessary system changes.

  • When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.

REF 795700 10/10/2024

Update: North American Medical Management (NAMM - N. CA) Payer Processing Issue

This message is intended for Assurance Reimbursement Management, Assurance EDI, RPA, iEDI, and submitters or trading partners to the Exchange or iEDI clearinghouse.

Updated message: Effective Sep. 14, 2024, NAMM – N. CA began sending remittance to Optum. The payer is working with Optum to provide historical ERA’s dating back to February 21, 2024. If you have not received ERAs from this payer since connectivity was restored on Sep. 13th, please verify you are enrolled to receive ERAs from this payer. Claims processing with NAMM – N. CA was reestablished on Jun. 13, 2024. Providers sending claims through Optum and enrolled to receive ERAs through Optum should have received ERAs for remittance posted Sep. 13, 2024, to current. If you have sent claims and enrolled for ERAs with Optum but you are not receiving ERAs, please open a Support ticket to research missing checks.

  • Payer Name: North American Medical Management (NAMM – N. CA)

  • CPID(s): 1782, 2931

  • Payer ID: E3510

Remit Enrollment Requirements:  

  • Payer enrollment for electronic remittance is required. Enrolment forms must be submitted and approved from Enrollment Central.

  • All new providers must complete a new enrollment form to receive electronic remittance for NAMM N. CA.

  • Providers who have not received any ERAs for NAMM N. CA and have sent claims may want to verify enrollment status

Previous message sent on September 20, 2024: As of Sep. 20, 2024, North American Medical Management (NAMM - N CA), has extended timely filing through Oct. 31, 2024. Claims will be processed without auto denying for untimely filing through the end of October. Electronic ERAs began going out to submitters Sep.11, 2024, and Optum continues to work with the payer to retrieve historical ERAs. An updated message will be sent as we know more information.

  • CPID(s): 1782, 2931

  • Payer ID: E3510

Previous message sent on September 18, 2024: As of Sep. 10, 2024, Optum has confirmed that NAMM – N. CA has received claims and responses have been returned. At this time, NAMM – N. CA is working on processing claims from Optum and remits should be available shortly. Claims from June 13, 2024, to September 9, 2024, will be resubmitted to the payer.

Previous message sent on August 27, 2024: As of Aug. 26, 2024, the payer is continuing to work to resolve the issue impacting claims submitted to Optum. Once the payer has completed their testing claims will be reprocessed to the payer for the CPIDs and Payer ID listed below. An updated message will be sent when the issue is resolved.

Previous message sent on August 23, 2024: Due to a processing issue, we are experiencing delays in claims processing with the payer. This issue affected claims submitted to Optum from Jun. 13, 2024, to current. We are working with the payer to resolve the issue and impacted claims will be processed to the payer once testing is completed. An updated message will be sent when the issue is resolved. 

We apologize for any inconvenience.

Action Required: None. Please be aware of this delay in claims processing.

REF 779856 / 795600 10/10/2024

Delay in Electronic Remittance Advice (ERA) for CPIDs 3550/3429/4523/6442 United Healthcare

Due to a payer processing issue, there has been a delay in professional and institutional Electronic Remittance Advice (ERA) for the following payers for dates of October 9, 2024, through present:

  • 3550 CPID UnitedHealthcare             

  • 3429 CPID UnitedHealthcare

  • 4523 UnitedHealthcare Community Plan Tenncare

  • 6442 UnitedHealthcare Community Plan Tenncare

Action Required: Please be aware of a delay in the delivery of ERA for dates above.

If you have any questions, feel free to contact your Customer Support Team and refer to INC-000001903.

REF 795603 10/10/2024

Payer Transmit Delay for CPIDs 2983 and 4464 SCAN Health Plan

Due to a system issue, a delay occurred in the transmissions to the following payer on Oct. 5, 2024.

Payer impacted:

  • CPID 2983 SCAN Health Plan

  • CPID 4464 SCAN Health Plan

A resolution has been implemented and claims were transmitted to the payer on Oct. 10, 2024.  

This delay affected claims released to Optum between 6 a.m. ET on Oct. 4, 2024 and 6 a.m. ET on Oct. 5, 2024.

Action Required: Be aware of the transmit delay above.

REF 795800 10/10/2024

Electronic Routing Change for CPIDs 8642 and 7225 Sharp Community Medical Group

Effective October 10, 2024, Optum will be changing electronic claims and remittance routing for the following payer:

Payer Name: Sharp Community Medical Group

Professional CPID: 7225

Current Edit Master: PE_O007

New Edit Master: PE_B800

Institutional CPID: 8642

Current Edit Master: HE9O007

New Edit Master: HE9B801

Line of Business Code (LOB): J3D

Payer-assigned Payer ID: SCMG1

 

Enrollment Requirements:

Claims:

  • Payer enrollment for electronic claims is not required. 

Remittance:

  • Payer enrollment for electronic remittance is required.

  • Providers currently receiving electronic remittance through Optum must complete a new enrollment form.

  • New providers must complete a new enrollment form. 

Report Changes:

You may see some differences in the payer reports you are receiving.

Action Required: Please make the following changes to accommodate the routing change:

  • Revalidate unreleased claims to edit correctly under new edit master.

  • Modify any bridge routines based on edit masters.

  • No Payer Alias changes are required. Payer name(s) and CPID(s) are not changing.

  • When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.

REF 795701 10/10/2024

Delay in Electronic Remittance Advice (ERA) for Maryland & DC CareFirst, Multiple CPIDs

Due to a payer processing issue, there has been a delay in Professional and Institutional Electronic Remittance Advice (ERA) for the following payers for check dates of May 29, 2024, through present:

 

CPID Payer Name

2419 Maryland CareFirst Blue Cross Blue Shield

7518 Maryland CareFirst Blue Cross Blue Shield

1509 District of Columbia CareFirst Blue Cross Blue Shield

2425 District of Columbia CareFirst Blue Cross Blue Shield

 

Additional updates will be forwarded as more information becomes available.

Action Required: Please be aware of a delay in the delivery of ERA for check dates above.

If you have any questions, feel free to contact your Customer Support Team.

REF 794251 10/10/2024

Delay in Electronic Remittance Advice (ERA) for Maryland & DC CareFirst, Multiple CPIDs

This message is intended for Assurance Reimbursement Management and Exchange customers.

Due to a payer processing issue, there has been a delay in Professional and Institutional Electronic Remittance Advice (ERA) for the following payers for check dates of May 29, 2024 through present: 

CPID  Payer Name: 

2419  Maryland CareFirst Blue Cross Blue Shield 

7518  Maryland CareFirst Blue Cross Blue Shield 

1509  District of Columbia CareFirst Blue Cross Blue Shield 

2425  District of Columbia CareFirst Blue Cross Blue Shield 

Additional updates will be forwarded as more information becomes available. 

Action Required: Please be aware of a delay in the delivery of ERA for check dates above. If you have any questions, feel free to contact your Customer Support Team. 

CSA/REF 794251

Electronic Claims Connection Suspended

Effective immediately, the payers listed below have been temporarily suspended at Optum for claims processing, and have been removed from the payer list.

Payer Name: WPP Eldercare
CPIDs: 3202, 5983
Payer ID: 77080

Payer Name: Independence Medical Group – Kern County
CPIDs: 6117
Payer ID: IMG01

Payer Name: Independence Medical Group – Tulare County
CPIDs: 6119
Payer ID: IMG01

Payer Name: True Health New Mexico (SS&C)
CPIDs: 3028, 8277
Payer ID: 85824

Payer Name: Liberty Advantage Health Plan
CPIDs: 4056, 8796
Payer ID: LIB01

Payer Name: Pinnacol Assurance
CPIDs: 2978, 3905
Payer ID: CCIA1, 84109

Payer Name: St. Barnabas Health Plan
CPIDs: 1897, 8590
Payer ID: 22240

REF 795192 10/09/2024

Report Generation Delay for CPID 4252 Presbyterian Salud

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted on Sept. 26, 2024 and Sept. 27, 2024.

Payer impacted: 

  • CPID 4252 Presbyterian Salud

Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 793859 10/9/2024

Update: Report Generation Delay for CPID 3792 Fidelis Care

The payer intermediary has been unable to generate and deliver the reports for some claims submitted on Sep. 17, 2024.

Action Required: Please resubmit claims if payment has not been received.

Original message sent Sep. 30, 2024:

A payer intermediary is experiencing issues affecting professional report generation for some claims submitted on Sep. 17, 2024.

Payer impacted:

  • CPID 3792 Fidelis Care

Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 795000 10/9/2024

Manhattan Life Real Time 270/271 - Member ID format must submit with space

Please be advised that the member ID format must be submitted with a space for Manhattan Life real time 270/271 transactions as shown below.

IMN Payer ID: MNHTN;

Exchange Payer ID: MNHTN

Payer Name: MANHATTAN LIFE

Manhattan Life Real Time 270/271 - Member ID format must be submitted with space

Examples of Member ID format: XXX XXXXXXXXXX, XXX XXXXXXXX, XX XXXXXX

Action required:

Please update your system to take advantage of this payer transaction.

REF 794850 10/9/2024

United American Insurance Electronic Claims Connection No Longer Available

This message is intended for Assurance EDI and Assurance Reimbursement Management customers.

Effective immediately, the payer listed below will no longer be available at Optum for claims processing.

 

Assurance EDI:

Payer Name: United American Insurance
Claim CPID: 1824
Payer ID: 55004
Reason: Payer no longer offers an electronic connection.
Action Required: None.

 

Assurance Reimbursement Management:

Payer Name: United American Insurance
Claim CPID: 1824
Payer ID: 55004
Reason: Payer no longer offers an electronic connection.
Action Required: None.

 

REF 794400 10/08/2024

Royal Health Extended Care MLTC Electronic Claims and Remittance Connections No Longer Available

This message is intended for Assurance EDI and Assurance Reimbursement Management customers.

Effective immediately, the payer listed below will no longer be available at Optum for claims and remittance processing.

 

Assurance EDI: 

Payer Name: Royal Health Extended Care MLTC

Claim and Remittance CPIDs: 6821, 7614

Reason: Payer no longer in business.  

Action Required: None.

 

Assurance Reimbursement Management:  

Payer Name: Royal Health Extended Care MLTC

Claim CPIDs: 6821, 7614

Remittance LOB: H2G

Reason: Payer no longer in business.

Action Required: None.

 

REF 794300 10/08/2024

Report Generation Delay for CPID 1750 Brown & Toland Physicians

A payer intermediary is experiencing issues affecting professional report generation for some claims submitted on Sep. 27, 2024.

Payer impacted:

  • CPID 1750 Brown & Toland Physicians

Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 793860 10/8/2024

Report Generation Delay for CPID 7138 Sierra Medical Group

Update: The payer intermediary has been unable to generate and deliver the reports for some claims submitted on Sept. 4, 2024. 

Action Required: Please resubmit claims if payment has not been received.  

Original notify sent Sept. 17, 2024: 

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted on Sept. 4, 2024. 

Payer impacted: 

  • CPID 7138 Sierra Medical Group 

Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received. 

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF793855 10/8/2024

Medical Attachments Restoration: Payer Updates

Optum is pleased to provide an update on payer connectivity for Medical Attachments. Review Connect Center payer search to determine connectivity for Medical Attachments. We will continue to provide additional updates as more payers are restored.

Action Required:

Assurance

  • Inform users of this change.

  • Assurance providers must be contracted with Assurance Attach Assist to submit electronic medical attachments. Please contact support at 1-800-457-1209 option 2, or by emailing [email protected] for additional information.

  • If you have not yet contracted for Attach Assist, contact your Client Executive to learn more about Attach Assist functionality.

  • When a payer requires enrollment, forms must be submitted and approved to begin submitting transactions.

REF 793601 10/8/2024

Report Generation Delay for CPIDs 2423 and 5558 Alabama Blue Cross Blue Shield

A payer is experiencing issues affecting Institutional and Professional report generation for some claims submitted on Sept. 27, 2024.

Payer impacted:

  • CPID 2423 Alabama Blue Cross Blue Shield

  • CPID 5558 Alabama Blue Cross Blue Shield

Optum is working diligently with the payer to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 793858 10/8/2024

Update: Report Generation Delay for CPIDs 4252 and 1691 Presbyterian Salud

The payer intermediary has been unable to generate and deliver the reports for some claims submitted on Sep. 4, 2024 and Sep. 5, 2024.

Action Required: Please resubmit claims if payment has not been received.

Original message sent Sept. 17, 2024:

A payer intermediary is experiencing issues affecting institutional and professional report generation for some claims submitted on Sep. 4, 2024 and Sep. 5, 2024.

Payer impacted:

  • CPID 4252 Presbyterian Salud

  • CPID 1691 Presbyterian Salud

Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 793857 10/8/2024

NYBCNE NEW YORK BLUE CROSS BLUE SHIELD NORTHEASTERN Eligibility Inquiry and Response 270/271

Effective October 3rd, 2024, Optum is pleased to announce the availability of Real-time 270/271 transactions for the below payer: 

Exchange Payer ID:  NYBCNE

Payer Name: NEW YORK BLUE CROSS BLUE SHIELD NORTHEASTERN

Action Required by customer: 

Please update your system to take advantage of this payer transaction. For assistance with submitting Real-Time transactions, please contact your Practice Management System Vendor or Optum Customer Care Hub case https://customercare.changehealthcare.com/public/home.html  Also, if you have not already done so, all Vendors and Direct Submitters must reenroll for Real-Time transactions to successfully process.  

Updated Payer Lists may be obtained from your software vendor or Payer Lists | Change Healthcare

REF 794050 10/8/2024

Update: Report Generation Delay for CPID 6220 Arizona Priority Care Plus

Update: The payer intermediary has been unable to generate and deliver the reports for some claims submitted on Sept. 4, 2024 and Sept. 5, 2024.

Action Required: Please resubmit claims if payment has not been received.

Original notify sent Sept. 17, 2024:

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted on Sept. 4, 2024 and Sept. 5, 2024.

Payer impacted: 

  • CPID 6220 Arizona Priority Care Plus

Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 793851 10/8/2024

Update: Report Generation Delay for CPID 6246 Riverside Medical Clinic

The payer intermediary has been unable to generate and deliver the reports for some claims submitted on Sep. 4, 2024, Sep. 10, 2024, and Sep. 12, 2024.

Action Required: Please resubmit claims if payment has not been received.

Update sent Sep. 26, 2024:

Update: A payer intermediary is experiencing issues affecting professional report generation for some claims submitted on Sep. 4, 2024, Sep. 10, 2024, and Sep. 12, 2024.

Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

Original message sent Sep. 17, 2024:

A payer intermediary is experiencing issues affecting professional report generation for some claims submitted on Sep. 4, 2024, and Sep. 10, 2024.

Payer impacted:

  • CPID 6246 Riverside Medical Clinic

Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 793854 10/8/2024

Update: Report Generation Delay for CPIDs 2983 and 4464 SCAN Health Plan

The payer intermediary has been unable to generate and deliver the reports for some claims submitted on Sep. 24, 2024.

Action Required: Please resubmit claims if payment has not been received.

Original message sent Oct. 7, 2024:

A payer intermediary is experiencing issues affecting institutional and professional report generation for some claims submitted Sep. 24, 2024.

Payer impacted:

  • CPID 2983 SCAN Health Plan

  • CPID 4464 SCAN Health Plan

Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 793850 10/8/2024

SFHP1 SAN FRANCISCO HEALTH PLAN - Real Time Payer Transaction

Eligibility Inquiry and Response 270/271.

Effective October 3, 2024, Optum is pleased to announce the availability of Real-time 270/271 transactions for the below payer:

IMN Payer id:  SFHP1

Payer Name: SAN FRANCISCO HEALTH PLAN

Action Required by customer:

Please update your system to take advantage of this payer transaction. For assistance with submitting Real-Time transactions, please contact your Practice Management System Vendor or Optum Customer Care Hub. Also, if you have not already done so, all Vendors and Direct Submitters must reenroll for Real-Time transactions to successfully process.  

Updated Payer Lists may be obtained from your software vendor or Payer Lists | Change Healthcare.

REF 792952 10/7/2024

Report Generation Delay for CPID 1116 Special Agents Mutual Benefit Association (SAMBA) Teledoc only

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted since Sept. 23, 2024.

Payer impacted:

  • CPID 1116 Special Agents Mutual Benefit Association (SAMBA) Teledoc only

Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 793052 10/07/2024

Electronic Routing Change for CPID 5702 Davis Vision

Effective immediately, Optum will be changing electronic claims routing for the following payer:

Payer Name: Davis Vision

Professional CPID: 5702

Current Payer-assigned Payer ID: V0QJA

New Payer-assigned Payer ID: 00157

Claim Surcharge: $0.10

Enrollment Requirements:

Claims:

  • Payer enrollment for electronic claims is required.

  • Providers currently sending electronic claims through Optum must complete a new enrollment form.

  • New providers must complete a new enrollment form.

Report Changes:

You may see some differences in the payer reports you are receiving.  

Action Required: Please make the following changes to accommodate the routing change:  

  • Edit Masters are not changing, no modification to the bridge routines needed.  

  • No Payer Alias changes are required. Payer name and CPID are not changing.

  • When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.

REF 793201 10/07/2024

00800 NEW YORK BCBS NORTHEASTERN - Real Time Payer Transaction

Eligibility Inquiry and Response 270/271.

Effective October 3rd, 2024, Optum is pleased to announce the availability of Real-time 270/271 transactions for the below payer: 

IMN Payer ID:  00800

Payer Name: NEW YORK BLUE CROSS BLUE SHIELD NORTHEASTERN

Action Required by customer: 

Please update your system to take advantage of this payer transaction. For assistance with submitting Real-Time transactions, please contact your Practice Management System Vendor or Optum Customer Care Hub ticket https://customercare.changehealthcare.com/public/home.html  Also, if you have not already done so, all Vendors and Direct Submitters must reenroll for Real-Time transactions to successfully process.  

Updated Payer Lists may be obtained from your software vendor or Payer Lists | Change Healthcare

REF 792951 10/7/2024

Report Generation Delay for CPIDs 2983 and 4464 SCAN Health Plan

A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted Sept. 24, 2024.

Payer impacted: 

  • CPID 2983 SCAN Health Plan

  • CPID 4464 SCAN Health Plan

Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 793053 10/7/2024

Edit Master Change for CPIDs 7690 and 7115 Eversana Life Sciences Services LLC

Effective immediately, Optum will be changing edit masters for the following payer:

Payer Name: Eversana Life Sciences Services LLC

Professional CPID: 7115

Current Edit Master: PE_E049

New Edit Master: PE_T007

Institutional CPID: 7690

Current Edit Master: HE9E049

New Edit Master: HE9T007

Payer-assigned Payer ID: 64300

Action Required: Please make the following changes to accommodate the edit master change:

  • Revalidate unreleased claims to edit correctly under new edit master.

  • Modify any bridge routines based on edit masters

  • No Payer Alias changes are required. Payer name and CPIDs are not changing.

REF 793252 10/7/2024

Electronic Connection No Longer Available for Southwest Service Administrators 

Effective immediately, the payer listed below will no longer be available at Optum for remittance processing.

Assurance EDI:

Payer Name: Southwest Service Administrators

Remittance CPIDs: 1184, 2555

Reason: Payer does not offer an electronic remittance connection.

Action Required: None

Assurance Reimbursement Management:

Payer Name: Southwest Service Administrators

Remittance CPIDs: 1184, 2555

Remittance LOB: K1E

Reason: Payer does not offer an electronic remittance connection.

Action Required: None.

REF 793150 10/07/2024

Report Generation Delay for CPID 7662 Community Care Plan (Medicaid)

A payer intermediary is experiencing issues affecting Institutional report generation for some claims submitted on Sept. 23, 2024.

Payer impacted:

  • CPID 7662 Community Care Plan (Medicaid)

The payer intermediary is unable to generate and deliver the reports.

Action Required: Please resubmit claims if payment has not been received from the payer.

REF 793050 10/07/2024

Update: Report Generation Delay for CPID 5440 Fox Valley Medicine

The payer intermediary has been unable to generate and deliver the reports for some claims submitted on Sept. 6, 2024 and Sept. 7, 2024.

Action Required: Please resubmit claims if payment has not been received.

Original notification sent Aug. 27, 2024:

A payer intermediary is experiencing issues affecting professional report generation for some claims submitted since Aug. 16, 2024.

Payer impacted:

  • CPID 5440 Fox Valley Medicine

Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 793054 10/7/2024

Report Generation Delay for CPID 1737 PodAmerica

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted on Sept. 23, 2024.

Payer impacted:

  • CPID 1737 PodAmerica

Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 793051 10/7/2024

Edit Master for CPIDs 9215, 6060 Everpointe, 9777, 8060 University Medical Center, 4253, 2979 Prominence Administrative Services

Effective immediately, Optum will be changing Edit Masters for the following payers:

Payer Name: Everpointe

Professional CPID: 9215

Current Edit Master: PE_T007

New Edit Master: PE_B800

Institutional CPID: 6060

Current Edit Master: HE9T007

New Edit Master: HE9B801

Payer-assigned Payer ID: 32052

Payer Name: University Medical Center

Professional CPID: 9777 

Current Edit Master: PE_C054

New Edit Master: PE_B800

Institutional CPID: 8060

Current Edit Master: HE9C054

New Edit Master: HE9B801

Payer-assigned Payer ID: 11149

Payer Name: Prominence Administrative Services

Professional CPID: 4253

Current Edit Master: PE_T007

New Edit Master: PE_B800

Institutional CPID: 2979  

Current Edit Master: HE9T007

New Edit Master: HE9B801

Payer-assigned Payer ID: 88022

Action Required: Please make the following changes to accommodate the routing change: 

  • Revalidate unreleased claims to edit correctly under new edit master. 

  • Modify any bridge routines based on the edit master. 

No Payer Alias changes are required. Payer name(s) and CPID(s) are not changing.

REF 792605 10/4/2024

Claims Delay for Massachusetts Medicaid

This message is intended for Revenue Performance Advisor customers.

Due to a payer system issue, a delay occurred in the transmissions to Massachusetts Medicaid since Aug. 27, 2024. 

Payer ID: 12K14 (Institutional) and SKMA0 (Professional)

Optum is working with the payer to resolve this issue. We will notify you as soon as additional information becomes available. 

Action Required: Be aware of the transmit delay above.

REF 792351 10/04/2024

Remittance Reactivation for CPIDs 1015, 7838 Aetna Better Health of California

Optum recently restored electronic remittance connectivity for the following payer:

Payer Name: Aetna Better Health of California
Professional CPID: 7838
Institutional CPID: 1015
Industry Payer ID: 128CA

Remittance Enrollment Requirements:

  • Payer enrollment for electronic remittance is required:

  • Providers currently receiving electronic remittance for this payer do not need to complete a new enrollment form.

  • Providers who moved their enrollment to another clearinghouse or have not received remittance will need to re-enroll to receive remittance for this payer from Optum (Change Healthcare).

  • New providers must complete a new enrollment form.

Action Required: Please consider the following to allow transactions to process properly due to the above changes:

  • Make any necessary system changes.

  • When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.

REF 792604 10/04/2024

Electronic Routing Change - SCAN Health Plan

Effective Oct. 4, 2024, Optum will be changing electronic claims routing for the following payer:

New Payer Name: SCAN Health Plan
Professional CPID: 4464
Institutional CPID: 2983
Payer-assigned Payer ID: 72261

Enrollment Requirements:
Claims:

  • Payer enrollment for electronic claims is not required.

Report Changes:
You may see some differences in the payer reports you are receiving.

Action Required: Please consider the following to allow transactions to process properly due to the above changes:

  • Make any necessary system changes.

  • When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.

REF 792800 10/4/2024

Electronic Claims Connection Suspended

Effective immediately, the payer listed below has been temporarily suspended at Optum for claims processing and removed from the payer list.

Payer Name: TDS/ATRIO

CPIDs: 6057, 9211

Payer ID: RP005

Action Required: Please refrain from submitting claims until further notice.

REF 792551 10/4/2024

Update for Paper Claim Payer ID SPRNT

This message is intended for Revenue Performance Advisor (RPA) customers.

Research found that paper-printed claims sent under an unpublished payer ID of SPRNT are being printed under a previous version of the HCFA 1500 form (08/05) since April 2024.

The published payer IDs for commercial paper-printed claims on RPA is either "PAPER" or "PRINT", and those claims are being printed on the correct HCFA form. We advise anyone using SPRNT, to update the payer ID to PAPER or PRINT.

The RPA system has been updated to route SPRNT claims to the current HCFA form, starting Oct. 5, 2024. Any claims previously sent with SPRNT, and not processed by payers due to incorrect form, can be resubmitted.

SPRNT can still be used at this time, but we strongly encourage providers to update the payer ID for paper printed claims to an RPA published payer ID.

Full list of RPA-specific payer IDs for paper-printed claims:

  • PAPER – Commercial Professional claims (may convert to EDI, if payer address is on file on RPA) PRINT – Commercial Professional claims

  • X4321 – Medicare Professional claims

  • X4322 – Medicaid Professional claims

  • X4323 – BCBS Professional claims

  • PAPER – Commercial Institutional claims (may convert to EDI, if payer address is on file on RPA) PRINT – Commercial Institutional claims

  • X4351 – Medicare Institutional claims

  • X4352 – Medicaid Institutional claims

  • X4353 – BCBS Institutional claims

Submitter Action: For providers using payer ID SPRNT, update the payer ID as noted above and resubmit any claims sent from April 2024 - to date, that have not been processed by the payer.

REF792350 10/4/2024

Update: Report Generation Delay for CPIDs 7543 and 2803 UPMC Health Plan

Update: The payer has been unable to generate and deliver the reports for some claims submitted from Sept. 23, 2024 through Sept. 25, 2024.

Action Required: Please resubmit claims if payment has not been received.

Update sent Sept. 27, 2024:

Update: The payer listed below is experiencing issues affecting Institutional and Professional report generation for some claims submitted since Sept. 23, 2024.

Payer impacted: 

  • CPID 7543 UPMC Health Plan

  • CPID 2803 UPMC Health Plan

Optum is working diligently with the payer to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

Original notify sent Sept. 26, 2024:

The payer listed below is experiencing issues affecting Professional report generation for some claims submitted since Sept. 23, 2024.

Payer impacted: 

  • CPID 2803 UPMC Health Plan

Optum is working diligently with the payer to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 787204 791050 10/3/2024

Remittance Reactivation

Optum recently restored and re-routed electronic remittance connectivity for the following payers:

Payer Name: Downey Select IPA (AppleCare Medical Management)

Professional CPID: 3071

Institutional CPID: 4152

Industry Payer ID: APP01

Payer Name: St. Joseph Heritage

Professional CPID: 9570

Institutional CPID: 3412

Industry Payer ID: STJOE

Remittance Enrollment Requirements:

  • Payer enrollment for electronic remittance is required for all providers.

Action Required: Please consider the following to allow transactions to process properly due to the above changes:

  • Make any necessary system changes.

  • When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.

REF 790796 10/3/2024

New Electronic Remittance Connections Available

Optum has new electronic remittance connections available:

Exchange

Payer Name: Joplin Claims
Institutional CPID: 1659
Professional CPID: 3255
Payer-assigned Payer ID: 43178
Payer Enrollment Required: Yes
Remittance Fee: N/A
Payer Location: Missouri

Payer Name: New Era Employee Welfare Benefit Plan Trust
Institutional CPID: 9525
Professional CPID: 1115
Payer-assigned Payer ID: 76031
Payer Enrollment Required: Yes
Remittance Fee: N/A
Payer Location: National

Assurance Reimbursement Management:

Payer Name: Joplin Claims
Institutional CPID: 1659
Professional CPID: 3255
Payer-assigned Payer ID: 43178
Line of Business (LOB) Code: N01
Payer Enrollment Required: Yes
Remittance Fee: N/A
Payer Location: Missouri

Payer Name: New Era Employee Welfare Benefit Plan Trust
Institutional CPID: 9525
Professional CPID: 1115
Payer-assigned Payer ID: 76031
Line of Business (LOB) Code: N19
Payer Enrollment Required: Yes
Remittance Fee: N/A
Payer Location: National

Action Required:

  • Add the payers to your system to begin using the new payer connection.

  • Enrollment forms must be submitted and approved to begin receiving electronic remittance through Optum.

REF 790522  10/2/2024

Optum Payer ID Change Notice

Optum is changing the payer ID for the payer listed below.  This change is effective immediately. 

Payer Name:  Partners Health Management

Old Payer ID:  52613

New Payer ID:  13141

CPIDs:  5682, 6701

Action required: Please adjust your transaction processing to accommodate the updated payer ID.

REF 789397 10/2/2024

Remittance Reactivation for Multiple Payers

Optum recently restored and re-routed electronic remittance connectivity for the following payers:

Payer Name: Medsolutions
Professional CPID: 1825
Institutional CPID: 8973
Industry Payer ID: 62160

Payer Name: Nascentia Health Options
Professional CPID: 6842
Institutional CPID: 7622
Industry Payer ID: 31626

Payer Name: Nascentia Health Plus
Professional CPID: 8780
Institutional CPID: 3086
Industry Payer ID: 45529

Remittance Enrollment Requirements:

  • Payer enrollment for electronic remittance is required for all providers.

Action Required: Please consider the following to allow transactions to process properly due to the above changes:

  • Make any necessary system changes.

  • When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.

REF 790200 10/01/2024

Electronic Claims Connection Suspended

Effective immediately, the payer listed below has been temporarily suspended at Optum for claims processing and removed from the payer list.

Payer Name: CentraCare

CPIDs: 3091, 8715

Payer ID: 66698

Action Required: Please refrain from submitting claims until further notice.

REF 789151 10/1/2024

AgeWell New York Electronic Claims and Remittance Connections No Longer Available

Effective immediately, the payer listed below will no longer be available at Optum for claims or remittance processing. 

Payer Name: AgeWell New York

Claim CPIDs: 7702, 9645

Remittance LOB: J35

Reason: Payer no longer in business.

Action Required: None.

REF 789450 10/01/2024

Update: Report Generation Delay for CPID 5432 Johns Hopkins Healthcare / Priority Partners

Update: The payer intermediary has been unable to generate and deliver the reports for some claims submitted on Sept. 16, 2024.

Action Required: Please resubmit claims if payment has not been received.

Original notify sent Sept. 30, 2024 (REF 787400):

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted on Sept. 16, 2024.

Payer impacted:

  • CPID 5432 Johns Hopkins Healthcare / Priority Partners

Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 788901 10/01/2024

Report Generation Delay for CPIDs 4727 and 1673 Public Employee Health Plan

A payer intermediary experienced issues affecting Professional and Institutional report generation for some claims submitted from Aug. 26, 2024 to Sept. 23, 2024.

Payer impacted:

  • CPID 1673 Public Employee Health Plan

  • CPID 4727 Public Employee Health Plan

The payer intermediary is unable to generate and deliver the reports.

Action Required: None. Please resubmit claims if payment has not been received.

REF 789300 10/01/2024

United Medical Alliance Electronic Claims Connection No Longer Available - Assurance EDI

This message is intended for Assurance EDI customers.

Effective immediately, the payer listed below will no longer be available at Optum for claims processing.

Payer Name: United Medical Alliance

Claim CPIDs: 1802, 4564

Reason: Payer no longer offers an electronic connection to which Optum can connect.  

Action Required: Claims must be submitted to Optum on paper.

REF 787453 10/01/2024

United Medical Alliance Electronic Claims Connection No Longer Available - Assurance Reimbursement Management

This message is intended for Assurance Reimbursement Management customers.

Effective immediately, the payer listed below will no longer be available at Optum for claims processing.

Payer Name: United Medical Alliance

Claim CPIDs: 1802, 4564

Reason: Payer no longer offers an electronic connection to which Optum can connect.

Action Required:  

Please be aware the payer alias entries will be removed and claims for this payer must now be submitted on paper. Please make the following changes to accommodate the payer no longer offering an electronic connection.

After the edit release date above, revalidate unreleased claims to edit correctly to send paper claims.

Modify any bridge routines based on Edit Masters for paper claims.

REF 787453 10/01/2024

Electronic Connections No Longer Available

Effective Oct. 1, 2024, the payers listed below will no longer be available at Optum for Claims and Remittance processing.

Payer Name: Bright Healthcare
CPIDs: 6091, 9269
Payer ID: BRGHT
Reason: Payer went out of business

Payer Name: Bright Health – Medicare Advantage
CPIDs: 1078, 8105
Payer ID: BRT01
Reason: Payer went out of business

*Paper claims are no longer accepted.

REF 788451

Report Generation Delay for CPID 5428 QualChoice of Arkansas

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted on Sept. 21, 2024. 

Payer impacted: 

  • CPID 5428 QualChoice of Arkansas 

The payer intermediary has been unable to generate and deliver the reports. 

Action Required: Please resubmit claims if payment has not been received from the payer.

REF 787952 9/30/2024

Update: Report Generation Delay for CPIDs 2150 and 3693 Florida Health Care Plans

Update: A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted since Sept. 4, 2024.

Payer impacted:

  • CPID 2150 Florida Health Care Plans

  • CPID 3693 Florida Health Care Plans

Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

Original notify sent Sept. 20, 2024: A payer intermediary is experiencing issues affecting Institutional report generation for some claims submitted since Sept. 4, 2024.

Payer impacted:

  • CPID 3693 Florida Health Care Plans

Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 787950  9/30/2024

New Electronic Claims Connections Available

Optum has new electronic claims connections available: 

Payer Name: Snedeker Risk Management

Institutional CPID: 3964

Professional CPID: 1891

Payer-assigned Payer ID: A7637

Payer Enrollment Required: No

Secondary Claims Accepted: No

Payer Location: Illinois

Claims Fee: N/A

Action Required: 

  • Add the payers to your system to begin using the new payer connection.

  • When a payer requires enrollment, forms must be submitted and approved to begin submitting transactions.

REF 788400 9/30/2024

Report Generation Delay for CPID 3792 Fidelis Care

A payer intermediary is experiencing issues affecting professional report generation for some claims submitted on Sept. 17, 2024.

Payer impacted:

  • CPID 3792 Fidelis Care

Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 787951 9/30/2024

Report Generation Delay for CPID 5432 Johns Hopkins Healthcare / Priority Partners

A payer intermediary is experiencing issues affecting professional report generation for some claims submitted on Sept. 16, 2024.

Payer impacted:

  • CPID 5432 Johns Hopkins Healthcare / Priority Partners

Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 787400 9/30/2024

999 Payer Batch Rejections for CPID 1407 Blue Cross Blue Shield of Georgia

Professional claims transmitted to the payer listed below from Optum on Sept. 26, 2024, were not processed by the payer intermediary due to a 999 Batch Rejection. 

  • CPID 1407 Blue Cross Blue Shield of Georgia

A resolution has been implemented and the claims were retransmitted to the payer intermediary on Sept. 27, 2024.

Action Required: None.

REF 787203 9/27/2024

Update: Report Generation Delay for CPIDs 7543 and 2803 UPMC Health Plan

Update: The payer listed below is experiencing issues affecting Institutional and Professional report generation for some claims submitted since Sept. 23, 2024.

Payer impacted:

  • CPID 7543 UPMC Health Plan

  • CPID 2803 UPMC Health Plan

Optum is working diligently with the payer to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

Original notify sent Sept. 26, 2024: The payer listed below is experiencing issues affecting Professional report generation for some claims submitted since Sept. 23, 2024.

Payer impacted:

  • CPID 2803 UPMC Health Plan

Optum is working diligently with the payer to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 787204 09/27/2024

Payer Transmit Delay for multiple CPIDs

Due to a system issue, a delay occurred in the transmissions to the following payers on Sept. 26, 2024.

Payers impacted:

  • CPID 1422 New York Medicaid

  • CPID 1500 New York Medicaid

  • CPID 1502 New York Medicaid Outpatient

  • CPID 2429 New York Medicaid

  • CPID 6540 New York Medicaid

  • CPID 2743 New York Medicaid

  • CPID 2745 New York Medicaid

A resolution has been implemented and claims were transmitted to the payers on Sept. 27, 2024.  

This delay affected claims released to Optum between 10 p.m. ET on Sept. 25, 2024, and 10 p.m. ET on Sept. 26, 2024.

Action Required: Be aware of the transmit delay above.

REF 787100 9/27/2024

Report Generation Delay for CPID 2803 UPMC Health Plan

The payer listed below is experiencing issues affecting professional report generation for some claims submitted since Sept. 23, 2024.

Payer impacted:

  • CPID 2803 UPMC Health Plan

Optum is working diligently with the payer to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 786218 9/26/2024

Report Generation Delay for CPID 2803 UPMC Health Plan

The payer listed below is experiencing issues affecting professional report generation for some claims submitted since Sept. 23, 2024.

Payer impacted:

  • CPID 2803 UPMC Health Plan

Optum is working diligently with the payer to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 786218 9/26/2024

Report Generation Delay for CPID 6987 Veterans Affairs Financial Services Center

A payer intermediary is experiencing issues affecting Institutional report generation for some claims submitted on Sept. 16, 2024.

Payer impacted:

  • CPID 6987 Veterans Affairs Financial Services Center

Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 786219 9/26/2024

Report Generation Delay for CPID 7543 UPMC Health Plan

The payer listed below is experiencing issues affecting institutional report generation for some claims submitted on Sept. 19, 2024.

Payer impacted:

  • CPID 7543 UPMC Health Plan

The payer has been unable to generate and deliver the reports.

Action Required: Please resubmit claims if payment has not been received from the payer.

CSA 786217 9/26/2024

Electronic Routing Change for Multiple Payers

Effective immediately, Optum will be changing electronic remittance routing for the following payers:

Payer Name: Contigo Health
Professional CPID: 2898
Institutional CPID: 7552
Line of Business Code (LOB): K38
Payer-assigned Payer ID: 34158

Payer Name: University Family Care/University Physician Care Advantage
Professional CPID: 2727
Institutional CPID: 3648
Line of Business Code (LOB): U1J
Payer-assigned Payer ID: 09830

Enrollment Requirements:
Remittance:

  • Payer enrollment for electronic remittance is required.

  • Providers currently receiving electronic remittance through Optum must complete a new enrollment form.

  • New providers must complete a new enrollment form.

Action Required: Please consider the following to allow transactions to process properly due to the above changes:

  • Make any necessary system changes.

  • When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.

REF 786550  9/26/24

Delay in Electronic Remittance Advice (ERA) for CPIDs 4749 and 5913 TRICARE For Life

Due to a payer processing issue, there has been a delay in some Professional and Institutional Electronic Remittance Advice (ERA) for the following payer for file dates since Sept. 20, 2024:

  • CPID 4749 TRICARE For Life

  • CPID 5913 TRICARE For Life

Additional updates will be forwarded as more information becomes available.

Action Required: Please be aware of a delay in the delivery of ERA for file dates above.

REF 786451 9/26/2024

Report Generation Delay for CPID 1592 Johns Hopkins Healthcare / Priority Partners

A payer intermediary is experiencing issues affecting Institutional report generation for some claims submitted on Sept. 16, 2024.

Payer impacted:

• CPID 1592 Johns Hopkins Healthcare / Priority Partners

The payer intermediary has been unable to generate and deliver the reports.

Action Required: Please resubmit claims if payment has not been received from the payer.

REF 786215 9/26/2024

Update: Report Generation Delay for CPID 9441 Wellspace NEXUS LLC

Update: A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted on Sept. 4, 2024, Sept. 10, 2024, and Sept. 12, 2024.

Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

Original notify sent Sept. 17, 2024:

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted on Sept. 4, 2024, and Sept. 10, 2024.

Payer impacted:

• CPID 9441 Wellspace NEXUS LLC

Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 786213 9/26/2024

Update: Report Generation Delay for CPID 6246 Riverside Medical Clinic

A payer intermediary is experiencing issues affecting professional report generation for some claims submitted on Sept. 4, 2024, Sept. 10, 2024, and Sept. 12, 2024.

Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

Original notification sent Sept. 17, 2024:

A payer intermediary is experiencing issues affecting professional report generation for some claims submitted on Sept. 4, 2024, and Sept. 10, 2024.

Payer impacted:

  • CPID 6246 Riverside Medical Clinic

Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 786212 9/26/2024

Update: Report Generation Delay for CPID 5813 SCAN Health Plan Arizona

Update: The payer intermediary has been unable to generate and deliver the reports for some claims submitted Sept. 4, 2024 and Sept. 10, 2024.

Action Required: Please resubmit claims if payment has not been received.

Original notify CSA/REF 779458 sent Sept. 17, 2024:

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted Sept. 4, 2024 and Sept. 10, 2024.

Payer impacted:

• CPID 5813 SCAN Health Plan Arizona

Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 786214  9/26/24

Update: Report Generation Delay for CPIDs 7662 and 6865 Community Care Plan

Update: The payer intermediary has been unable to generate and deliver the reports for some claims submitted on Aug. 29, 2024.

Payer impacted:

• CPID 7662 Community Care Plan (Medicaid)

• CPID 6865 Community Care Plan (Medicaid)

Action Required: Please resubmit claims if payment has not been received.

Original notify sent Sept. 10, 2024: A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted on Aug. 29, 2024.

Payer impacted:

• CPID 6865 Community Care Plan (Medicaid)

Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 786210 9/26/2024

Delay in Electronic Remittance Advice (ERA) for Noridian Payers

This message is intended for Revenue Performance Advisor customers.

Due to a payer issue, there has been a delay in professional and institutional Electronic Remittance Advice (ERA/835) delivery for the following payers beginning on Thursday, September 12, 2024, through present:

SMAK0

Alaska Medicare Part B

12M02

Arizona Medicare Part A

SMAZ0

Arizona Medicare Part B

12M64

California Medicare Part A

12M64

Hawaii Medicare Part A

SMHI0

Hawaii Medicare Part B

12M07

Idaho and Alaska Medicare Part A

SMID0

Idaho Medicare Part B

SKIA0

Iowa Medicaid

12M65

Medicare Part A (CA, HI, NV) Legacy

12M77

Montana Medicare Part A

SMMT

Montana Medicare Part B

12M64

Nevada Medicare Part A

SMNV0

Nevada Medicare Part B

12M82

North Dakota Medicare Part A

SMND0

North Dakota Medicare Part B

SMCA1

Northern California Medicare Part B

12M41

Oregon Medicare Part A

SMOR0

Oregon Medicare Part B

12M83

South Dakota Medicare Part A

SMSD0

South Dakota Medicare Part B

SMCA2

Southern California Medicare Part B

12M84

Utah Medicare Part A

SMUT0

Utah Medicare Part B

12M45

Washington Medicare Part A

SMWA0

Washington Medicare Part B

12M30

Wyoming Medicare Part A

SMWY0

Wyoming Medicare Part B

Action Required:

Please be aware of a delay in the delivery of ERA for the dates above.

REF 786250 9/26/2024

Update: Report Generation Delay for CPIDs 8551 and 1844 Wellcare Health Plans

Update: The payer intermediary has been unable to generate and deliver the reports for some claims submitted Aug. 29, 2024.

Action Required: Please resubmit claims if payment has not been received.

Original notify CSA/REF 773651 sent Sept. 10, 2024:

A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted Aug. 29, 2024.

Payer impacted:

  • CPID 8551 Wellcare Health Plans

  • CPID 1844 Wellcare Health Plans

Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 786211  9/26/24

Update: Payer Transmit Delay for Multiple CPIDs

Due to a payer system issue, a delay occurred in the transmissions to the following payers since Aug. 27, 2024. 

Payers impacted: 

  • CPID 5529 Massachusetts Medicaid 

  • CPID 2905 Massachusetts Medicaid Long Term Care 

  • CPID 4492 Massachusetts Medicaid Format 5 

  • CPID 4491 Massachusetts Medicaid Format 9 

Optum is working with the payers to resolve this issue. We will notify you as soon as additional information becomes available. 

This delay affected claims released to Optum since 12 p.m. CT on Aug. 26, 2024. 

Action Required: Be aware of the transmit delay above.

REF 784852 9/25/2024

Delay in Electronic Remittance Advice (ERA) for Novitas, Multiple CPIDs

Due to a payer issue, there has been a delay in Professional and Institutional Electronic Remittance Advice (ERA) for the following payers beginning Sept. 12, 2024-present:

AR|Arkansas Novitas JH 2455 1526
CO|Colorado Novitas JH 1449 1547
DE|Delaware Novitas JL 2456 5912
ID|Idaho Novitas JL 2465 5581
LA|Louisiana Novitas JH 1460 3579
MD|Maryland Novitas JL 7402 5554
MS|Mississippi Novitas JH 2451 5556
NJ|New Jersey Novitas JH 1465 5503
NM|New Mexico Novitas JH 1457 5566
OK|Oklahoma Novitas JH 1458 1558
PA|Pennsylvania Novitas JL 2457 5598
TX|Texas Novitas JH 1440 5502
TN|Tennessee Novitas JH 1453 5525

Additional updates will be forwarded as more information becomes available. 

Action Required: Please be aware of a delay in the delivery of ERA for the dates above. 

If you have any questions, feel free to contact your Customer Support Team and refer to case 09103197.

REF 784950  9/25/24

New Electronic Remittance Connection Available

Optum has a new electronic remittance connection available:

Payer Name: Dean Health Plan by Medica DOS After 12312023
Institutional CPID: 3921
Professional CPID: 1870
Payer-assigned Payer ID: 41822
Payer Enrollment Required: Yes
Remittance Fee: N/A
Payer Location: Wisconsin

Action Required:

  • Add the payers to your system to begin using the new payer connection.

  • Enrollment forms must be submitted and approved to begin receiving electronic remittance through Optum.

REF 784651  9/25/24

Claims Processing Termination for CPIDs 6039 and 9193, KISx Card LLC

Effective immediately, the payer listed below will no longer be available at Optum for CLAIMS processing.

Payer Name: KISx Card LLC

CPID(s): 6039 and 9193

Payer ID: 83313

Reason: The payer decided to terminate agreement with Optum/Change Healthcare.

Action Required: None.

REF 784850 9/25/2024

New Electronic Claims Connections Available

Optum has new electronic claims connections available: 

Payer Name: UTMB Health Plans, Inc

Institutional CPID: 7933

Professional CPID: 2762

Payer-assigned Payer ID: 87892

Payer Enrollment Required: No

Secondary Claims Accepted: No

Payer Location: Texas

Claims Fee: N/A 

Action Required: 

  • Add the payers to your system to begin using the new payer connection

  • When a payer requires enrollment, forms must be submitted and approved to begin submitting transactions.

Please note: We are providing you with a list of new electronic connections. Please review and choose payers that are appropriate for your business.

REF 784851 9/25/2024

New Electronic Remittance Connection Available

Optum has a new electronic remittance connection available:

Payer Name: Dean Health Plan by Medica Date of Service (DOS) After Dec. 31, 2023
Institutional CPID: 3921
Professional CPID: 1870
Payer-assigned Payer ID: 41822
Line of Business (LOB) Code: N30
Payer Enrollment Required: Yes
Remittance Fee: N/A
Payer Location: Wisconsin

Action Required: 

  • Add the payers to your system to begin using the new payer connection.

  • Enrollment forms must be submitted and approved to begin receiving electronic remittance through Optum. 

REF 784650 9/25/2024

Report Generation Delay for CPID 2712 The Alliance

A payer is experiencing issues affecting professional report generation for some claims submitted on Sept. 13, 2024.

Payer impacted:

  • CPID 2712 The Alliance

The payer has been unable to generate and deliver the reports.

Action Required: Please resubmit claims if payment has not been received from the payer.

REF 784450 9/25/2024

Invalid Rejections for CPID 7751 Health Net of CA, OR

Due to a processing issue, claims submitted to the payer listed below from Sept. 4, 2024, through Sept. 23, 2024, may have received the following invalid rejection.

Rejection message:

  • L2           PAYER ID IS UNSUPPORTED        7751

Payer Impacted:

  • CPID 7751 Health Net of CA, OR

A resolution has been implemented and claims were transmitted to the payer on Sept. 24, 2024.

This delay affected claims released to Optum between 1 a.m. ET on Sept. 5, 2024, and 6 p.m. ET on Sept. 23, 2024.

Action Required: Be aware of the invalid rejection above.

REF 783651 9/24/2024

Payer Processing Issue for Multiple CPIDs

Due to a payer intermediary processing issue, some Professional claims transmitted to the payers listed below on Sept. 23, 2024, were not processed by the payers.

Payers Impacted:

CPID

Payer Name 

8454

Align Senior Care of Michigan

2113

Allcare Health Plan

8714

Allstate - Except New Jersey

1764

Ambetter From Absolute Total Care

9278

Ambetter from Nebraska Total Care

9431

Ambetter from WellCare of Kentucky

9433

Ambetter of Oklahoma

9429

American Health Advantage of Idaho & Utah

9142

American Health Advantage of Mississippi

9117

American Health Advantage of Texas

1741

Amerigroup

1412

Anthem Blue Cross and Blue Shield - Indiana

2421

Anthem Blue Cross and Blue Shield - Kentucky

1413

Anthem Blue Cross and Blue Shield (Virginia)

2418

Anthem Blue Cross and Blue Shield of Ohio

4437

Anthem Blue Cross Blue Shield New York

6220

Arizona Priority Care Plus

4477

Asuris Northwest Medadvantage Regence

7272

Axminster Medical Group

3845

Banner Health Network

1415

Blue Cross Blue Shield of Colorado

1407

Blue Cross Blue Shield of Georgia

7496

Blue Cross Blue Shield of Nevada

1169

Blue Cross Blue Shield of Western New York Medicaid/CHP

1401

Blue Cross Blue Shield of Wisconsin

1243

Blue Cross Community Centennial

1167

Blue Cross Medicare Advantage PPO/HMO

9162

Blue Medicare Advantage

6779

Bridgespan Regence

1750

Brown & Toland Physicians

4246

Capital Health Plan

2810

Capitol Administrators

8146

Care N Care Insurance Co.

2289

Care1st Health Plan of Arizona Medicaid

9759

Care1st Health Plan of Arizona Medicaid

4743

Carelon Behavioral Health

6127

Carelon Behavioral Health, MBHP

3293

Carelon Health

2830

CarePlus Health Plans

1194

CareSource of Georgia

7143

CareSource of Indiana

3826

CareSource of Ohio

7263

CareSource of West Virginia

6777

Centers Plan for Healthy Living

7275

Citrus Valley Physicians Group

7416

Colorado Anthem Blue Cross Blue Shield HMO

7763

Columbine Health Plan

8834

Commonwealth Care Alliance DOS after 3/31/2023

8477

Community Care Plan

2160

Community Care Plan (Commercial)

6865

Community Care Plan (Medicaid)

8147

Community Care Plan (Palm Beach Health District)

1420

Connecticut Anthem Blue Cross Blue Shield

3419

Connecticut Federal Employee Health Benefits

6795

Contra Costa Health Plan

7738

CountyCare Health Plan

9747

Delaware First Health

2433

Denver Health and Hospital Authority

8135

Doctors HealthCare Plans

1119

Easy Choice Health Plan of California

7294

Eberle Vivian

4289

El Paso Health-CHIP

4279

El Paso Health-STAR

5483

Employee Benefit Management Services (EBMS)

8137

Empower Healthcare Solutions

1795

Envolve Benefit Options

9215

Everpointe

5238

Evolent Specialty Cardiology

3792

Fidelis Care

2875

First Health Network(Coventry Health Care National Network)

7435

FirstCare Health Plans

1414

Florida Blue Cross Blue Shield

3417

Florida Blue Cross Blue Shield Health Options HMO

9417

Florida Complete Care

2150

Florida Health Care Plans

6851

Friday Health Plans

8189

Gemcare IPA

1258

Global Healthcare Alliance

2720

GlobalCare

9766

Gold Kidney Health Plan

1772

HAP CareSource

1797

HAP CareSource Michigan Dual Medicare/Medicaid

5243

Healthcare Management Administrators

1723

HealthCare Partners IPA

4448

HealthLink PPO

8750

Healthy Blue Dual Advantage Louisiana

7760

Healthy Blue Louisiana

8867

Healthy Blue Missouri

9133

Healthy Blue North Carolina

7715

Hopkins Health Advantage

6259

Humana - CareSource of Kentucky

7426

Idaho Regence Blue Shield

1405

Illinois Blue Cross Blue Shield

5865

Indian Health Services

4445

Insurance Management Services TX

4116

IntegraNet Health

8814

Integrated Homecare Services

4876

International Medical Group

1404

Iowa Wellmark Blue Cross Blue Shield

6733

Iowa Wellmark Blue Cross Blue Shield Crossover

5479

IU Health Plan Medicare Advantage

5432

Johns Hopkins Healthcare / Priority Partners

5882

Kane County IPA

7782

Kansas Health Advantage

9412

Leon Health Plans

7446

Maine Anthem Blue Cross Blue Shield

8812

Maryland Physicians Care

8860

Medica Government Programs

7859

Medica Health Plan Solutions

6799

Medica Individual and Family (IFB)

2287

Medicare Plus Blue of MI(MAP)

3475

Memorial Hermann Health Solutions

9102

Meridian Medicare Medicaid Plan

9118

MeridianComplete Michigan

2426

Michigan Blue Care Network

1421

Michigan Blue Cross Blue Shield

1402

Minnesota Blue Cross Blue Shield

1410

Minnesota Blue Cross Blue Shield CC Systems

7892

Minnesota Blue Cross Blue Shield Health Care Programs

1429

Minnesota Blue Cross Blue Shield HMO

1408

Missouri Anthem Blue Cross Blue Shield

8723

MN BCBS Health Care Programs Non Emergent Transportation

7450

Montana Blue Cross Blue Shield

7422

New Hampshire Anthem Blue Cross Blue Shield

7403

New Mexico Blue Cross Blue Shield

8864

NextBlue of North Dakota

2411

North Dakota Blue Cross Blue Shield

1403

Oklahoma Blue Cross Blue Shield

2404

Oregon Regence Blue Cross Blue Shield

7829

Passport Advantage

2798

Pinnacol Assurance

1737

PodAmerica

5838

Preferred Administrators

4252

Presbyterian Salud

4253

Prominence Administrative Services

7281

PruittHealth Premier Medicare Advantage

5428

QualChoice of Arkansas

7264

Quartz ASO

1209

Regence Group Administrators

4464

SCAN Health Plan

2254

Scott & White Health Plan

4480

SelectHealth

9438

Shared Health Mississippi

7138

Sierra Medical Group

8124

Simply Healthcare Plans, Inc.

8816

SOMOS Emblem

1740

Sonder Health Plans

2490

South Dakota Blue Cross Blue Shield

8134

Summit Community Care

1406

Texas Blue Cross Blue Shield

1729

Texas Childrens Health Plan (CHIP)

2483

Texas Childrens Health Plan (STAR Medicaid)

4278

The Boon Group

8763

U.S. Networks and Administrative Services

7810

UMass Medical School Health and Criminal Justice Program

8473

Unicare (TX,MA,KS,WV,RI,IL)

2412

Utah Regence Blue Cross Blue Shield

2788

Utah Regence Blue Cross Blue Shield Federal Employee Program

7493

Vermont Blue Cross Blue Shield

4258

VNS Health

7451

Washington Regence Blue Shield

9430

Wellcare by Allwell of Oklahoma

1844

Wellcare Health Plans

3211

Wellcare Health Plans (Encounters)

1775

Wellpoint

9441

Wellspace NEXUS LLC

7489

Wyoming Blue Cross Blue Shield

A resolution has been implemented and the claims were retransmitted to the payer intermediary on Sept. 24, 2024.

This delay affected claims released to Optum between 3 p.m. and 7 p.m. ET on Sept. 23, 2024.

Action Required: Be aware of the processing issue above.

REF 783900 9/24/2024

Electronic Routing Change - SCAN Health Plan

Effective Sept. 24, 2024, Optum will be changing electronic claims routing for the following payer:

New Payer Name: SCAN Health Plan

Professional CPID: 4464

Professional Edit Master: PE_T007

Institutional CPID: 2983

Institutional Edit Master: HE9T007

Payer-assigned Payer ID: 72261

Enrollment Requirements:

Claims:

  • Payer enrollment for electronic claims is not required.

Report Changes: You may see some differences in the payer reports you are receiving.

Action Required: Please consider the following to allow transactions to process properly due to the above changes:

  • Make any necessary system changes.

  • When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.

REF 784001 9/24/2024

Update: Report generation delay for CPID 2464 Maryland Medicare (Montgomery, Prince George)

Update: The payer has been unable to generate and deliver the reports for some claims submitted between Aug. 30, 2024, and Sept. 3, 2024. 

Action Required: Please resubmit claims if payment has not been received. 

Original notify sent Sept. 6, 2024:

The below payer is experiencing issues affecting Professional report generation for some claims submitted since Aug. 30, 2024. 

Payer impacted:

  • CPID 2464 Maryland Medicare (Montgomery, Prince George) 

  • Optum is working diligently with the payer to resolve the issue and ensure reports are received. 

 Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 783501 9/24/2024

New electronic claims connections available

Optum has new electronic claims connections available for the following payer: 

Payer Name: UTMB Health Multi-Share Plan

Institutional CPID: 7932

Professional CPID: 2761

Payer-assigned Payer ID: 98455

Payer Enrollment Required: No

Secondary Claims Accepted: No

Payer Location: Texas

Claims Fee: N/A

Action Required: 

  • Add the payers to your system to begin using the new payer connection.

  • When a payer requires enrollment, forms must be submitted and approved to begin submitting transactions.

Please note: We are providing you with a list of new electronic connections. Please review and choose payers that are appropriate for your business.

REF 783801 9/24/2024

Update: Report Generation Delay for CPIDs 1440 and 4946 Texas Medicare

Update: A payer is experiencing issues affecting Professional and Institutional report generation for some claims submitted since Sept. 13, 2024.

Payer impacted:

  • CPID 1440 Texas Medicare

  • CPID 4946 Texas Medicare

Optum is working diligently with the payer to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

Original notify sent Sept. 20, 2024:

A payer is experiencing issues affecting Professional report generation for some claims submitted since Sept. 15, 2024.

Payer impacted:

  • CPID 1440 Texas Medicare

Optum is working diligently with the payer to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 783500 9/24/2024

Remittance Reactivation for Health Alliance Medical Plans of Illinois and FirstCarolinaCare

Optum recently restored electronic remittance connectivity for the following payers:

Payer Name: Health Alliance Medical Plans of Illinois

Professional CPID: 2494

Institutional CPID: 2509

Industry Payer ID: 77950

Payer Name: FirstCarolinaCare - New

Professional CPID: 8821

Institutional CPID: 4077

Industry Payer ID: FCC01

Remittance Enrollment Requirements:

  • Payer enrollment for electronic remittance is required:

  • Providers currently receiving electronic remittance for these payers do not need to complete a new enrollment form.

  • Providers who moved their enrollment to another clearinghouse or have not received remittance will need to re-enroll to receive remittance for this payer from Optum (Change Healthcare).

  • New providers must complete a new enrollment form.

Action Required: Please consider the following to allow transactions to process properly due to the above changes:

·    Make any necessary system changes.

  • When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.

REF 783000 9/23/2024

Optum Alert: Report Generation Delay for CPID 8189 Gemcare IPA

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted on Sept. 12, 2024.

Payer impacted:

  • CPID 8189 Gemcare IPA

The payer intermediary has been unable to generate and deliver the reports.

Action Required: Please resubmit claims if payment has not been received from the payer.

REF 782800 9/23/2024

Real-Time Payer availability eligibility 270/271 for Payer ID MDCAID Maryland Medicaid

Effective Sept. 18, 2024.Optum is pleased to announce the availability of Real-time eligibility 270/271 transactions for the below payer:

Exchange Payer ID: MDCAID

Payer Name: Maryland Medicaid

Action required by customer:

Please update your system to take advantage of this payer transaction. For assistance with submitting Real-Time transactions, please contact your Practice Management System Vendor or create a support case Optum Customer Care Hub.

Updated Payer Lists may be obtained from your software vendor or Payer Lists | Change Healthcare

REF 782552 9/23/2024

Report Generation Delay for CPID 7272 Axminster Medical Group

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted Sept. 12, 2024.

Payer impacted:

  • CPID 7272 Axminster Medical Group

Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 782802  9/23/24

Report Generation Delay for CPID 5871 Mission Community IPA Medical Group

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted on Sept. 12, 2024.

Payer impacted: 

  • CPID 5871 Mission Community IPA Medical Group

The payer intermediary has been unable to generate and deliver the reports.

Action Required: Please resubmit claims if payment has not been received from the payer.

REF 782801 9/23/2024

Insurance Design Administrators Electronic Claims Connection No Longer Available

Effective immediately, the payer listed below will no longer be available at Optum for claims processing:

Payer Name: Insurance Design Administrators

Claim CPIDs: 2871, 3906

Reason: Payer no longer offers an electronic connection.

Action Required: None

REF 782554 9/23/2024

Real-Time Payer Availability 270/271 and 276/277

Effective Sept. 18, 2024, Optum is pleased to announce the availability of Real-time eligibility (270/271) and claim status inquiry (276/277) transactions for the following payers:

Molina Healthcare of TX 20554 TXMLNA
Molina Healthcare of CA 38333 CAMLNA
Molina Healthcare of WA 38336 WAMLNA
Molina of Ohio MLNOH OHMLNA
Molina Healthcare of FL 51062 FLMLNA
Molina Healthcare of MI 38334 MIMLNA
Passport Healthplan by Molina Healthcare MLNKY MLNKY
Molina Healthcare of SC MLNSC SCMLNA
Molina Healthcare of IL 20934 MOLIL
Molina Healthcare of UTAH SX109 UTMLNA
Molina Complete Care of Virginia 26176 MLNVA
Molina Healthcare of WI ABRI1 MLNAWI
Molina Healthcare of Idaho 61799 MLNID
Molina Healthcare of NM 09824 NMMLNA
Molina Healthcare of NV MLNNV MLNNV
Molina Complete Care of AZ MLNAZ MLNAZ
Molina Healthcare of MS 77010 MLNMS

Action Required by customer:
Please update your system to take advantage of this payer transaction. For assistance with submitting Real-Time transactions, please contact your Practice Management System Vendor or Optum Customer Care Hub ticket.

Updated Payer Lists may be obtained from your software vendor or Payer Lists | Change Healthcare.

REF 782550  9/23/24

Real-time payer availability 270/271 and 276/277

Effective September 17, 2024, Optum is pleased to announce the availability of real-time eligibility 270/271 and claim status inquiry 276/277 transactions for the below payer:

IMN payer ID: SKMD0

Payer name: MARYLAND MEDICAID

Action Required by customer:

Please update your system to take advantage of this payer transaction. For assistance with submitting real-time transactions, please contact your Practice Management System Vendor or Optum Customer Care Hub.

Updated Payer Lists may be obtained from your software vendor or Payer Lists | Change Healthcare.

REF 782551 9/23/2024

Claim Processing Suspended for CPID 7751, Health Net of CA, OR

Effective immediately, the payer listed below has been temporarily suspended at Optum for claim processing and removed from the payer list.

Payer Name: Health Net of CA, OR

CPID: 7751

Payer ID: 68069

Reason: Connection temporarily unavailable

Action Required: Please refrain from submitting claims until further notice.

REF 782300 9/23/2024

Electronic Claims Connection Suspended

Effective immediately, the payer listed below has been temporarily suspended at Optum for claims processing and removed from the payer list.

Payer Name: Partners Health Management

CPIDs: 5682, 6701

Payer ID: 52613

Action Required: Please refrain from submitting claims until further notice.

REF 782203 9/23/2024

Report Generation Delay for CPID 8189 Gemcare IPA

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted on Sept. 9, 2024.

Payer impacted:

  • CPID 8189 Gemcare IPA

The payer intermediary has been unable to generate and deliver the reports.

Action Required: Please resubmit claims if payment has not been received from the payer.

REF 781902 9/20/2024

Report Generation Delay for CPID 3693 Florida Health Care Plans

A payer intermediary is experiencing issues affecting Institutional report generation for some claims submitted since Sept. 4, 2024.

Payer impacted:

  • CPID 3693 Florida Health Care Plans

Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 781900 9/20/2024

Electronic Claims Connection Suspended

Effective immediately, the payer listed below has been temporarily suspended at Optum for claims processing and removed from the payer list.

Payer Name: Care to Care
CPIDs: 7671
Payer ID: 71222

Action Required: Please refrain from submitting claims until further notice.

REF 781954  9/20/24

Remittance Reactivation for CPIDs 5653, 6294 Sage Breast and Cervical Cancer Screening 

Optum recently restored electronic remittance connectivity for the following payer:

Payer Name: Sage Breast and Cervical Cancer Screening

Professional CPID: 6294

Institutional CPID: 5653

Industry Payer ID: MNDH1

Remittance Enrollment Requirements:

  • Payer enrollment for electronic remittance is required:

  • Providers currently receiving electronic remittance for this payer do not need to complete a new enrollment form.

  • Providers who moved their enrollment to another clearinghouse or have not received remittance will need to re-enroll to receive remittance for this payer from Optum (Change Healthcare).

  • New providers must complete a new enrollment form.

Action Required: Please consider the following to allow transactions to process properly due to the above changes:

  • Make any necessary system changes.

  • When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.

REF 781901 9/20/2024

Report Generation Delay for CPID 1116 Special Agents Mutual Benefit Association (SAMBA)

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted on Sept. 9, 2024.

Payer impacted: 

  • CPID 1116 Special Agents Mutual Benefit Association (SAMBA)

The payer intermediary has been unable to generate and deliver the reports.

Action Required: Please resubmit claims if payment has not been received from the payer.

REF 781903 9/20/2024

Report Generation Delay for CPIDs 6128 and 4616 Gold Coast Health Plan

A payer is experiencing issues affecting Institutional and Professional report generation for some claims submitted on Sept. 16, 2024.

Payer impacted: 

  • CPID 6128 Gold Coast Health Plan

  • CPID 4616 Gold Coast Health Plan

Optum is working diligently with the payer to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 781950 9/20/2024

Report Generation Delay for CPID 1440 Texas Medicare

A payer is experiencing issues affecting Professional report generation for some claims submitted since Sept. 15, 2024.

Payer impacted:

  • CPID 1440 Texas Medicare

Optum is working diligently with the payer to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 781951  9/20/24

Suspended Payer - Multiple Payers (Payer ID: 87020, CPID: 1130, 4055)

Effective immediately, the payers listed below has been removed from the payer list at Optum for electronic claim processing.

Payer Name: Atlantic Coast Life Insurance
CPIDs: 1130, 4055
Payer ID: 87020
Transaction Type: 837
Reason: Payer is unavailable electronically

Payer Name: Catholic Life Insurance
CPIDs: 1130, 4055
Payer ID: 87020
Transaction Type: 837
Reason: Payer is unavailable electronically

Payer Name: Catholic United Financial
CPIDs: 1130, 4055
Payer ID: 87020
Transaction Type: 837Transaction Type:
Reason: Payer is unavailable electronically

Payer Name: Sentinel Security Life
CPIDs: 1130, 4055
Payer ID: 87020
Transaction Type: 837
Reason: Payer is unavailable electronically

Payer Name: National Guardian Life Insurance Company
CPIDs: 1130, 4055
Payer ID: 87020
Transaction Type: 837
Reason: Payer is unavailable electronically

Payer Name: Pan-American Life Insurance Company (SSLCO)
CPIDs: 1130, 4055
Payer ID: 87020
Transaction Type: 837
Reason: Payer is unavailable electronically

Payer Name: Polish Falcons of America
CPIDs: 1130, 4055
Payer ID: 87020
Transaction Type: 837
Reason: Payer is unavailable electronically

Payer Name: Renaissance Life and Health Insurance Company of America
CPIDs: 1130, 4055
Payer ID: 87020
Transaction Type: 837
Reason: Payer is unavailable electronically

Action Required: Please refrain from submitting claims until further notice.

REF 781701 9/19/2024

New Electronic Claims Connections Available

Optum has new electronic claims connections available:

Payer Name:  Sage
Institutional CPID:  7924
Professional CPID:  2746
Payer-assigned Payer ID:  SAGE1
Payer Enrollment Required:  No
Secondary Claims Accepted: Yes
Payer Location:  National
Claims Fee:  N/A

Action Required:

  • Add the payers to your system to begin using the new payer connection.

  • When a payer requires enrollment, forms must be submitted and approved to begin submitting transactions.

Please note: We are providing you with a list of new electronic connections, please review and choose payers that are appropriate for your business.

REF 781301 9/19/2024

RPA Maintenance - Sept. 21, 2024

Please be advised the the Revenue Performance Advisor (RPA) Platform will be undergoing maintenance Sept. 21, 2024, 9 p.m. ET to 11 p.m. ET.  All RPA services will be unavailable during this time.

REF 781302 9/19/2024

Delay in Electronic Remittance Advice (ERA) for CPIDs 5648, 6286. Payer TriWest

Due to a payer processing issue, there has been a delay in Professional and Institutional Electronic Remittance Advice (ERA) for the following payers for file dates Feb. 22, 2024-Aug. 29, 2024. TriWest completed reprocessing remits for this period August 29th, 2024:

  • CPID 5648 / Payer ID SCWI0 TriWest

  • CPID 6286 / Payer ID SCWI0 TriWest

Action Required: If Electronic Remittance Advice (ERA) was generated, but check date is greater than 30 days, TriWest is unable to requeue those files. Provider will need to work directly with the payer for any check date older than 30 days.  

Contact the PGBA EDI Help Desk at 1-800-259-0264, option 2 or email [email protected].

If you have any questions, feel free to contact your Customer Support Team and refer to Case 09006858.

REF 781550  9/19/24

Remittance Reactivation for CPIDs 3447, 3568 CenCal Health

Optum recently restored electronic remittance connectivity for the following payer: 

Payer Name: CenCal Health Professional 

CPID: 3447 Institutional 

CPID: 3568 Industry

Payer ID: 95386 

Remittance Enrollment Requirements: 

  • Payer enrollment for electronic remittance is required: 

  • Providers currently receiving electronic remittance for this payer do not need to complete a new enrollment form. 

  • Providers who moved their enrollment to another clearinghouse or have not received remittance will need to re-enroll to receive remittance for this payer from Optum (Change Healthcare). 

  • New providers must complete a new enrollment form. 

Action Required: Please consider the following to allow transactions to process properly due to the above changes: 

  • Make any necessary system changes. 

  • When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.

REF 781300 9/19/2024

Novitas Medicare Electronic Remittance Advice (ERA)

There were issues that impacted clearinghouse delivery of remits from Novitas Medicare (various payer IDs – see below) issued during the period starting February 19, 2024, through April 19, 2024. Novitas Medicare completed reprocessing remits for this period as of September 16, 2024.

Noridian payers                           (RPA Professional, Institutional payer ID):

AR|Arkansas Novitas JH              (SMAR0, 12022)

CO|Colorado Novitas JH             (SMCO0, 12M03)

DE|Delaware Novitas JL              (SMDE0, 12M76)

ID|Idaho Novitas JL                       (SMID0, 12M07)

LA|Louisiana Novitas JH             (SMLA0, 12M12)

MD|Maryland Novitas JL             (SMMD0, 12010) 

MS|Mississippi Novitas JH           (SMMS0, 12M76)

NJ|New Jersey Novitas JH          (SMNJ0, 12005)

NM|New Mexico Novitas JH        (SMNM0, 12M22)

OK|Oklahoma Novitas JH            (SMOK0, 12M37)

PA|Pennsylvania Novitas JL        (SMPA0, 12M60)

TX|Texas Novitas JH                        (SMTX0, 12M53)

Action Required: 

If you are missing any remits from Novitas Medicare for the above period, visit the Novitas Medicare website to download them.

REF 780500 9/19/2024

New Electronic Claims Connections Available

Optum has new electronic claims connections available: 

Payer Name: IMX Easy

Institutional CPID: 7931

Professional CPID: 2755

Payer-assigned Payer ID: 86070

Payer Enrollment Required: No

Secondary Claims Accepted: No

Payer Location: Alaska, Hawaii, Idaho, Oregon, Washington

Claims Fee: N/A

Action Required: 

  • Add the payers to your system to begin using the new payer connection.

  • When a payer requires enrollment, forms must be submitted and approved to begin submitting transactions.

Please note:  We are providing you with a list of new electronic connections, please review and choose payers that are appropriate for your business.

REF 780600 9/19/2024

Update: North American Medical Management (NAMM - N. CA) Payer Processing Issue

This message is intended for Assurance Reimbursement Management, Assurance EDI, RPA, iEDI, and submitters or trading partners to the Exchange or iEDI clearinghouse.

Updated Message: As of Sept. 10, 2024, Optum has confirmed that NAMM – N. CA has received claims and responses have been returned. At this time, NAMM – N. CA is working on processing claims from Optum and remits should be available shortly. Claims from June 13, 2024, to Sept. 9, 2024, will be resubmitted to the payer. An updated message will be sent when we know more information.  

  • CPID(s): 1782, 2931

  • Payer ID: E3510

Previous message sent on August 27, 2024: As of Aug. 26, 2024, the payer is continuing to work to resolve the issue impacting claims submitted to Optum. Once the payer has completed their testing claims will be reprocessed to the payer for the CPIDs and Payer ID listed below. An updated message will be sent when the issue is resolved.

Previous message sent on August 23, 2024: Due to a processing issue, we are experiencing delays in claims processing with the payer. This issue affected claims submitted to Optum from Jun. 13, 2024, to current. We are working with the payer to resolve the issue and impacted claims will be processed to the payer once testing is completed. An updated message will be sent when the issue is resolved. 

We apologize for any inconvenience.

Action Required: None. Please be aware of this delay in claims processing.

REF 779856 9/18/2024

Real-Time Availability 270/271 Eligibility

Eligibility Inquiry and Response 270/271 Effective Sept. 17, 2024, Optum is pleased to announce the availability of Real-Time (270/271) transactions for the below payer: 

IMN Payer ID: MNHTN; Exchange Payer ID: MNHTN
Payer Name: MANHATTAN LIFE

Action Required by customer:
Please update your system to take advantage of this payer transaction. For assistance with submitting Real-Time transactions, please contact your Practice Management System Vendor or Optum Customer Care Hub ticket https://customercare.changehealthcare.com/public/home.html. Also, if you have not already done so, all Vendors and Direct Submitters must reenroll for Real-Time transactions to successfully process.

Updated Payer Lists may be obtained from your software vendor or Payer Lists | Change Healthcare.

REF 779855 9/18/2024

Real-Time Availability 270/271 Eligibility

Eligibility Inquiry and Response 270/271 Effective Sept. 17, 2024, Optum is pleased to announce the availability of Real-Time (270/271) transactions for the below payer: 

IMN Payer ID: THRIV; Exchange Payer ID: THRVNT
Payer Name: THRIVENT FINANCIAL

Action Required by customer:
Please update your system to take advantage of this payer transaction. For assistance with submitting Real-Time transactions, please contact your Practice Management System Vendor or Optum Customer Care Hub ticket https://customercare.changehealthcare.com/public/home.html. Also, if you have not already done so, all Vendors and Direct Submitters must reenroll for Real-Time transactions to successfully process.

Updated Payer Lists may be obtained from your software vendor or Payer Lists | Change Healthcare.

REF 779853 9/18/2024

Report Generation Delay for CPIDs 5635 and 3293 Carelon Health

A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted since Sept. 7, 2024.

Payer impacted:

  • CPID 5635 Carelon Health

  • CPID 3293 Carelon Health

Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 780150 9/18/2024

Rhode Island Medicaid SKRI0- Real Time Transactions

Effective Sept. 16, 2024, Optum is pleased to announce the availability of Real-Time (Eligibility Inquiry and Response 270/271 and Claim status inquiry and response 276/277) transactions for the below payer:

  • SKRI0

Action Required by customer:

Please update your system to take advantage of these payer transactions. For assistance with submitting Real-Time transactions, please contact your Practice Management System Vendor or Optum a Customer Care Hub ticket at the following location: https://customercare.changehealthcare.com/public/home.html.

Updated Payer Lists may be obtained from your software vendor or Payer Lists | Change Healthcare.

REF 779800 9/18/2024

Real-Time Payer availability 270/271 Eligibility

Eligibility Inquiry and Response 270/271 Effective September 17, 2024, Optum is pleased to announce the availability of Real-time (270/271) transactions for the below payer: 

IMN Payer id:  39856; Exchange Payer id: Angle

Payer Name: Angle Health

Action Required by customer: 

Please update your system to take advantage of this payer transaction. For assistance with submitting Real-Time transactions, please contact your Practice Management System Vendor or open a support case on the Optum Customer Care Hub. If you have not already done so, all Vendors and Direct Submitters must reenroll for Real-Time transactions to successfully process.  

Updated Payer Lists may be obtained from your software vendor or Payer Lists.

REF 779851 9/18/2024

New Payer Availability Real-Time Transactions Quartz ASO 39180

Effective September 10th  2024, Optum is pleased to announce the availability of Real-time (Eligibility Inquiry and Response 270/271 and Claim status inquiry and response 276/277 ) transactions for the below payer:

Quartz ASO 39180

Action Required by customer:

Please update your system to take advantage of these payer transactions. For assistance with submitting Real-Time transactions, please contact your Practice Management System Vendor or open a support case on the Optum Customer Care Hub.

Updated Payer Lists may be obtained from your software vendor or Payer Lists.

REF 779802 9/18/2024

Payer Processing Issue for CPIDs 6128 and 4616 Gold Coast Health Plan

Due to a payer processing issue, some Professional and Institutional claims transmitted to the payer listed below on Sept. 10, 2024 and Sept. 11, 2024 were not processed by the payer.

Payer impacted:

  • CPID 6128 Gold Coast Health Plan

  • CPID 4616 Gold Coast Health Plan

A resolution has been implemented and the claims were retransmitted to the payer on Sept. 18, 2024.

This delay affected claims released to Optum between 10 p.m. ET on Sept. 9, 2024, and 10 p.m. ET on Sept. 11, 2024.

Action Required: Be aware of the processing issue above.

REF 780350 9/18/2024

New Electronic Remittance Connection Available - San Francisco Health Plan – Re-enrollment required

Effective immediately, Optum has new electronic Remittance connection available:

Payer Name: San Francisco Health Plan

Professional CPID: 6736

Institutional CPID: 6633

Payer-assigned Payer ID: SFHP1

LOB Code: U8A

Remit Key: SFHP_COM

Payer enrollment for electronic remittance is required. 

Action Required:

All providers must complete a new enrollment form to receive electronic remittance for San Francisco Health Plan.

  • Make any necessary system changes. 

  • When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.  

REF 780101 9/18/2024

Real-time payer availability 270/271 Eligibility

Effective September 17, 2024, Optum is pleased to announce the availability of real-time (270/271) transactions for the below payer:

IMN Payer id:  45564; Exchange Payer id: CENTV

Payer Name: CENTIVO

Action Required by customer:

Please update your system to take advantage of this payer transaction. For assistance with submitting real-time transactions, please contact your Practice Management System Vendor or Optum Customer Care Hub.  Also, if you have not already done so, all Vendors and Direct Submitters must reenroll for real-time transactions to successfully process. 

Updated Payer Lists may be obtained from your software vendor or Payer Lists | Change Healthcare

REF 779852 9/18/2024

Real-time availability 270/271 Eligibility

Optum is pleased to announce the availability of real-time (270/271) transactions for the below payer:

IMN Payer id: 88056; Exchange Payer id: CYPRSS

Payer Name: LUCENT HEALTH  

Action Required by customer:

Please update your system to take advantage of this payer transaction. For assistance with submitting real-time transactions, please contact your Practice Management System Vendor or Optum Customer Care Hub.

Also, if you have not already done so, all Vendors and Direct Submitters must reenroll for real-time transactions to successfully process. 

Updated Payer Lists may be obtained from your software vendor or Payer Lists | Change Healthcare

REF 779854 9/18/2024

Update: Report Generation Delay for CPID 5428 QualChoice of Arkansas

The payer intermediary has been unable to generate and deliver the reports for some claims submitted from Aug. 16, 2024, through Aug. 29, 2024.

Action Required: Please resubmit claims if payment has not been received.

Original notification sent Aug. 27, 2024:

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted since Aug. 16, 2024.

Payer impacted:

  • CPID 5428 QualChoice of Arkansas

Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 780000 9/18/2024

Delay in Electronic Remittance Advice (ERA) for CIGNA CPIDs 4509, 6405

Due to a payer processing issue, there has been a delay in Professional and Institutional Electronic Remittance Advice (ERA) for the following payers for check dates of September 10th, 2024, through present:

  • CPID 4509 CIGNA

  • CPID 6405 CIGNA

Additional updates will be forwarded as more information becomes available.

Action Required: Please be aware of a delay in the delivery of ERA for check dates above.

If you have any questions, feel free to contact your Customer Support Team.

REF 779850 9/18/2024

New Electronic Remittance Connection Available: Highmark BCBS DE Health Options – Re-enrollment Required

Effective July 2, 2024, Optum has new electronic Remittance connection available:

Payer Name: Highmark BCBS DE Health Options
Professional CPID: 7148
Institutional CPID: 7693
Payer-assigned Payer ID: 47181
LOB Code: J1V
Remit Key: HLOP_COM

Payer enrollment for electronic remittance is required. 

Action Required: All providers must complete a new enrollment form to receive electronic remittance for Highmark BCBS DE Health Options.

  • Make any necessary system changes. 

  • When a payer requires enrollment, forms must be submitted and approved from Enrollment Central. 

REF 778752 9/17/2024

Report Generation Delay for CPID 7138 Sierra Medical Group

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted on Sept. 4, 2024.

Payer impacted:

  • CPID 7138 Sierra Medical Group

Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 779457 9/17/2024

Claims Processing Termination for Institutional CPID 5005, Special Agents Mutual Benefit Association (SAMBA)

Effective immediately, the payer listed below will no longer be available at Optum for Institutional CLAIMS processing.

Payer Name: Special Agents Mutual Benefit Association (SAMBA)
CPID(s): 5005
Payer ID: 50322
Reason: Payer ID 50322 is only valid for Teledoc claims. Please use Professional CPID 1116 to submit teledoc claims for this payer.

All regular claims for Special Agents Mutual Benefit Association (SAMBA) should be submitted to Cigna Payer ID 62308 - CPIDs 6405 & 4509.

Action Required: None.

REF 778753  9/17/24

Novitas Medicare Electronic Remittance Advice (ERA)

There were issues that impacted clearinghouse delivery of remits from Novitas Medicare (various payer IDs – see below) issued during the period starting Feb. 19, 2024, through April 19, 2024. Novitas Medicare completed reprocessing remits for this period as of September 16, 2024. If you are missing any remits from Novitas Medicare for the above period, visit the Novitas Medicare website to download them.

Noridian payer IDs:

  • AR|Arkansas Novitas JH 2455 1526

  • CO|Colorado Novitas JH 1449 1547

  • DE|Delaware Novitas JL 2456 5912

  • ID|Idaho Novitas JL 2465 5581

  • LA|Louisiana Novitas JH 1460 3579

  • MD|Maryland Novitas JL 7402 5554

  • MS|Mississippi Novitas JH 2451 5556

  • NJ|New Jersey Novitas JH 1465 5503

  • NM|New Mexico Novitas JH 1457 5566

  • OK|Oklahoma Novitas JH 1458 1558

  • PA|Pennsylvania Novitas JL 2457 5598

  • TX|Texas Novitas JH 1440 5525

REF 779210 9/17/2024

Report Generation Delay for CPID 3845 Banner Health Network

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted on Sept. 4, 2024.

Payer impacted: 

  • CPID 3845 Banner Health Network

The payer intermediary is unable to generate and deliver the reports.

Action Required: Please resubmit claims if payment has not been received from the payer.

REF 779454 9/17/2024

Report Generation Delay for CPIDs 4252 and 1691 Presbyterian Salud

A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted on Sept. 4, 2024 and Sept. 5, 2024.

Payer impacted:

  • CPID 4252 Presbyterian Salud

  • CPID 1691 Presbyterian Salud

Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 779602 9/17/2024

Report Generation Delay for Multiple CPIDs

A payer intermediary is experiencing issues affecting professional and institutional report generation for some claims submitted since Sept. 4, 2024.

Payers impacted:

  • CPID 4159 GMP Employers Retiree Trust

  • CPID 2159 GMP Employer's Trust thru DST

  • CPID 4902 GMP Employer's Trust thru DST

Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 779601 9/17/2024

Report Generation Delay for CPID 6246 Riverside Medical Clinic

A payer intermediary is experiencing issues affecting professional report generation for some claims submitted Sept. 4, 2024 and Sept. 10, 2024. 

Payer impacted: 

  • CPID 6246 Riverside Medical Clinic 

Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received. 

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 779451 9/17/2024

Report Generation Delay for CPID 4464 SCAN Health Plan

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted on Sept. 4, 2024, and Sept. 10 2024.

Payer impacted:

  • CPID 4464 SCAN Health Plan

Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 779458 9/17/2024

Report Generation Delay for CPID 2499 Mountain Health

A payer is experiencing issues affecting Professional report generation for some claims submitted since on Sept. 5, 2024.

Payer impacted:

  • CPID 2499 Mountain Health

Optum is working diligently with the payer to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 779600 9/17/2024

Report Generation Delay for CPID 6220 Arizona Priority Care Plus

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted Sept. 4, 2024 and Sept. 5, 2024.

Payer impacted:

  • CPID 6220 Arizona Priority Care Plus

Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 779445  9/17/24

Electronic Routing Change for CPIDs 8668 Carelon Anthem Home Health

Effective immediately, Optum will be changing electronic claims and remittance routing for the following payer:

Assurance Exchange:

Payer Name: Carelon Anthem Home Health

Institutional CPID: 8668

Payer-assigned Payer ID: 34009

Assurance Reimbursement Management:

Payer Name: Carelon Anthem Home Health

Institutional CPID: 8668

Payer-assigned Payer ID: 34009

Previous Claims Edit Master: HE9B801

Current Claims Edit Master: HE9T007

Claims Enrollment Requirements: 

Payer enrollment for electronic claims is not required.

Remittance Enrollment Requirements:  

  • Payer enrollment for electronic remittance is required:  

  • Providers currently receiving electronic remittance for this payer do not need to complete a new enrollment form.  

  • Providers who moved their enrollment to another clearinghouse or have not received remittance will need to re-enroll to receive remittance for this payer from Optum (Change Healthcare).  

  • New providers must complete a new enrollment form.  

Report Changes: You may see some differences in the payer reports you are receiving.

Action Required: Please consider the following to allow transactions to process properly due to the above changes: 

  • Make any necessary system changes.

  • When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.

REF 779250 9/17/2024

Report Generation Delay for CPID 5813 SCAN Health Plan Arizona

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted on Sept. 4, 2024 and Sept. 10, 2024.

Payer impacted:

  • CPID 5813 SCAN Health Plan Arizona

Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 779450 9/17/2024

New Electronic Claims and Remittance Connections Available

Effective immediately, Optum has a new electronic claim and remittance connection available:  

Assurance EDI:  

Payer Name: Carelon Anthem Home Health  

Professional CPID: 7250 

Payer-assigned Payer ID: 34009 

Payer Claims Enrollment Required: No 

Secondary Claims Accepted: No 

Payer Location: National 

Claims Fee: N/A 

Payer Remittance Enrollment Required: Yes 

Assurance Reimbursement Management:

Payer Name: Carelon Anthem Home Health 

Professional CPID: 7250 

Payer-assigned Payer ID: 34009 

Payer Claims Enrollment Required: No  

Secondary Claims Accepted: No 

Payer Location: National 

Claims Fee: N/A 

Claims Edit Master: PE_T007 

Remittance LOB Code: U61 

Remittance Remit Key: MNEX_COM 

Payer Remittance Enrollment Required: Yes 

Action Required: All providers must complete a new enrollment form to receive electronic remittance for Carelon Anthem Home Health.   

Add the payers to your system to begin using the new payer connection. 

When a payer requires enrollment, forms must be submitted and approved to begin submitting transactions. 

Please note:  We are providing you with a list of new electronic connections, please review and choose payers that are appropriate for your business.

REF 779251 9/17/2024

Report Generation Delay for CPID 9441 Wellspace NEXUS LLC

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted Sept. 4, 2024 and Sept. 10, 2024.

Payer impacted:

  • CPID 9441 Wellspace NEXUS LLC

Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 779350  9/17/24

New Electronic Remittance Connection Available – Hennepin Health – Re-enrollment required

Effective July 30, 2024, Optum has new electronic Remittance connection available:

Payer Name: Hennepin Health

Professional CPID: 2787

Institutional CPID: 1566

Payer-assigned Payer ID: 60058

LOB Code: U48

Remit Key: MHP_COM

Payer enrollment for electronic remittance is required. 

Action Required:

All providers must complete a new enrollment form to receive electronic remittance for Hennepin Health

  •  Make any necessary system changes. 

  • When a payer requires enrollment, forms must be submitted and approved from Enrollment Central. 

REF 779200 9/17/2024

Payer Deactivation: Universal Care - California

This message is intended for Revenue Performance Advisor customers.

Effective immediately, Institutional and Professional Claims for the following payer have been deactivated on the Revenue Performance Advisor system:

Payer Name: Universal Care - California

Payer ID: 33001

Updated payer lists may be obtained from your software vendor or Optum.

Optum removed this payer from the Revenue Performance Advisor payer list, and any transactions sent using the above Payer ID will be rejected.

Submitter Action:

Please review the patient's current insurance ID card for current claim billing information.

REF 778603 9/16/2024

Report Generation Delay for CPID 4790 Division of Immigration Health Services

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted on Sept. 10, 2024.

Payer impacted:

  • CPID 4790 Division of Immigration Health Services

Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 778650 9/16/2024

Electronic Remittance Enrollment MDwise Healthy Indiana Plan and MDwise Hoosier Healthwise

Optum recently restored electronic remittance connectivity for the following payers:

Payer Name: MDwise Healthy Indiana Plan

Professional CPID: 8113

Institutional CPID: 1086

Industry Payer ID: 3135M

Payer Name: MDwise Healthy Hoosier Healthwise

Professional CPID: 8112

Institutional CPID: 1085

Industry Payer ID: 3519M

Remittance Enrollment Requirements:

  • Payer enrollment for electronic remittance is required:

  • Providers currently receiving electronic remittance for these payers do not need to complete a new enrollment form.

  • Providers who moved their enrollment to another clearinghouse or have not received remittance will need to re-enroll to receive remittance for this payer from Optum (Change Healthcare).

  • New providers must complete a new enrollment form.

Action Required: Please consider the following to allow transactions to process properly due to the above changes:

  • Make any necessary system changes.

  • When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.

REF 778652 9/16/2024

Report Generation Delay for CPIDs 2569 and 1193 PHP TPA Services

The payer listed below is experiencing issues affecting Institutional and Professional report generation for some claims submitted from Aug. 28, 2024 through Sept. 4, 2024.

Payer impacted: 

  • CPID 2569 PHP TPA Services

  • CPID 1193 PHP TPA Services

The payer has been unable to generate and deliver the reports.

Action Required: Please resubmit claims if payment has not been received from the payer.

REF 778651 9/16/2024

New Electronic Remittance Connection Available – Re-enrollment required

Effective immediately, Optum has new electronic Remittance connection available:

Payer Name: Network Health Insurance Corp Medicare

Professional CPID: 2102

Institutional CPID: 1615

Payer-assigned Payer ID: 77076

LOB Code: U29

Remit Key: NTPL_COM

Payer enrollment for electronic remittance is required. 

Action Required:

All providers must complete a new enrollment form to receive electronic remittance for Network Health Insurance Corp Medicare 

  • Make any necessary system changes. 

  • When a payer requires enrollment, forms must be submitted and approved from Enrollment Central. 

REF 778500 9/16/2024

Update: Delay in Electronic Remittance Advice (ERA)

This issue is ongoing, affecting Electronic Remittance Advice (ERA) Aug. 21, 2024, through present:

Original message sent on Aug. 29, 2024:

Due to a processing issue, there has been a delay in Professional and Institutional Electronic Remittance Advice (ERA) for the following payers beginning on Aug. 21, 2024, through present:

  • CPID 2855 HEALTHNET

  • CPID 6514 HEALTHNET

Additional updates will be forwarded as more information becomes available.  

Action Required: Please be aware of a delay in the delivery of ERA for the dates above.

If you have any questions, feel free to contact your Customer Support Team and refer to case 09070825.

REF 776414 9/13/2024

Report Generation Delay for CPID 1486 Utah Medicaid

A payer intermediary experienced issues affecting Professional report generation for some claims submitted July 26, 2024.

Payer impacted: 

• CPID 1486 Utah Medicaid

The payer intermediary is unable to generate and deliver the reports.

Action Required: None. Please resubmit claims if payment has not been received.

REF 777650  9/13/24

Electronic Routing Change for CPIDs 2016, 8150 BayCare Plus Medicare Advantage and 2013, 8146 Care N Care Insurance Co.

Effective immediately, Optum will be changing electronic remittance routing for the following payers:

Payer Name: BayCare Plus Medicare Advantage

Professional CPID: 8150

Institutional CPID: 2016

Payer-assigned Payer ID: 81079

 

Payer Name: Care N Care Insurance Co.

Professional CPID: 8146

Institutional CPID: 2013

Payer-assigned Payer ID: 66010

 

Enrollment Requirements: 

Remittance:

  • Payer enrollment for electronic remittance is required:

  • Providers currently receiving electronic remittance must complete a new enrollment form.

  • New providers must complete a new enrollment form.

Action Required: Please consider the following to allow transactions to process properly due to the above changes:

  • Make any necessary system changes.

  • When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.

REF 776400

Resolved: Payer connectivity Blue and Medicaid Eligibility payers

This issue has been resolved.

Original message sent Sep. 9, 2024.

Optum is currently experiencing a connectivity issue for several of our Blue and Medicaid Eligibility payers.

Optum is currently working to resolve this issue.

REF 776450 9/9/2024

Report Generation Delay for CPID's 4472 and 5949 Viva Health Care and Viva Medicare

A payer is experiencing issues affecting Professional and Institutional report generation for some claims submitted on Aug. 19, 2024.

Payer impacted:

  • CPID 4472 Viva Health Care and Viva Medicare

  • CPID 5949 Viva Health Care and Viva Medicare

The payer is unable to generate and deliver the reports.

Action Required: None. Please resubmit claims if payment has not been received.

REF 776450 9/12/2024

Claim Processing Termination for CPIDs 6039, 9193, KISx Card LLC

Effective immediately, the payer listed below will no longer be available at Optum for Claims and Remittance processing.

Payer Name: KISx Card LLC

CPID(s): 6039, 9193

Payer ID: 83313

Reason: Payer terminated their agreement.

Action Required: None

REF 776650 9/12/2024

Electronic Routing Change for Multiple AmeriHealth Payers

Effective Sept. 12, 2024, Optum will be changing electronic claims routing for the following payer:

AmeriHealth Caritas Pennsylvania 1710 4547 22248
Keystone First 8475 6531 23284
First Choice by Select Health of South Carolina 2890 7544 23285
AmeriHealth Caritas Louisiana 6156 4638 27357
Blue Cross Complete of Michigan 7409 5096 32002
First Choice VIP Care 9248 6087 32456
AmeriHealth Caritas Next a Product of AmeriHealth Caritas Florida, Inc. 9427 7044 45408
AmeriHealth Caritas Next a Product of AmeriHealth Caritas VIP Next, Inc. 9426 7043 47073
First Choice Next aProduct of Select Health of South Carolina, Inc. 9425 7042 57103
Perform Care 6183 4657 65391
AmeriHealth Caritas District of Columbia 6441 5670 77002
AmeriHealth Caritas Florida 2106 8963 77003
First Choice VIP Care Plus by Select Health of South Carolina 7193 8631 77009
AmeriHealth Caritas VIP Care Plus (Michigan) 7212 8656 77013
AmeriHealth Caritas VIP Care PA CommHealth Choices 1268 6501 77062
Keystone First VIP Choice 6751 6649 77741
AmeriHealth Caritas Delaware 7746 7507 77799
AmeriHealth Caritas Next a Product of AmeriHealth Caritas North Carolina, Inc. 9192 6038 83148
AmeriHealth Caritas VIP Care – Delaware DSNP 9484 7081 87406
AmeriHealth Caritas New Hampshire 8238 2090 87716
AmeriHealth Caritas VIP Care – Florida DSNP 9485 7082 88232
Keystone First Community HealthChoices 8121 1093 42344

Enrollment Requirements:

Claims:

  • Payer enrollment for electronic claims is not required.

Report Changes: You may see some differences in the payer reports you are receiving.

Action Required: Please consider the following to allow transactions to process properly due to the above changes:

  • Make any necessary system changes.

  • When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.

REF 776300 9/12/2024

Update: Payer Transmit Delay for CPIDs 2735 and 7916 Volunteers of America National Services

A resolution has been implemented and claims were transmitted to the payer on Sept. 12, 2024. This delay affected claims released to Optum between 2 a.m. ET on Sept. 5, 2024, and 2 a.m. ET on Sept. 11, 2024.

Action Required: Be aware of the transmit delay.

Original message sent on Sep. 11, 2024:

Due to a system issue, a delay occurred in the transmissions to the following payer since Sept. 6, 2024.

Payer impacted:

  • CPID 2735 Volunteers of America National Services

  • CPID 7916 Volunteers of America National Services

Optum is working with the payer to resolve this issue. We will notify you as soon as additional information becomes available.

This delay affected claims released to Optum since 2 a.m. ET on Sept. 5, 2024.

Action Required: Be aware of the transmit delay above.

REF 776200 9/12/2024

Report Generation Delay for CPID 1291 Umpqua Health Alliance

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted on Sept. 2, 2024.

Payer impacted:

  • CPID 1291 Umpqua Health Alliance

Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 775301 9/11/2024

Payer Transmit Delay for CPIDs 2735 and 7916 Volunteers of America National Services

Due to a system issue, a delay occurred in the transmissions to the following payer since Sept. 6, 2024.

Payer impacted:

  • CPID 2735 Volunteers of America National Services

  • CPID 7916 Volunteers of America National Services

Optum is working with the payer to resolve this issue. We will notify you as soon as additional information becomes available.

This delay affected claims released to Optum since 2 a.m. ET on Sept. 5, 2024.

Action Required: Be aware of the transmit delay above.

REF 775203 9/11/2024

Remittance Reactivation and New Electronic Remittance Connection Available

Effective immediately, 835 connectivity is restored for the following payer:         

Payer Name: Partners Health Management (formerly Partners Behavioral Health)

Professional CPID: 6701

Payer-assigned Payer ID: 52613

Optum also has a new electronic remittance connection available:

Payer Name: Partners Health Management (formerly Partners Behavioral Health)

Institutional CPID: 5682

Payer-assigned Payer ID: 52613

Enrollment Requirement:

  • Providers who were previously enrolled with Optum (Change Healthcare) and did not switch their enrollment away from Optum (Change Healthcare) for CPID 6701 will begin receiving ERAs.

  • Providers who moved their enrollment to another clearinghouse for CPID 6701 will need to re-enroll with Optum (Change Healthcare) to receive ERAs for this payer from Optum (Change Healthcare).

  • New providers must complete a new enrollment form for CPIDs 6701 and 5682.

Action Required:

  • Make any necessary system changes

  • When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.

REF 775500 9/11/2024

Update: Report Generation Delay for CPID 1461 Michigan Medicare

Update: It has been determined that the report delay below was due to a payer claims processing issue. We have retransmitted the impacted claims to WPS on Sept. 11, 2024.  Reports will be delivered once the claims have successfully processed at the payer.

Action Required: Please be aware of delays.

Original Notice Sent Sept. 11, 2024:
WPS is experiencing issues affecting Professional report generation for some claims submitted on Sept. 6, 2024.

Payer impacted:

  • CPID 1461 Michigan Medicare

Optum is working diligently with WPS to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 775200 775201 9/11/2024

Payer Processing Issue for CPID 2296 MetroPlusHealth

Due to a payer processing issue, some Professional claims transmitted to the payer listed below Aug. 30, 2024 were not processed by the payer.

Payer impacted:

  • 2296 MetroPlusHealth

A resolution has been implemented and the claims were retransmitted to the payer Sept. 11, 2024.

This delay affected claims released to Optum Aug. 29, 2024, 12:00 a.m.-Aug. 30, 2024, 12:00 a.m. CT.

Action Required: Be aware of the processing issue above.

REF 775256  9/11/2024

Payer Processing Issue for CPID 1500 New York Medicaid

Due to a payer processing issue, some Institutional claims transmitted to the payer listed below on Sept. 9, 2024, were not processed by the payer.

Payer impacted:

  • 1500 New York Medicaid

A resolution has been implemented and the claims were retransmitted to the payer on Sept. 11, 2024.

This delay affected claims released to Change Healthcare between 3 p.m. ET and 10 p.m. ET on Sept. 9, 2024.

Action Required: Be aware of the processing issue above.

REF 775202 09/11/2024

Report Generation Delay for CPID 4876 International Medical Group

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted on Aug. 31, 2024.

Payer impacted:

  • CPID 4876 International Medical Group

The payer intermediary is unable to generate and deliver the reports.

Action Required: Please resubmit claims if payment has not been received from the payer.

REF 775300 9/11/2024

Report Generation Delay for CPID 6865 Community Care Plan (Medicaid)

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted on Aug. 29, 2024.

Payer impacted: 

  • CPID 6865 Community Care Plan (Medicaid)

Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 773652 9/10/2024

Report Generation Delay for CPID 1116 Special Agents Mutual Benefit Association (SAMBA)

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted on Aug. 30, 2024.

Payer impacted:

  • CPID 1116 Special Agents Mutual Benefit Association (SAMBA)

The payer intermediary is unable to generate and deliver the reports.

Action Required: Please resubmit claims if payment has not been received from the payer.

REF 773950 9/10/2024

Update: Report Generation Delay for CPID 1468 Minnesota Medicaid

Update: It has been determined that the report delay below was due to a payer claims processing issue. We have retransmitted the impacted claims to the payer Sept. 10, 2024.  Reports will be delivered once the claims have successfully processed at the payer.

Action Required: Please be aware of delays.

Original Notice Sent Sept. 9, 2024:

The below payer is experiencing issues affecting Professional report generation for some claims submitted Sept. 4, 2024.

Payer impacted:

  • CPID 1468 Minnesota Medicaid

Optum is working diligently with the payer to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 773900/772700  9/10/24

Report Generation Delay for CPIDs 8551 and 1844 Wellcare Health Plans

A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted on Aug. 29, 2024.

Payer impacted:

  • CPID 8551 Wellcare Health Plans

  • CPID 1844 Wellcare Health Plans

Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 773651 9/10/2024

Report Generation Delay for CPID 4743 Carelon Behavioral Health

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted on Aug. 27, 2024.

Payer impacted:

  • CPID 4743 Carelon Behavioral Health

Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 773650 9/10/2024

CLAIM/REMITTANCE Processing Termination for CPIDs 2578, 3771, JP Farley

Effective immediately, the payer listed below will no longer be available at Optum for (CLAIMS, REMITTANCE) processing.

Payer Name: JP Farley
CPID(s): 2578, 3771
Payer ID: 34136
LOB code: H3T
Remit Key: JPF_COM
Reason: Payer no longer has EDI connection

Action Required: None.

REF 773150 9/10/2024

Report Generation Delay for CPID 1806 FiServ Health (Kansas & Tennessee)

The below payer is experiencing issues affecting professional report generation for some claims submitted since Aug. 27, 2024.

Payer impacted:

  • CPID 1806 FiServ Health (Kansas & Tennessee)

Optum is working diligently with the payer to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 773300 9/9/2024

Real Time Fee Changes for Multiple Payers

Effective October 1, 2024, the following Real Time payer fees will change:

American Republic Insurance (MAP) Eligibility AMRREP $0.02 $0
Arizona Medicaid Eligibility AZCAID $0.055 $0
Boon Chapman Administrators Eligibility BNCHAP $0.01 $0
California Medi-Cal Eligibility CACAID $0.01 $0
Connecticut Medicaid Eligibility CTCAID $0 $0.045
Delaware Medicaid Eligibility DECAID $0.045 $0.05
Denver Health Medical Plan Eligibility DNVHMP $0.05 $0
District of Columbia Medicaid Eligibility DCCAID $0.0325 $0.03
Evry Health Eligibility EVRYHP $0.02 $0
Georgia Medicaid Eligibility GACAID $0 $0.05
Hawaii Medicaid Eligibility HICAID $0.0325 $0
Health Plan of San Joaquin Eligibility SJHP $0.01 $0
Health Plan of San Mateo Eligibility HPOSM $0.05 $0
Inland Empire Health Plan - DOS after 3/31/18 Eligibility IEHP $0.01 $0
Kansas Medicaid Eligibility KSCAID $0.04 $0
Mississippi Blue Cross Blue Shield Claim Status MSBCBS $0.03 $0
Mississippi Blue Cross Blue Shield State Employees Eligibility MSSEHP $0.03 $0
Montana Medicaid Eligibility MTCAID $0 $0.03
New Hampshire Medicaid Eligibility NHCAID $0 $0.05
New Mexico Medicaid Eligibility NMCAID $0 $0.03
New York Blue Cross Blue Shield Western Eligibility NYBCBS $0 $0.05
Oklahoma Medicaid Eligibility OKCAID $0 $0.02
SCAN Health Plan Eligibility SCNHMO $0.18 $0
SIHO Insurance Services Eligibility SIHO $0.02 $0
Sutter and Aetna Insurance Company Eligibility SUTAET $0.02 $0
Tennessee BlueCare/TennCare Eligibility TNCAID $0 $0.04
Texas Medicaid Eligibility TXCAID $0 $0.075
Wyoming Medicaid Eligibility WYCAID $0 $0.03

Payer Transmit Delay for Multiple CPIDs

Due to a payer system issue, a delay occurred in the transmissions to the following payers since Aug. 27, 2024.

Payers impacted:

  • CPID 5529 Massachusetts Medicaid

  • CPID 2905 Massachusetts Medicaid Long Term Care

  • CPID 4492 Massachusetts Medicaid Format 5

  • CPID 4491 Massachusetts Medicaid Format 9

Optum is working with the payers to resolve this issue. We will notify you as soon as additional information becomes available.

This delay affected claims released to Optum since 12 p.m. CT on Aug. 26, 2024. 

Action Required: Be aware of the transmit delay above.

REF 772250 9/9/2024

Report Generation Delay for CPID 1468 Minnesota Medicaid

The below payer is experiencing issues affecting Professional report generation for some claims submitted on Sept. 4, 2024.

Payer impacted:

  • CPID 1468 Minnesota Medicaid

Optum is working diligently with the payer to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 772700 9/9/2024

Report Generation Delay for CPID 3693 Florida Health Care Plans

A payer intermediary is experiencing issues affecting Institutional report generation for some claims submitted since July 26, 2024.

Payer impacted:

  • CPID 3693 Florida Health Care Plans

Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 772150 9/9/2024

Update: Report Generation Delay for CPIDs 6700 and 5681 Centurion Managed Care

The payer intermediary has been unable to generate and deliver the reports for some claims submitted on Aug. 17, 2024.

Action Required: Please resubmit claims if payment has not been received.

Update sent Sept. 4, 2024:

A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted since Aug. 4, 2024.

Payer impacted:

  • CPID 6700 Centurion Managed Care

  • CPID 5681 Centurion Managed Care

Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

Original message sent July 19, 2024:

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted since Aug. 17, 2024.

Payer impacted:

  • CPID 6700 Centurion Managed Care

Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 772350 9/9/2024

Report Generation Delay for CPID 2464 Maryland Medicare (Montgomery,Prince George)

The below payer is experiencing issues affecting Professional report generation for some claims submitted since Aug. 30, 2024.

Payer impacted:

  • CPID 2464 Maryland Medicare (Montgomery,Prince George)

Optum is working diligently with the payer to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 771750 9/6/2024

Resolved: Payer Processing Issue for Health Plan of San Joaquin CPID 4682, 3469

Resolved: Per the Payer Intermediary, this issue was resolved on August 19, 2024, and all affected claims from May 15, 2024, through August 19, 2024, were reprocessed to the payer on August 22, 2024.

Action Required: Please be aware of the delay in processing.

Original Notification sent on August 20, 2024:

Due to a payer processing issue, some of the Professional and Institutional files submitted to the payers listed below may have received a rejection of claim not on file for claims submitted April 15, 2024, to present.

Payers impacted:

  • CPID 4682 Health Plan of San Joaquin

  • CPID 3469 Health Plan of San Joaquin

Additional updates will be forwarded as more information becomes available.

Action Required: Please be aware of the processing issue. We apologize for any inconvenience as we work to resolve.

REF 763400 770958 9/06/2024

Payer Processing Issue for Mulitple CPIDs

Due to a payer processing issue, Institutional and Professional claims transmitted to the payers listed below since July  26, 2024, have not been processed by the payers.

Payers impacted:

  • CPID 1411 North Carolina Blue Cross Blue Shield

  • CPID 3562 North Carolina Blue Cross Blue Shield

  • CPID 7514 Blue Medicare PPO/HMO of North Carolina

  • CPID 7814 Blue Medicare PPO/HMO of North Carolina

  • CPID 7472 Blue Medicare PPO/HMO of North Carolina

The payers were unable to successfully process the file transmitted on July 26, 2024. Optum retransmitted the file on Sept. 6, 2024.  

Action Required: Be aware of the processing issue above.

REF 771202 9/06/2024

Report Generation Delay for CPID 6987 Veterans Affairs Financial Services Center

A payer intermediary is experiencing issues affecting Institutional report generation for some claims submitted on Aug. 30, 2024.

Payer impacted:

  • CPID 6987 Veterans Affairs Financial Services Center

The payer intermediary is unable to generate and deliver the reports.

Action Required: Please resubmit claims if payment has not been received from the payer.

REF 770252 9/06/2024

Report Generation Delay for Mississippi Medicare

This message is intended for Revenue Performance Advisor customers.

Mississippi Medicare (SMMS0) is experiencing issues affecting Professional report generation for some claims submitted since Aug. 22, 2024.

Optum is working diligently with the payer to resolve the issue and ensure reports are received. 

Action Required: Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 771701 9/06/2024

Claims Delay for Virginia Medicaid

This message is intended for Revenue Performance Advisor customers.

Due to a payer system issue, a delay occurred in the transmission to payer Virginia Medicaid (SKVA0, 12003).

This delay affected claims released to Optum Aug. 22, 2024, 2:00-Sept. 3, 2024, 2:00 p.m. CT.

A resolution has been implemented and claims were transmitted to the payer Sept. 4, 2024.

Action Required:
Be aware of the transmit delay.

REF 771700  9/6/24

Report Generation Delay for CPID 1411 and 3562 North Carolina Blue Cross Blue Shield

The payer experienced issues affecting Professional and Institutional report generation for some claims submitted on July 19, 2024, and Aug. 26, 2024. 

Payer impacted: 

  • CPID 1411 North Carolina Blue Cross Blue Shield 

  • CPID 3562 North Carolina Blue Cross Blue Shield 

The payer is unable to generate and deliver the reports. 

Action Required: None. Please resubmit claims if payment has not been received.

REF 771201 9/06/2024

Resolved: Assurance Reimbursement Management Performance Issue

Resolved: This issue has been resolved and performance has been restored. 

Original message posted Sept. 6, 2024:

Assurance Reimbursement Management is experiencing an issue with performance.

This may result in:

  • Inability to log into Assurance Reimbursement Management.

  • Experiencing Errors when logging into Assurance Reimbursement Management.

Optum is working to resolve this issue. We will notify you as soon as additional information becomes available. We apologize for any inconvenience.

Action Required: None.

REF 770750 / 770751 9/06/2024

Remittance Processing Termination for CPIDs 1003, 7828 Virginia Premier Health Plans

Effective immediately, the payer listed below will no longer be available at Optum for REMITTANCE processing.

Payer Name: Virginia Premier Health Plans

CPIDs: 1003, 7828

Payer ID: VAPRM

LOB code: H96

Remit Key: VPMD_COM

Reason: Payer no longer in business.

Action Required: None.

REF 770402 9/6/2024

Health Plan of San Mateo Connectivity Update (Payer IDs: HPSM1, 12X74, SX174 / CPIDs: 5678, 4292)

This message is intended for Assurance Reimbursement Management, Exchange, RPA, and iEDI customers.

Effective September 5, 2024, Optum is pleased to announce connectivity has been restored with Health Plan of San Mateo for claim and remit transactions:

  • Payer name: Health Plan of San Mateo

  • Payer ID: HPSM1, 12X74, SX174

  • CPIDs: 5678, 4292

  • Transaction types: 837I, 837P, 837D (iEDI only), and 835

Payer Enrollment for remits is required

  • Providers who moved their enrollment to another clearinghouse or have not received remittance since connectivity was restored will need to re-enroll with Optum to receive ERAs for this payer

  • New providers must complete a new enrollment form

Action Required by customer:

  • Assurance Reimbursement Management, Exchange, and RPA submitters can access and submit forms through Enrollment Central

  • Optum iEDI submitters can find the latest copies of the EMC and ERA Enrollment Forms, optumprovider.optum.com

If you have any questions, please submit a support request:

  • Intelligent EDI customers: please contact the support team at 1-866-OptumGo

REF 769550 9/6/2024

Duplicate Electronic Remittance Advice (ERA) Transmission for multiple CPIDs

Due to historical payer processing of Electronic Remittance Advice (ERA) files, duplicate remittance advice dated from Feb. 21, 2024, to present.  may have been received.

Please be aware of the possibility of duplicate remittance advice for check dates Feb. 21, 2024, to present.

Action Required: Please be aware of this processing error and possible duplicate ERA received for the check dates above.

If you have any questions, please contact Customer Support. We apologize for any inconvenience.

REF 770100 9/6/2024

Resolved: Medicare Eligibility Connection Unavailable

Update: This issue has been resolved and eligibility transactions are processing as expected.

Original message posted on Sept. 5, 2024:

At this time, the Eligibility connection for Medicare is unavailable.

Teams are working to resolve this issue.

Updates will be provided as progress is made toward a resolution.

REF 769500 / 769751 9/05/2024

Claim Fee Change for Multiple Payers

Effective October 1, 2024, the claim fees will change for the following payers:

Current Fee: $0.00
New Fee: $0.10

CPID      Payer Name

1843  ACS Benefit Services

3908  ACS Benefit Services

7099  American Health Advantage of Florida

9712  American Health Advantage of Florida

7047  American Health Advantage of Idaho & Utah

9429  American Health Advantage of Idaho & Utah

5093  American Health Advantage of Mississippi

9142  American Health Advantage of Mississippi

7280  American Health Advantage of Missouri

8987  American Health Advantage of Missouri

1027  American Health Advantage of Oklahoma

7854  American Health Advantage of Oklahoma

6436  American Postal Workers Union

2983  AmeriHealth Administrators

6220  Arizona Priority Care Plus

3230  Automated Benefit Services

8947  Automated Benefit Services

7272  Axminster Medical Group

8686  Axminster Medical Group

5666  Clover Health

6433  Clover Health

1180  Colonial Penn Life Insurance Company

7061  DCHP - Texas Medicaid

9444  DCHP - Texas Medicaid

8013  Dignity Health Plan DOS after 12/31/2022

9731  Dignity Health Plan DOS after 12/31/2022

4026  Dignity Health Plan DOS before 1/1/2023

8755  Dignity Health Plan DOS before 1/1/2023

1834  Employee Plans

8548  Employee Plans

6851  Friday Health Plans

7634  Friday Health Plans

5032  Georgia Health Advantage

8879  Georgia Health Advantage

1107  Integrated Health Partners (IHP)

9519  Integrated Health Partners (IHP)

8000  Iowa Health Advantage

9713  Iowa Health Advantage

7720  Kalos Health

9665  Kalos Health

1168  Kempton Group Administrators (USC)

2514  Kempton Group Administrators (USC)

1245  National General

4574  National General

1859  Neighborhood Healthcare PACE

3692  Neighborhood Healthcare PACE

6293  Northwest Administrators

7279  PACE Southeast Michigan

8980  PACE Southeast Michigan

1652  Preferred Benefit Administrators (Longwood, Florida)

3198  Preferred Benefit Administrators (Longwood, Florida)

4464  SCAN Health Plan

4901  SCAN Health Plan Arizona

5813  SCAN Health Plan Arizona

8644  Sharp Rees-Stealy Medical Group

1116  Special Agents Mutual Benefit Association (SAMBA)

5005  Special Agents Mutual Benefit Association (SAMBA)

1203  TCC Basic Plus

3541  TCC Basic Plus

3068  Texas Independence Health Plan, Inc

7807  Tri-Valley Medical Group

8582  Tri-Valley Medical Group

2075  UCS Benveo

8220  UCS Benveo

2024  United Benefit Advisors

8160  United Benefit Advisors

Action Required: None. Please be aware of the changes above.

REF 769450 9/5/2024

MHC01 - Mountain Health CO-OP - New Real Time Transaction Availability

Effective September 1, 2024, Optum is pleased to announce the new payer and real-time transaction payer specified below.

Payer id: MHC01

Payer name: Mountain Health CO-OP

Transaction type: Eligibility (270/271)

Action Required:

Please update your system to take advantage of this new payer transaction. For assistance with submitting Real-Time transactions, please contact your Practice Management System Vendor or the Support team for your Optum product or you may request assistance by submitting a Customer Care Hub ticket

Updated Payer Lists may be obtained from your software vendor or download the IMN Real-Time Eligibility & Claim Status Payer List.

REF 768798 9/5/2024

Update: Payer Transmit Delay for Multiple CPIDs

Update: A resolution has been implemented and claims were transmitted to the payers on Sept. 4, 2024. This delay affected claims released to Optum between 2 p.m. CT on Aug. 22, 2024 and 2 p.m. CT on Sept. 3, 2024.

Action Required: Be aware of the transmit delay.

Original Notify sent on Aug. 28, 2024:
Due to a payer system issue, a delay occurred in the transmission to the following payers since Aug. 23, 2024.

Payers impacted:

  • CPID 1472 Virginia Medicaid

  • CPID 5538 Virginia Medicaid

  • CPID 7447 Virginia Medicaid Lab

Optum is working with the payers to resolve this issue. We will notify you as soon as additional information becomes available.

This delay affected claims released to Optum since 2 p.m. CT on Aug. 22, 2024.

Action Required: Be aware of the transmit delay above.

REF 768301 9/04/2024

UPDATE:  New Electronic Claims Connections Available

Mountain Health CO-OP is now available for claim submission.

Original notice:

Effective September 1, 2024, Optum will have new electronic claims connections available:

Payer Name: Mountain Health CO-OP

Institutional CPID: 7565

Professional CPID: 2499

Payer-assigned Payer ID: MHC01

Payer Enrollment Required: No

Secondary Claims Accepted: Yes

Payer Location: Montana, Wyoming, Utah

Claims Fee: NA

Effective August 15, 2024, discontinue using CPIDs 4779 and 5920, linked to University of Utah payer ID SX155, for Mountain Health CO-OP claims. Please hold claims until CPID’s 2499, 7565 are available on September 1, 2024.

Action Required:

  • Effective August 15, 2024, discontinue using CPIDs 4779 and 5920, linked to University of Utah payer ID SX155, for Mountain Health CO-OP claims.

  • Add Mountain Health CO-OP to your system to begin using the new payer connection under CPIDs 2499 and 7565, payer ID MHC01 on September 1, 2024.

  • When a payer requires enrollment, forms must be submitted and approved to begin submitting transactions.

REF 768171 9/4/2024

Restored Payer Connectivity

Effective Aug. 29, 2024, Optum is pleased to announce Payer connectivity has been restored and Real-Time Eligibility transactions for the below payer may now be submitted:

Payer ID:  BCDEL, DEBCBS
Payer name:  Highmark Blue Cross Blue Shield Delaware
Transaction type:  Eligibility 270/271 .

Action Required by customer:
Please update your system to take advantage of this payer transaction. For assistance with submitting Real-Time transactions, please contact your Practice Management System Vendor or Optum Customer Care Hub ticket https://customercare.changehealthcare.com/public/home.html.  Also, if you have not already done so, all Vendors and Direct Submitters must reenroll for Real-Time transactions to successfully process.  

Updated Payer Lists may be obtained from your software vendor or Payer Lists | Change Healthcare.

REF 767702 9/04/2024

Report Generation Delay for CPID 1500 New York Medicaid

A payer is experiencing issues affecting Institutional report generation for some claims submitted on Aug. 30, 2024.

Payer impacted: 

  • CPID 1500 New York Medicaid

The payer is unable to generate and deliver the reports.

Action Required: None. Please resubmit claims if payment has not been received.

REF 768300 9/04/2024

Report Generation Delay for CPIDs 4727 and 1673 Public Employee Health Plan

A payer experienced issues affecting Professional and Institutional report generation for some claims submitted from June 18, 2024, to Aug. 26, 2024.

Payer impacted:

  • CPID 1673 Public Employee Health Plan

  • CPID 4727 Public Employee Health Plan

The payer is unable to generate and deliver the reports.

Action Required: None. Please resubmit claims if payment has not been received.

REF 768200 9/4/2024

SNCLF - Santa Clara Family Health Plan - Claim Status - Live

Effective August 23, 2024, Optum is pleased to announce connectivity has been restored and Real-time Claim Status transactions for the below payer may now be submitted:

Payer ID: SNCLF

Payer name: Santa Clara Family Health Plan

Action Required by customer:

Please update your system to take advantage of this payer transaction. For assistance with submitting Real-Time transactions, please contact your Practice Management System Vendor or Optum Customer Care Hub. Also, if you have not already done so, all Vendors and Direct Submitters must re-enroll for real-time transactions to successfully process. 

Updated Payer Lists may be obtained from your software vendor or Payer Lists | Change Healthcare.

REF 767700 9/4/2024

BCPAC - Highmark Blue Cross Blue Shield Pennsylvania - Eligibility and Claim Status - Live

Effective August 29, 2024, Optum is pleased to announce Payer connectivity has been restored and Real-time Eligibility and Claim Status transactions for the below payer may now be submitted:

Payer ID:  BCPAC, PABCBS, 95462

Payer name:  Blue Cross Blue Shield of Pennsylvania

Transaction type:  Eligibility 270/271 and Claim Status inquiry 276/277.

Action Required by customer:

Please update your system to take advantage of this payer transaction. For assistance with submitting real-time transactions, please contact your Practice Management System Vendor or submit a support request Optum Customer Care Hub.  

Also, if you have not already done so, all Vendors and Direct Submitters must reenroll for real-time transactions to successfully process. An updated payer Lists may be obtained from your software vendor or Payer Lists | Change Healthcare.

REF 767701 9/04/2024

Update: Report Generation Delay for CPIDs 6700 and 5681 Centurion Managed Care

A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted since Aug. 4, 2024.

Payer impacted:

  • CPID 6700 Centurion Managed Care

  • CPID 5681 Centurion Managed Care

Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

Original message sent July 19, 2024:

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted since Aug. 17, 2024.

Payer impacted:

  • CPID 6700 Centurion Managed Care

Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 767950 9/4/2024

New Electronic Claims Connections Available

Effective Sept. 3, 2024, Optum has new electronic claims connections available:

Payer Name: Active Care Inc.
Institutional CPID: 7090
Professional CPID: 2450
Payer-assigned Payer ID: 66310
Payer Enrollment Required: No
Secondary Claims Accepted: No
Payer Location: New Jersey
Claims Fee: N/A

Payer Name: First Managed Care Options, Inc.
Institutional CPID: 7092
Professional CPID: 2460
Payer-assigned Payer ID: 40270
Payer Enrollment Required: No
Secondary Claims Accepted: No
Payer Location: New Jersey
Claims Fee: N/A

Action Required:

  • Add the payers to your system to begin using the new payer connection.

  • When a payer requires enrollment, forms must be submitted and approved to begin submitting transactions.

Please note: We are providing you with a list of new electronic connections, please review and choose payers that are appropriate for your business.

REF 767550  9/4/24

New Payer Edit for Individual CPID 2593

The payer listed below has informed Optum of a new edit requirement effective immediately. In order to meet the new requirement, we will add the following edit on Sept. 9, 2024:

  • IHI-01A285 – INVALID VALUE CODE: For an electronic claim, Value Code D4 is not allowed. Exception: For a Medicare claim, when Direct Submit is equal to DDE, this requirement does not apply.

Note: If this requirement does not apply to your billing situation, you can override the edit within the Error Text.  LOOP 2300 HI 

Edit applies to:

  • CPID 2593 QUALCHOICE of Arkansas

REF 767150 9/03/2024

Report Generation Delay for CPID 5586 Montana Medicaid

The below payer is experiencing issues affecting Institutional report generation for some claims submitted on Aug. 29, 2024.

Payer impacted: 

  • CPID 5586 Montana Medicaid

Optum is working diligently with the payer to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 767002 9/03/2024

Report Generation Delay for CPID 3509 Ohio Medicaid

A payer is experiencing issues affecting Institutional report generation for some claims submitted on Aug. 26, 2024.

Payer impacted: 

  • CPID 3509 Ohio Medicaid

The payer is unable to generate and deliver the reports.

Action Required: None. Please resubmit claims if payment has not been received.

REF 767000 9/03/2024

Report Generation Delay for CPIDs 1928 and 2772 Medical Associates Health Plan

The payer listed below is experiencing issues affecting Institutional and Professional report generation for some claims submitted on Aug. 28, 2024.

Payer impacted:

  • CPID 1928 Medical Associates Health Plan

  • CPID 2772 Medical Associates Health Plan

Optum is working diligently with the payer to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 766808 9/3/2024

Electronic Routing Change for CPIDs 1960, 4294 ASR Physicians Care

Effective September 3, 2024, Optum will be changing electronic claims routing for the following payer:

Payer Name: ASR Physicians Care

Professional CPID: 4294

Institutional CPID: 1960

Payer-assigned Payer ID: 38265

Enrollment Requirements:

Claims:

  • Payer enrollment for electronic claims is not required.

Report Changes:

You may see some differences in the payer reports you are receiving.

Action Required: Please consider the following to allow transactions to process properly due to the above changes:

  • Make any necessary system changes.

  • When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.

REF 767201 9/3/2024

Massachusetts Medicaid Enrollment and Routing Update

This message is intended for Revenue Performance Advisor customers.

Effective Aug. 1, 2024, Optum is changing electronic routing for EDI claims and remits for the following payer:

  • Massachusetts Medicaid

  • Payer ID: 12K14 (Institutional) and SKMA0 (Professional)

Adding or Changing Billing Intermediary to Optum Insight - Requirement to submit, or receive, Massachusetts Medicaid EDI transactions with Optum:

  • To participate in submitting or receiving EDI transactions to Massachusetts Medicaid through Optum please go to Enrollment Central for a template to submit the following information on your company letterhead to MassHealth.

  • MassHealth Provider ID / Service Location (PIDSL)

  • National Provider ID (NPI) Number

  • Provider Federal Tax Identification Number (TIN) or Employer Identification Number (EIN)

  • Provider Full Mailing Address 

  • Contact Information (Name, Phone Number, and Email Address)

  • Signed with typed/printed name

  • Brief description of the request with HIPAA transactions specified (for example, institutional or professional claims or ERA)

  • Vendor Name and Vendor’s MassHealth Submitter ID (PIDSL)

  • Vendor Name: Optum Insight 

  • Massachusetts Medicaid PID/SL: 110210691A

Action Required:

  • Providers are responsible for emailing the information above to MassHealth at [email protected] to receive or submit transactions with Optum.

Historical ERAs

Optum has been working to restore ERA services with Massachusetts Medicaid. On February 29, 2024, MassHealth terminated their connection with Change Healthcare, and we are unable to retrieve any files for delivery to Providers. For Providers who need to retrieve historical ERAs, MassHealth has made ERAs from March 3, 2024, forward available to providers as direct receivers.

For access, providers can go to the Provider Online Service Center (POSC) on the MassHealth website to retrieve these historical ERAs. If there are any ERAs needed that are not posted on POSC, providers can use the .PDF remit to reconcile accounts. For more information on the remittance advice report please visit the MMIS Job Aid on the MassHealth website.

Note: providers will need to follow the instructions above to participate in submitting or receiving transactions with MassHealth through Optum.

Timely Filing

Optum has been working with Massachusetts Medicaid to restore services to providers. For providers who need exceptions for the 90-day timely filing window, the state has provided the following guidance:

  • Providers have two options for timely filing exception:

  • Providers may submit 90-DW with each claim via Direct Data Entry (DDE) on the Provider Online Service Center (POSC).

  • Providers may initiate a batch 90-DW process with the MassHealth EDI team by sending an email request to [email protected] letting them know that a request for batch 90-DW process is being requested, and the EDI team will assist the provider in pursuing this option. 

For more information please visit: https://www.mass.gov/how-to/submit-a-90-day-claim-waiver-request-form

REF 766307 9/3/2024

Optum Alert: Report Generation Delay for CPID 5835 Trilogy Health Network

The payer is experiencing issues affecting professional report generation for some claims submitted July 9, 2024, and July 19, 2024.

Payer impacted:

  • CPID 5835 Trilogy Health Network

The payer is unable to generate and deliver the reports.

Action Required: None. Please resubmit claims if payment has not been received.

Ref 767300  9/3/2024

Report Generation Delay for CPID 8864 NextBlue of North Dakota

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted on Aug. 21, 2024. 

Payer impacted: 

  • CPID 8864 NextBlue of North Dakota 

The payer intermediary is unable to generate and deliver the reports. 

Action Required: Please resubmit claims if payment has not been received from the payer. 

REF 766950 9/03/2024

Report Generation Delay for CPID 2203 Mississippi Medicare

The below payer is experiencing issues affecting Professional report generation for some claims submitted since Aug. 22, 2024.

Payer impacted:

  • CPID 2203 Mississippi Medicare 

Optum is working diligently with the payer to resolve the issue and ensure reports are received. 

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF767004 9/03/2024

Payer Processing Issue for multiple CPIDs

Due to a payer processing issue, Institutional and Professional claims transmitted to the payers listed below on Aug. 29, 2024, were not processed by the payers.

Payers impacted:

  • CPID 2423 Alabama Blue Cross Blue Shield

  • CPID 5558 Alabama Blue Cross Blue Shield

  • CPID 1002 Alabama Blue Cross Blue Shield Medicare Advantage

A resolution has been implemented and the claims were retransmitted to the payers on Sep. 3, 2024.

This delay affected claims released to Optum between 2 p.m. ET on Aug. 28, 2024, and 2 p.m. ET on Aug. 29, 2024.

Action Required: Be aware of the processing issue above.

REF 767001 9/3/2024

Report Generation Delay for CPID 2171 Louisiana Medicare

The below payer is experiencing issues affecting Professional report generation for some claims submitted since Aug. 22, 2024.

Payer impacted:

  • CPID 2171 Louisiana Medicare

Optum is working diligently with the payer to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 767003 9/3/2024

Report Generation Delay for CPIDs 2979 and 4253 Prominence Administrative Services

A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted since Aug. 19, 2024.

Payer impacted:

  • CPID 2979 Prominence Administrative Services

  • CPID 4253 Prominence Administrative Services

Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 766800 9/3/2024

Update: Electronic Remittance Connection Unsuspended for CPIDs 3234, 3925 Driscoll Children’s Health Plan

Due to a payer intermediary change July 23, 2024, it has been determined providers must re-enroll to continue receiving electronic remittance for the payer listed below. Payer has been unsuspended and will be published on the payer list.

Payer Name: Driscoll Children’s Health Plan
CPIDs: 3234, 3925
Payer ID: 74284

Remittance Enrollment Requirements:

  • Payer enrollment for electronic remittance is required:

  • All providers must complete a new enrollment form to receive electronic remittance for this payer from Optum (Change Healthcare).

Action Required: Please consider the following to allow transactions to process properly due to the above changes:

  • Required enrollment must be submitted and approved from Enrollment Central.

  • Contact payer regarding reposting of electronic remittances since July 23, 2024.

Original notice sent Aug. 20, 2024 - Ref #: 757552:

Effective immediately, the payer listed below has been temporarily suspended at Optum for remittance processing and removed from the payer list.

Payer Name: Driscoll Children’s Health Plan
CPIDs: 3234, 3925
Payer ID: 74284

Action Required: Please watch for future updates regarding remittance processing.

Ref 766452  8/30/24

AlohaCare (ALOHA) ERA Enrollment and Routing Update

This message is intended for Revenue Performance Advisor customers.

Effective immediately, Optum is changing electronic remittance routing for the following payer:

Payer Name: AlohaCare
RPA Payer ID: ALOHA

Enrollment Requirements for Remittance:

  • Payer enrollment for electronic remittance is required. All providers must complete a new enrollment form to receive electronic remittance for AlohaCare.

Submitter Action Required:

  • Please be aware of the changes above and complete a new enrollment form to receive remittance.

If you’re in RPA, you can also open the RPA Resource Center, click the Quick Reference Guides tab, and then click the Billing Provider Enrollment link to find the payer enrollment intake form. 

REF 766001 8/30/2024

North American Medical Management (NAMM - N. CA) Payer Processing Issue

This message is intended for Revenue Performance Advisor customers.

Due to a processing issue, we are experiencing delays in claims processing with the payer. This issue affected claims submitted to Optum from Jun. 13, 2024, to current. We are working with the payer to resolve the issue, and impacted claims will be processed by the payer once testing is completed. An updated message will be sent when the issue is resolved. 

  • Payer ID: E3510 - North American Medical Management (NAMM - N. CA)

We apologize for any inconvenience.

Action Requested: None. Please be aware of this delay in claims processing.

REF 766305 8/30/2024

Aetna Bulk Encounters

This message is intended for Submitters sending Encounters to Aetna.

Effective Aug. 7, 2024, Optum is connected to Payer ID 60055, CPIDs 7902 / 3428 for Aetna Bulk Encounters Only:

  • Payer Name: Aetna Bulk Encounters Only

  • Institutional CPID: 7902

  • Professional CPID: 3428

  • Payer-assigned Payer ID: 60055

  • Payer Enrollment Required: No

If you are sending Encounters, please ensure you are utilizing the correct Payer ID (60055, CPIDs 7902 and 3428). Encounters sent incorrectly to Aetna Payer ID (60054, CPIDs 4500 and 6400) may cause processing issues.

Aetna 60054 4500 6400 04/02/2024
Aetna Bulk Encounters Only 60055 7902 3428 08/07/2024

Action Required: Check the Optum payer list to confirm you are sending transactions to the correct payer. If you have any questions, please submit a support request.

  • Intelligent EDI customers: please contact the support team at 1-866-OptumGo.

REF 766350 8/30/2024

Update: Claim Processing Rejection 

This message is intended for Assurance Reimbursement Management and Exchange customers. 

Update: Claims that received rejections similar to or related to the original issue are processing successfully.

Action Required: Please be aware that you may see a delay in the rejection reports related to the original issue. 

Original Notification sent on August 21, 2024: 

Aug. 20, 2024, a processing issue through Optum caused claims to deliver with EDI file syntax errors to payers or intermediaries. This issue may have led to payers or intermediaries:

  • Being unable to process the claim files

  • Rejecting claim files

  • Rejecting claims with a message such as: Missing HIPAA-required 2330B (Other Payer Name)

This issue has been corrected and Optum is working to send corrected files to payers or intermediaries impacted by this issue. When all corrected files have been delivered, we will send a follow-up notification indicating that this issue has been resolved.

Action Required: Please be aware of the delay in claims processing. If you have any questions:

  • Intelligent EDI customers: please contact the support team at 1-866-OptumGo.

REF 758950 8/30/2024

Claim Processing Rejection

This message is intended for Revenue Performance Advisor customers.

Due to a clearinghouse processing issue, some Professional and Institutional claim files processed by the Optum clearinghouse on August 20, 2024, were delivered to payers or intermediaries with EDI file syntax errors. This issue may have led to payers or intermediaries:

  • Being unable to process the claim files.

  • Rejecting claim files.

  • Rejecting claims with a message similar to “Missing HIPAA-required 2330B (Other Payer Name)”.

This issue has been corrected and Optum is working to send corrected files to payers or intermediaries impacted by this issue. When all corrected files have been delivered, we will send a follow-up notification indicating that this issue has been resolved.

Action Required: Please be aware of the delay in claims processing.

REF 766306 8/30/2024

Report Generation Delay for Alabama Blue Cross Blue Shield

This message is intended for Revenue Performance Advisor customers.

Alabama Blue Cross Blue Shield (SB510) is unable to generate and deliver the reports for some claims submitted on Aug. 2, 2024, and Aug. 8, 2024.

Action Required:

Please resubmit claims if payment has not been received.

REF 766304 8/30/2024

Report Generation Delay for CPID 5072 MeridianComplete Michigan

A payer intermediary is experiencing issues affecting Institutional report generation for some claims submitted since Aug. 19, 2024.

Payer impacted:

  • CPID 5072 MeridianComplete Michigan

Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 766400 8/30/2024

Electronic Routing Change for CPIDs 3812, 2981 North American Administrators (NAA)

This message is intended for Assurance Reimbursement Management customers.

Effective immediately, Optum will be changing electronic claims routing for the following payer:

Payer Name: North American Administrators (NAA)
Professional CPID: 3812, 2981 
Payer-assigned Payer ID: 65085 
Previous Edit Master: PE_E049, HE9E049 
New Edit Master: PE_T007, HE9T007  

Enrollment Requirements:
Claims:
Payer enrollment for electronic claims is not required.

Report Changes:
You may see some differences in the payer reports you are receiving.  

Action Required: Please make any necessary system changes to allow transactions to process properly.

REF 765107  8/30/24

Remittance Enrollment for CPIDs 4097, 8840 Aspirus Medicare Advantage

Optum changed electronic remittance routing for the following payer August 12, 2024:

Payer Name: Aspirus Medicare Advantage
Professional CPID: 8840
Institutional CPID: 4097
Industry Payer ID: 36483

Remittance Enrollment Requirements:

  • Payer enrollment for electronic remittance is required:

  • Providers who moved their enrollment to another clearinghouse or have not received remittance since connectivity was restored will need to re-enroll with Optum (Change Healthcare) to receive ERAs for this payer from Optum (Change Healthcare).

  • New providers must complete a new enrollment form.

Action Required: Please be aware of the changes above and complete a new enrollment form to receive remittance.

  • When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.

REF 766450  8/30/24

Remittance Reactivation for CPIDs 1419, 5539 Magellan Healthcare

This message is intended for Assurance EDI and Assurance Reimbursement Management customers.

Effective Sept. 2, 2024, Optum will restore 835 connectivity for the following payer:

Payer Name: Magellan Healthcare

Professional CPID: 1419

Institutional CPID: 5539

Industry Payer ID: 01260

Remittance Enrollment Requirements:

  • Payer enrollment for electronic remittance is required:

  • Providers who were previously enrolled with Optum (Change Healthcare) and did not switch their enrollment away from Optum (Change Healthcare) will begin receiving ERAs.

  • New providers must complete a new enrollment form.

  •  Providers who moved their enrollment to another clearinghouse or have not received remittance since connectivity was restored will need to re-enroll with Optum (Change Healthcare) to receive ERAs for this payer from Optum (Change Healthcare).

Action Required: Please consider the following to allow transactions to process properly due to the above changes:

  •  Make any necessary system changes.

  • When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.

REF 766050 8/30/2024

Care Wisconsin Health Plan (27004) ERA Enrollment and Routing Update

This message is intended for Revenue Performance Advisor customers.

Effective immediately, Optum is changing electronic remittance routing for the following payer:

Payer Name: Care Wisconsin Health Plan
Revenue Performance Advisor Payer ID: 27004

Enrollment Requirements for Remittance:

  • Payer enrollment for electronic remittance is required. All providers must complete a new enrollment form to receive electronic remittance for Care Wisconsin Health Plan.

Submitter Action Required:

  • Please be aware of the changes above and complete a new enrollment form to receive remittance.

If you’re in Revenue Performance Advisor, you can also open the Revenue Performance Advisor Resource Center, click the Quick Reference Guides tab, and then click the Billing Provider Enrollment link to find the payer enrollment intake form.

REF 766200  8/30/24

New Electronic Remittance Connection Available TakeCare Insurance Company

This message is intended for Exchange and Assurance Reimbursement Management customers.

Effective immediately, Optum has new electronic remittance connection available:

Payer Name: TakeCare Insurance Company

Professional CPID: 8827

Institutional CPID: 4085

Payer-assigned Payer ID: 98022

LOB Code: N23

Remit Key: TKCR_COM

Payer enrollment for electronic remittance is required. 

Action Required: All providers must complete a new enrollment form to receive electronic remittance for TakeCare Insurance Company  

  • Make any necessary system changes. 

  • When a payer requires enrollment, forms must be submitted and approved from Enrollment Central. 

REF 765553 8/30/2024

Electronic Remittance Advice delay for Health Net (95567)

This message is intended for Revenue Performance Advisor customers.

Due to a processing issue, there has been a delay in some Electronic Remittance Advice for payer ID 95567, Health Net, beginning on Aug. 21, 2024, through present.

Additional updates will be forwarded as more information becomes available. 

Action Required:

Please be aware of a delay in the delivery of Electronic Remittance Advice for the dates above.

REF 766000 8/30/24

CMS Infrastructure Maintenance

CMS advises HETS Submitters that CMS IT will be conducting the last of two infrastructure maintenance sessions related to CMS network/firewall changes. 

While neither of these sessions should impact availability or performance of HETS, we are notifying HETS Submitters in case you notice any impact. 

The HETS 270/271 system should remain available during CMS maintenance.

The second maintenance session will be Friday, Aug. 30, 2024, from 9:00 p.m. to 10:00 p.m. ET.

REF 765250 8/29/2024

Update on Humana ERA Connectivity

This message is intended for Revenue Performance Advisor customers.

Aug. 27, 2024, Update: A subset of our customers may have received Humana ERAs through July 17, 2024. After July 17, no ERAs were received. For providers who were previously enrolled for Humana ERA under Revenue Performance Advisor network, you will need to re-enroll.

Action Required:

For providers who haven’t received a Humana ERA since July 17, 2024, payer re-enrollment is required.

Access the payer enrollment intake form on the Revenue Performance Advisor (RPA) restoration resources page in the User Community.

If you’re in RPA, you can also open the RPA Resource Center, click the Quick Reference Guides tab, and then click the Billing Provider Enrollment link to find the payer enrollment intake form.

Aug. 1, 2024, Action Required Update:

Access the payer enrollment intake form on the Revenue Performance Advisor (RPA) restoration resources page in the User Community.

  • If you’re in RPA, you can also open the RPA Resource Center, click the Quick Reference Guides tab, and then click the Billing Provider Enrollment link to find the payer enrollment intake form.

Original notice sent on July 29, 2024:

Since April 9, 2024, we restored electronic remittance advice (ERA) connectivity with Humana’s clearinghouse. While we have worked with the payer and their clearinghouse to reduce the disruption to providers as much as possible, Humana is asking that any provider who is not receiving current remits to re-enroll.

The following Payer IDs may be impacted:

Humana I 61101 61101
Humana P 61101 61101
Humana Encounters I 61102 61101
Humana Encounters P 61102 61101
Humana Long Term Care I 61115 61101
Humana Long Term Care P 61115 61101

Remittance Enrollment Requirement:

This payer requires enrollment for electronic remittance:

  • Providers receiving current ERAs do not need to re-enroll.

  • Providers who may have received historical ERAs but are experiencing issues receiving current ERAs need to re-enroll.

  • New providers must complete a new enrollment form.

Action Required:

Enrollment requirements and forms are available for self-service through Enrollment Central. For assistance, please submit a support case.

REF 762850 8/29/2024

Optum Notice: New Electronic Claims Connections Available

This message is intended for Assurance EDI and Assurance Reimbursement Management customers.

Effective Aug. 29, 2024, Optum has new electronic claims connections available:

Payer Name: National Telecommunications Cooperative Association
Professional CPID: 2733
Payer-assigned Payer ID: 52120
Payer Enrollment Required: No
Secondary Claims Accepted: Yes
Payer Location: National
Claims Fee: N/A

Action Required: 

  • Add the payers to your system to begin using the new payer connection.

  • When a payer requires enrollment, forms must be submitted and approved to begin submitting transactions.

Please note: We are providing you with a list of new electronic connections, please review and choose payers that are appropriate for your business.

REF 765552 8/29/2024

Electronic Remittance Advice Enrollment Required for Payer ID's SB870, 12B74, Blue Cross & Blue Shield of Rhode Island

Blue Cross & Blue Shield of Rhode Island has informed their providers and Optum that the Legacy Emdeon\Change Healthcare destination ID/trading partner IDs are now defunct and can no longer be used. 

Action Required:

  • Please be aware of the changes above and complete a new enrollment form to receive remittance.

  • Failure to update your destination ID by Oct. 1, 2024, will result in paper remittance.

  • Any 835’s generated after the payer updates your request will be issued to your new destination ID

If you’re in RPA, you can also open the RPA Resource Center, click the Quick Reference Guides tab, and then click the Billing Provider Enrollment link to find the payer enrollment intake form.

REF 763733 8/29/2024

Electronic Routing Change for CPIDs 5702, Davis Vision

This message is intended for Assurance Reimbursement Management customers.

Effective immediately, Optum will be changing electronic claims routing for the following payer:

Payer Name: Davis Vision Professional CPID: 5702

Payer-assigned Payer ID: V0QJA

Previous Edit Master: PE_D014 New Edit Master: PE_T007

Enrollment Requirements: Payer enrollment for electronic claims is not required.

You may see some differences in the payer reports you are receiving.

Action Required: Please consider the following to allow transactions to process properly due to the above changes: Make any necessary system changes. When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.

REF 765100 8/29/2024

Remittance Reactivation for CPIDs 2249, 2551 CareOregon

This message is intended for Assurance EDI and Assurance Reimbursement Management customers.

Effective immediately, Optum has restored 835 connectivity for the following payer:

Payer Name: CareOregon
Professional CPID: 2249
Institutional CPID: 2551
Industry Payer ID: 93975

Remittance Enrollment Requirements:

  • Payer enrollment for electronic remittance is required:

  • Providers who were previously enrolled with Optum (Change Healthcare) and did not switch their enrollment away from Optum (Change Healthcare) will begin receiving ERAs.

  • New providers must complete a new enrollment form.

  • Providers who moved their enrollment to another clearinghouse or have not received remittance since connectivity was restored will need to re-enroll with Optum (Change Healthcare) to receive ERAs for this payer from Optum (Change Healthcare).

Action Required: Please consider the following to allow transactions to process properly due to the above changes:

  • Make any necessary system changes.

  • When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.

REF 763200 8/29/2024

Report Generation Delay for multiple CPIDs

This message is intended for Assurance EDI and Assurance Reimbursement Management customers.

WPS is experiencing issues affecting Professional and Institutional report generation for some claims submitted since Aug. 20, 2024.

Payers impacted:

  • CPID 2900 WPS Commercial/Regular Business

  • CPID 4457 WPS Commercial/Regular Business

  • CPID 2136 WPS Commercial/Regular Business

  • CPID 4525 WPS Commercial/Regular Business

Optum is working diligently with WPS to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 764850 8/29/2024

Delay in Electronic Remittance Advice (ERA) for HEALTHNET CPID: 2855/6514

This message is intended for Assurance EDI and Assurance Reimbursement Management customers.

Due to a processing issue, there has been a delay in Professional and Institutional Electronic Remittance Advice (ERA) for the following payers beginning on Aug. 21, 2024, through present:

  • CPID 2855 HEALTHNET

  • CPID 6514 HEALTHNET

Additional updates will be forwarded as more information becomes available.  

Action Required: Please be aware of a delay in the delivery of ERA for the dates above.

If you have any questions, feel free to contact your Customer Support Team and refer to case 09070825.

REF 765000 8/29/2024

Report Generation Delay for CPID 1500 New York Medicaid

A payer is experiencing issues affecting Institutional report generation for some claims submitted on Aug. 26, 2024.

Payer impacted:

  • CPID 1500 New York Medicaid

The payer is unable to generate and deliver the reports.

Action Required: None. Please resubmit claims if payment has not been received.

REF 765102 8/29/2024

Report Generation Delay for multiple CPIDs

The below payers are experiencing issues affecting Professional and Institutional report generation for some claims submitted since Aug. 23, 2024.

Payers impacted:

  • CPID 7499 Sentara Health/Optima Health

  • CPID 7567 Sentara Health/Optima Health

  • CPID 1285 Sentara Mental Health

Optum is working diligently with the payers to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 763653 8/29/2024

ERA Enrollment for CPIDs 7420, 5579, Blue Cross & Blue Shield of Rhode Island

Blue Cross & Blue Shield of Rhode Island has informed their providers and Optum that the Legacy Emdeon destination ID/trading partner IDs are now defunct and can no longer be used.  

Action Required:
Legacy Emdeon providers must update their enrollment with the payer by completing the enrollment process via Connect Center and Enrollment Central, prior to Tuesday, October 1, 2024. Optum cannot submit the enrollment form on your behalf.

Failure to update your destination ID by October 1, 2024, will result in paper remittance.

Any 835’s generated after the payer updates your request will be issued to your new destination ID.  

Non-Legacy Emdeon customers are not impacted, therefore, no action required.

REF 762954 8/29/2024

Electronic Routing Change for CPIDs 2680, 5809 Care Wisconsin Health Plan

Effective Aug. 27, 2024, Optum will be changing electronic remit routing for the following payer:

Payer Name: Care Wisconsin Heath Plan

Professional CPID: 5809

Institutional CPID: 2680

Payer-assigned Payer ID: 27004

Remittance Enrollment Requirements:

Payer enrollment for electronic remittance is required:

  • All providers must complete a new enrollment form to receive electronic remittance for Care Wisconsin Health Plan

Action Required:

Complete the required enrollment form and return the completed enrollment form to Enrollment Central.

REF 763800 8/29/2024

Report Generation Delay for CPID 5428 QualChoice of Arkansas

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted since Aug. 16, 2024.

Payer impacted:

  • CPID 5428 QualChoice of Arkansas

Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 762952 8/29/2024

Update: Payer Processing Issue for Health Plan of San Joaquin CPID 4682, 3469

Update: We continue to troubleshoot this issue and will advise when it is resolved.

Original Notification sent on August 20, 2024:

Due to a payer processing issue, some of the Professional and Institutional files submitted to the payers listed below may have received a rejection of claim not on file for claims submitted April 15, 2024, to present.

Payers Impacted:

  • CPID 4682 Health Plan of San Joaquin

  • CPID 3469 Health Plan of San Joaquin

Additional updates will be forwarded as more information becomes available.

Action Required: Please be aware of the processing issue.

We apologize for any inconvenience as we work to resolve.

REF 763400 8/29/2024

Payer Processing Issue for CPIDs 1500, 2429, 6540 New York Medicaid

Due to a payer processing issue, some professional and institutional claims transmitted to the payer listed below on Aug. 22, 2024, were not processed by the payer.

Payer impacted:

  • 1500 New York Medicaid

  • 2429 New York Medicaid

  • 6540 New York Medicaid

A resolution has been implemented and the claims were retransmitted to the payer on Aug. 28, 2024. This delay affected claims released to Optum between 9 p.m. CT on Aug. 21, 2024 and 9 p.m. CT on Aug. 22, 2024.

Action Required: Be aware of the processing issue above.

REF 764300 8/29/2024

Electronic Routing Change for CPIDs 2909, 5231 AlohaCare

Effective immediately, Optum is changing electronic remittance routing for the following payer:

Payer Name: AlohaCare
Professional CPID: 2909
Institutional CPID: 5231
Payer-assigned Payer ID: 99030 

Enrollment Requirements: 
Remittance:
All providers must complete a new enrollment form to receive electronic remittance for AlohaCare.  

Action Required:
Complete the required enrollment form and return the completed enrollment form to Enrollment Central. 

REF 765101  8/29/2024

Report Generation Delay for CPID 1500 New York Medicaid

A payer is experiencing issues affecting Institutional report generation for some claims submitted on Aug. 26, 2024.

Payer impacted:

  • CPID 1500 New York Medicaid

The payer is unable to generate and deliver the reports.

Action Required: None. Please resubmit claims if payment has not been received.

REF 765102 8/29/2024

Enrollment Required for Washington Labor and Industry Workers Compensation

Effective Aug. 27, 2024, Optum reestablished connectivity to Washington Labor and Industry Workers Compensation for the following CPIDs and transactions:

  • CPIDs: 4404, 5563

  • Industry Payer ID: SX063, SX064

  • Transaction Types: 837I, 837P, 835

Providers sending transactions through Optum Intelligent EDI, Assurance EDI, or Assurance Reimbursement Management prior to Feb. 21, 2024, and have not moved their transactions to another clearinghouse do not need to reenroll. Providers who were sending transactions through the legacy Emdeon/OKC or Revenue Performance Advisor do need to complete an enrollment form changing their clearinghouse delivery method.

Claims Enrollment Requirements:

  • Payer enrollment for electronic claims is required:

  • Providers changing clearinghouse must complete a new enrollment form.

  • This includes providers submitting claims through legacy Emdeon/OKC or Revenue Performance Advisor (RPA)

  • New providers must complete a new enrollment form

  • The provider or authorized individual must sign where indicated.

  • Estimated payer processing time is 12 business days.

Remittance Enrollment Requirements:

  • Payer enrollment for electronic remittance is required:

  • Providers changing clearinghouse must complete a new enrollment form.

  • This includes providers picking up remittance from legacy Emdeon/OKC or Revenue Performance Advisor (RPA)

  • New providers must complete a new enrollment form.

  • Provider must sign and notarize Power of Attorney authorizing Optum to deliver Washington L & I Medicaid Remittance Advice files. 

  • Complete one Power of Attorney for each provider number you wish to receive an ERA.

  • Estimated payer processing time is 12 business days.

Action Required:
Complete the required enrollment form per the above instructions and return the completed enrollment form to Enrollment Central.

REF 762907  8/29/2024

Payer Transmit Delay for Multiple CPIDs

Due to a payer system issue, a delay occurred in the transmission to the following payers since Aug. 23, 2024.

Payers impacted:

  • CPID 1472 Virginia Medicaid

  • CPID 5538 Virginia Medicaid

  • CPID 7447 Virginia Medicaid Lab

Optum is working with the payers to resolve this issue. We will notify you as soon as additional information becomes available.

This delay affected claims released to Optum since 2 p.m. CT on Aug. 22, 2024. 

Action Required: Be aware of the transmit delay above.

REF 763654 8/29/2024

New Electronic Remittance Connection Available – Re-enrollment required

Effective immediately, Optum has new electronic Remittance connection available: 

Payer Name: Special Agents Mutual Benefit Association (SAMBA)

Professional CPID: 1116

Institutional CPID: 5005

Payer-assigned Payer ID: 50322

LOB Code: J7D

Remit Key: SAMB_COM

Payer enrollment for electronic remittance is required. 

Action Required: 

All providers must complete a new enrollment form to receive electronic remittance for Special Agents Mutual Benefit Association (SAMBA)

  • Make any necessary system changes. 

  • When a payer requires enrollment, forms must be submitted and approved from Enrollment Central. 

REF 762901 8/29/2024

Humana 8.27 Update

8/27/2024 Update:

Providers who are enrolled for Humana Electronic Remittance Advice (ERA) who are receiving EFTs through Humana but are not receiving current ERAs must CHANGE their ERA retrieval method with Humana. Under the ERA Delivery Method, you will need to select CHC1 from the list of clearinghouses to receive your ERAs from Optum.

Humana’s clearinghouse has informed us that providers enrolled to have ERAs delivered to Emdeon Business Services need to be updated to CHC1 to continue to receive ERAs from Optum. The ERA delivery method must be updated by the Provider and cannot be updated by Optum or Humana.

Humana > ERA/EFT Enrollment

  • ERA Delivery Method: Clearinghouse

  • Clearinghouse Name: CHC1

* Please note, previous clearinghouse name may be set to Emdeon Business Services and needs to be changed to CHC1 to receive ERAs from Exchange, iEDI, or RPA.

Humana Screen

Message sent on Aug. 15: A subset of our customers may have received Humana ERAs through July 17, 2024. After July 17, no ERAs were received. For providers who were previously enrolled for Humana ERA under Emdeon Business Services on the OKC network, you will need to re-enroll.

Original Message sent Jul. 26:

Since April 9, 2024, we restored ERA connectivity with Humana’s clearinghouse. While we have worked with the payer and their clearinghouse to reduce the disruption to providers as much as possible, Humana is asking that any provider who is not receiving current remits to re-enroll.

The following payer IDs may be impacted:

Humana I 61101 4544 61101 4544
Humana P 61101 2449 61101 2449
Humana Encounters I 61102 9589 61101 4544
Humana Encounters P 61102 3890 61101 2449
Humana Long Term Care I 61115 9508 61101 4544
Humana Long Term Care P 61115 1104 61101 2449

Remittance Enrollment Requirement:

  • This payer requires enrollment for electronic remittance:

  • Providers receiving current ERAs do not need to re-enroll.

  • Providers who may have received historical ERAs but are experiencing issues receiving current ERAs need to re-enroll.

  • New providers must complete a new enrollment form.

Action Required:

  • Enrollment requirements and forms are available for self-service through Enrollment Central. For assistance, please submit a support case.

REF 762550 8/27/2024

Report Generation Delay for CPID 6700 Centurion Managed Care

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted since Aug. 17, 2024.

Payer impacted:

  • CPID 6700 Centurion Managed Care

Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 763100 08/27/2024

Report Generation Delay for CPID 1673 Public Employee Health Plan

A payer experienced issues affecting Institutional report generation for some claims submitted on May 28, 2024, and May 31, 2024.

Payer impacted:

  • CPID 1673 Public Employee Health Plan

The payer is unable to generate and deliver the reports.

Action Required: None. Please resubmit claims if payment has not been received.

REF 762750 8/27/2024

Report Generation Delay for CPID 5440 Fox Valley Medicine

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted since Aug. 16, 2024.

Payer impacted:

  • CPID 5440 Fox Valley Medicine

Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 762951  8/27/2024

Update: Payer Processing Issue: North American Medical Management (NAMM - N. CA)

This message is intended for customers of Assurance Reimbursement Management, Assurance EDI, and submitters or trading partners to the Exchange clearinghouse.

Updated Message:

As of Aug. 26, 2024 the payer is continuing to work to resolve the issue impacting claims submitted to Optum. Once the payer has completed their testing claims will be reprocessed to the payer for the CPIDs and Payer ID listed below. An updated message will be sent when the issue is resolved.

  • CPID(s): 1782, 2931

  • Payer ID: E3510

Previous Message sent on Aug. 23, 2024: 

Due to a processing issue, we are experiencing delays in claims processing with the payer. This issue affected claims submitted to Optum from Jun. 13, 2024, to current. We are working with the payer to resolve the issue and impacted claims will processed to payer once testing is completed. An updated message will be sent when the issue is resolved. 

We apologize for any inconvenience.

Action Requested: None. Please be aware of this delay in claims processing.

REF 759652 762600 8/27/2024

Optum Notice: New Payer Edit for CPID 1548 Colorado Medicaid

The payer listed below has informed Optum of a new edit requirement effective immediately. To meet the new requirement, we will add the following edit on Aug. 28, 2024:

  • INM109A173: MISSING REFERRING PROVIDER NPI: The Referring Provider NPI is required. Exception: When the Service Line Referring Provider NPI is present, this requirement does not apply. Notes: 1. If this requirement does not apply to your billing situation, you can override the edit in the Edit/Error Severity application or within the Error Text. 2. Edit is based on Colorado Provider Bulletin, B2400509, June 2024 https://hcpf.colorado.gov/sites/hcpf/files/Bulletin_0624_B2400509.pdf  LOOP 2310F NM109 

Edit applies to:

  • CPID 1548 Colorado Medicaid

Action Required: Please be aware of updated edit requirements.

REF 762450 8/26/2024

Update: West Virgina Medicare – Submitter Not Approved Claim Rejections

Dear Revenue Performance Advisor customers,

We have worked with West Virginia Medicare (Payer ID SMWV0) regarding the following rejections:

  • R ACKNOWLEDGEMENT / REJECTED FOR RELATIONAL FIELD IN ERROR. SUBMITTER NOT APPROVED FOR ELECTRONIC CLAIM SUBMISSIONS ON BEHALF OF THIS ENTITY.
    ACKNOWLEDGEMENT, REJECTED FOR RELATIONAL FIELD IN ERROR.-SUBMITTER NOT APPROVED FOR ELECTRONIC CLAIM SUBMISSIONS ON BEHALF OF THIS ENTITY-BILLING PROVIDER

Starting Aug. 20, 2024, any claim submitted, on this date and going forward, that receives the above error may require re-enrollment with the payer. If you were submitting claims to SMWV0 before Feb. 21, 2024, successfully, please open a Customer Care Hub request (Choose RPA Claims as the Product and Enrollment Assistance as the Product Request Type) with your Provider Name, NPI, PTAN and description of the issue for the RPA Enrollment team. Customers who are supported by vendors should reach out to their vendors for support.

If you are needing to complete a new enrollment for SMWV0, follow these instructions:

How to complete RPA Enrollments (if applicable):

  • If you’re in Revenue Performance Advisor, you can also open the Revenue Performance Advisor Resource Center, click the Quick Reference Guides tab, and then click the Billing Provider Enrollment link to find the payer enrollment intake form.

  • Download, complete, and submit the payer enrollment intake form.

  • Follow the instructions for completing the intake form on the “Instructions” tab in the form. 

  • Send the completed form to Revenue Performance Advisor Provider Enrollment ([email protected]).

  • Use the subject line “New Revenue Performance Advisor Enrollment request, < Revenue Performance Advisor Account Number >.”

  • Make sure to enter your account number. 

Note: An enrollment representative will confirm assignment within 24-48 hours. Your enrollment representative will provide on-going payer enrollment status

REF 750901 759751 8/26/2024

New Electronic Remittance Connection Available

Effective immediately, Optum has new electronic Remittance connection available: 

Assurance EDI 

Payer Name: Optum Care Network - Monarch 

Professional CPID: 2475 

Institutional CPID: 6606 

Payer-assigned Payer ID: IP095 

Assurance Plus 

Payer Name: Optum Care Network - Monarch 

Professional CPID: 2475 

Institutional CPID: 6606 

Payer-assigned Payer ID: IP095 

LOB Code: K75 

Remit Key: OCNM_COM 

Payer enrollment for electronic remittance is required. 

All providers must complete a new enrollment form to receive electronic remittance for Optum Care Network - Monarch. 

Action Required: Please consider the following to allow transactions to process properly due to the above changes: 

  • Make any necessary system changes. 

  • When a payer requires enrollment, forms must be submitted and approved from Enrollment Central. 

REF 761810 8/26/2024

Payer Processing Issue for CPID 4588 Security Health Plan

Due to a payer processing issue, some Institutional claims transmitted to the payer listed below Aug. 23, 2024 were not processed by the payer.

Payer impacted:

  • CPID 4588 Security Health Plan

A resolution has been implemented and the affected claims were retransmitted to the payer Aug. 26, 2024.

This delay affected claims released to Optum Aug. 21, 2024, 8:00 p.m.- Aug. 22, 2024, 8:00 p.m. CT.

Action Required: Be aware of the processing issue above.

REF 762053  8/26/2024

Update: Report Generation Delay for multiple CPIDs

Update: The payer intermediary has been unable to generate and deliver the reports for some claims submitted on Aug. 13 2024.

Action Required: Please resubmit claims if payment has not been received.

Original notify sent Aug. 19, 2024:

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted below on Aug. 13, 2024.

Payers impacted: 

  • 8215 2020 Eyecare

  • 8267 AHP Provider Network

  • 9489 Access IPA

  • 1739 Advanced Medical Doctors of California

  • 9437 Adventist Health Physicians Network

  • 8242 Adventist Health Plan

  • 7888 Adventist White Memorial - Crown City Medical Group

  • 9736 Aligned Community Physicians

  • 8744 Alivi Health

  • 8743 Alivi Therapy Network

  • 9423 All United Medical Group IPA

  • 9281 AmericasHealth Plan

  • 3466 Amida Care

  • 8886 Astiva Health

  • 8105 Bright Health - Medicare Advantage

  • 1830 Brokerage Concepts

  • 8203 California IPA

  • 8835 Calvo's SelectCare Health Plans

  • 5868 Centinela Valley IPA

  • 4283 Choice Medical Group

  • 1836 Choice Physicians Network All United Medical Group

  • 6405 Cigna Health Plans

  • 3839 Cigna HealthSpring Maryland/Pennsylvania

  • 5436 Cigna Healthcare for Seniors

  • 4742 Cigna Medicare

  • 6408 Cigna Select Great-West Healthcare

  • 6852 Clinicas Del Camino Real

  • 8226 Community Care IPA

  • 8705 Connected Senior Care Advantage

  • 7800 Crown City Medical Group (CCMG)

  • 6271 Custody Medical Services

  • 1867 DHMN Preferred IPA Hospital Risk

  • 1866 DHMN Santa Cruz

  • 8232 Dignity Health Sacramento Hospital

  • 9284 EasyAccess Care IPA

  • 1752 Emanate Health Center - EHIPA/NMM

  • 8764 Emanate Health IPA

  • 8181 Emanate Health Med Center AltaMed

  • 8174 Emanate Health Med Center NMM

  • 8175 Emanate Health Med Center PDT MSO

  • 1198 Employer Direct Healthcare

  • 1841 Evernorth Behavioral Health, Inc

  • 2246 Foundation for Medical Care Tulare/King County

  • 9492 Freedom Claims Management Inc

  • 8237 Global One Ventures, LLC

  • 8729 Golden Physicians Medical Group

  • 8731 Good Samaritan Hospital

  • 3463 Gulf Quest Renaissance

  • 7206 Health Network Solutions Blue Cross Blue Shield North Carolina

  • 7198 Health Network Solutions Select Health South Carolina

  • 1724 HealthCosmos of New Mexico LLC

  • 7243 HealthSmart MSO

  • 6706 Healthcare Partners of Arizona

  • 9757 Healthcosmos Medical Group LLC

  • 7274 Heritage Victor Valley Medical Group

  • 8401 Hoag

  • 7802 Hollywood Presbyterian Medical Center - St Vincent IPA

  • 6430 Horizon Valley Medical Group

  • 1879 IEHP Covered (Covered California)

  • 9195 IN Physicians Associates IPA

  • 2488 Illinois Medicaid

  • 7465 Imperial Insurance Company of Texas

  • 7112 Inland Faculty Medical Group Encounters

  • 6274 Inland Health Organization (IHO)

  • 8208 Integrated Eye Care Network

  • 9723 Jade Health Care Medical Group

  • 8201 Johns Hopkins Home Care Group

  • 2282 Leon Medical Center Health Plan

  • 2854 Lifewise Health Plan of Oregon

  • 9440 Lone Star Medical Group

  • 8268 Longevity Health Plan of Florida

  • 1780 Managed Care Advisors - Sedgwick

  • 1875 MedCare Partners

  • 4266 Medcore HP

  • 9422 MyTru Advantage

  • 8797 NP Providence Health Plan Commercial

  • 8798 NP Providence Health Plan Medicare

  • 8799 NP Providence Health Plan OHP

  • 9104 NP Yamhill County CCO

  • 1148 North Carolina Department of Public Safety

  • 7860 Northwood

  • 7123 Physician Health Network

  • 9143 Physician Healthcare Integration IPA

  • 7141 Physicians Choice Medical Group of San Luis Obispo

  • 8838 Podiatry Plan

  • 1142 Premier Care IPA

  • 6855 Premier Physician Network

  • 9126 Provider Partners Health Plan of Missouri

  • 9233 Provider Partners Health Plan of Ohio

  • 9434 River City Medical Group Senior

  • 1823 SD All Women Count

  • 6464 Sagamore Health Network

  • 8176 Saint Johns Health Clinic

  • 5860 Santa Barbara Select IPA

  • 9159 Santa Monica Unite Here Health Benefit Fund

  • 9742 Serendib Healthways

  • 9746 Silicon Valley Medical Development

  • 9244 SolarteHealth

  • 7151 Southland San Gabriel Valley Medical Group

  • 7886 St. Francis - HCLA by MedPoint

  • 8837 Superior Choice Medical Group

  • 4701 Sutter Connect - Santa Rosa

  • 8241 TCC Benefits Administrator

  • 1470 Texas Medicaid

  • 8202 Texas Medicaid Long Term Care

  • 7801 Torrance Memorial Medical Center

  • 9707 UCI Health

  • 7266 UCLA Medical Group

  • 9219 Universal Healthcare IPA

  • 6702 Vantage Medical Group Encounters

  • 1850 Verda Healthcare

Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.

This delay affected claims released to Optum between 6 p.m. ET on Aug. 12, 2024, and 6 p.m. ET on Aug. 13, 2024.

Action Required: Be aware of the processing issue above.

REF 757100 / 762050 8/26/2024

Update: Report Generation Delay for CPID 1795 Envolve Benefit Options

Update: The payer intermediary has been unable to generate and deliver the reports for some claims submitted from July 3, 2024 through July 29, 2024.

Action Required: Please resubmit claims if payment has not been received.

Original notify sent July 15, 2024:

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted on July 3, 2024 and July 4, 2024.

Payer impacted: 

  • CPID 1795 Envolve Benefit Options

Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.

Action Required:  None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 761650 8/26/2024

Resolved: Remittance Management Customization (RMCX) Performance Issue

Resolved: The issue has been resolved. RMCX is now running at optimal performance and all affected files have been processed.

Original notification sent August 22, 2024.

Assurance Reimbursement Management is experiencing a processing issue with Remittance Management Customization (RMCX). This is impacting all payers for processing date August 21, 2024, through present.

This may result in:

  • Delayed Electronic Remittance Advice (ERA)

  • Delayed Remit Audit Reports

Additional updates will be forwarded as more information becomes available.

REF 761700 08262024

Payer Processing Issue for CPID 6163 Integrated Medical Solutions

Due to a payer intermediary processing issue, Professional claims transmitted to the payer listed below on Aug. 20, 2024, have not been processed by the payer.

Payer impacted:

  • CPID 6163 Integrated Medical Solutions

A resolution has been implemented and claims were retransmitted to the payer intermediary on Aug. 26, 2024.

This delay affected claims released to Optum between 9 p.m. ET on Aug. 19, 2024, and 9 p.m. ET on Aug. 20, 2024.

Action Required: Be aware of the transmit delay above.

REF 762000 8/26/2024

Optum Alert: Payer Processing Issue for CPID 4588 Security Health Plan

Due to a payer processing issue, some Institutional claims transmitted to the payer listed below on Aug. 22, 2024 were not processed by the payer.

Payer impacted: 

  • CPID 4588 Security Health Plan

A resolution has been implemented and the affected claims were retransmitted to the payer on Aug. 23, 2024.

This delay affected claims released to Optum between 8 p.m. CT on Aug. 21, 2024 and 8 p.m. CT on Aug. 22, 2024.

Action Required: Be aware of the processing issue above.

REF 760451 8/23/2024

Electronic Routing Change for Health Safety Net

This message is intended for Assurance Reimbursement Management, Assurance EDI, and submitters or trading partners to the Exchange clearinghouse.

Effective August 21, 2024, Optum will be changing electronic routing for claims the following payer:

Health Safety Net 995 4605 7852

Health Safety Network Enrollment instructions

  • Complete MassHealth enrollment. 

    • Because all HSN claims go through MassHealth all providers, even those not sending claims to MassHealth, must enroll at MassHealth.

  • Register for INET 

    • If you file data for your organization, you must complete a User Agreement Form. This form identifies employees or agents/contractors from your organization. It also introduces the submissions to which each require access.

  • Complete and return BPSA (Business Partner Security Agreement) 

    • Health Safety Net facilities (i.e. acute hospitals/community health centers) adding or changing a billing intermediary will need to contact both the Health Safety Net as well as MassHealth EDI, as collaboration with both agencies is required.

  • To participate in submitting EDI transactions Health Safety Net through Optum please submit the following information to Health Safety Net on your company letterhead. 

    • MassHealth Provider ID / Service Location (PIDSL)

    • National Provider ID (NPI) Number

    • Vendor Name and Vendor’s Health Safety Net Submitter ID (PIDSL)

    • Signed with typed/printed name

    • Brief description of the request with HIPAA transactions specified (institutional or professional claims)

Action Required:

  • Enrollment requirements and forms are available for self-service through Enrollment Central. For assistance, please submit a support case.

REF 757801 8/23/2024

Update: Report Generation Delay for multiple CPIDs

The payers are unable to generate and deliver the reports for some claims submitted on Aug. 2, 2024, and Aug. 8, 2024.

Action Required: Please resubmit claims if payment has not been received.

Original message sent Aug. 19, 2024:

The below payers are experiencing issues affecting Institutional and Professional report generation for some claims submitted on Aug. 2, 2024, and Aug. 8, 2024.

Payers impacted:

  • CPID 2423 Alabama Blue Cross Blue Shield

  • CPID 5558 Alabama Blue Cross Blue Shield

  • CPID 1002 Alabama Blue Cross Blue Shield Medicare Advantage

Optum is working diligently with the payers to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 760450 8/23/2024

Optum Update: Claim Processing Rejection Resolved

Due to a clearinghouse processing issue, some Professional, Institutional, and Dental claim files processed by the Optum clearinghouse on August 20, 2024, were delivered to payers or intermediaries with EDI file syntax errors.  This issue may have led to payers or intermediaries:

  • Being unable to process the claim files.

  • Rejecting claim files.

  • Rejecting claims with a message similar to “Missing HIPAA-required 2330B (Other Payer Name)”.

This issue has been corrected and Optum is working to send corrected files to payers or intermediaries impacted by this issue.  When all corrected files have been delivered, we will send a follow-up notification indicating that this issue has been resolved.

REF 759653 8/22/2024

Update: Restoration Efforts and Routing Change for Cigna Healthcare Medicare Advantage Plans

While Optum and Cigna Healthcare are restoring medical network connectivity for Cigna Healthcare's Commercial and Individual and Family Plans (IFP) business – including Electronic Remittance Advice (ERA) and historical remittance data (i.e., 835s) – we will not be able to reconnect directly with Cigna Healthcare’s Medicare Advantage line of business for ERAs.

Requirement to receive new ERAs for Cigna Healthcare Medicare Advantage

While we are not reconnecting directly with Cigna Healthcare Medicare Advantage, Optum has connected through a trading partner that provides ERAs for Cigna Healthcare Medicare Advantage claims. Given that, providers can re-enroll with Optum to receive Cigna Healthcare Medicare Advantage ERAs:

  • Providers who already re-enrolled with Optum and are receiving current ERAs from Cigna Healthcare Medicare Advantage do not need to re-enroll or take any action.

  • Providers who were previously enrolled to receive ERAs from Cigna Healthcare Medicare Advantage, but are not receiving current ERAs, need to re-enroll.

  • Providers who were not previously enrolled to receive ERAs from Cigna Healthcare Medicare Advantage must complete a new enrollment form with Optum.

Historical ERAs

  • Optum does not have ability to regenerate historical ERAs for Cigna Healthcare Medicare Advantage claims. 

  • For more information about claims submitted prior to March 8, 2024, please contact the Cigna Healthcare Medicare Advantage Provider Service Team at 800.230.6138. For ERAs after March 8, 2024, please contact Zelis at 1.855.496.1571.

Updated Payer IDs

Additionally, Optum has changed the ERA electronic routing for the Cigna Healthcare Medicare Advantage payers listed below:

Cigna HealthSpring
Tennessee/Alabama
63092 63092 1556 2795
Cigna HealthSpring
Maryland/Pennsylvania
52192 63092 1978 3839
Cigna Medicare
(other states)
52192 63092 5694 4742

Action Required:

  • Enrollment requirements and forms are available for self-service through Enrollment Central. For assistance, please submit a support case.

REF 759650 8/22/2024

Electronic Connection No Longer Available for CPID 3402 Block Vision

Effective immediately the payer listed below will no longer be available at Optum for remittance processing.

Payer Name: Block Vision

Remittance CPID: 3402

Reason: Payer no longer contracted.

Action Required: None

CSA 759364 8/22/2024

Payer Processing Issue for CPID 4644 Integrated Medical Solutions

Due to a payer intermediary processing issue, Institutional claims transmitted to the payer listed below on Aug. 20, 2024, have not been processed by the payer.

Payer affected:

  • CPID 4644 Integrated Medical Solutions

A resolution has been implemented and claims were retransmitted to the payer intermediary on Aug. 22, 2024.

This delay affected claims released to Optum between 9 p.m. ET on Aug. 29, 2024, and 9 p.m. ET on Aug. 30, 2024.

Action Required: Be aware of the transmit delay above.

REF 759452 8/22/2024

CMS Infrastructure Maintenance

Medicare 270/271 Submitters:

CMS IT will be conducting two upcoming infrastructure maintenance sessions related to CMS network/firewall changes. While neither of these sessions should impact availability or performance , we are notifying Submitters in case you notice any impact. The 270/271 system should remain available during CMS maintenance.

The first maintenance session will be Friday, August 23, 2024 from 9:00 p.m. - 10:00 p.m. ET.

The second maintenance session will be Friday, August 30, 2024 from 9:00 p.m. - 10:00 p.m. ET.

REF 759550 8/22/2024

Remittance Management Customization (RMCX) Performance Issue

Assurance Reimbursement Management is experiencing a processing issue with Remittance Management Customization (RMCX). This is impacting all payers for processing date August 21, 2024, through present.

 This may result in:

  • Delayed Electronic Remittance Advice (ERA)

  • Delayed Remit Audit Reports

Additional updates will be forwarded as more information becomes available.

Action Required: Please be aware of a delay in the delivery of ERA for processing dates above.

If you have any questions, feel free to contact your Customer Support Team and refer to case 09068399.

REF 759155 8/22/2024

Payer Processing Issue for multiple CPIDs

Due to a payer processing issue, some Institutional and Professional claims transmitted to the payers listed below May 21, 2024-Aug. 21, 2024 were not processed by the payers.

Payers impacted:

  • CPID 1475 Louisiana Medicaid

  • CPID 3578 Louisiana Medicaid

  • CPID 1183 Louisiana Medicaid Medicare Advantage Crossovers

  • CPID 2554 Louisiana Medicaid Medicare Advantage Crossovers

  • CPID 1675 Louisiana Medicaid Home Health

  • CPID 2236 Louisiana Medicaid Ambulance

  • CPID 4604 Louisiana Medicaid Long Term Care

  • CPID 5232 Louisiana Medicaid Durable Medical Equipment

  • CPID 7177 Louisiana Medicaid Rehab

A resolution has been implemented and the affected claims were retransmitted to the payers Aug. 22, 2024.

This delay affected claims released to Optum May 20, 2024, 10:00 a.m.-Aug. 21, 2024, 10:00 a.m. CT.

Action Required: Be aware of the processing issue above.

Ref 759800  8/22/2024

Update: Report Generation Delay for CPID 2287 Medicare Plus Blue of MI(MAP)

The payer intermediary is unable to generate and deliver the reports for some claims submitted on July 25, 2024 and July 26, 2024.

Action Required: Please resubmit claims if payment has not been received.

Original message sent July 19, 2024:

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted since July 25, 2024.

Payer impacted:

  • CPID 2287 Medicare Plus Blue of MI(MAP)

Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 759451 8/22/2024

Optum Notice: Claim Processing Rejection

This message is intended for claims submitters, claims payers, and trading partners of Optum.

Aug. 20, 2024, a processing issue through Optum caused claims to deliver with EDI file syntax errors to payers or intermediaries. This issue may have led to payers or intermediaries:

  • Being unable to process the claim files

  • Rejecting claim files

  • Rejecting claims with a message such as: Missing HIPAA-required 2330B (Other Payer Name)

This issue has been corrected and Optum is working to send corrected files to payers or intermediaries impacted by this issue. When all corrected files have been delivered, we will send a follow-up notification indicating that this issue has been resolved.

Action Required: Please be aware of the delay in claims processing. If you have any questions:

  • Intelligent EDI customers: please contact the support team at 1-866-OptumGo.

REF 758950  8/21/2024

ERA Processing Termination for CPIDs 6994, 6814 Consumers Choice of South Carolina/HealthSCOPE Benefits

Effective immediately, the payer listed below will no longer be available at Optum for remittance processing.

Payer Name: Consumers Choice of South Carolina/HealthSCOPE Benefits

CPID(s): 6994, 6814

Payer ID: 45321

LOB code: J3Z

Remit Key: CCSC_COM

Reason: Payer no longer contracted.

Action Required: None

REF 758451 8/21/2024

ERA Processing Termination for CPIDs 4943, 3874 NCAS - Charlotte, North Carolina

This message is intended for Assurance Reimbursement Management and Assurance EDI customers.

Effective immediately, the payer listed below will no longer be available at Optum for remittance processing.

Payer Name: NCAS - Charlotte, North Carolina
CPID(s): 4943, 3874
Payer ID: 75191
LOB code: H29
Remit Key: NCAS_COM
Reason: Payer no longer contracted.

Action Required: None

REF 758452  8/21/2024

Report Generation Delay for CPIDs 2972 and 6781 Bienvivir Senior Health Services

The payer is experiencing issues affecting institutional and professional report generation for some claims submitted on Aug. 9, 2024.

Payer impacted:

  • CPID 2972 Bienvivir Senior Health Services

  • CPID 6781 Bienvivir Senior Health Services

The payer is unable to generate and deliver reports.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 756552 8/21/2024

September Medicare HETS updates

CMS is planning the upcoming HETS2024-3 system release which will impact HETS 270/271 Submitters. 

The HETS2024-3 release will introduce potential changes to the HETS 270 request and the HETS 271 response. CMS has published the HETS2024-3 Release Summary in anticipation of this release. 

Updates in this release include:

Support of the new Annual Wellness visit preventative HCPCS - G0136 (Social Determinants of Health Risk) when submitted on the 270 request.

Expanded number of MDPP (Medicare Diabetes Prevention Program) service occurrences will be returned on the 271 responses.  The expansion will send up to 50 prior MDPP occurrences.

The HETS2024-3 release is currently scheduled for September 2024.  Submitters will be notified when additional information is available regarding HETS2024-3.

REF 758400 8/21/2024

ERA Processing Termination for CPIDs 1280, 6526 Healthcare Highways

Effective immediately, the payer listed below will no longer be available at Optum for remittance processing.

Payer Name: Healthcare Highways

CPID(s): 1280, 6526

Payer ID: HCH01

LOB code: H4R 

Remit Key: HCHW_COM

Reason: Payer no longer contracted.

Action Required: None.

REF 758450 8/21/2024

Electronic Remittance Connection Suspended

Effective immediately, the payer listed below has been temporarily suspended at Optum for remittance processing and removed from the payer list.

Payer Name: Driscoll Children’s Health Plan

CPIDs: 3234, 3925

Payer ID: 74284

Action Required: Please watch for future updates regarding remittance processing.

REF 757552 08/21/2024

Payer Processing Issue for Health Plan of San Joaquin CPID 4682, 3469

Due to a payer processing issue, some of the Professional and Institutional files submitted to the payers listed below may have received a rejection of claim not on file for claims submitted April 15, 2024 to present.

Payers Affected:

  • CPID 4682 Health Plan of San Joaquin

  • CPID 3469 Health Plan of San Joaquin

Additional updates will be forwarded as more information becomes available.

Action Required: Please be aware of the processing issue.

We apologize for any inconvenience as we work to resolve.

CSA 757900 08/20/2024

Report Generation Delay for CPID 2208 Texas Medicare

The below payer is experiencing issues affecting professional report generation for some claims submitted since Aug. 5, 2024.

Payer impacted:

  • CPID 2208 Texas Medicare

Optum is working diligently with the payer to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 757651 8/20/2024

Report Generation Delay for CPID 2165 District of Columbia Metropolitan Area (DCMA) Medicare

The below payer is experiencing issues affecting Professional report generation for some claims submitted since Aug. 5, 2024.

 Payer impacted:

  • CPID 2165 District of Columbia Metropolitan Area (DCMA) Medicare

Optum is working diligently with the payer to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 757650 08/20/2024

New Electronic Claims Connections Available

Effective August 20, 2024, Optum has new electronic claims connections available: 

Payer Name: FenyxHealth

Institutional CPID: 7914

Professional CPID: 2725

Payer-assigned Payer ID: 83309

Payer Enrollment Required: No

Secondary Claims Accepted: No                                                                     

Payer Location: National

Claims Fee: N/A

Action Required: 

  • Add the payers to your system to begin using the new payer connection.

  • When a payer requires enrollment, forms must be submitted and approved to begin submitting transactions.

Please note: We are providing you with a list of new electronic connections, please review and choose payers that are appropriate for your business.

REF 757600 8/20/2024

New Electronic Claims Connections Available

Effective Sept. 1, 2024, Optum will have new electronic claims connections available:  

Payer Name: Mountain Health CO-OP 

Institutional CPID: 7565 

Professional CPID: 2499 

Payer-assigned Payer ID: MHC01 

Payer Enrollment Required: No 

Secondary Claims Accepted: Yes 

Payer Location: Montana, Wyoming, Utah 

Claims Fee:  NA 

Action Required:  

Effective Aug. 15, 2024, discontinue using CPIDs 4779 and 5920, linked to University of Utah Payer ID SX155, for Mountain Health CO-OP claims.  Please hold claims until CPID’s 2499, 7565 are available on Sept. 1, 2024. 

Add Mountain Health CO-OP to your system to begin using the new payer connection under CPIDs 2499 and 7565, Payer ID MHC01 on Sept. 1, 2024. 

When a payer requires enrollment, forms must be submitted and approved to begin submitting transactions.

REF 756516 8/19/2024

Report Generation Delay for CPID 1451 Nebraska Medicare

WPS is experiencing issues affecting Professional report generation for some claims submitted on Aug. 16, 2024.

Payer Impacted: 

  • CPID 1451 Nebraska Medicare

WPS is unable to generate and deliver the reports.

Action Required: None. Please resubmit claims if payment has not been received.

REF 757154 8/19/2024

Report Generation Delay for CPID 1480 and 3564 North Carolina Medicaid

A payer is experiencing issues affecting Institutional and Professional report generation for some claims submitted on Aug. 15, 2024.

Payer Impacted: 

  • CPID 1480 North Carolina Medicaid

  • CPID 3564 North Carolina Medicaid

Optum is working diligently with the payer to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 756703 8/19/2024

Report Generation Delay for multiple CPIDs

The below payers are experiencing issues affecting Institutional and Professional report generation for some claims submitted on Aug. 2, 2024 and Aug. 8, 2024.

Payers impacted: 

  • CPID 2423 Alabama Blue Cross Blue Shield
  • CPID 5558 Alabama Blue Cross Blue Shield
  • CPID 1002 Alabama Blue Cross Blue Shield Medicare Advantage

Optum is working diligently with the payers to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 757150 8/19/2024

RESOLVED: Centers for Medicare & Medicaid Services Eligibility Unavailable

This issue has been resolved and eligibility transactions are processing as expected.

Original Message sent Aug. 15, 2024

At this time the Eligibility connection for Medicare is unavailable.

Teams are working to resolve this issue.

Updates will be provided as progress is made toward a resolution.

REF 757050 08/19/2024

Report Generation Delay for multiple CPIDs

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted below on Aug. 13, 2024.

Payers impacted: 

  • 8215 2020 Eyecare

  • 8267 AHP Provider Network

  • 9489 Access IPA

  • 1739 Advanced Medical Doctors of California

  • 9437 Adventist Health Physicians Network

  • 8242 Adventist Health Plan

  • 7888 Adventist White Memorial - Crown City Medical Group

  • 9736 Aligned Community Physicians

  • 8744 Alivi Health

  • 8743 Alivi Therapy Network

  • 9423 All United Medical Group IPA

  • 9281 AmericasHealth Plan

  • 3466 Amida Care

  • 8886 Astiva Health

  • 8105 Bright Health - Medicare Advantage

  • 1830 Brokerage Concepts

  • 8203 California IPA

  • 8835 Calvo's SelectCare Health Plans

  • 5868 Centinela Valley IPA

  • 4283 Choice Medical Group

  • 1836 Choice Physicians Network All United Medical Group

  • 6405 Cigna Health Plans

  • 3839 Cigna HealthSpring Maryland/Pennsylvania

  • 5436 Cigna Healthcare for Seniors

  • 4742 Cigna Medicare

  • 6408 Cigna Select Great-West Healthcare

  • 6852 Clinicas Del Camino Real

  • 8226 Community Care IPA

  • 8705 Connected Senior Care Advantage

  • 7800 Crown City Medical Group (CCMG)

  • 6271 Custody Medical Services

  • 1867 DHMN Preferred IPA Hospital Risk

  • 1866 DHMN Santa Cruz

  • 8232 Dignity Health Sacramento Hospital

  • 9284 EasyAccess Care IPA

  • 1752 Emanate Health Center - EHIPA/NMM

  • 8764 Emanate Health IPA

  • 8181 Emanate Health Med Center AltaMed

  • 8174 Emanate Health Med Center NMM

  • 8175 Emanate Health Med Center PDT MSO

  • 1198 Employer Direct Healthcare

  • 1841 Evernorth Behavioral Health, Inc

  • 2246 Foundation for Medical Care Tulare/King County

  • 9492 Freedom Claims Management Inc

  • 8237 Global One Ventures, LLC

  • 8729 Golden Physicians Medical Group

  • 8731 Good Samaritan Hospital

  • 3463 Gulf Quest Renaissance

  • 7206 Health Network Solutions Blue Cross Blue Shield North Carolina

  • 7198 Health Network Solutions Select Health South Carolina

  • 1724 HealthCosmos of New Mexico LLC

  • 7243 HealthSmart MSO

  • 6706 Healthcare Partners of Arizona

  • 9757 Healthcosmos Medical Group LLC

  • 7274 Heritage Victor Valley Medical Group

  • 8401 Hoag

  • 7802 Hollywood Presbyterian Medical Center - St Vincent IPA

  • 6430 Horizon Valley Medical Group

  • 1879 IEHP Covered (Covered California)

  • 9195 IN Physicians Associates IPA

  • 2488 Illinois Medicaid

  • 7465 Imperial Insurance Company of Texas

  • 7112 Inland Faculty Medical Group Encounters

  • 6274 Inland Health Organization (IHO)

  • 8208 Integrated Eye Care Network

  • 9723 Jade Health Care Medical Group

  • 8201 Johns Hopkins Home Care Group

  • 2282 Leon Medical Center Health Plan

  • 2854 Lifewise Health Plan of Oregon

  • 9440 Lone Star Medical Group

  • 8268 Longevity Health Plan of Florida

  • 1780 Managed Care Advisors - Sedgwick

  • 1875 MedCare Partners

  • 4266 Medcore HP

  • 9422 MyTru Advantage

  • 8797 NP Providence Health Plan Commercial

  • 8798 NP Providence Health Plan Medicare

  • 8799 NP Providence Health Plan OHP

  • 9104 NP Yamhill County CCO

  • 1148 North Carolina Department of Public Safety

  • 7860 Northwood

  • 7123 Physician Health Network

  • 9143 Physician Healthcare Integration IPA

  • 7141 Physicians Choice Medical Group of San Luis Obispo

  • 8838 Podiatry Plan

  • 1142 Premier Care IPA

  • 6855 Premier Physician Network

  • 9126 Provider Partners Health Plan of Missouri

  • 9233 Provider Partners Health Plan of Ohio

  • 9434 River City Medical Group Senior

  • 1823 SD All Women Count

  • 6464 Sagamore Health Network

  • 8176 Saint Johns Health Clinic

  • 5860 Santa Barbara Select IPA

  • 9159 Santa Monica Unite Here Health Benefit Fund

  • 9742 Serendib Healthways

  • 9746 Silicon Valley Medical Development

  • 9244 SolarteHealth

  • 7151 Southland San Gabriel Valley Medical Group

  • 7886 St. Francis - HCLA by MedPoint

  • 8837 Superior Choice Medical Group

  • 4701 Sutter Connect - Santa Rosa

  • 8241 TCC Benefits Administrator

  • 1470 Texas Medicaid

  • 8202 Texas Medicaid Long Term Care

  • 7801 Torrance Memorial Medical Center

  • 9707 UCI Health

  • 7266 UCLA Medical Group

  • 9219 Universal Healthcare IPA

  • 6702 Vantage Medical Group Encounters

  • 1850 Verda Healthcare

Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.

This delay affected claims released to Optum between 6 p.m. ET on Aug. 12, 2024, and 6 p.m. ET on Aug. 13, 2024.

Action Required: Be aware of the processing issue above.

REF 757100 08/19/2024

Report Generation Delay for CPID 5879 Erisa Administrative Services

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted since Aug. 7, 2024. 

Payer impacted: 

  • CPID 5879 Erisa Administrative Services 

Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received. 

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 756551 08/19/2024

New Electronic Remittance Connections Available

Effective September 1, 2024, Optum will have new electronic remittance connections available: 

Payer Name: Mountain Health CO-OP

Institutional CPID: 7565

Professional CPID: 2499

Payer-assigned Payer ID: MHC01

Payer Enrollment Required: Yes

Payer Location: Montana, Wyoming, Utah

Remittance Fee:  NA

Action Required: 

  • Add the payers to your system to begin using the new payer connection.

  • Enrollment forms must be submitted and approved to begin receiving electronic remittance through Optum.

REF 756517 8/19/2024

Update: Massachusetts Medicaid

This message is intended for Assurance Reimbursement Management, Assurance EDI, and submitters or trading partners to the Exchange clearinghouse.

Update: Please note the CPID was listed incorrectly for Massachusetts Medicaid Format 9 and Massachusetts Medicaid Format 5. The correct CPID for Massachusetts Medicaid Format 9 is 4491 and the correct CPID for Massachusetts Medicaid Format 5 is 4492.

Massachusetts Medicaid Format 5 DMA7384 4492
Massachusetts Medicaid Format 9 DMA7384 4491

Original Message: Effective Aug. 1, 2024, Optum will be changing electronic routing for EDI claims and remits for the following payer:

Massachusetts Medicaid DMA7384 5529
Massachusetts Medicaid Long Term Care DMA7384 2905
Massachusetts Medicaid Format 5 DMA7384 4491 4492
Massachusetts Medicaid Format 9 DMA7384 4492 4491

Adding or Changing Billing Intermediary to Optum Insight - Requirement to submit, or receive, Massachusetts Medicaid EDI transactions with Optum:

  • To participate in submitting or receiving EDI transactions to Massachusetts Medicaid through Optum please go to Enrollment Central for a template to submit the following information on your company letterhead to MassHealth. For assistance, please submit a support case.

  • MassHealth Provider ID / Service Location (PIDSL)

  • National Provider ID (NPI) Number

  • Provider Federal Tax Identification Number (TIN) or Employer Identification Number (EIN)

  • Provider Full Mailing Address

  • Contact Information (Name, Phone Number, and Email Address)

  • Signed with typed/printed name

  • Brief description of the request with HIPAA transactions specified (for example, institutional or professional claims or ERA)

  • Vendor Name and Vendor’s MassHealth Submitter ID (PIDSL)

  • Vendor Name: Optum Insight

  • Massachusetts Medicaid PID/SL: 110210691A

Action Required:

  • Providers are responsible for emailing the information above to MassHealth at [email protected] to receive or submit transactions with Optum.

Historical ERAs

Optum has been working to restore ERA services with Massachusetts Medicaid. Feb. 29, 2024, MassHealth terminated their connection with Change Healthcare, and we are unable to retrieve any files for delivery to Providers. For Providers who need to retrieve historical ERAs, MassHealth has made ERAs from March 3, 2024 forward available to providers as direct receivers.

For access, providers can go to the Provider Online Service Center (POSC) on the MassHealth website to retrieve these historical ERAs. If there are any ERAs needed that are not posted on POSC, providers can use the .PDF remit to reconcile accounts. For more information on the remittance advice report please visit the MMIS Job Aid on the MassHealth website.

Note: providers will need to follow the instructions above to participate in submitting or receiving transactions with MassHealth through Optum.

Timely Filing

Optum has been working with Massachusetts Medicaid to restore services to providers. For providers who need exceptions for the 90-day timely filing window, the state has provided the following guidance:

  • Providers have two options for timely filing exception:

  • Providers may submit 90-DW with each claim via Direct Data Entry (DDE) on the Provider Online Service Center (POSC).

  • Providers may initiate a batch 90-DW process with the MassHealth EDI team by sending an email request to [email protected] letting them know that a request for batch 90-DW process is being requested, and the EDI team will assist the provider in pursuing this option.

REF 756750  8/19/2024

New Electronic Claims Connections Available

Effective August 16, 2024, Optum has new electronic claims connections available:

Payer Name: Guarantee Trust Life

Institutional CPID: 7517

Professional CPID: 9180

Payer-assigned Payer ID: 36117

Payer Enrollment Required: No

Secondary Claims Accepted: No

Payer Location: Illinois

Claims Fee: N/A

Action Required:

  • Add the payers to your system to begin using the new payer connection.

  • When a payer requires enrollment, forms must be submitted and approved to begin submitting transactions.

Please note:  We are providing you with a list of new electronic connections, please review and choose payers that are appropriate for your business.

REF 756650 08/19/2024

Report Generation Delay for CPID 1681 International Medical Group

A payer intermediary is experiencing issues affecting Institutional report generation for some claims submitted on Aug. 6, 2024.

Payer impacted: 

  • CPID 1681 International Medical Group

The payer intermediary is unable to generate and deliver the reports.

Action Required: None. Please resubmit claims if payment has not been received.

REF 756550 8/19/2024

999 Payer Batch Rejections for CPID 3578 Louisiana Medicaid

Institutional claims transmitted to the payer listed below from Optum on Aug. 16, 2024 were not processed by the payer due to a 999 Batch Rejection. 

  • CPID 3578 Louisiana Medicaid

A resolution has been implemented and the claims were retransmitted to the payer on Aug. 19, 2024.

This delay affected claims released to Optum between 7 p.m. CT on Aug. 15, 2024 and 10 a.m. CT on Aug. 16, 2024.

Action Required: None.

REF 756701 8/19/2024

Payer Processing Issue for Midlands Choice (47080)

Due to a processing issue, Institutional and Professional claims for the payer listed below may be found as not on file.

This issue began on March 27, 2024, and was resolved by Optum on Aug. 1, 2024.  All affected claims released from May 4, 2024, through Aug. 1, 2024, were resubmitted on Aug. 1, 2024.  Any claims that have not been received for claim released date March 27, 2024, through May 3, 2024,  will need to be resubmitted.

Payer affected:

  • 47080  Midlands Choice

Action Required:

Please resubmit any impacted claims not on file at this payer at this time.

REF 756450 8/19/2024

Electronic Connection No Longer Available

Effective immediately, the payer listed below will no longer be available at Optum for claims and remittance processing.

Payer Name: Blue Cross Blue Shield Arizona Advantage
Claim CPIDs: 5904, 2275
Remittance LOB: J2S
Reason: Payer no longer in business.

Action Required: None

REF 755101 8/19/2024

999 Payer Batch Rejections for CPID 1475 Louisiana Medicaid

Professional claims transmitted to the payer listed below from Optum on Aug. 16, 2024, were not processed by the payer due to a 999 Batch Rejection. 

  • CPID 1475 Louisiana Medicaid

A resolution has been implemented and the claims were retransmitted to the payer on Aug. 16, 2024, after the payer's cutoff.

This delay affected claims released to Optum between 11 a.m. ET on Aug. 15, 2024, and 11 a.m. ET on Aug. 16, 2024.

Action Required: None.

REF 756066 8/16/2024

Payer Processing Issue for Midlands Choice CPIDs: 1742, 6588

Due to a processing issue, Institutional and Professional claims for the payer listed below may be found as not on file.

This issue began on March 27, 2024, and was resolved by Optum on Aug. 1, 2024.  All affected claims released from May 4, 2024, through Aug. 1, 2024, were resubmitted on Aug. 1, 2024.  Any claims that have not been received for claim released date March 27, 2024, through May 3, 2024,  will need to be resubmitted.

Payers affected: 

  • CPID 1742 Midlands Choice

  • CPID 6588 Midlands Choice

Action Required: Please resubmit any impacted claims not on file at this payer at this time.

REF 755650 8/16/2024

Provider Announcement: 837P and 837I McLaren Health Plans and MDWise Claim Submission

On Aug. 15, 2024, Optum was asked by McLaren Health Plans (MHP) and MDwise to hold claims submitted to Optum beginning Aug. 5, 2024, and until further notice. Please be aware that claims submitted via the Exchange clearinghouse were suspended from Aug. 13, 2024, at 6:00 p.m. ET through Aug. 15, 2024, at 6:00 p.m. ET. If claims were submitted during this time frame, they would have rejected with a message of “PAYER ID IS EXPIRED.” If that message was received, please resubmit.

McLaren and MDwise have provided the following statements regarding submission of claims:

McLaren Health Plans (MHP):
If you are submitting claims to McLaren Health Plan electronically, they are currently being held and will be released to McLaren Health Plan as our claims adjudication system becomes available. Continue to send electronic claims. Do not send paper claims.

Payer IDs:
McLaren Health Advantage 3833A (CPID 6634, 6735)
McLaren Health Plan 38338 (CPID 2592, 3794)
McLaren Medicaid 3833C (CPID 6631, 6732)
McLaren Medicare Supplement 3833S 
McLaren State of Michigan 3833M
McLarenAdvantage SNP 3833R (CPID 6637, 6739)

MDwise:
If you are submitting claims to MDwise electronically, they are currently being held and will be released to MDwise as our claims adjudication system becomes available. Continue to send electronic claims. Do not send paper claims.

Payer IDs: 
MDwise Health Indiana Plan 3135M (CPID 1086, 8113)
MDwise Hoosier Healthwise 3519M (CPID 1085, 8112)
MDwise Medicare Advantage MDADV

If you have additional questions or require assistance, please submit a support case at customercare.changehealthcare.com.

REF 756150 8/16/2024

Electronic Claims Connection Available

We would like to remind providers the following electronic claims connection is available for use:

Payer Name: NAHGA Claim Services
Institutional CPID: 4520
Professional CPID: 1223
Payer-assigned Payer ID: 67788
Payer Enrollment Required: No
Secondary Claims Accepted: Yes
Payer Location: National
Claims Fee: No

Action Required:

  • Add the payer to your system to begin using this payer connection.

REF 756102

Meritain Health Rejections CPIDs 1708, 4561

This message is for providers that submitted claims July 17, 2024-July 23, 2024 to Meritain Health (CPIDs 1708, 4561). 

Providers must resubmit claims sent during this time if a rejection of “PAYER ID IS EXPIRED” was received. 

Payer impacted:

Meritain Health 41124 4561 1708

Action Required: Please resubmit claims if this rejection was received.

REF 755700

Payer Deactivation  - Transamerica payers

This message is intended for Revenue Performance Advisor customers.

Effective immediately, the payers listed below will no longer be available at Optum for claims and remittance processing:

  • TRP1P Transamerica Life Insurance Company  - W Plano Parkway

  • TRCLF Transamerica Premier Life Insurance Company

  • TRLTC Transamerica Life Insurance Company (LTC)

Updated Payer Lists may be obtained from your software vendor or Optum. Optum is removing this payer from the Revenue Performance Advisor Payer List and any transactions sent using the above Payer ID will be rejected.

Action Required:
Please discontinue use of the above Payer IDs. Providers should review the patient's current insurance ID card for claim filing information.

REF 755600

Update on Humana ERA Connectivity

This message is for Assurance Reimbursement Management, Assurance EDI, and submitters or trading partners to the Exchange clearinghouse.

Update: A subset of our customers may have received Humana ERAs through July 17, 2024. After July 17, no ERAs were received. For providers who were previously enrolled for Humana ERA under Emdeon Business Services on the OKC network, you will need to re-enroll.

Original Message sent July 26:  

Since April 9, 2024, we restored electronic remittance advice (ERA) connectivity with Humana’s clearinghouse. While we have worked with the payer and their clearinghouse to reduce the disruption to providers as much as possible, Humana is asking that any provider who is not receiving current remits to re-enroll.

The following payer IDs may be impacted:

Humana I 61101 4544 61101 4544
Humana P 61101 2449 61101 2449
Humana Encounters I 61102 9589 61101 4544
Humana Encounters P 61102 3890 61101 2449
Humana Long Term Care I 61115 9508 61101 4544
Humana Long Term Care P 61115 1104 61101 2449

Remittance Enrollment Requirement:

  • This payer requires enrollment for electronic remittance:
    • Providers receiving current ERAs do not need to re-enroll.
    • Providers who may have received historical ERAs but are experiencing issues receiving current ERAs need to re-enroll.
    • New providers must complete a new enrollment form.

Action Required: Enrollment requirements and forms are available for self-service through Enrollment Central. For assistance, please submit a support case.

REF 754901 08/15/2024

Payer Removal CPID 1802 and 4564 United Medical Alliance

Effective immediately, the payer listed below has been removed from the payer list at Optum for electronic claim processing. 

Payer Name: United Medical Alliance

CPIDs: 1802, 4564

Payer ID: 84132

Transaction Type: 837I, 837P

Reason: Payer is unavailable electronically

Action Required: Please refrain from submitting claims until further notice.

REF 753251 8/15/2024

Centers for Medicare & Medicaid Services Eligibility Unavailable

Currently, the Eligibility connection for Medicare is unavailable.

Teams are working to resolve this issue.

Updates will be provided as progress is made toward a resolution.

REF754906 8/15/2024

Electronic Connection No Longer Available

Effective immediately, the payer listed below will no longer be available at Optum for claims and remittance processing.

Payer Name: Blue Cross Blue Shield Arizona Advantage
Claim and Remittance CPIDs: 5904, 2275
Reason: Payer no longer in business.

Action Required: None

REF 755100

Claim Processing Suspended for McLaren Health Plans

This message is intended for Assurance, Exchange, and Revenue Performance Advisor (RPA) customers.

Effective immediately, the payer listed below has been removed from the payer list at Optum for electronic claim processing.

Payer Name: McLaren Health Plans
CPIDs: 2592, 3794
Payer ID: 38338
Transaction Type: 837, 835
Reason: Payer is unavailable electronically

Payer Name: McLaren Advantage SNP
CPIDs: 6739, 6634
Payer ID: 3833R
Transaction Type: 837, 835
Reason: Payer is unavailable electronically

Payer Name: McLaren Health Advantage
CPIDs: 6634, 6735
Payer ID: 3833A
Transaction Type: 837, 835
Reason: Payer is unavailable electronically

Payer Name: McLaren Health Plan Medicaid
CPIDs: 6631, 6732
Payer ID: 3833C
Transaction Type: 837, 835
Reason: Payer is unavailable electronically

Action Required: Please refrain from submitting claims until further notice. 

REF 753250 8/15/2024

Report Generation Delay for CPID 2410 South Carolina Blue Cross Blue Shield

The payer listed below is experiencing issues affecting Professional report generation for some claims submitted on Aug. 5, 2024 and Aug. 8, 2024.

Payer impacted:

  • CPID 2410 South Carolina Blue Cross Blue Shield

The payer is unable to generate and deliver the reports.

Action Required: None. Please resubmit claims if payment has not been received.

REF 754450 08/15/2024

Report Generation Delay for CPID 2401 Tennessee Blue Cross Blue Shield

The payer listed below is experiencing issues affecting Professional report generation for some claims submitted on Aug. 5, 2024.

Payer impacted:

  • CPID 2401 Tennessee Blue Cross Blue Shield

The payer is unable to generate and deliver the reports.

Action Required: None. Please resubmit claims if payment has not been received.

REF 754451 08/15/2024

Report Generation Delay for CPIDs 5514 and 2495 Tennessee BlueCare/TennCare

The payer listed below is experiencing issues affecting Institutional and Professional report generation for some claims submitted from Aug. 2, 2024, through Aug. 7, 2024.

Payer impacted:

  • CPID 5514 Tennessee BlueCare/TennCare
  • CPID 2495 Tennessee BlueCare/TennCare

Optum is working diligently with the payer to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 754452 8/15/2024

Electronic Routing Change for CPIDs 7264, 8677 Quartz ASO

Effective immediately, Optum will be changing electronic remittance routing for the following payer:

Payer Name: Quartz ASO
Professional CPID: 7264
Institutional CPID: 8677
Payer-assigned Payer ID: 39180

Enrollment Requirements:
Remittance:

  • Payer enrollment for electronic remittance is required.
  • All providers must complete a new enrollment form to receive electronic remittance for Quartz ASO.

Action Required:

  • Please be aware of the changes above and complete a new enrollment form to receive remittance.
  • Forms must be submitted and approved from Enrollment Central.

REF 753356

Electronic Claims Connection Suspended for CPID 7293 Amwins Connect Administrators

Effective immediately, the payer listed below has/have been temporarily suspended at Optum for claims processing and removed from the payer list.

Payer Name: Amwins Connect Administrators

CPID: 7293

Payer ID: 41201

Action Required: Please refrain from submitting claims until further notice.

REF 753402 8/14/2024

Claims Consolidation Amalgamated Life Pennsylvania/Alicare

Effective immediately, claims currently exchanged with the following payer must use different CPIDs.

Payer Name: Amalgamated Life Pennsylvania/Alicare
Professional CPID: 4297
Institutional CPID: 4673
Remittance Available: No
Payer-assigned Payer ID: 13343

Claims must begin using the following:

Payer Name: Amalgamated Life
Professional CPID: 5403
Institutional CPID: 4591
Remittance Available: Yes
Payer-assigned Payer ID: 13550
Claim Fee: N/A

Enrollment Requirements:
Claims:

  • Payer enrollment for electronic claims is not required.

Remittance:

  • Payer enrollment for electronic remittance is required.
  • Providers currently receiving electronic remittance through Optum for CPIDs 5403, 4591 Amalgamated Life do not need to complete a new enrollment form.
  • Providers not receiving electronic remittance through Optum for CPIDs 5403, 4591 Amalgamated Life must complete a new enrollment form.
  • New providers must complete a new enrollment form.

Action Required:

  • Please be aware of the changes above and make any necessary changes in your system.
  • To access the new enrollment forms, please visit Enrollment Central.

REF 753052  8/13/24

Report Generation Delay for Multiple CPIDs

Due to a payer intermediary processing issue, Institutional claims transmitted to the payers listed below were not processed on Aug. 2, 2024.

Payers Impacted: 

CPID

Payer Name 

2689

ASRM Corporation

9644

Accelerated Claims, Inc.

1631

Alameda Alliance for Health

2086

Beacon of Life

2680

Care Wisconsin Health Plan

7964

Carolina Behavioral Health Alliance

2550

Colonial Penn Life Insurance Company

5095

CommuniCare Advantage

8045

Desert Oasis Healthcare

5662

Eastpointe Human Services

3588

Florida PACE Centers

4669

Freedom Life Insurance Company

6685

Health First Health Plan

1023

HealthTeam Advantage

4644

Integrated Medical Solutions

8672

JLS Family Enterprises (dba League Medical Concepts)

8936

Jai Medical Systems

1659

Joplin Claims

5930

Medigold PPO

2957

Merchant Benefit Administration (Repriced Claims Only)

1098

Molina Complete Care of Arizona

3042

Molina Complete Care of Virginia

8050

Molina Healthcare Iowa

6086

Molina Healthcare Of Nevada

3539

Molina Healthcare of California

1019

Molina Healthcare of California (Encounters Only)

8913

Molina Healthcare of Florida

1018

Molina Healthcare of Idaho

6907

Molina Healthcare of Illinois

3551

Molina Healthcare of Michigan

1053

Molina Healthcare of Mississippi

3626

Molina Healthcare of Nebraska

8914

Molina Healthcare of New Mexico

5684

Molina Healthcare of New York

1908

Molina Healthcare of Ohio

6998

Molina Healthcare of South Carolina

4957

Molina Healthcare of Texas

3611

Molina Healthcare of Utah

2561

Molina Healthcare of Washington

5951

Molina Healthcare of Wisconsin

5015

Passport Health Plan by Molina Healthcare

8034

Peak Health

3053

Provider Partners Health Plan of Illinois

4505

Provider Partners Health Plan of Maryland

2077

Provider Partners Health Plan of Pennsylvania

7023

Provider Partners Health Plans of Texas

5068

Senior Whole Health New York

6085

Senior Whole Health of Massachusetts

9567

Signature Advantage

1907

iCARE, Independent Care Health

A resolution has been implemented and the claims were retransmitted to the payer intermediary on Aug. 9, 2024.

This delay affected claims released to Optum between 9 p.m. ET on Aug. 1, 2024, and 9 p.m. ET on Aug. 2, 2024.

Action Required: Be aware of the processing issue above.

REF 752051 8/13/2024

Electronic Claims Connection Suspended

Effective immediately, the payer listed below has/have been temporarily suspended at Optum for claims processing and removed from the payer list. 

Payer Name:  United Medical Alliance

CPIDs:  4564, 1802

Payer ID:  84132

Action Required: Please refrain from submitting claims until further notice.

REF 752700 8/13/2024

Electronic Claims Connection No Longer Available Transamerica Life Insurance Company - Plano and Hurst TX

Effective immediately, the payer listed below will no longer be available at Optum for claims and remittance processing.

Payer Name: Transamerica Life Insurance Company - Plano and Hurst TX

Claim and Remittance CPIDs: 1083, 8110

Payer ID TRLTC

Remittance LOB: H6I

Reason: Payer no longer in business.

Action Required: None

REF 752150 8/12/2024

Update: Report Generation Delay for multiple CPIDs

Due to a payer intermediary processing issue, Institutional claims transmitted to the payers listed below July 31, 2024 were not processed by the payers.

Payers impacted:

  • CPID 3539 Molina Healthcare of California
  • CPID 3551 Molina Healthcare of Michigan
  • CPID 4957 Molina Healthcare of Texas

A resolution has been implemented and the claims were retransmitted to the payer intermediary Aug. 12, 2024.

Action Required: Be aware of the processing issue above.

Original notify sent Aug. 5, 2024:
A payer intermediary is experiencing issues affecting Institutional report generation for some claims submitted July 31, 2024.

Payers impacted:

  • CPID 3539 Molina Healthcare of California
  • CPID 3551 Molina Healthcare of Michigan
  • CPID 4957 Molina Healthcare of Texas

Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 752055  8/12/2024

Block Vision Suspended

This message is intended for Assurance, Exchange, and RPA customers.

Effective immediately, the payer listed below has been removed from the payer list at Optum for electronic claim processing.

Payer Name: Block Vision

CPIDs: 3402

Payer ID: BVTX1 BLOCK, BV001

Transaction Type: 837P

Reason: Payer is unavailable electronically

Action Required: Please refrain from submitting claims until further notice.

REF 751900 8/12/2024

Electronic Routing Change for UCare and Aspirius ERAs

This message is for Assurance Reimbursement Management, Assurance EDI, and submitters or trading partners to the Exchange clearinghouse.

Optum will be changing electronic routing for the following payer:

Aspirus Medicare Advantage 36483 4097 8840
UCare Plans 55413 1038 7867

ERA Enrollment Requirements:

  • This payer requires enrollment for electronic remittance:
  • Providers who were previously enrolled with Optum (Change Healthcare) as of Aug. 12, 2024, and did not switch their enrollment away from Optum (Change Healthcare) will begin receiving ERAs when connectivity is reestablished.
  • New providers must complete a new enrollment form.
  • Providers who moved their enrollment to another clearinghouse will need to re-enroll with Optum (Change Healthcare) to receive ERAs for this payer from Optum (Change Healthcare).

Historical ERAs:

For providers who need historical ERAs (electronic remittance advice), UCare and Aspirius have provided the following guidance:

  • UCare providers may contact the UCare Provider Assistance Center here or call 612-676-3300 or 888-531-1493 to request historical ERAs going back 90 days. For anything older than 90 days, UCare can provide a copy of the EOP (paper remit).
  • Aspirus providers may contact the Aspirus Health Plan Provider Assistance Center at 715-631-7412 or toll-free at 855-931-4851 to request any historical 835s going back 90 days.  For anything older than 90 days, Aspirus can provide a copy of the EOP (paper remit).

Action Required: Please consider the following to allow transactions to process properly due to the above changes:

  • Make any necessary system changes.
  • When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.

REF 747154 8/8/2024

Report Generation Delay for CPIDs 1920 and 2297 Health Services for Children with Special Needs

A payer is experiencing issues affecting Professional and Institutional report generation for claims submitted since Aug. 1, 2024.

Payer impacted: 

  • CPID 1920 Health Services for Children with Special Needs
  • CPID 2297 Health Services for Children with Special Needs

Optum is working diligently with the payer to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 750200 8/07/2024

Report Generation Delay for CPID 4016 CareCentrix Wellcare

A payer experienced issues affecting Institutional report generation for some claims submitted on July 19, 2024.

Payer impacted: 

  • CPID 4016 CareCentrix Wellcare

The payer is unable to generate and deliver the reports.

Action Required: None. Please resubmit claims if payment has not been received.

REF 750201 8/07/2024

New Electronic Claims Connections Available

Effective August 8, 2024, Optum has new electronic claims connections available: 

Payer Name: Aetna Encounters

Institutional CPID: 7902

Professional CPID: 3428

Payer-assigned Payer ID: 60055

Payer Enrollment Required: No

Secondary Claims Accepted: Yes

Payer Location: National

Claims Fee: NA

Action Required: 

  • Add the payers to your system to begin using the new payer connection.
  • When a payer requires enrollment, forms must be submitted and approved to begin submitting transactions.

REF 750750 8/7/2024

Claim Processing Suspended for CPIDs 4643, 6162 Healthscope Benefits

This message is intended for Assurance and Exchange customers.

Effective immediately, the payer listed below has been temporarily suspended at Optum for claims processing and removed from the payer list.

Payer Name: Healthscope Benefits
CPIDs: 4643, 6162
Payer ID: 52429

Reason: Payer unavailable electronically

Action Required: Please refrain from submitting claims until further notice.

REF 749901 8/7/2024

Report Generation Delay for CPID 8149 IU Health Transplant

A payer intermediary is experiencing issues affecting professional report generation for some claims submitted since Aug. 2, 2024.

Payer impacted:

  • CPID 8149 IU Health Transplant

Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 750400  8/7/2024

Report Generation Delay for multiple CPIDs

A payer intermediary is experiencing issues affecting Institutional report generation for some claims submitted on Aug. 2, 2024.

Payers impacted:  

  • CPID 2689 ASRM Corporation
  • CPID 9644 Accelerated Claims, Inc.
  • CPID 1631 Alameda Alliance for Health
  • CPID 2086 Beacon of Life
  • CPID 2680 Care Wisconsin Health Plan
  • CPID 7964 Carolina Behavioral Health Alliance
  • CPID 2550 Colonial Penn Life Insurance Company
  • CPID 5095 CommuniCare Advantage
  • CPID 8045 Desert Oasis Healthcare
  • CPID 5662 Eastpointe Human Services
  • CPID 3588 Florida PACE Centers
  • CPID 4669 Freedom Life Insurance Company
  • CPID 6685 Health First Health Plan
  • CPID 1023 HealthTeam Advantage
  • CPID 4644 Integrated Medical Solutions
  • CPID 8672 JLS Family Enterprises (dba League Medical Concepts)
  • CPID 8936 Jai Medical Systems
  • CPID 1659 Joplin Claims
  • CPID 5930 Medigold PPO
  • CPID 2957 Merchant Benefit Administration (Repriced Claims Only)
  • CPID 1098 Molina Complete Care of Arizona
  • CPID 3042 Molina Complete Care of Virginia
  • CPID 8050 Molina Healthcare Iowa
  • CPID 6086 Molina Healthcare Of Nevada
  • CPID 3539 Molina Healthcare of California
  • CPID 1019 Molina Healthcare of California (Encounters Only)
  • CPID 8913 Molina Healthcare of Florida
  • CPID 1018 Molina Healthcare of Idaho
  • CPID 6907 Molina Healthcare of Illinois
  • CPID 3551 Molina Healthcare of Michigan
  • CPID 1053 Molina Healthcare of Mississippi
  • CPID 3626 Molina Healthcare of Nebraska
  • CPID 8914 Molina Healthcare of New Mexico
  • CPID 5684 Molina Healthcare of New York
  • CPID 1908 Molina Healthcare of Ohio
  • CPID 6998 Molina Healthcare of South Carolina
  • CPID 4957 Molina Healthcare of Texas
  • CPID 3611 Molina Healthcare of Utah
  • CPID 2561 Molina Healthcare of Washington
  • CPID 5951 Molina Healthcare of Wisconsin
  • CPID 5015 Passport Health Plan by Molina Healthcare
  • CPID 8034 Peak Health
  • CPID 3053 Provider Partners Health Plan of Illinois
  • CPID 4505 Provider Partners Health Plan of Maryland
  • CPID 2077 Provider Partners Health Plan of Pennsylvania
  • CPID 7023 Provider Partners Health Plans of Texas
  • CPID 5068 Senior Whole Health New York
  • CPID 6085 Senior Whole Health of Massachusetts
  • CPID 9567 Signature Advantage
  • CPID 1907 iCARE, Independent Care Health

Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 749950 8/7/24

Claim Processing Termination for CPIDs 9533, 7822 Florida Hospital VBR

Effective immediately, the payer listed below will no longer be available at Optum for claims processing.

Payer Name: Florida Hospital VBR

  • CPID(s): 9533, 7822

Reason: Payer no longer contracted.

Action Required: None.

REF 749700 8/06/2024

Invalid Error Message for CPID 5000 Braven Health

Due to a payer processing issue, Institutional claims for the payer listed below may have received the following invalid error messages on the Payer Batch Totals Report (SB), Payer Batch Totals Data File (SD), Payer Claim Data Report (SR), Payer Claim Data Report (SE),  Payer Report Data File (SF):

Reject Code: A8:255

Message: ACKNOWLEDGEMENT, REJECTED FOR RELATIONAL FIELD IN ERROR.:DIAGNOSIS CODE.

Payer impacted: 

  • CPID 5000 Braven Health

This issue began on July 26, 2024 and was resolved by the payer on July 31, 2024.

Claims were retransmitted to the payer on Aug. 6, 2024. 

Action Required: Please be aware of the invalid error message and possible valid duplicate rejections.

REF 749704 8/7/2024

Delay in Electronic Remittance Advice (ERA) for Multiple CPIDs

Due to a payer processing issue, there has been a delay in some Professional and Institutional Electronic Remittance Advice (ERA) for the following payers for file dates of May 21, 2024, through present: 

  • CPID 1475 Louisiana Medicaid
  • CPID 3578 Louisiana Medicaid
  • CPID 1183 Louisiana Medicaid Medicare Advantage Crossovers
  • CPID 1675 Louisiana Medicaid Home Health
  • CPID 2236 Louisiana Medicaid Ambulance
  • CPID 2554 Louisiana Medicaid Medicare Advantage Crossovers
  • CPID 4604 Louisiana Medicaid Long Term Care
  • CPID 5232 Louisiana Medicaid Durable Medical Equipment
  • CPID 7177 Louisiana Medicaid Rehab

Additional updates will be forwarded as more information becomes available. 

Action Required: Please be aware of a delay in the delivery of ERA for file dates above.

REF 749702 8/06/2024

Report Generation Delay for CPID 3889 Physicians Mutual Insurance Company

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted between July 19, 2024, and July 20, 2024.

Payer impacted: 

  • CPID 3889 Physicians Mutual Insurance Company

Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 749751 8/06/2024

Payer Transmit Delay for CPIDs 1492 and 5562 New Mexico Medicaid

Due to a payer system issue, a delay occurred in transmission to the following payer from Aug. 5, 2024, to present.

Payer impacted:

  • CPID 1492 New Mexico Medicaid
  • CPID 5562 New Mexico Medicaid

Optum is working with the payer to resolve this issue. We will notify you as soon as additional information becomes available.

This delay affected claims released to Optum since 10 p.m. ET on Aug. 5, 2024. 

Action Required: Be aware of the transmit delay above.

REF 749701 8/06/2024

Report Generation Delay for CPID 7646 Ultimate Health Plans

A payer intermediary is experiencing issues affecting Institutional report generation for some claims submitted between July 10, 2024, and July 29, 2024.

Payer impacted:

  • CPID 7646 Ultimate Health Plans

Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 749750 8/06/2024

Delay in Electronic Remittance Advice (ERA) for CPIDs 1518 and 2714 Hawaii Blue Cross Blue Shield HMSA

Due to a processing issue, there has been a delay in some Professional and Institutional Electronic Remittance Advice (ERA) for the following payer for file dates April 19, 2024 through present:

  • CPID 1518 Hawaii Blue Cross Blue Shield HMSA
  • CPID 2714 Hawaii Blue Cross Blue Shield HMSA

Additional updates will be forwarded as more information becomes available.

Action Required: Please be aware of a delay in the delivery of ERA for file dates above.

REF 749703

Report Generation Delay for CPID 5835 Trilogy Health Network

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted since July 8, 2024.

Payer impacted:

  • CPID 5835 Trilogy Health Network

Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 749752

Payer Processing Issue for multiple CPIDs

Due to a payer processing issue, Institutional and Professional claims transmitted to the payers listed below on Aug. 1, 2024 were not processed by the payers.

Payers impacted: 

  • CPID 2423 Alabama Blue Cross Blue Shield
  • CPID 5558 Alabama Blue Cross Blue Shield
  • CPID 1002 Alabama Blue Cross Blue Shield Medicare Advantage

A resolution has been implemented and the claims were retransmitted to the payers on Aug. 6, 2024.

This delay affected claims released to Optum between 1 p.m. CT on July 31, 2024 and 1 p.m. CT on Aug. 1, 2024.

Action Required: Be aware of the processing issue above.

REF 748553 8/6/2024

Report Generation Delay for CPID 3826 CareSource of Ohio

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted July 27, 2024.

Payer impacted:

  • CPID 3826 CareSource of Ohio

The payer intermediary is unable to generate and deliver the reports.

Action Required: None. Please resubmit claims if payment has not been received.

REF 749300  8/6/2024

Payer Processing Issue for CPID 3509 Ohio Medicaid

Due to a payer processing issue, institutional claims transmitted to the payer listed below on Aug. 5, 2024, were not processed by the payer.

Payer impacted:

  • CPID 3509 Ohio Medicaid

A resolution has been implemented and the claims were retransmitted to the payer on Aug. 6, 2024.

This delay affected claims released to Optum between 2 p.m. CT on Aug. 2, 2024, and 2 a.m. CT on Aug. 5, 2024.

Action Required: Be aware of the processing issue above.

REF 749250 8/06/2024

Report Generation Delay for CPID 2483 Texas Childrens Health Plan (STAR Medicaid)

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted on July 23, 2024, and July 24, 2024.

Payer impacted: 

  • CPID 2483 Texas Childrens Health Plan (STAR Medicaid)

Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 748702 8/05/2024

Report Generation Delay for CPID 8149 IU Health Transplant

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted August 1, 2024.

Payer impacted:

  • CPID 8149 IU Health Transplant

The payer intermediary is unable to generate and deliver the reports.

Action Required: None. Please resubmit claims if payment has not been received.

REF 748705  8/5/2024

Report Generation Delay for multiple CPIDs

A payer intermediary is experiencing issues affecting Institutional report generation for some claims submitted on July 31, 2024.

Payers impacted: 

  • CPID 3539 Molina Healthcare of California
  • CPID 3551 Molina Healthcare of Michigan
  • CPID 4957 Molina Healthcare of Texas

Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 748704 8/5/2024

Report Generation Delay for CPID 5016 NextBlue of North Dakota

A payer intermediary is experiencing issues affecting institutional report generation for some claims submitted July 23, 2024.

Payer impacted:

  • CPID 5016 NextBlue of North Dakota

The payer intermediary is unable to generate and deliver the reports.

Action Required: None. Please resubmit claims if payment has not been received.

REF 748701  8/5/2024

Update: Report Generation Delay for CPID 3532 Michigan Blue Care Network

Update: The payer intermediary is unable to generate and deliver the reports for some claims submitted on July 12, 2024.

Action Required: Please resubmit claims if payment has not been received.

Original notify sent July 29, 2024:

A payer intermediary is experiencing issues affecting Institutional report generation for some claims submitted on July 12, 2024.

Payer impacted: 

  • CPID 3532 Michigan Blue Care Network

Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 744051 / 748700 8/5/2024

Report Generation Delay for CPIDs 3658 and 5862 CorrectCare Integrated Health

A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted since July 24, 2024.

Payer impacted:

  • CPID 3658 CorrectCare Integrated Health
  • CPID 5862 CorrectCare Integrated Health

Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 748702  8/5/2024

Invalid Rejections for CPID 5526 New Jersey Horizon Blue Cross Blue Shield

Due to a payer processing issue, some claims submitted to the payer listed below from Optum on July 29, 2024, may have received the following invalid rejection.

Rejection message: A8:255 RELATIONAL EDIT -AGE AND DIAGNOSIS CODE

Payer impacted:

  • CPID 5526 New Jersey Horizon Blue Cross Blue Shield

Action Required: Please resubmit any affected claims.

REF 747950 8/02/2024

Report Generation Delay for CPID 3509 Ohio Medicaid

A payer is experiencing issues affecting Institutional report generation for some claims submitted on July 24, 2024.

Payer impacted: 

  • CPID 3509 Ohio Medicaid

The payer is unable to generate and deliver the reports.

Action Required: None. Please resubmit claims if payment has not been received.

REF 747300 8/02/2024

Report Generation Delay for CPID 1500 New York Medicaid

A payer is experiencing issues affecting Institutional report generation for some claims submitted July 29, 2024.

Payer impacted:

  • CPID 1500 New York Medicaid

The payer is unable to generate and deliver the reports.

Action Required: None. Please resubmit claims if payment has not been received.

REF 746951 8/02/2024

Update: Report Generation Delay for CPIDs 2423 and 5558 Alabama Blue Cross Blue Shield

Update: It has been determined that the report delay below was due to a payer claims processing issue. We have retransmitted the impacted claims to the payer on Aug. 2, 2024.  Reports will be delivered once the claims have successfully processed at the payer.

Action Required: Please be aware of delays.

Original Notice Sent 7/30/24:

A payer is experiencing issues affecting Institutional report generation for some claims submitted on July 26, 2024.

Payer impacted: 

  • CPID 2423 Alabama Blue Cross Blue Shield
  • CPID 5558 Alabama Blue Cross Blue Shield

Optum is working diligently with the payer to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 744604 / 747301 8/2/2024

Enrollment Required for Kansas Medicaid

Update: As of July 24, 2024, Optum has restored the existing routing and connectivity to Kansas Medicaid. ERAs will be available to providers enrolled with Optum (Change Healthcare) and did not move their enrollment to another vendor. Providers do not need to reenroll if they did not move enrollment. 

Previous Message: Effective July 10, 2024, Optum will be changing electronic routing and restoring 835 connectivity for the following payer:

Kansas Medicaid SKKS0 5520 1485

Remittance Enrollment Requirements:

  • Payer enrollment for electronic remittance is required
  • New providers must complete a new enrollment form.

Action Required:

Enrollment requirements and forms are available for self-service through Enrollment Central. For assistance, please submit a support case.

REF 747152

Important Announcement from Optum regarding Massachusetts Medicaid

This message is intended for Assurance Reimbursement Management, Assurance EDI, and submitters or trading partners to the Exchange clearinghouse.

Effective August 1, 2024, Optum will be changing electronic routing for EDI claims and remits for the following payer:

Massachusetts Medicaid DMA7384 5529
Massachusetts Medicaid Long Term Care DMA7384 2905
Massachusetts Medicaid Format 5 DMA7384 4491
Massachusetts Medicaid Format 9 DMA7384 4492

Adding or Changing Billing Intermediary to Optum Insight - Requirement to submit, or receive, Massachusetts Medicaid EDI transactions with Optum:

  • To participate in submitting or receiving EDI transactions to Massachusetts Medicaid through Optum please go to Enrollment Central for a template to submit the following information on your company letterhead to MassHealth. For assistance, please submit a support case.
  • MassHealth Provider ID / Service Location (PIDSL)
  • National Provider ID (NPI) Number
  • Provider Federal Tax Identification Number (TIN) or Employer Identification Number (EIN)
  • Provider Full Mailing Address
  • Contact Information (Name, Phone Number, and Email Address)
  • Signed with typed/printed name
  • Brief description of the request with HIPAA transactions specified (for example, institutional or professional claims or ERA)
  • Vendor Name and Vendor’s MassHealth Submitter ID (PIDSL)
  • Vendor Name: Optum Insight
  • Massachusetts Medicaid PID/SL: 110210691A

Action Required:

  • Providers are responsible for emailing the information above to MassHealth at [email protected] to receive or submit transactions with Optum.

Historical ERAs:

Optum has been working to restore ERA services with Massachusetts Medicaid. On February 29, 2024, MassHealth terminated their connection with Change Healthcare, and we are unable to retrieve any files for delivery to Providers. For Providers who need to retrieve historical ERAs, MassHealth has made ERAs from March 3, 2024 forward available to providers as direct receivers.

For access, providers can go to the Provider Online Service Center (POSC) on the MassHealth website to retrieve these historical ERAs. If there are any ERAs needed that are not posted on POSC, providers can use the .PDF remit to reconcile accounts. For more information on the remittance advice report please visit the MMIS Job Aid on the MassHealth website.

Note: providers will need to follow the instructions above to participate in submitting or receiving transactions with MassHealth through Optum.

Timely Filing:

Optum has been working with Massachusetts Medicaid to restore services to providers. For providers who need exceptions for the 90-day timely filing window, the state has provided the following guidance:

  • Providers have two options for timely filing exception:
  • Providers may submit 90-DW with each claim via Direct Data Entry (DDE) on the Provider Online Service Center (POSC).
  • Providers may initiate a batch 90-DW process with the MassHealth EDI team by sending an email request to [email protected] letting them know that a request for batch 90-DW process is being requested, and the EDI team will assist the provider in pursuing this option.

REF 747150 8/2/2024

Report Generation Delay for CPID 6671 HealthSun

A payer intermediary is experiencing issues affecting Institutional report generation for some claims submitted on July 22, 2024.

Payer Impacted: 

  • CPID 6671 HealthSun

The payer intermediary is unable to generate and deliver the reports.

Action Required: None. Please resubmit claims if payment has not been received.

REF 746301 8/01/2024

Payer Processing Issue for CPIDs 1485 and 5520 Kansas Medicaid

Due to a payer processing issue, Professional and Institutional claims transmitted to the following payer between July 25, 2024, and July 31, 2024, were not processed by the payer.

Payer Impacted: 

  • CPID 1485 Kansas Medicaid
  • CPID 5520 Kansas Medicaid

A resolution has been implemented and the claims were retransmitted to the payer on Aug. 1, 2024.

This delay affected claims released to Optum between 2 p.m. ET on July 24, 2024, and 2  p.m. ET on July 31, 2024.

Action Required: Be aware of the processing issue above.

REF 746552 8/01/2024

Report Generation Delay for multiple CPIDs

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted since July 25, 2024.

Payers impacted:

  • CPID 2162 Colorado Medicare
  • CPID 2163 Delaware Medicare
  • CPID 2165 District of Columbia Metropolitan Area (DCMA) Medicare
  • CPID 1806 FiServ Health (Kansas & Tennessee)
  • CPID 2224 Illinois Medicare
  • CPID 2201 Maryland Medicare
  • CPID 2229 Massachusetts Medicare
  • CPID 2464 Maryland Medicare (Montgomery, Prince George)
  • CPID 2209 Medicare DME MAC Jurisdiction A
  • CPID 2211 Medicare DME MAC Jurisdiction B
  • CPID 2213 Medicare DME MAC Jurisdiction C
  • CPID 2215 Medicare DME MAC Jurisdiction D
  • CPID 2205 New Jersey Medicare
  • CPID 2260 New York Medicare GHI
  • CPID 2261 New York Medicare Upstate
  • CPID 2206 Oklahoma Medicare
  • CPID 2207 Pennsylvania Medicare
  • CPID 2208 Texas Medicare
  • CPID 2278 Vermont Medicare

Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 746950 08/01/2024

Report Generation Delay for CPID 5243 Healthcare Management Administrators

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted on July 22, 2024 and July 23, 2024.

Payer impacted: 

  • CPID 5243 Healthcare Management Administrators

The payer intermediary is unable to generate and deliver the reports.

Action Required: None. Please resubmit claims if payment has not been received.

REF 746300 8/1/2024

Report Generation Delay for CPID 2830 CarePlus Health Plans

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted on July 22, 2024.

Payer impacted:

  • CPID 2830 CarePlus Health Plans

The payer intermediary is unable to generate and deliver the reports.

Action Required: None. Please resubmit claims if payment has not been received.

REF 746200 8/1/2024

999 Payer Batch Rejections for multiple CPIDs

Institutional claims transmitted to the payers listed below from Optum on June 12, 2024, were not processed by the payers due to a 999 Batch Rejection. 

Payers impacted:

  • CPID 3539 Molina Healthcare of California
  • CPID 3551 Molina Healthcare of Michigan
  • CPID 4957 Molina Healthcare of Texas

A resolution has been implemented and the claims were retransmitted to the payers on July 31, 2024.

Action Required: None.

REF 745603 7/31/2024

Payer Transmit Delay for Multiple CPIDs

Due to a payer system issue, a delay occurred in the transmission to the following payers since July 26, 2024.

Payers impacted:

  • CPID 7827 CHCS Services
  • CPID 3003 CHCS Services
  • CPID 2489 USAA
  • CPID 7527 USAA

Optum is working with the payers to resolve this issue. We will notify you as soon as additional information becomes available.

This delay affected claims released to Optum since 12 a.m. CT on July 25, 2024. 

Action Required: Be aware of the transmit delay above.

REF 744605 7/30/2024

Report Generation Delay for CPID 6987 Veterans Affairs Financial Services Center

A payer intermediary is experiencing issues affecting Institutional report generation for some claims submitted July 18, 2024.

Payer impacted:

  • CPID 6987 Veterans Affairs Financial Services Center

The payer intermediary is unable to generate and deliver the reports.

Action Required: None. Please resubmit claims if payment has not been received.

REF 744904  7/30/2024

Report Generation Delay for CPID 4790 Division of Immigration Health Services

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted on July 16, 2024.

Payer impacted:

  • CPID 4790 Division of Immigration Health Services

The payer intermediary is unable to generate and deliver the reports.

Action Required: None. Please resubmit claims if payment has not been received.

REF 744902 07/30/2024

New Electronic Remittance Connection Available

Effective July 30, 2024, Optum has a new electronic remittance connection available:

Payer Name: Liberty Dental

Professional CPID: 2716

Payer-assigned Payer ID: CX083

Line of Business (LOB) Code: N24

Payer Enrollment Required: Yes

Remittance Surcharge: N/A

Payer Location: National

Action Required:

  • Add the payers to your system to begin using the new payer connection.
  • Enrollment forms must be submitted and approved to begin receiving electronic remittance.

REF 744502 07/30/2024

Payer Processing Issue for CPIDs 6991 and 2446 Arkansas Managed Care Organization (AMCO)

Due to a payer intermediary processing issue, Institutional and Professional claims transmitted to the payer listed below since July 9, 2024, have not been processed by the payer.

Payer affected:

  • CPID 6991 Arkansas Managed Care Organization (AMCO)
  • CPID 2446 Arkansas Managed Care Organization (AMCO)

Optum is working with the payer intermediary to resolve this processing issue.

Action Required: Be aware of the processing issue above.

REF 745100 07/30/2024

Report Generation Delay for CPID 2991 UMWA H & R Funds

A payer experienced issues affecting Institutional report generation for some claims submitted June 27, 2024 and June 28, 2024.

Payer impacted:

  • CPID 2991 UMWA H & R Funds

The payer is unable to generate and deliver the reports.

Action Required: None. Please resubmit claims if payment has not been received.

REF 744851  7/30/2024

Report Generation Delay for CPIDs 2423 and 5558 Alabama Blue Cross Blue Shield

A payer is experiencing issues affecting Institutional and Professional report generation for some claims submitted on July 26, 2024.

Payer impacted: 

  • CPID 2423 Alabama Blue Cross Blue Shield
  • CPID 5558 Alabama Blue Cross Blue Shield

Optum is working diligently with the payer to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 744604 7/30/2024

Report Generation Delay for CPID 3509 Ohio Medicaid

The payer listed below is experiencing issues affecting institutional report generation for some claims submitted July 24, 2024.

Payer impacted:

  • CPID 3509 Ohio Medicaid
  • RPA Payer ID SKOH0  Ohio Medicaid

Optum is working diligently with the payer to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 744603  7/30/2024

Payer Transmit Delay for CPIDs 2986 and 3207 Employee Benefit Management

Due to a system issue, a delay occurred in the transmission to the following payer July 19, 2024-July 29, 2024.

Payer impacted:

  • CPID 2986 Employee Benefit Management
  • CPID 3207 Employee Benefit Management

A resolution has been implemented and claims were transmitted to the payer July 30, 2024. This delay affected claims released to Optum July 18, 2024, 4:30 a.m. -July 29, 2024, 4:30 a.m. CT.

Action Required: Be aware of the transmit delay above.

REF 744701  7/30/2024

Payer Processing Issue for CPIDs 9180 and 7517 Guarantee Trust Life

Claim files were not sent to the payer listed below. The payer does not currently have a live electronic connection with Optum yet. This issue started on July 23, 2024.

Payer Name and CPIDs:

  • Guarantee Trust Life 
  • CPID 9180
  • CPID 7517

Submitter Action Required: No action is needed.

This report is informational only.

REF 744500 7/30/2024

Report Generation Delay for CPID 7499 Sentara Health/Optima Health

The payer listed below is experiencing issues affecting Professional report generation for some claims submitted on July 25, 2024.

Payer impacted:

  • CPID 7499 Sentara Health/Optima Health

The payer is unable to generate and deliver the reports for some claims submitted on July 25, 2024.

Action Required: Please resubmit claims if payment has not been received.

REF 744602 07/30/2024

Report Generation Delay for CPIDs 1485 and 5520 Kansas Medicaid

A payer is experiencing issues affecting Professional and Institutional report generation for some claims submitted since July 25, 2024.

Payer impacted:

  • CPID 1485 Kansas Medicaid
  • CPID 5520 Kansas Medicaid

Optum is working diligently with the payer to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 744601  7/30/2024

Payer Processing Issue for Multiple CPIDs

Due to a payer processing issue, some Professional and Institutional claims transmitted to the payer listed below on July 25, 2024 were not processed by the payer.

Payer impacted: 

  • 1422 New York Medicaid
  • 1500 New York Medicaid
  • 2429 New York Medicaid
  • 6540 New York Medicaid

A resolution has been implemented and the claims were retransmitted to the payer on July 30, 2024.

This delay affected claims released to Change Healthcare between 9 p.m. CT on July 24, 2024 and 9 p.m. CT on July 25, 2024.

Action Required: Be aware of the processing issue above.

REF 744600 7/30/2024

Report Generation Delay for CPIDs 2986 and 3207 Employee Benefit Management

A payer intermediary is experiencing issues affecting institutional and professional report generation for some claims submitted on July 18, 2024.

Payer impacted:

  • CPID 2986 Employee Benefit Management
  • CPID 3207 Employee Benefit Management

The payer intermediary is unable to generate and deliver the reports.

Action Required: None. Please resubmit claims if payment has not been received.

REF 744053 07/29/2024

Report Generation Delay for CPID 3532 Michigan Blue Care Network

A payer intermediary is experiencing issues affecting Institutional report generation for some claims submitted on July 12, 2024.

Payer impacted:

  • CPID 3532 Michigan Blue Care Network

Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 744051 07/29/24

Electronic Routing Change for Texas Medicaid Long Term Care (CPIDs 2904, 8202)

This message is for Assurance Reimbursement Management, Assurance EDI, and submitters or trading partners to the Exchange clearinghouse.

Effective July 11, 2024, Optum will be changing electronic routing for the following payer.

Texas Medicaid Long Term Care SKTX1 2904 8202

Enrollment Requirements:

  • Claims:
    • Electronic claims to this payer require enrollment
  • Remits:
    • Electronic remittance from this payer requires enrollment

Report Changes: You may see some differences in the payer reports you are receiving.

Action Required: Enrollment requirements and forms are available for self-service through Enrollment Central. For assistance, please submit a support case.

REF 743650 7/29/2024

Report Generation Delay for CPIDs 2979 and 4253 Prominence Administrative Services

A payer intermediary is experiencing issues affecting institutional and professional report generation for some claims submitted since July 10, 2024.

Payer impacted:

  • CPID 2979 Prominence Administrative Services
  • CPID 4253 Prominence Administrative Services

Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 744050 07/29/2024

Claims Consolidation Notice

Effective immediately, claims currently exchanged with the following payer must use a different CPID.

Payer Name: WPPA-ProviDRs Care Network

Old Professional CPID:  5191

Payer-assigned Payer ID: 48100

Claims must begin using the following immediately:

Payer Name: ProviDRS Care Network

New Professional CPID:  6133

Payer-assigned Payer ID: 48100

Claim Fee: n/a

Enrollment Requirements: 

Claims:

  • Payer enrollment for electronic claims is not required.

Action Required: 

  • Please be aware of the changes above and make any necessary changes in your system.
  • To access the new enrollment forms, please visit Enrollment Central.

REF 743700 7/26/2024

Delay in Electronic Remittance Advice (ERA) for AlohaCare CPIDs: 2909, 5231

Due to a processing issue, there has been a delay in professional and institutional electronic remittance advice (ERA) for the following payers beginning March 12, 2024, through present:

  • CPID 2909 Alohacare
  • CPID 5231 Alohacare

Additional updates will be forwarded as more information becomes available.

Action Required: Please be aware of a delay in the delivery of ERA for the dates above.

REF 743450  07262024

Payer Processing Issue for CPID 1451 Nebraska Medicare

Due to WPS processing issue, some Professional claims transmitted to the payer listed below on July 19, 2024 were not processed by the payer.

Payer impacted: 

  • 1451 Nebraska Medicare

A resolution has been implemented and the claims were retransmitted to WPS on July 25, 2024.

This delay affected claims released to Optum between 2 p.m. CT on July 18, 2024 and 2 p.m. CT on July 19, 2024.

Action Required: Be aware of the processing issue above.

REF 742557 7/25/2024

Update: Payer Processing Issue for multiple CPIDs

Update: A resolution has been implemented and claims were transmitted to WPS on July 25, 2024.

This delay affected claims released to Optum between 2 p.m. CT on July 19, 2024 and 2 p.m. CT on July 24, 2024.

Action Required: Be aware of the processing issue above.

Original notify July 23, 2024:

Due to a WPS system issue, a delay occurred in the transmission to the following payers since July 19, 2024:

Payers impacted:

  • 7579      Arise Health Plan
  • 4512      Arise Health Plan
  • 2131       Arise Health Plan
  • 2832 Arise Health Plan
  • 3500 Indiana Medicare
  • 3975 Indiana Medicare
  • 1445      Indiana Medicare
  • 1898      Indiana Medicare
  • 3976      Iowa Medicare
  • 2537      Iowa Medicare
  • 1438      Iowa Medicare
  • 2101       Iowa Medicare
  • 3986 J5 National Part A
  • 2535 J5 National Part A
  • 3994 Kansas Medicare
  • 5518      Kansas Medicare
  • 2463 Kansas Medicare
  • 2107      Kansas Medicare
  • 3972 Michigan Medicare
  • 3515      Michigan Medicare
  • 1461      Michigan Medicare
  • 1895     Michigan Medicare
  • 3997    Missouri Medicare Eastern
  • 5572    Missouri Medicare Eastern
  • 1441 Missouri Medicare Eastern
  • 2120    Missouri Medicare Eastern
  • 4451    Missouri Northwest Medicare Kansas City
  • 4502   Nebraska Medicare
  • 1519    Nebraska Medicare
  • 1451    Nebraska Medicare
  • 2127   Nebraska Medicare
  • 4585  TRICARE East Region
  • 1253   TRICARE East Region
  • 5913   TRICARE For Life
  • 4535  TRICARE For Life
  • 4749  TRICARE For Life
  • 2132   TRICARE For Life
  • 2900  WPS Commercial/Regular Business
  • 4525  WPS Commercial/Regular Business
  • 2136  WPS Commercial/Regular Business

Optum is working with WPS to resolve this issue. We will notify you as soon as additional information becomes available.

This delay affected claims released to Optum since 3 p.m. ET on July 19, 2024.

Action Required: Be aware of the transmit delay above.

REF 741253/742552 7/25/2024

Report Generation Delay for CPIDs 6704 Conifer Health Solutions

A payer intermediary experienced issues affecting professional report generation for some claims submitted on July 09, 2024.

Payer impacted:

  • CPID 6704 Conifer Health Solutions

The payer intermediary is unable to generate and deliver the reports.

Action Required: None. Please resubmit claims if payment has not been received.

REF 742400 07/25/2024

Report Generation Delay for CPID 6886 Optum Salt Lake County Public Sector

A payer intermediary experienced issues affecting Professional report generation for some claims submitted on June 20, 2024.

Payer impacted:

  • CPID 6886 Optum Salt Lake County Public Sector

The payer intermediary is unable to generate and deliver the reports.

Action Required: None. Please resubmit claims if payment has not been received.

REF 742401 7/25/2024

Payer Processing Issue for CPIDs 2579 and 2715 Hawaii Medicaid

Due to a payer intermediary system issue, a delay occurred in the transmission to the following payer since July 19, 2024:

Payer impacted: 

  • CPID 2715 Hawaii Medicaid
  • CPID 2579 Hawaii Medicaid

Optum is working with the payer intermediary to resolve this issue. We will notify you as soon as additional information becomes available.

This delay affected claims released to Optum since 8 p.m. ET on July 19, 2024. 

Action Required: Be aware of the transmit delay above.

REF 741850 7/24/2024

Resolved: Real-time transactions fully restored – Veterans Administration (VA) Payer ID VAFEE VAHAC

The Veterans Administration (VA) payer would like to inform providers and submitters that eligibility and claims status requests for real-time transactions have been fully restored and are now available for use.

Payer Name: VETERANS ADMINISTRATION FEE BASIS PROGRAMS & CHAMPVA – HAC

Payer ID: VAFEE VAHAC

This issue began Feb. 21, 2024, and was resolved July 18, 2024.

REF 741252 07/23/2024

New Electronic Claims Connection Available

Effective July 19, 2024, Optum has a new electronic claims connection available:

Payer Name: USAA Life Insurance CO

Institutional CPID: 7527

Professional CPID: 2489

Payer-assigned Payer ID: 74147

Payer Enrollment Required: No

Secondary Claims Accepted: No

Payer Location: National 

Claims Fee: n/a

REF 739050 7/19/2024

Report Generation Delay for multiple CPIDs

Due to a payer intermediary processing issue, some Professional claims transmitted to the payers listed below on July 18, 2024, were not processed by the payers.

Payers impacted: 

  • 9267 Align Senior Care of Florida
  • 8454 Align Senior Care of Michigan
  • 4101 AllCare Advantage
  • 2113 Allcare Health Plan
  • 8714 Allstate - Except New Jersey
  • 1210 AlphaCare
  • 1764 Ambetter From Absolute Total Care
  • 9278 Ambetter from Nebraska Total Care
  • 9432 Ambetter from WellCare of New Jersey
  • 9433 Ambetter of Oklahoma
  • 2138 American Family Insurance
  • 9218 American Health Advantage of Tennessee
  • 9117 American Health Advantage of Texas
  • 4468 Americas Choice Healthplan
  • 1741 Amerigroup
  • 1412 Anthem Blue Cross and Blue Shield - Indiana
  • 2421 Anthem Blue Cross and Blue Shield - Kentucky
  • 1413 Anthem Blue Cross and Blue Shield (Virginia)
  • 2418 Anthem Blue Cross and Blue Shield of Ohio
  • 4437 Anthem Blue Cross Blue Shield New York
  • 6220 Arizona Priority Care Plus
  • 4477 Asuris Northwest Medadvantage Regence
  • 4881 Asuris Northwest Regence
  • 3845 Banner Health Network
  • 8482 Benefit Plan Administrators - Roanoke, VA
  • 1415 Blue Cross Blue Shield of Colorado
  • 1407 Blue Cross Blue Shield of Georgia
  • 7496 Blue Cross Blue Shield of Nevada
  • 1401 Blue Cross Blue Shield of Wisconsin
  • 1243 Blue Cross Community Centennial
  • 1167 Blue Cross Medicare Advantage PPO/HMO
  • 9162 Blue Medicare Advantage
  • 6165 Bridgeview
  • 1750 Brown & Toland Physicians
  • 4246 Capital Health Plan
  • 2810 Capitol Administrators
  • 8146 Care N Care Insurance Co.
  • 2289 Care1st Health Plan of Arizona Medicaid DOS after 11/30/2022
  • 9759 Care1st Health Plan of Arizona Medicaid DOS before 12/01/2022
  • 4743 Carelon Behavioral Health
  • 6127 Carelon Behavioral Health, MBHP
  • 3293 Carelon Health
  • 2830 CarePlus Health Plans
  • 1194 CareSource of Georgia
  • 7143 CareSource of Indiana
  • 3826 CareSource of Ohio
  • 7263 CareSource of West Virginia
  • 6777 Centers Plan for Healthy Living
  • 6700 Centurion Managed Care
  • 7275 Citrus Valley Physicians Group
  • 8123 Clear Health Alliance
  • 7416 Colorado Anthem Blue Cross Blue Shield HMO
  • 7763 Columbine Health Plan
  • 8834 Commonwealth Care Alliance DOS after 3/31/2023
  • 2160 Community Care Plan (Commercial)
  • 8147 Community Care Plan (Palm Beach Health District)
  • 1420 Connecticut Anthem Blue Cross Blue Shield
  • 3419 Connecticut Federal Employee Health Benefits
  • 6795 Contra Costa Health Plan
  • 7738 CountyCare Health Plan
  • 9747 Delaware First Health
  • 2433 Denver Health and Hospital Authority
  • 8135 Doctors HealthCare Plans
  • 3477 Early Intervention Central Billing
  • 1119 Easy Choice Health Plan of California
  • 5483 Employee Benefit Management Services (EBMS)
  • 1834 Employee Plans
  • 8137 Empower Healthcare Solutions
  • 1795 Envolve Benefit Options
  • 5238 Evolent Specialty Cardiology
  • 3792 Fidelis Care
  • 2875 First Health Network(Coventry Health Care National Network)
  • 7435 FirstCare Health Plans
  • 1414 Florida Blue Cross Blue Shield
  • 3417 Florida Blue Cross Blue Shield Health Options HMO
  • 9417 Florida Complete Care
  • 2150 Florida Health Care Plans
  • 5440 Fox Valley Medicine
  • 6851 Friday Health Plans
  • 2720 GlobalCare
  • 1772 HAP CareSource
  • 1797 HAP CareSource Michigan Dual Medicare/Medicaid
  • 5243 Healthcare Management Administrators
  • 1723 HealthCare Partners IPA
  • 4448 HealthLink PPO
  • 8413 HealthSCOPE Benefits
  • 8750 Healthy Blue Dual Advantage Louisiana
  • 7760 Healthy Blue Louisiana
  • 8867 Healthy Blue Missouri
  • 9133 Healthy Blue North Carolina
  • 7715 Hopkins Health Advantage
  • 6259 Humana - CareSource of Kentucky
  • 7426 Idaho Regence Blue Shield
  • 1405 Illinois Blue Cross Blue Shield
  • 5865 Indian Health Services
  • 5404 Insight Benefit Administrators
  • 4445 Insurance Management Services TX
  • 4116 IntegraNet Health
  • 8814 Integrated Homecare Services
  • 1404 Iowa Wellmark Blue Cross Blue Shield
  • 6733 Iowa Wellmark Blue Cross Blue Shield Crossover
  • 5479 IU Health Plan Medicare Advantage
  • 5432 Johns Hopkins Healthcare / Priority Partners
  • 5882 Kane County IPA
  • 9412 Leon Health Plans
  • 7446 Maine Anthem Blue Cross Blue Shield
  • 8812 Maryland Physicians Care
  • 6732 McLaren Health Plan Medicaid
  • 8860 Medica Government Programs
  • 7859 Medica Health Plan Solutions
  • 6799 Medica Individual and Family (IFB)
  • 2287 Medicare Plus Blue of MI(MAP)
  • 3475 Memorial Hermann Health Solutions
  • 2262 Meridian Health Plan of Michigan
  • 9102 Meridian Medicare Medicaid Plan
  • 9118 MeridianComplete Michigan
  • 2426 Michigan Blue Care Network
  • 1421 Michigan Blue Cross Blue Shield
  • 1402 Minnesota Blue Cross Blue Shield
  • 1410 Minnesota Blue Cross Blue Shield CC Systems
  • 7892 Minnesota Blue Cross Blue Shield Health Care Programs
  • 1429 Minnesota Blue Cross Blue Shield HMO
  • 5871 Mission Community IPA Medical Group
  • 1408 Missouri Anthem Blue Cross Blue Shield
  • 8723 MN BCBS Health Care Programs Non Emergent Transportation
  • 7450 Montana Blue Cross Blue Shield
  • 7422 New Hampshire Anthem Blue Cross Blue Shield
  • 7403 New Mexico Blue Cross Blue Shield
  • 8864 NextBlue of North Dakota
  • 2411 North Dakota Blue Cross Blue Shield
  • 1403 Oklahoma Blue Cross Blue Shield
  • 8283 OptiMed Health
  • 2404 Oregon Regence Blue Cross Blue Shield
  • 7829 Passport Advantage
  • 9199 Piedmont Community Health Plan
  • 2807 Professional Benefit Administrators (Oakbrook, Illinois)
  • 7281 PruittHealth Premier Medicare Advantage
  • 5428 QualChoice of Arkansas
  • 7264 Quartz ASO
  • 1209 Regence Group Administrators
  • 6423 RevClaims
  • 6246 Riverside Medical Clinic
  • 9410 Sante Community Medical Centers
  • 2254 Scott & White Health Plan
  • 4480 SelectHealth
  • 7237 Seoul Medical Group
  • 9438 Shared Health Mississippi
  • 8124 Simply Healthcare Plans, Inc.
  • 8816 SOMOS Emblem
  • 1740 Sonder Health Plans
  • 2490 South Dakota Blue Cross Blue Shield
  • 8134 Summit Community Care
  • 1406 Texas Blue Cross Blue Shield
  • 1729 Texas Childrens Health Plan (CHIP)
  • 2483 Texas Childrens Health Plan (STAR Medicaid)
  • 4278 The Boon Group
  • 8763 U.S. Networks and Administrative Services
  • 8473 Unicare (TX,MA,KS,WV,RI,IL)
  • 6849 United Group Programs
  • 2412 Utah Regence Blue Cross Blue Shield
  • 2788 Utah Regence Blue Cross Blue Shield Federal Employee Program
  • 7493 Vermont Blue Cross Blue Shield
  • 4258 VNS Health
  • 7451 Washington Regence Blue Shield
  • 9430 Wellcare by Allwell of Oklahoma
  • 1844 Wellcare Health Plans
  • 3211 Wellcare Health Plans (Encounters)
  • 1775 Wellpoint
  • 7489 Wyoming Blue Cross Blue Shield

A resolution has been implemented and the claims were retransmitted to the payer intermediary on July 19, 2024.

This delay affected claims released to Optum between 2 p.m. CT and 6 p.m. CT on July 19, 2024.

Action Required: Be aware of the processing issue above.

REF 739353 7/19/2024

Report Generation Delay for CPID 7028 Leon Health Plans

A payer intermediary is experiencing issues affecting Institutional report generation for some claims submitted on July 9, 2024.

Payer impacted: 

  • CPID 7028 Leon Health Plans

The payer intermediary is unable to generate and deliver the reports.

Action Required: None. Please resubmit claims if payment has not been received.

REF 739351 7/19/2024

Report Generation Delay for CPID 3207 Employee Benefit Management

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted on July 17, 2024.

Payer impacted: 

  • CPID 3207 Employee Benefit Management

The payer intermediary is unable to generate and deliver the reports.

Action Required: None. Please resubmit claims if payment has not been received.

REF 739352 7/19/2024

Payer Processing Issue for Multiple CPIDs

Due to a payer processing issue, Professional and Institutional claims submitted to the payers listed below may have received the following rejection:

  • PAYER NAME MATCHING REQUIRED. X12 INFO- 2010BB-NM1.PAYER NAME MATCHING REQUIRED.

This issue has been resolved as of July 18, 2024. All impacted claims submitted from May 8, 2024, to July 17, 2024, were resubmitted for processing on July 18, 2024.

Payers Affected:

  • 5943 Evernorth Behavioral Health
  • 1841 Evernorth Behavioral Health
  • 2488 Illinois Medicaid
  • 1563 Illinois Medicaid
  • 2904 TX Medicaid LTC
  • 8202 TX Medicaid LTC
  • 5520 Kansas Medicaid
  • 1485 Kansas Medicaid

Action Required: None. Please be aware of the processing issue.

REF 739400 7/19/2024

Report Generation Delay for CPID 1532 SelectHealth

A payer intermediary is experiencing issues affecting Institutional report generation for some claims submitted on July 8, 2024.

Payer impacted: 

  • CPID 1532 SelectHealth

The payer intermediary is unable to generate and deliver the reports.

Action Required: None. Please resubmit claims if payment has not been received.

REF 739350 7/19/2024

Delay in Electronic Remittance Advice (ERA) for SAMBA CPID: 1116, 5005

Due to a processing issue, there has been a delay in Professional and Institutional Electronic Remittance Advice (ERA) for the following payers beginning on February 21, 2024, through present:

  • CPID 1116 SAMBA
  • CPID 5005 SAMBA

Additional updates will be forwarded as more information becomes available.  

Action Required: Please be aware of a delay in the delivery of ERA for the dates above.

REF 738202 7/18/2024

Report Generation Delay for CPIDs 5972/9166 Yale University Heath Plan

A payer intermediary experienced issues affecting Professional and Institutional report generation for some claims submitted on June 22, 2024.

Payer impacted: 

  • CPID 9166 Yale University Heath Plan
  • CPID 5972 Yale University Heath Plan

The payer intermediary is unable to generate and deliver the reports.

Action Required: None. Please resubmit claims if payment has not been received.

REF 738501 7/18/2024

Report Generation Delay for CPIDs 5972/9166 Yale University Heath Plan

A payer intermediary experienced issues affecting Professional and Institutional report generation for some claims submitted July 6, 2024-July 8, 2024.

Payer impacted:

  • CPID 9166 Yale University Heath Plan
  • CPID 5972 Yale University Heath Plan

The payer intermediary is unable to generate and deliver the reports.

Action Required: None. Please resubmit claims if payment has not been received.

REF 738502

Update: Remittance Processing Delay for Electronic Remittance Advice (ERA) for Humana CPID 2449, 1104, 3890, 9508, 4544

We continue to troubleshoot this issue and will advise when it is resolved.

Original Message sent on May 20, 2024:

Please be aware of a remittance processing delay for Professional and Institutional Electronic Remittance Advice (ERA) for the following payers dated April 9, 2024, through current. 

Payers Affected:

  • 2449 Humana
  • 1104 Humana Long Term Care
  • 3890 Humana Encounter
  • 9508 Humana Long Term Care
  • 4544 Humana

Additional updates will be forwarded as more information becomes available.

Action Required: Please be aware of the processing issue.

We apologize for any inconvenience as we work to resolve.

REF 738400 7/18/2024

Report Generation Delay for CPID 6284 Trillium Health Resources

A payer experienced issues affecting Professional report generation for some claims submitted on June 1, 2024.

Payer impacted: 

  • CPID 6284 Trillium Health Resources

The payer is unable to generate and deliver the reports.

Action Required: None. Please resubmit claims if payment has not been received.

REF 738500 7/18/2024

Delay in Electronic Remittance Advice (ERA) for TriWest CPID: 5648, 6286

Due to a processing issue, there has been a delay in Professional and Institutional Electronic Remittance Advice (ERA) for the following payers beginning on February 22, 2024 through June 18th, 2024:

  • CPID 5648 TriWest
  • CPID 6286 TriWest

Additional updates will be forwarded as more information becomes available.  

Action Required: Please be aware of a delay in the delivery of ERA for the dates above.

REF 738113 7/18/2024

Report Generation Delay for CPID 3889/4508 Physicians Mutual Insurance Company

A payer intermediary experienced issues affecting Professional and Institutional report generation for some claims submitted May 30, 2024-June 25, 2024.

Payer impacted:

  • CPID 3889 Physicians Mutual Insurance Company
  • CPID 4508 Physicians Mutual Insurance Company

The payer intermediary is unable to generate and deliver the reports.

Action Required: None. Please resubmit claims if payment has not been received.

REF 737700  7/17/2024

Report Generation Delay for CPIDs 2593 and 5428 QualChoice of Arkansas

A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted since July 4, 2024.

Payer impacted: 

  • CPID 2593 QualChoice of Arkansas
  • CPID 5428 QualChoice of Arkansas

Optum is working diligently with the payers to resolve the issue and ensure reports are received.

Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 737352 7/17/2024

Report Generation Delay for CPID 6484 LA Care Health Plan

A payer intermediary experienced issues affecting Professional report generation for some claims submitted June 19, 2024, through June 24, 2024.

Payer impacted: 

  • CPID 6484 LA Care Health Plan

The payer intermediary is unable to generate and deliver the reports.

Action Required: None. Please resubmit claims if payment has not been received.

REF 737553 7/17/2024

Electronic Remittance Advice (ERA) Processing Issue for MetroPlus Health CPIDs 8972, 2296

Due to a processing issue, Professional and Institutional Electronic Remittance Advice (ERA) for the following payers were suspended July 10, 2024.

Payers impacted:

  • CPID 8972 MetroPlus Health
  • CPID 2296 MetroPlus Health

Action Required: Please monitor the current payer list and make any necessary adjustments to ERA processes as new connections are added daily.

REF 737650 7/17/2024

Report Generation Delay for CPID 7435 FirstCare Health Plans

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted June 27, 2024, and June 28, 2024.

Payer impacted:

  • CPID 7435 FirstCare Health Plans

The payer intermediary is unable to generate and deliver the reports.

Action Required: None. Please resubmit claims if payment has not been received.

REF 737351  7/17/2024

Correction: Remittance Processing Delay for Electronic Remittance Advice (ERA) for Cigna HealthSpring CPID 3839, 1978

Correction: Please see below corrections. On the original notification, sent on July 16, it was advised that claims were suspended. It is our remit connection that is currently suspended. We apologize for the inconvenience.

Due to a payer processing issue, Professional and Institutional Electronic Remittance Advice (ERA) for the following payers have been suspended on July 15, 2024. 

Payers affected:

  • CPID 3839 Cigna HealthSpring Maryland/Pennsylvania
  • CPID 1978 Cigna HealthSpring Maryland/Pennsylvania

Action Required: Please monitor the current payer list and make any necessary adjustments to ERA processes as new connections are added daily.

REF 736807/737350 7/17/2024

Report Generation Delay for CPID 2481 Ohio Medicaid

The payer listed below is experiencing issues affecting Professional report generation for some claims submitted on July 5, 2024.

Payer impacted:

  • CPID 2481 Ohio Medicaid

The payer is unable to generate and deliver the reports for some claims submitted on July 5, 2024.

Action Required: Please resubmit claims if payment has not been received.

REF 736552 7/16/2024

Report Generation Delay for CPID 5483 Employee Benefit Management Services (EBMS)

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted on June 25, 2024.

Payer impacted: 

  • CPID 5483 Employee Benefit Management Services (EBMS)

The payer intermediary is unable to generate and deliver the reports

Action Required: None. Please resubmit claims if payment has not been received.

REF 735901 7/16/2024

Report Generation Delay for CPID 7071 Anthem Ohio Medicaid

The payer listed below is experiencing issues affecting Institutional report generation for some claims submitted June 17, 2024.

Payer impacted:

  • CPID 7071 Anthem Ohio Medicaid.

The payer is unable to generate and deliver the reports for some claims submitted June 17, 2024.

Action Required: Please resubmit claims if payment has not been received.

REF 736551  7/16/2024

Report Generation Delay for CPID 7499 Sentara Health/Optima Health

The payer listed below is experiencing issues affecting Professional report generation for some claims submitted June 14, 2024-June 28, 2024.

Payer impacted:

  • CPID 7499 Sentara Health/Optima Health

The payer is unable to generate and deliver the reports for some claims submitted June 14, 2024-June 28, 2024.

Action Required: Please resubmit claims if payment has not been received.

REF 736650  7/16/2024