April 2025
April Payer Processing Issues
Summary
When Optum discovers issues or interruptions to transaction processing, the details* will appear below.
If you're looking for a specific payer or specific transaction type, please use Ctrl + F on Windows or ⌘ + F on Mac to find that term within the page.
*These updates can also be found within Optum Customer Care Hub under Payer Processing Issues: https://customercare.optum.com/public/home.html
Reminder: Payer Change for CPIDs 5805, 3627 PacificSource Administrators (PSA)
Reminder that CPIDs 5805, 3627 PacificSource Administrators (PSA) will be terminated effective May 6, 2025.
Original notice sent April 22, 2025:
Effective immediately, claims currently exchanged with the following payer must use different CPIDs.
Payer Name: PacificSource Administrators (PSA)
Professional CPID: 5805
Professional Edit Master: PE_T007
Institutional CPID: 3627
Institutional Edit Master: HE9T007
Payer-assigned Payer ID: 93031
Claims must begin using the following:
Payer Name: PacificSource Health
Professional CPID: 5441
Professional Edit Master: PE_P006
Institutional CPID: 6575
Institutional Edit Master: HE9P006
Payer-assigned Payer ID: 93029
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 5441, 6575 PacificSource Health do not need to complete a new enrollment form.
- Providers not receiving electronic remittance through Optum for CPIDs 5441, 6575 PacificSource Health must complete a new enrollment form.
- New providers must complete a new enrollment form.
CPIDs 5805, 3627 PacificSource Administrators (PSA) will be terminated effective May 6, 2025.
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 17481809 4/30/2025
Reminder: Payer Change for CPIDs 5805, 3627 PacificSource Administrators (PSA)
Reminder that CPIDs 5805, 3627 PacificSource Administrators (PSA) will be terminated effective May 6, 2025.
Original notice sent April 22, 2025:
Effective immediately, claims currently exchanged with the following payer must use different CPIDs.
Payer Name: PacificSource Administrators (PSA)
Professional CPID: 5805
Institutional CPID: 3627
Payer-assigned Payer ID: 93031
Claims must begin using the following:
Payer Name: PacificSource Health
Professional CPID: 5441
Institutional CPID: 6575
Payer-assigned Payer ID: 93029
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 5441, 6575 PacificSource Health do not need to complete a new enrollment form.
- Providers not receiving electronic remittance through Optum for CPIDs 5441, 6575 PacificSource Health must complete a new enrollment form.
- New providers must complete a new enrollment form.
CPIDs 5805, 3627 PacificSource Administrators (PSA) will be terminated effective May 6, 2025.
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 17482109 4/30/2025
Edit Master for CPIDs 4551 and 5405 1199 SEIU Family of Funds
Effective May 1, 2025, Optum will be changing Edit Masters for the following payer:
Payer Name: 1199SEIU Family of Funds
Professional CPID: 5405
Current Edit Master: PE_N000
New Edit Master: PE_T007
Institutional CPID: 4551
Current Edit Master: HE9N000
New Edit Master: HE9T007
Payer-assigned Payer ID: 13162
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 and CPIDs are not changing.
REF 17478809 4/30/2025
Payer Change for TRICARE East Region
This message is intended for Revenue Performance Advisor customers.
Effective May 1, 2025, the payer listed below will no longer be available at Optum for claims processing.
Payer Name: TRICARE East Region (DOS before Jan. 1, 2025)
RPA Payer ID: 68299
Reason: Payer no longer contracted with WPS.
The last day WPS will generate payments and remittance advices is July 1, 2025, or sooner if all claims are adjudicated. Optum will process remittance advice from WPS until the run-out period has ended.
Beginning May 1, 2025, all claims for TRICARE East Region, regardless of dates of service, must be sent to:
Payer Name: TRICARE East Region
Payer-assigned Payer ID: 99727
Remittance Available: Yes
Enrollment Requirements for TRICARE East Region ID 99727:
Claims:
- Payer enrollment for electronic claims is not required. However, PGBA requires an Electronic Data Interchange (EDI) Provider Trading Partner Agreement to be on file.
- If the provider is credentialed with PGBA and has an Electronic Data Interchange (EDI) Provider Trading Partner Agreement on file with PGBA the Optum Enrollment is not required.
- If the provider is not credentialed with PGBA, please complete the Optum Enrollment form process prior to sending claims.
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.
ERA enrollment/set up is required for all ERA transactions on Revenue Performance Advisor. You can access the payer enrollment intake form on the Revenue Performance Advisor (RPA) restoration resources page in the User Community.
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 17477666 4/30/2025
Delay in Electronic Remittance Advice (ERA) for Multiple Payers
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 April 17, 2025 through present:
- CPID 1412 Indiana Anthem Blue Cross Blue Shield
- CPID 1415 Colorado Anthem Blue Cross Blue Shield
- CPID 2418 Ohio Anthem Blue Cross Blue Shield
- CPID 3505 Ohio Anthem Blue Cross Blue Shield
- CPID 3520 Anthem Blue Cross Blue Shield New York
- CPID 1466 Georgia Medicare
- CPID 3537 Blue Cross Blue Shield of Georgia
- CPID 3548 Maine Anthem Blue Cross Blue Shield
- CPID 3511 California Anthem Blue Cross
- CPID 4417 California Anthem Blue Cross
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 and refer to Case Number INC-000002612.
REF 17476858 4/30/2025
Electronic Eligibility, Claim status Connection Available
Effective April 17, 2025 Optum is pleased to announce the availability of Real-time Eligibility Inquiry and Response 270/271 and Claim Status inquiry 276/277 for the below payer:
Payer Name: Zing Health
Industry Payer ID: 83248
IMN Real Time ID: 83248
Exchange Real Time ID: ZINGIL
CPID(s): 8246, 2097
Optum IEDi Real Time ID: 83248
Payer Enrollment Required: No
Connection Type: X12
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.
REF 17476362 4/30/2025
Report Generation Delay for Multiple CPIDs
A payer intermediary is experiencing issues affecting Professional and Institutional report generation for some claims submitted since April 18, 2025.
Payers impacted:
- CPID 1528 Utah Medicaid
- CPID 1486 Utah Medicaid
- CPID 2400 Utah Medicaid
- CPID 5975 Utah Medicaid
- CPID 6640 Utah Medicaid Crossover
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.
If you have any questions, please contact Customer Support and refer to Case Number 09483492.
REF 17475653 4/30/2025
New Electronic Remittance Connections Available
Optum has new electronic remittance connections available:
Payer Name: Anatomy
Professional CPID: 3431
Payer-assigned Payer ID: ANAMY
Payer Enrollment Required: Yes
Remittance Fee: N/A
Payer Location: California
Anatomy Financial converts PDF explanation of benefits/payments (EOB/EOP) into ERAs, in addition to enrollment, groups will need to sign up for this service through Anatomy directly. If you have questions on this ERA connection please visit anatomy.com/optum or email [email protected]
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 17474560 4/30/2025
New Electronic Remittance Connections Available
Optum has new electronic remittance connections available:
Payer Name: Anatomy
Professional CPID: 3431
Payer-assigned Payer ID: ANAMY
Line of Business (LOB) Code: H54
Payer Enrollment Required: Yes
Payer Location: California
Anatomy Financial converts PDF explanation of benefits/payments (EOB/EOP) into ERAs, in addition to enrollment, groups will need to sign up for this service through Anatomy directly. If you have questions on this ERA connection please visit anatomy.com/optum or email [email protected]
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 17474561 4/30/2025
Electronic Claims Reactivation for CPIDs 4098 and 8841, Truli for Health
Effective May 1, 2025, Optum will be reactivating electronic claims for the following payer:
Payer Name: Truli for Health
Professional CPID: 8841
Institutional CPID: 4098
Payer-assigned Payer ID: TRULI
Action Required: None. Optum will resubmit all affected claims received between April 1, 2025 through April 17, 2025 on 5/1/2025.
REF 17472589 4/30/2025
Delay in Electronic Remittance Advice (ERA) for CPIDs 4590, 5402 United Medical Resources
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 date of April 23, 2025:
- CPID 4590 United Medical Resources
- CPID 5402 United Medical Resources
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 date above.
If you have any questions, feel free to contact your Customer Support Team and refer to Case Number INC-000002603.
REF 17469759 4/30/2025
999 Payer Batch Rejections for CPID 1403 Oklahoma Blue Cross Blue Shield
Professional claims transmitted to the payer listed below from Optum April 29, 2025 were not processed by the payer due to a 999 Batch Rejection.
- CPID 1403 Oklahoma Blue Cross Blue Shield
A resolution has been implemented and the claims were retransmitted to the payer April 30, 2025.
Action Required: None.
If you have any questions, please contact Customer Support and refer to Case Number 09482827.
REF 17469208 4/30/2025
New Electronic Remittance Connections Available
Optum has new electronic remittance connections available:
Payer Name: IQVIA
Institutional CPID: 7548
Professional CPID: 2474
Payer-assigned Payer ID: 15060
Line of Business (LOB) Code: E13
Payer Enrollment Required: Yes
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 17468358 4/30/2025
New Electronic Remittance Connections Available
Optum has new electronic remittance connections available:
Payer Name: HAP Caresource Michigan Marketplace
Institutional CPID: 8095
Professional CPID: 2891
Payer-assigned Payer ID: MICS1
Line of Business (LOB) Code: E10
Payer Enrollment Required: Yes
Payer Location: Michigan
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 17468160 4/30/2025
New Electronic Remittance Connections Available
Optum has new electronic remittance connections available:
Payer Name: HAP Caresource Michigan Marketplace
Institutional CPID: 8095
Professional CPID: 2891
Payer-assigned Payer ID: MICS1
Payer Enrollment Required: Yes
Remittance Fee: N/A
Payer Location: Michigan
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 17468159 4/30/2025
New Electronic Remittance Connections Available
Optum has new electronic remittance connections available:
Payer Name: IQVIA
Institutional CPID: 7548
Professional CPID: 2474
Payer-assigned Payer ID: 15060
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 17468359 4/30/2025
Report Generation Delay for CPIDs 6233 and 5645 Vaya Health
A payer is experiencing issues affecting Professional and Institutional report generation for some claims submitted since April 25, 2025.
Payer impacted:
- CPID 6233 Vaya Health
- CPID 5645 Vaya 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.
If you have any questions, please contact Customer Support and refer to Case Number 09482789.
REF 17468208 4/30/2025
New Electronic Claims Connections Available
Optum has new electronic claims connections available:
Payer Name: Integra Group - CHA
Institutional CPID: 7917
Professional CPID: 3860
Payer-assigned Payer ID: 31129
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 17462808 4/29/2025
Restoration and Electronic Routing Change for CPID 8952 Tucker Administrators Inc.
Effective April 30, 2025, Optum will be restoring and changing electronic claims routing for the following payer:
Payer Name: Tucker Administrators Inc
Professional CPID: 9251
Current Edit Master: PE_O007
New Edit Master: PE_T007
Current Payer-assigned Payer ID: 30799
New Payer-assigned Payer ID: 00128
Payer Claim Enrollment Required: No
Secondary Claims Accepted: Yes
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 17460417 4/29/2025
Restoration and Electronic Routing Change for CPID 8952 Tucker Administrators Inc.
Effective April 30, 2025, Optum will be restoring and changing electronic claims routing for the following payer:
Payer Name: Tucker Administrators Inc
Professional CPID: 9251
Current Payer-assigned Payer ID: 30799
New Payer-assigned Payer ID: 00128
Payer Claim Enrollment Required: No
Secondary Claims Accepted: Yes
Claims Fee: N/A
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 17460419 4/29/2025
New Electronic Claims Connections Available
Optum has new electronic claims connections available:
Payer Name: Integra Group - Home
Institutional CPID: 8543
Professional CPID: 2790
Payer-assigned Payer ID: 31128
Payer Enrollment Required: No
Secondary Claims Accepted: Yes
Payer Location: National
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 17460856 4/29/2025
New Electronic Claims Connections Available
Optum has new electronic claims connections available:
Payer Name: Integra Group - Home
Institutional CPID: 8543
Professional CPID: 2790
Payer-assigned Payer ID: 31128
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 17460855 4/29/2025
NorthShore Physician Associates Electronic Remittance Connection No Longer Available
Effective immediately, the payer listed below will no longer be available at Optum for remittance processing.
Payer Name: NorthShore Physician Associates
Remittance CPIDs: 4659, 6187
Payer-assigned Payer ID: 48026
Reason: Payer no longer offers an electronic connection to which Optum can connect.
Action Required: None.
REF 17460161 4/29/2025
New Electronic Claims Connections Available
Optum has new electronic claims connections available:
Payer Name: Tucker Administrators Inc
Institutional CPID: 8952
Payer-assigned Payer ID: 00128
Payer Enrollment Required: No
Secondary Claims Accepted: Yes
Payer Location: Georgia
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 17460415 4/29/2025
NorthShore Physician Associates Electronic Remittance Connection No Longer Available
Effective immediately, the payer listed below will no longer be available at Optum for remittance processing.
Payer Name: NorthShore Physician Associates
Remittance CPIDs: 4659, 6187
Remittance LOB: J94
Payer-assigned Payer ID: 48026
Reason: Payer no longer offers an electronic connection to which Optum can connect.
Action Required: None.
REF 17460160 4/29/2025
Electronic Routing Change for CPID 6776 EyeQuest
Effective April 29, 2025, Optum will be reactivating and changing electronic claims routing for the following payer:
Payer Name: EyeQuest
Professional CPID: 6776
Current Edit Master: PE_E049
New Edit Master: PE_T007
Payer-assigned Payer ID: 63740
Payer Claim Enrollment Required: No
Secondary Claims Accepted: No
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 CPID are not changing.
When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.
REF 17460159 4/29/2025
Electronic Routing Change for CPID 6776 EyeQuest
Effective April 29, 2025, Optum will be reactivating and changing electronic claims routing for the following payer:
Payer Name: EyeQuest
Professional CPID: 6776
Payer-assigned Payer ID: 63740
Payer Claim Enrollment Required: No
Secondary Claims Accepted: No
Claims Fee: N/A
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 17460158 4/29/2025
Update: Report Generation Delay for CPID 9581 Division of Immigration Health Services
Update: The payer intermediary has been unable to generate and deliver the reports for some claims submitted on April 3, 2025.
Action Required: Please resubmit claims if payment has not been received.
Original notify sent April 8, 2025:
A payer intermediary is experiencing issues affecting Institutional report generation for some claims submitted on April 3, 2025.
Payer impacted:
- CPID 9581 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.
If you have any questions, please contact Customer Support and refer to Case Number 09453794.
REF 17454858 4/29/2025
Report Generation Delay for CPID 1871 Aetna Employee Assistance Program
A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted April 22, 2025.
Payer impacted:
- CPID 1871 Aetna Employee Assistance Program
The payer intermediary has been unable to generate and deliver the reports.
Action Required: None. Please resubmit claims if payment has not been received.
If you have any questions, please contact Customer Support and refer to Case Number 09480846.
REF 17452466 4/29/2024
MedPay First One Electronic Claims Connection No Longer Available
Effective immediately, the payer listed below will no longer be available at Optum for claims processing.
Payer Name: MedPay First One
Claims CPIDs: 1162, 3698
Payer-assigned Payer ID: MP001
Reason: Payer no longer offers an electronic connection.
Action Required: Providers need to submit claims to Meritain Health, Payer ID 41124, CPID 1708 or 4561.
REF 17453136 4/29/2025
Report Generation Delay for Multiple CPIDs
A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted since April 18, 2025.
Payers impacted:
|
CPID |
Payer Name |
|
5405 |
1199 National Benefit Fund |
|
8721 |
6 Degrees Health |
|
2722 |
AAG/Gallagher Benefits Administrator |
|
5271 |
AARP |
|
8719 |
Access Medical Group |
|
7273 |
Accountable Healthcare IPA - DOS >= 5/1/15 |
|
5404 |
Activa Benefits Services, LLC |
|
4295 |
Administrative Services, Inc. |
|
6141 |
Advantage Care IPA |
|
6122 |
ADVANTEK BENEFIT ADMINISTRATORS |
|
3704 |
Advocate Health Centers |
|
2801 |
Advocate Health Partners |
|
7187 |
Aetna ASA/GEHA |
|
8861 |
Aetna Better Health of Illinois - Medicaid |
|
5810 |
Affiliated Doctors of Orange County (ADOC) |
|
9737 |
Affiliated Partners IPA |
|
3262 |
Affiliated Physicians IPA |
|
5217 |
Affinity Medical Group |
|
9178 |
AIDS Healthcare Foundation - PHC |
|
9443 |
AIDS Healthcare Foundation - RW |
|
1455 |
AK Medicare |
|
2468 |
AL Medicare |
|
1220 |
Albuquerque Public Schools |
|
7235 |
Alignment Health Care |
|
7247 |
Allcare IPA |
|
7163 |
AllCare PEBB |
|
2295 |
Allegiance Benefit Plan Management, Inc. |
|
6463 |
ALLIANCE BEHAVIORAL HEALTHCARE |
|
7861 |
Alliance Physicians of the High Desert |
|
1759 |
Allied Benefit System |
|
8247 |
Alpha Care Medical Group NMM |
|
7745 |
AlphaCare Medical Group |
|
9167 |
Alterwood Advantage |
|
3755 |
AmeriBen Solutions, Inc |
|
7481 |
American Medical Security (AMS) |
|
8276 |
American Plan Administrators |
|
8177 |
American Public Life (APL) |
|
2806 |
AmeriChoice of NJ (Medicaid NJ) |
|
8859 |
AmeriHealth Caritas North Carolina |
|
9479 |
Amerihealth Caritas Ohio Transportation |
|
6254 |
AmFirst Insurance |
|
7144 |
Amida Care Medicare |
|
4269 |
Anchor Benefit Consulting |
|
4417 |
Anthem Blue Cross (fka CA Blue Cross) |
|
2416 |
AR BCBS |
|
2455 |
AR Medicare |
|
9734 |
Arcadia Healthcare Solutions - IPG |
|
9735 |
Arcadia Healthcare Solutions - NPA |
|
7178 |
Argus Dental and Vision, Inc. |
|
2161 |
Arkansas Medicare |
|
1124 |
Asian American Medical Group (AAMG) |
|
8840 |
Aspirus Medicare Advantage |
|
1424 |
Asserta Health |
|
8224 |
Associated Hispanic Physicians of Southern California IPA |
|
7117 |
Assurant Health Self Funded |
|
9778 |
Assured Benefits Administrators - ClaimsBridge |
|
6429 |
Atlantic Medical |
|
4799 |
Atrio Health Plans |
|
3802 |
AvMed, Inc |
|
1456 |
AZ Medicare |
|
3432 |
AZ Physicians IPA |
|
4241 |
Bakersfield Family Medical Center |
|
8822 |
Bakersfield Family Medical Group |
|
1290 |
Banner- University Family Care (UNIVERSITY OF ARIZONA HEALTH PLANS) |
|
8450 |
BARInet |
|
8150 |
BayCare Plus Medicare Advantage |
|
6275 |
Beaver Medical Group |
|
6106 |
Behavioral Health Systems |
|
5874 |
Bella Vista Medical Group |
|
8810 |
BeneBay |
|
1416 |
Benefit Plan Administrators - Eau Claire, WI |
|
2882 |
Benefit Plan Administrators WI |
|
7299 |
Blue Cross Blue Shield of Texas Medicaid |
|
7165 |
Blue Cross Community Options |
|
1239 |
BMS Oncology Copay Program |
|
6425 |
Boilermakers National Health |
|
8802 |
Boncura Health Solutions |
|
7871 |
Brand New Day |
|
1218 |
Britcay Medical |
|
3250 |
Butler Benefit |
|
2850 |
C & O Employees Hospital Assn |
|
1436 |
CA (Northern) Medicare |
|
1444 |
CA (Southern) Medicare |
|
4221 |
Cal Optima Direct |
|
4461 |
California Care |
|
2730 |
California Care(Humboldt Del Norte) |
|
6874 |
California Pacific Medical Center |
|
7806 |
CALMED Global |
|
4276 |
Cardiovascular Care Providers Inc. (CVCP) |
|
5229 |
Care Access PSN |
|
7114 |
Care To Care |
|
2835 |
CareCore Aetna Radiology |
|
3894 |
CareCore National |
|
4870 |
CareCore National Wellcare Health Plan |
|
1727 |
CareCore Oxford Radiology |
|
7250 |
Carelon Anthem Home Health |
|
2249 |
CareOregon |
|
9487 |
CarePlus (Encounters) |
|
1275 |
Cedars Sinai Medical Center |
|
3472 |
Cedars Sinai Medical Encounter |
|
3295 |
Cedars Sinai Medical Network |
|
5219 |
Celtic Insurance |
|
6820 |
Centerlight Healthcare |
|
6198 |
Central Health Medicare Plan |
|
9779 |
Centurion, LLC |
|
9741 |
Chaffey Medical Group |
|
3807 |
CHAMPVA - HAC |
|
8138 |
CHC out of State Medicaid |
|
1145 |
Children's Physicians Medical Group |
|
1197 |
Children's Specialists of San Diego |
|
3473 |
Chinese Community Health Plan |
|
6792 |
CHOC - Childrens Hospital of Orange County Health - Rady |
|
9456 |
Choice Physicians Network Nivano Physicians |
|
6202 |
Christian Brothers Services |
|
7154 |
Christian Care Ministries |
|
4493 |
Christus Health (USFHP) for TX/LA |
|
7805 |
Christus Health Medicare Advantage |
|
6167 |
CHRISTUS HEALTH PLAN |
|
7716 |
Christus Health Plan Texas HIX |
|
7191 |
Claims Development Corporation |
|
6270 |
ClaimsBridge High Performance Network |
|
8889 |
Clear Spring Health |
|
1449 |
CO Medicare |
|
3404 |
Coachella Medical Group |
|
6726 |
Coastal Communities Physician Network (CCPN) |
|
5811 |
Colonial Medical |
|
8772 |
Colonial Medical Eastern Caribbean |
|
7865 |
Colorado Community Health Alliance |
|
6816 |
Colorado HealthOP |
|
2162 |
Colorado Medicare |
|
3809 |
Community First |
|
7155 |
Community Health Alliance TN |
|
3119 |
Community Health Center Network |
|
1706 |
Community Health Electronic Claims |
|
1874 |
CommunityCare MHP of OK |
|
3273 |
Companion Life |
|
6200 |
Complementary Healthcare Plan |
|
3737 |
Comprehensive Benefits Administrators |
|
6206 |
ComPsych |
|
2223 |
Connecticut Medicare |
|
2233 |
Consolidated Associates Railroad |
|
6814 |
Consumers Choice of SC/Healthscope Benefits |
|
7113 |
Continuum Health Solutions |
|
9295 |
Continuum Health Solutions Worker Comp |
|
8773 |
Cook Medical Group |
|
3856 |
Core Administrative Services |
|
1829 |
Cornerstone Hospice and Palliative Care, Inc. |
|
3828 |
Covenant Administrators |
|
1861 |
Covet Health |
|
8748 |
COVID19 HRSA Uninsured Testing and Treatment Fund |
|
6289 |
Crescent Health Solutions |
|
1452 |
CT Medicare |
|
9774 |
Curative |
|
2425 |
DC BCBS of the NCA (Carefirst) |
|
2459 |
DC Medicare |
|
7175 |
DCHS Medical Foundation |
|
2456 |
DE Medicare |
|
1497 |
Dean Health Plan |
|
9711 |
Decent Health |
|
2163 |
Delaware Medicare |
|
4285 |
Denver Health Medical Plan |
|
3285 |
Desert Med Group |
|
1206 |
Desert Valley Medical Group |
|
8196 |
Devoted Health |
|
7797 |
Dignity HCLA |
|
7796 |
Dignity Health Medical Foundation for Mercy Medical Group or Woodland Clinic Medical Group |
|
7729 |
Dignity Health Medical Group - Inland Empire |
|
7736 |
Direct Care Administrators |
|
1719 |
DirectCARE |
|
2165 |
District of Columbia Metropolitan Area (DCMA) Medicare |
|
6481 |
Diversified Group Brokerage |
|
9174 |
Dolton Medical Group |
|
4152 |
Downey Select IPA (Applecare Medical Management) |
|
4410 |
Educators Mutual Insurance Association |
|
5869 |
El Proyecto Del Barrio |
|
6811 |
Elder Service Plan of the North Shore |
|
1853 |
ElderPlan, Inc |
|
5205 |
Employee Benefit Administrators Management (EBAM) |
|
5877 |
Employee Benefit Systems |
|
2763 |
EOB TPA |
|
7101 |
ES Beveridge and Associates, Inc |
|
2274 |
Essence |
|
8709 |
Essential Health Partners IPA |
|
4438 |
Evolutions Healthcare Systems, Inc |
|
7732 |
Exceedent LLC |
|
1113 |
Exclusive Care |
|
5817 |
EyeMed Vision Care |
|
4896 |
Facey Medical Foundation |
|
8207 |
Falling Colors (BHSD STAR) |
|
2479 |
Family Care Network |
|
9733 |
Farm Bureau Health Plans MAPD |
|
5876 |
Farm Family |
|
7885 |
Fenix Medical Group |
|
8125 |
Fire Department City of New York |
|
9710 |
Firefly Health |
|
6453 |
First Choice Health Network |
|
8821 |
FirstCarolinaCare - New |
|
7238 |
FirstChoice Medical Group |
|
1806 |
FiServ Health (Kansas & Tennessee) |
|
1448 |
FL Medicare |
|
8129 |
Florida Community Care |
|
7822 |
Florida Hospital VBR |
|
2216 |
Florida Medicare |
|
8273 |
Flume Health, Inc. |
|
5433 |
Fox Everett |
|
2100 |
Freedom Health |
|
5247 |
Fringe Benefits Coordinators (Medical and Accident) |
|
2299 |
FrontPath Health Coalition |
|
1466 |
GA Medicare |
|
7148 |
Gateway Health Plan - Highmark Health Options |
|
8472 |
Gateway Health Plan - Medicaid PA |
|
2298 |
Gateway Health Plan - Medicare Assured |
|
3287 |
Gateway IPA |
|
5473 |
Geisinger Health Plan |
|
6100 |
GEMCare - Kern County |
|
5870 |
Global Care Medical Group IPA |
|
6185 |
GLOBAL EXCEL MANAGEMENT INC |
|
5814 |
Global Health OKC |
|
9229 |
Global Health Texas |
|
1767 |
Global TBSP |
|
9158 |
Golden Coast MSO |
|
6483 |
Golden Rule |
|
1886 |
Great Lakes Health Plan |
|
8133 |
Greater Covina Medical Group |
|
4154 |
Greater Orange County Medical Group IPA |
|
1770 |
Group Administrators LTD |
|
8405 |
Group Health Cooperative of the Northwest |
|
6819 |
Gulf Stream General Dynamics |
|
2865 |
H.E.R.E.I.U. Welfare Pension Plan |
|
1105 |
Halcyon Behavioral Health |
|
2494 |
Health Alliance Medical Plans of Illinois |
|
3232 |
Health Choice Arizona |
|
4878 |
Health Choice Generations |
|
6775 |
Health Choice Utah |
|
3267 |
Health Claims Service |
|
2898 |
Health Design Plus |
|
2855 |
Health Net of California - Claims |
|
2822 |
Health Partners Plans of Pennsylvania |
|
3469 |
Health Plan of San Joaquin |
|
4292 |
Health Plan of San Mateo |
|
6768 |
Health Services Preferred (HSP) Emerald Health |
|
8722 |
Health Source MSO |
|
1280 |
Healthcare Highways |
|
5840 |
HealthCare LA, IPA |
|
4730 |
Healthcare Partners |
|
4267 |
Healthcare Solutions Group |
|
7748 |
HealthChoice Oklahoma |
|
8431 |
HealthPlan Services |
|
9725 |
HealthSCOPE |
|
1283 |
HealthScope Benefits |
|
5280 |
HealthSmart Accel |
|
2724 |
HealthSmart Preferred Care, Inc. |
|
2795 |
HealthSpring (MAP) |
|
6800 |
HealthTexas Medical Group |
|
9442 |
Healthy Valley Provider Network |
|
6883 |
Healthy York Network |
|
7703 |
Hemet Community Medical Group |
|
2717 |
HFN, Inc. |
|
2467 |
HI / Guam Medicare |
|
4102 |
Highline MSO Molina |
|
8169 |
Hollywood Presbyterian Medical Center - Global Care Medical |
|
2839 |
Hometown Health Plan Nevada |
|
2189 |
Horace Mann |
|
4747 |
HSHS Medical Group IPA |
|
7879 |
Human Behavior Institute |
|
2449 |
Humana |
|
3890 |
Humana Encounters |
|
1104 |
Humana Long Term Care |
|
1469 |
IA Medicaid |
|
5299 |
ICARE Health Options TPA |
|
2465 |
ID Medicare |
|
8724 |
IEC Group AmeriBen |
|
1437 |
IL Medicare |
|
2224 |
Illinois Medicare |
|
1229 |
Illinois Physicians Alliance IPA |
|
7722 |
illumifin Corporation |
|
1295 |
Imperial Health Plan of California |
|
8811 |
Imperial Health Plan of California |
|
2755 |
IMX Easy |
|
1189 |
Independence American Insurance Company |
|
8214 |
Industry Buying Group (IBG) |
|
6460 |
Inetico, Inc |
|
7252 |
Ingham Health Plan |
|
6134 |
Innovante Benefit Administrator |
|
8120 |
Innovative Health Plan |
|
8707 |
Innovative Healthware Services North |
|
8426 |
Innovative Healthware Services South |
|
9111 |
Innovative Healthware Solutions 10 |
|
9100 |
Innovative Healthware Solutions 3 |
|
9106 |
Innovative Healthware Solutions 6 |
|
9108 |
Innovative Healthware Solutions 7 |
|
9109 |
Innovative Healthware Solutions 8 |
|
9110 |
Innovative Healthware Solutions 9 |
|
8809 |
Innovative Payer 2 |
|
3237 |
Insurance Administrators of America (IAA) |
|
7425 |
Insurance Services of Lubbock |
|
1864 |
Integra Group |
|
1117 |
Integra Managed Long Term Care |
|
6163 |
Integrated Medical Solutions |
|
4441 |
Interface EAP |
|
5485 |
Intergroup Services Corporation |
|
1165 |
International Benefits Administrators |
|
2176 |
International Funding Inc. |
|
8225 |
Island Home Insurance Company |
|
1236 |
IU Health Plans |
|
4271 |
John Muir Trauma Physicians |
|
4750 |
Johns Hopkins US Family Health Plan (USFHP) |
|
8717 |
Kemberton Healthcare Services |
|
2821 |
Key Benefit Administrators |
|
4167 |
Key Medical Group |
|
4150 |
Key Medical Group - Medicare Advantage |
|
5880 |
Key Select |
|
7256 |
Key Solutions |
|
5422 |
Klais & Company |
|
2884 |
Know the Costs |
|
9763 |
Kopp Billing Agency Inc. |
|
1298 |
Kova Healthcare, Inc |
|
2462 |
KY Medicare |
|
1460 |
LA Medicare |
|
7884 |
LACH HealthNet by MedPOINT |
|
5886 |
Lakeside Medical Group |
|
5262 |
Lancaster General Health Group |
|
3294 |
Landmark Insurance |
|
9156 |
Lawndale Christian Health Center |
|
8796 |
Liberty Advantage Health Plan |
|
6101 |
Lifeprint |
|
7850 |
Little Company of Mary Health Providers |
|
6189 |
Lockard and Williams |
|
8466 |
Longevity Health Plan - New Jersey |
|
8270 |
Longevity Health Plan of Illinois |
|
9299 |
Longevity Health Plan of Michigan |
|
8260 |
Longevity Health Plan of New York |
|
9268 |
Longevity Health Plan of North Carolina |
|
6219 |
Los Angeles Medical Center (LAMC) |
|
2171 |
Louisiana Medicare |
|
1278 |
Luther Care |
|
2469 |
MA Medicare |
|
1419 |
Magellan Health Services |
|
1704 |
Magnacare |
|
6827 |
Maine Community Health Options |
|
2225 |
Maine Medicare |
|
1495 |
Managed Health Network |
|
5246 |
March Vision Care |
|
8294 |
Mary Washington Health Plan |
|
2201 |
Maryland Medicare |
|
2818 |
Mashantucket Pequot Trib |
|
2229 |
Massachusetts Medicare |
|
1701 |
MBACLM |
|
6739 |
McLaren Advantage SNP |
|
6735 |
McLaren Health Advantage |
|
6732 |
McLaren Health Plan Medicaid |
|
3794 |
McLaren Health Plans |
|
3261 |
McLaren Medicare Supplement |
|
2419 |
MD BCBS (Carefirst) |
|
7402 |
MD Medicare |
|
2464 |
MD Medicare (Montg,Prince George) |
|
8295 |
MDsave |
|
8113 |
MDwise Healthy Indiana Plan DOS>12/31/2018 |
|
8112 |
MDwise Hoosier Healthwise DOS>21/31/2019 |
|
2766 |
MDwise Medicare Advantage |
|
7139 |
MDX Hawaii Queens Healthcare |
|
2472 |
ME Medicare |
|
1892 |
MedAdmin Solutions(PHC) |
|
3271 |
MedCom |
|
6474 |
Medcost, Inc. PPO |
|
1431 |
Medica Choice FFS |
|
4243 |
Medica Health Care Plan, Inc. |
|
3231 |
Medical Benefit Administration, Inc. |
|
2209 |
Medicare DME MAC Jurisdiction A |
|
4229 |
Medicare DME MAC Jurisdiction A |
|
7475 |
Medicare DME MAC Jurisdiction A |
|
2211 |
Medicare DME MAC Jurisdiction B |
|
4230 |
Medicare DME MAC Jurisdiction B |
|
7476 |
Medicare DME MAC Jurisdiction B |
|
2213 |
Medicare DME MAC Jurisdiction C |
|
4231 |
Medicare DME MAC Jurisdiction C |
|
7477 |
Medicare DME MAC Jurisdiction C |
|
2215 |
Medicare DME MAC Jurisdiction D |
|
4232 |
Medicare DME MAC Jurisdiction D |
|
7478 |
Medicare DME MAC Jurisdiction D |
|
9138 |
Mediview, INC. |
|
7480 |
Med-Pay, Inc. |
|
8819 |
MedStar DC |
|
9400 |
Memorial Medical Center - AllCare |
|
7878 |
Mental Health Consultants Inc |
|
1274 |
Merchants Benefit Administration |
|
5298 |
MercyCare |
|
5294 |
Mid-America Associates |
|
6424 |
Mid-American Benefits (Elite Choice) |
|
3229 |
Midland Management/MFC |
|
1742 |
Midlands Choice |
|
2230 |
Minnesota Medicare |
|
2203 |
Mississippi Medicare |
|
1186 |
ML Healthcare |
|
1435 |
MN Medicare |
|
2475 |
Monarch IPA |
|
5180 |
Mondial Assistance |
|
8290 |
Morecare |
|
6728 |
MPM PROSPECT (DOS after 07/01/2012) |
|
1700 |
MPMBA |
|
2415 |
MS BCBS |
|
2451 |
MS Medicare |
|
7400 |
MT Medicare |
|
2167 |
Municipal Health Benefit Fund |
|
2420 |
Mutual of Omaha |
|
1748 |
MVP Health Plans of NY |
|
2737 |
My Patient Prepaid |
|
8430 |
N. American Benefits Network |
|
1223 |
NAHGA Claim Services |
|
8221 |
NAMCI/Global Care |
|
6208 |
Naphcare |
|
8780 |
Nascentia Health |
|
6842 |
Nascentia Health Options |
|
7224 |
National Association of Letter Carriers (Remit Only) |
|
2407 |
National Telecommunications Coop Assoc (NTCA) |
|
1464 |
NC Medicare |
|
3874 |
NCAS - Charlotte |
|
1730 |
NCAS - Fairfax, VA |
|
2453 |
ND Medicare |
|
6847 |
Neighborhood Health Partnership of Florida |
|
7277 |
Netcare Life and Health Insurance |
|
1159 |
Network Solutions IPA |
|
9419 |
NeueHealth |
|
7714 |
New Avenues Inc |
|
5292 |
New Century Health - CA Eye Care |
|
1477 |
New Era Life Insurance Company |
|
2237 |
New Hampshire Medicare |
|
7757 |
New Jersey Manufacturers (NJM) WC |
|
2205 |
New Jersey Medicare |
|
2204 |
New Mexico Medicare |
|
2244 |
New York Medicare Empire |
|
2260 |
New York Medicare GHI |
|
2261 |
New York Medicare Upstate |
|
2470 |
NH Medicare |
|
2414 |
NJ BCBS (Horizon) |
|
1465 |
NJ Medicare |
|
1457 |
NM Medicare |
|
2291 |
Northern Illinois Health Plan |
|
3721 |
Northern Nevada Trust Fund |
|
5258 |
NTCA STAFF |
|
1446 |
NV Medicare |
|
3736 |
NW Suburban IPA (IL)/Midland Mgmt |
|
4442 |
NY Medicare Empire |
|
7401 |
NY Medicare GHI |
|
1463 |
NY Medicare Upstate |
|
5863 |
NY State Dept of Health Uncompensated Care Program |
|
8725 |
Oak Street Health |
|
1447 |
OH Medicare |
|
1860 |
Ohio Health Choice, PPO |
|
6159 |
Ohio PPO Connect (OPPOC) |
|
1458 |
OK Medicare |
|
7750 |
Oklahoma Department of Corrections |
|
2206 |
Oklahoma Medicare |
|
6707 |
OLOLRMC Uninsured Patient Services Program |
|
6812 |
Olympus Managed Health Care |
|
1745 |
Omnicare Medical Group |
|
8740 |
Oncology Network of Orange County |
|
4227 |
Optimum HealthCare Services |
|
5891 |
Optum Health Specialty Benefits - Vision Only |
|
3784 |
Optum Physical Health |
|
2765 |
Optum RX |
|
9756 |
Optum San Diego Public Sector Behavioral Health |
|
1840 |
Optum Workers Comp Auto |
|
1459 |
OR Medicare |
|
7468 |
Oscar Health (California and Texas) |
|
7877 |
OSF Healthcare Central |
|
8100 |
OSF Healthcare East |
|
6485 |
Oxford Health Plans |
|
2457 |
PA Medicare |
|
4170 |
Pacific IPA |
|
2740 |
Pacificare of CA - Encounters |
|
2741 |
Pacificare of OR - Encounters |
|
5468 |
Pacificare of WA - Encounters |
|
6861 |
Pan American Life Insurance Group |
|
8254 |
Parthers In Health |
|
1111 |
Partners Health Plan |
|
1281 |
Passport Health Plan |
|
6853 |
Payer Fusion |
|
6862 |
Peak Pace Solutions |
|
9231 |
PEF Clinic |
|
2207 |
Pennsylvania Medicare |
|
6228 |
Pennsylvania Pace |
|
8898 |
People One Health |
|
2840 |
Physicians Care Network (IL)/Midland Mgmt |
|
7142 |
Physicians Choice Medical Group of Santa Maria |
|
8293 |
Physicians Health Plan of Michigan Medicare |
|
3430 |
Physicians Medical Group of San Jose |
|
3889 |
Physicians Mutual Insurance Company |
|
8857 |
PhysMetrics |
|
8229 |
PIH Health |
|
1106 |
Pinnacle Medical Group |
|
6719 |
Pioneer Provider Network Healthy Families by MedPOINT |
|
1737 |
PodAmerica |
|
8881 |
Pomona Valley Hospital Medical Center |
|
8131 |
Pool Administrators, INC. (PAI) - CA Dept of Public Health Secondary Claims |
|
3436 |
Populytics |
|
6884 |
Positive Healthcare |
|
7764 |
ppoONE |
|
2785 |
PR Medicare |
|
2240 |
Preferred Care Partners |
|
1791 |
Preferred Community Choice |
|
5253 |
Preferred Health Care of Pennsylvania |
|
8866 |
Preferred Health Plan of the Carolinas |
|
3225 |
Preferred IPA |
|
6130 |
Premier Eye Care |
|
5242 |
Presbyterian Health Plan |
|
8888 |
Presence ERC |
|
8274 |
Prezzo |
|
1757 |
Primary Physician Care |
|
7218 |
Prominence Health Plan of Nevada |
|
7219 |
Prominence Health Plan of Texas |
|
8878 |
Prominence HealthFirst of Florida Inc |
|
1141 |
Providence Care Network |
|
4498 |
Providence Health Plan |
|
6133 |
ProviDRS CARE NETWORK |
|
2220 |
Puerto Rico Medicare |
|
7717 |
QualCare IPA |
|
6160 |
Quality Care Partners |
|
8251 |
Quest EAP |
|
1443 |
Railroad Medicare |
|
3863 |
RBMS, LLC |
|
5892 |
Redlands Yucaipa Medical Group |
|
3292 |
Regal Medical Group |
|
6201 |
Regency Employee Benefits |
|
2268 |
Rhode Island Medicare |
|
7419 |
RI Medicare |
|
6182 |
RightCare Scott & White Health Plan |
|
6749 |
Riverside Health of Maryland |
|
9120 |
Riverside San Bernardino County Indian Health Inc |
|
4144 |
Rush Prudential Health Plans (HMO Only) |
|
6294 |
Sage MN Dept of Health |
|
3761 |
Sage Technologies |
|
4256 |
Saint Marys Health Plan |
|
2700 |
Saint Mary's Health Plan (Encounters) |
|
1294 |
San Bernardino Medical Group |
|
6190 |
San Diego County Medical Services (CMS) |
|
6177 |
San Diego County Ryan White Care Act |
|
9403 |
San Diego County Sheriff |
|
6736 |
San Francisco Health Plan |
|
8161 |
Sana Benefits |
|
2116 |
Sanford Health Plan |
|
9277 |
Sanford Health Plan Medicare Advantage |
|
6222 |
Santa Clara County IPA PPO |
|
1134 |
Sante Community Physicians Medical Group Corp |
|
2281 |
Sante Health System and Affiliates |
|
2452 |
SC Medicare |
|
9273 |
SCHS Alta Global Care Medical Group |
|
4100 |
Scott & White Health Plan |
|
2454 |
SD Medicare |
|
4259 |
Seaview |
|
3426 |
SECUR Health Plan |
|
1890 |
Select Benefit Administrators - IA |
|
8164 |
Selman & Company |
|
3256 |
Sentinel Management Services |
|
7227 |
Sharp Rees-Stealy Medical Group |
|
3880 |
Sierra Health Services (Claims) |
|
3879 |
Sierra Health Services Inc. (Encounters) |
|
9271 |
Simpra Advantage Inc. DOS after 12/31/2022 |
|
2491 |
Sisco |
|
3467 |
Smith Administrators |
|
1122 |
South Atlantic Medical Group |
|
3888 |
South Central Preferred |
|
5828 |
Southern Cal Physicians Managed Care Services |
|
1125 |
Southern California Childrens Health Care Network |
|
7887 |
Southern California Healthcare Systems (SCHS) Alta Pod by MedPOINT |
|
9748 |
Southwest Michigan Behavioral Health |
|
1123 |
Southwest Physicians Group LTD |
|
3412 |
St Joseph Heritage |
|
6255 |
Standard Life and Accident Insurance Company |
|
2708 |
StandardHealth with Health Choice (HCS) |
|
5419 |
State Farm Insurance |
|
6465 |
Student Insurance |
|
1228 |
Superior Insurance Services |
|
7893 |
Superior Select Health Plan |
|
4789 |
Sutter Connect - Central Valley claims |
|
4788 |
Sutter Connect - Central Valley encounters |
|
4705 |
Sutter Connect - Delta claims |
|
4274 |
Sutter Connect - East Bay Medical Foundation |
|
4713 |
Sutter Connect - Gould claims |
|
4712 |
Sutter Connect - Gould encounters |
|
4708 |
Sutter Connect - SIP,SMG,SWMG encounters |
|
6848 |
Swedish Covenant Hospital |
|
8827 |
TakeCare Insurance Company |
|
4465 |
Tall Trees Administrators |
|
9208 |
TDS/2 |
|
9207 |
TDS/3 |
|
9206 |
TDS/4 |
|
9211 |
TDS/ATRIO |
|
9201 |
TDS/Golden Times |
|
9210 |
TDS/Mid America ACO |
|
9105 |
Teddy Health |
|
8471 |
Texas Independence Health Plan, Inc |
|
2208 |
Texas Medicare |
|
2712 |
The Alliance |
|
6161 |
The Care Network/The Savannah Business Group |
|
3245 |
The City of Odessa |
|
9739 |
The Colorado Purchasing Alliance |
|
2824 |
The Health Plan |
|
1273 |
The Macaluso Group |
|
1453 |
TN Medicare |
|
9140 |
TOP Data Services/Vytalize/IPANS/BCBS |
|
4222 |
Torrance Hospital IPA |
|
4770 |
Total Community Care |
|
8200 |
Total Plan Concepts |
|
2872 |
TRICARE East Region |
|
6286 |
Tricare West Region |
|
5150 |
TriHealth Physicians Solutions |
|
5835 |
Trilogy Health Network (TRLHN/EB) |
|
9170 |
TriWest Region 4 CCN |
|
9169 |
TriWest Region 5 CCN |
|
9176 |
TriWest Region 6 CCN |
|
8841 |
Truli For Health |
|
6401 |
Trustmark |
|
1440 |
TX Medicare |
|
8763 |
U.S. Networks and Administrative Services |
|
6877 |
UC Davis Medical Group |
|
7867 |
Ucare Individual & Family Plans |
|
1132 |
UCS (The City of East Chicago) |
|
6868 |
Ultimate Health Plans |
|
6266 |
UltraBenefits Inc |
|
5711 |
UMC Health Plan |
|
1758 |
UMWA H & R Funds |
|
3838 |
Unified Group Services |
|
9780 |
Unified Health Plan TPA |
|
5420 |
Unified Health Services |
|
8728 |
Unite Health Share Ministries (UHSM) |
|
8817 |
Unite Here Health Las Vegas |
|
3281 |
United Agriculture Benefit Trust |
|
6840 |
United Care Medical Group |
|
1288 |
United Claim Solutions |
|
6442 |
United HealthCare of the River Valley |
|
3824 |
United Resource Network |
|
3429 |
UnitedHealthcare |
|
6283 |
UnitedHealthcare Community Plan of Kansas (aka KanCare) |
|
1227 |
UnitedHealthcare Community Plan of Missouri |
|
5495 |
UnitedHealthcare Vision for Shopko |
|
5494 |
UnitedHealthcare Vision for Walmart |
|
2719 |
University Family Care - Maricopa Health Plan |
|
2727 |
University Family Care/University Physician Care Advantage |
|
7217 |
University Health Care Advantage |
|
1211 |
University of Illinois |
|
8800 |
University of Illinois at Chicago, Div of Specialized Care for Children |
|
7487 |
University of Maryland Health Advantage |
|
4779 |
University of Utah Health Plan |
|
1792 |
Upper Peninsula Health Group (TPA) |
|
3741 |
Upper Peninsula Health Plan |
|
2241 |
US Benefits |
|
2458 |
UT Medicare |
|
1442 |
VA Medicare |
|
2461 |
VA Medicare (Alex,Arlgtn,Fairfax) |
|
6818 |
Valley Health Plan (Commercial) |
|
9288 |
Valley Presbyterian Hospital |
|
8831 |
Valley Presbyterian Hospital Community Family Care VPRESCFC |
|
8832 |
Valley Presbyterian Hospital Preferred IPA VPRESPREF |
|
8132 |
Valor Health Plan |
|
7718 |
Ventura County Health Care Plan |
|
2278 |
Vermont Medicare |
|
3887 |
Veterans Administration Fee Basis Programs |
|
8257 |
Veterans Affairs Community Care Network Region 1 |
|
6767 |
VGM Homelink |
|
6186 |
VHN |
|
4487 |
VI (Virgin Islands) Medicare |
|
9121 |
Village Practice Management Company |
|
6834 |
VillageCareMAX |
|
8244 |
VillageMD of Chicago |
|
8248 |
VillageMD of Houston |
|
8240 |
VillageMD of New Hampshire |
|
8249 |
VillageMD of Northern Indiana |
|
8173 |
VillageMD of Western Kentucky |
|
2221 |
Virgin Islands Medicare |
|
1702 |
Vitori Health |
|
4472 |
Viva Health Care and Viva Medicare |
|
8876 |
Vivida Health Plan DOS after 12/31/20 |
|
8818 |
VMD Primary Providers of Arizona |
|
2471 |
VT Medicare |
|
1462 |
WA Medicare |
|
5873 |
Watts Healthcare Corp |
|
5402 |
Wausau Insurance Companies |
|
6204 |
Weiss Health Providers |
|
9477 |
WelbeHealth |
|
3201 |
WellMed |
|
5843 |
Wellmed Encounters |
|
8801 |
WellNet Health Plans |
|
1735 |
Western Growers/Pinnacle |
|
6267 |
Western Health Advantage |
|
9761 |
Western Pennsylvania Electrical Employees Insurance Trust Fund |
|
8402 |
Weyco, Inc. |
|
1434 |
WI Medicare |
|
3465 |
William C Earhart |
|
5710 |
WIN Healthcare (Woman's Integrated Network, Inc.) |
|
2288 |
Wisconsin Medicare |
|
9205 |
Wisconsin Physician Service - Third Party Pricing |
|
1450 |
WV Medicare |
|
2466 |
WY Medicare |
|
1426 |
Yuzu Health |
|
8246 |
Zing Choice IL (HMO) |
|
2852 |
Zurich American 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.
If you have any questions, please contact Customer Support and refer to Case Number 09479735.
REF 17452259 4/29/2025
Report Generation Delay for CPID 5953 Healthy Blue South Carolina
A payer is experiencing issues affecting Institutional report generation for some claims submitted April 21, 2025.
Payer impacted:
- CPID 5953 Healthy Blue South Carolina
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.
If you have any questions, please contact Customer Support and refer to Case Number 09480633.
REF 17452408 4/29/2025
Update: Report Generation Delay for CPID 6284 Trillium Health Resources
Update: The payer has been unable to generate and deliver the reports for some claims submitted from Feb. 28, 2025 to April 18, 2025.
Action Required: Please resubmit claims if payment has not been received.
Original notify sent March 11, 2025:
A payer is experiencing issues affecting Professional report generation for some claims submitted since Feb. 28, 2025.
Payer impacted:
- CPID 6284 Trillium Health Resources
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.
If you have any questions, please contact Customer Support and refer to Case Number 09416564.
REF 17442908 4/28/2025
New Electronic Claims Connections Available
Optum has new electronic claims connections available:
Payer Name: Buenaventura Affiliated Physicians
Institutional CPID: 8982
Professional CPID: 3439
Payer-assigned Payer ID: BVAP1
Payer Enrollment Required: No
Secondary Claims Accepted: Yes
Payer Location: California
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 17440421 4/28/2025
Report Generation Delay for CPID 6254 AmFirst Insurance
A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted since April 17, 2025.
Payer impacted:
- CPID 6254 AmFirst Insurance
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.
If you have any questions, please contact Customer Support and refer to Case Number 09479449.
REF 17438330 4/28/2025
Payer Processing Issue for CPIDs 2872 and 5979 TRICARE East Region
Due to a payer processing issue, some Professional and Institutional claims transmitted to the payer listed below since April 21, 2025 were not processed by the payer.
Payer(s) impacted:
- CPID 2872 TRICARE East Region
- CPID 5979 TRICARE East Region
Optum is working diligently with the payer to resolve the issue and ensure reports are received.
This delay affected claims released to Optum since April 21, 2025, 3:00 P.M. CT.
Action Required: Be aware of the processing issue above.
If you have any questions, please contact Customer Support and refer to Case Number 09479475.
REF 17438210 4/28/2025
Report Generation Delay for CPID 3802 AvMed
A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted since April 17, 2025.
Payer impacted:
- CPID 3802 AvMed
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.
If you have any questions, please contact Customer Support and refer to Case Number 09479144.
REF 17436310 4/28/2025
New Electronic Claims Status Connection Available
Effective April 17, 2024, Optum is pleased to announce the availability of Real-time Claim Status Inquiry 276/277 for the below payer:
Payer Name: Group Administrators LTD
Industry Payer ID: 36338
IMN Real Time ID: 36338
Exchange Real Time ID: GRPAD
CPID(s): 8501/1770
Optum IEDi Real Time ID: 36338
Payer Enrollment Required: No
Connection Type: X12
Search Options:
Subscriber: Member ID, First Name, Last Name, Date of Birth
Dependent: Member ID, Subscriber Last Name, Dependent First Name, Dependent Last Name, Dependent Date of Birth
Claim Status Inquiries are currently only accepted for members of the following Group IDs:
CCL
CHE24
DFF
DMOS
EIQC
EJEI
EXMP
GSTC
HSS
HUNT
HYVE
NSH
NWI
OPL
REC
RSNF
SYNC
TBG
TDC
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.
REF 17436010 4/28/2025
Update: Report Generation Delay for CPIDs 1876 and 8990 Group Health Cooperative of South Central Wisconsin
Update: The payer has been unable to generate and deliver the reports for some claims submitted on April 15, 2025 and April 16, 2025.
Action Required: Please resubmit claims if payment has not been received.
Original notify sent April 22, 2025:
A payer is experiencing issues affecting Institutional and Professional report generation for some claims submitted since April 15, 2025.
Payer impacted:
- CPID 1876 Group Health Cooperative of South Central Wisconsin
- CPID 8990 Group Health Cooperative of South Central Wisconsin
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.
If you have any questions, please contact Customer Support and refer to Case Number 09471570.
REF 17433909 4/28/2025
Report Generation Delay for CPID 6671 HealthSun
A payer intermediary is experiencing issues affecting Institutional report generation for some claims submitted April 18, 2025.
Payer impacted:
- CPID 6671 HealthSun
The payer intermediary has been unable to generate and deliver the reports.
Action Required: None. Please resubmit claims if payment has not been received.
If you have any questions, please contact Customer Support and refer to Case Number 09478950.
REF 17433908 4/28/2025
Update: Delay in Electronic Remittance Advice (ERA) for Multiple Payers
Update: This issue is now resolved for the following payers. All impacted ERAs have been reprocessed.
- CPID 3429 United Healthcare
- CPID 3550 United Healthcare
- CPID 6485 Oxford Health Plans
- CPID 6549 Oxford Health Plans
Please be aware there is still a delay for the below payer. Optum will continue to work with this payer.
- CPID 4590 United Medical Resources
- CPID 5402 United Medical Resources
Action Required: None.
Original notification sent April 24, 2025:
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 date of April 14, 2025 and deposit dates of April 12, 2025 through April 16, 2025:
- CPID 3429 United Healthcare
- CPID 3550 United Healthcare
- CPID 4590 United Medical Resources
- CPID 5402 United Medical Resources
- CPID 6485 Oxford Health Plans
- CPID 6549 Oxford Health Plans
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 and refer to Case Number INC-000002574.
REF 17432708 4/28/2025
Integra Group - CHA Payer ID 31129
New Payer Announcement - The following items are covered in this announcement:
Optum Intelligent EDI is pleased to announce new claim payer connectivity for the following transaction types. Please incorporate claims into existing files you submit to Optum today.
Payer Name: Integra Group - CHA
Payer ID: 31129
Transaction Types: 837 Professional & Institutional
Effective Date: 4/24/25
Please direct any questions to the Support Team at 1-866-OptumGo. Please do not reply to this email directly.
REF 17428595 4/25/2025
Integra Group - Home Payer ID 31128
New Payer Announcement - The following items are covered in this announcement:
Optum Intelligent EDI is pleased to announce new claim payer connectivity for the following transaction types. Please incorporate claims into existing files you submit to Optum today.
Payer Name: Integra Group - Home
Payer ID: 31128
Transaction Types: 837 Professional & Institutional
Effective Date: 4/24/25
Please direct any questions to the Support Team at 1-866-OptumGo. Please do not reply to this email directly.
REF 17428594 4/25/2025
Electronic Medical Attachment Connection Suspended
Effective immediately, the payers listed below have been temporarily suspended at Optum for electronic medical attachment processing and removed from the payer list.
Payer Name: HealthChoice Oklahoma
Payer ID: 71064
CPIDs: 7511, 7748
Transaction: Medical Attachments
Payer Name: HealthSCOPE
Payer ID: 40026
CPIDs: 8011, 9725
Transaction: Medical Attachments
Payer Name: Oklahoma Department of Corrections
Payer ID: 71065
CPIDs: 7513, 7750
Transaction: Medical Attachments
Payer Name: United Medical Resources
Payer ID: 39026
CPIDs: 4590, 5402
Transaction: Medical Attachments
Action Required: Please refrain from submitting medical attachments until further notice.
REF 17428658 4/25/2025
Unicare Electronic Eligibility and Claim Status Connections No Longer Available
Effective immediately, electronic eligibility and claim status connections for the payer below will no longer be available at Optum.
Payer Name: Unicare
Real Time ID: UNICAR
CPID(s): 4589, 8473
Industry Payer ID: 80314
Connection Type: X12
Reason: The Unicare Real Time Payer ID UNICAR has been terminated, providers should use WLPNT going forward instead.
Payer Name: Wellpoint
Real Time Payer ID: WLPNT
CPID(s): 2560, 1775
Industry Payer ID: WLPNT
Connection Type: X12
Action Required: Please update your system immediately with the new real time payer ID WLPNT.
REF 17427958 4/25/2025
Update: Electronic Claims Connection Suspended for CPIDs 5681, 6700 Centurion Managed Care
Effective immediately, the payer listed below will no longer be available at Optum for claims and remittance processing and must use different CPIDs.
Payer Name: Centurion Managed Care
Professional CPID: 6700
Institutional CPID: 5681
Payer-assigned Payer ID: 42140
Remittance Available: Yes
Providers must begin using the following for claims submission:
Payer Name: Centurion, LLC
Professional CPID: 9779
Institutional CPID: 8062
Payer-assigned Payer ID: IHS11
Remittance Available: No
Claim Fee: No
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.
Original notice sent April 4, 2025:
Effective immediately, the payer listed below has been temporarily suspended at Optum for claim processing and removed from the payer list.
Payer Name: Centurion Managed Care
CPIDs: 5681, 6700
Payer ID: 42140
Reason: Payer no longer supports this Payer ID number.
Action Required: Please refrain from submitting claims until further notice.
REF 17426659 4/25/2025
Update: Electronic Claims Connection Suspended for CPIDs 5681, 6700 Centurion Managed Care
Effective immediately, the payer listed below will no longer be available at Optum for claims and remittance processing and must use different CPIDs.
Payer Name: Centurion Managed Care
Professional CPID: 6700
Professional Edit Master: PE_B800
Institutional CPID: 5681
Institutional Edit Master: HE9B801
Payer-assigned Payer ID: 42140
Remittance LOB: U6W
Providers must begin using the following for claims submission:
Payer Name: Centurion, LLC
Professional CPID: 9779
Professional Edit Master: PE_T007
Institutional CPID: 8062
Institutional Edit Master: HE9T007
Payer-assigned Payer ID: IHS11
Line of Business Code (LOB): N/A
Enrollment Requirements:
Claims:
- Payer enrollment for electronic claims is not required.
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.
Original notice sent April 4, 2025:
Effective immediately, the payer listed below has been temporarily suspended at Optum for claim processing and removed from the payer list.
Payer Name: Centurion Managed Care
CPIDs: 5681, 6700
Payer ID: 42140
Reason: Payer no longer supports this Payer ID number.
Action Required: Please refrain from submitting claims until further notice.
REF 17426616 4/25/2025
TRICARE East Region DOS before 01/01/25 Electronic Claims Connection No Longer Available
Effective May 1, 2025, the payer listed below will no longer be available at Optum for claims processing and must use different CPIDs.
Payer Name: TRICARE East Region DOS before Jan. 1, 2025
Claims CPIDs: 1253, 4585
Payer-assigned Payer ID: TREST
Reason: Payer no longer contracted with WPS.
Claims must be submitted to Optum by April 30, 2025, 8:00 p.m. CT to meet the payer’s final cutoff time for claims submission.
The last day WPS will generate payments and remittance advices is July 1, 2025, or sooner if all claims are adjudicated. Optum will process remittance advice from WPS until the run-out period has ended.
Beginning May 1, 2025, all claims for TRICARE East Region, regardless of dates of service, must be sent to:
Payer Name: TRICARE East Region
CPIDs: 2872, 5979
Payer-assigned Payer ID: 99727
Remittance Available: Yes
Claim Fee: No
Enrollment Requirements for payer ID 99727:
Claims:
- Payer enrollment for electronic claims is not required. However, PGBA requires an Electronic Data Interchange (EDI) Provider Trading Partner Agreement to be on file.
- If the provider has an Electronic Data Interchange (EDI) Provider Trading Partner Agreement on file with PGBA, the Optum Enrollment is not required and providers may send claims.
- If the provider does not have an Electronic Data Interchange (EDI) Provider Trading Partner Agreement on file with PGBA, please complete the Optum Enrollment form process prior to sending claims.
Remittance:
- Payer enrollment for electronic remittance is required.
- Providers currently receiving electronic remittance through Optum for CPIDs 2872, 5979 TRICARE East Region do not need to complete a new enrollment form.
- Providers not receiving electronic remittance through Optum for CPIDs 2872, 5979 TRICARE East Region 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 17420361 4/25/2025
TRICARE East Region DOS before 01/01/25 Electronic Claims Connection No Longer Available
Effective May 1, 2025, the payer listed below will no longer be available at Optum for claims processing and must use different CPIDs.
Payer Name: TRICARE East Region DOS before Jan. 1, 2025
Payer Alias: TRICARE East Region
Claims CPIDs: 1253, 4585
Payer-assigned Payer ID: TREST
Reason: Payer no longer contracted with WPS.
Claims must be submitted to Optum by April 30, 2025, 8:00 p.m. CT to meet the payer’s final cutoff time for claims submission.
The last day WPS will generate payments and remittance advices is July 1, 2025, or sooner if all claims are adjudicated. Optum will process remittance advice from WPS until the run-out period has ended.
Beginning May 1, 2025, all claims for TRICARE East Region, regardless of dates of service, must be sent to:
Payer Name: TRICARE East Region
Payer Alias: TRICARE East Reg
CPIDs: 2872, 5979
Payer-assigned Payer ID: 99727
Line of Business (LOB): M08
Enrollment Requirements for payer ID 99727:
Claims:
- Payer enrollment for electronic claims is not required. However, PGBA requires an Electronic Data Interchange (EDI) Provider Trading Partner Agreement to be on file.
- If the provider has an Electronic Data Interchange (EDI) Provider Trading Partner Agreement on file with PGBA, the Optum Enrollment is not required and providers may send claims.
- If the provider does not have an Electronic Data Interchange (EDI) Provider Trading Partner Agreement on file with PGBA, please complete the Optum Enrollment form process prior to sending claims.
Remittance:
- Payer enrollment for electronic remittance is required.
- Providers currently receiving electronic remittance through Optum for CPIDs 2872, 5979 TRICARE East Region do not need to complete a new enrollment form.
- Providers not receiving electronic remittance through Optum for CPIDs 2872, 5979 TRICARE East Region 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 17420359 4/25/2025
Report Generation Delay for CPIDs 2481 and 3509 Ohio Medicaid
A payer is experiencing issues affecting Professional and Institutional report generation for some claims submitted April 21, 2025.
Payer impacted:
- CPID 2481 Ohio Medicaid
- CPID 3509 Ohio Medicaid
The payer has been unable to generate and deliver the reports for some claims submitted April 21, 2025.
Action Required: Please resubmit claims if payment has not been received.
If you have any questions, please contact Customer Support and refer to Case Number 09477473.
REF 17419764 4/25/2025
Report Generation Delay for Multiple CPIDs
A payer intermediary is experiencing issues affecting Professional and Institutional report generation for some claims submitted since April 22, 2025.
Payers impacted:
- CPID 6482 Associates for Healthcare - HEALTHEOS
- CPID 4592 Associates for Healthcare - HEALTHEOS
- CPID 3899 Health Care Network of WI (HCN) - HEALTHEOS
- CPID 0033 MultiPlan HealthEOS (Professional)
- CPID 0034 MultiPlan HealthEOS (Institutional)
- CPID 1865 Multiplan New Orleans Division
- CPID 8556 Multiplan New Orleans Division
- CPID 2971 WI Preferred Provider Network (WPPN)
- CPID 3823 WI Preferred Provider Network (WPPN)
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.
If you have any questions, please contact Customer Support and refer to Case Number 09475926.
REF 17420520 4/25/2025
Report Generation Delay for Multiple CPIDs
The payers listed below are experiencing issues affecting Professional and Institutional report generation for some claims submitted April 21, 2025.
Payers impacted:
- CPID 3428 Aetna Bulk Encounters
- CPID 4011 Aetna Affordable Health Choices
- CPID 7780 Allina Health and Aetna Insurance Company
- CPID 7559 Allina Health and Aetna Insurance Company
- CPID 7752 Banner Health and Aetna Health Insurance Company
- CPID 7521 Banner Health and Aetna Health Insurance Company
- CPID 6869 Innovation Health
- CPID 1262 Texas Health Aetna
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.
If you have any questions, please contact Customer Support and refer to Case Number 09477359.
REF 17420519 4/25/2025
Update: Report Generation Delay for CPID 6671 HealthSun
Update: The payer intermediary has been unable to generate and deliver the reports for some claims submitted March 26, 2025.
Action Required: Please resubmit claims if payment has not been received.
Original notify sent April 8, 2025:
A payer intermediary is experiencing issues affecting Institutional report generation for some claims submitted March 26, 2025.
Payer impacted:
- CPID 6671 HealthSun
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.
If you have any questions, please contact Customer Support and refer to Case Number 09454048.
REF 17418058 4/25/2025
999 Payer Batch Rejections for CPID 8551 Wellcare Health Plans
Institutional claims transmitted to the payer listed below from Optum on April 24, 2025 were not processed by the payer due to a 999 Batch Rejection.
- CPID 8551 Wellcare Health Plans
A resolution has been implemented and the claims were retransmitted to the payer on April 25, 2025.
Action Required: None.
If you have any questions, please contact Customer Support and refer to Case Number 09476569.
REF 17417258 4/25/2025
Delay in Electronic Remittance Advice for Multiple Payers
Due to a payer processing issue, there has been a delay in Professional and Institutional Electronic Remittance Advice for the following payers for check date of April 14, 2025 and deposit dates of April 12, 2025-April 16, 2025:
- CPID 3429 United Healthcare
- CPID 3550 United Healthcare
- CPID 4590 United Medical Resources
- CPID 5402 United Medical Resources
- CPID 6485 Oxford Health Plans
- CPID 6549 Oxford Health Plans
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 and refer to Case Number INC-000002574.
REF 17405453 4/24/2025
Electronic Claims Connection Suspended
Effective immediately, the payer listed below has been suspended at Optum for claim processing and removed from the payer list.
Payer Name: Healthcare Highways
CPIDs: 1280, 6526
Payer ID: HCH01
Reason: Payer unavailable electronically.
Action Required: Please refrain from submitting claims until further notice.
REF 17400858 4/24/2025
New Electronic Medical Attachment Connections Available
Optum has new electronic medical attachment connections available:
Payer Name: United Medical Resources
Professional CPID: 5402
Institutional CPID: 4590
Payer-assigned Payer ID: 39026
Accepted Attachment Type: Unsolicited
Payer Enrollment Required: No
Payer Location: National
Payer Name: HealthChoice Oklahoma
Professional CPID: 7748
Institutional CPID: 7511
Payer-assigned Payer ID: 71064
Accepted Attachment Type: Unsolicited
Payer Enrollment Required: No
Payer Location: National
Payer Name: HealthSCOPE
Professional CPID: 9725
Institutional CPID: 8011
Payer-assigned Payer ID: 40026
Accepted Attachment Type: Unsolicited
Payer Enrollment Required: No
Payer Location: National
Payer Name: Oklahoma Department of Corrections
Professional CPID: 7750
Institutional CPID: 7513
Payer-assigned Payer ID: 71065
Accepted Attachment Type: Unsolicited
Payer Enrollment Required: No
Payer Location: National
Action Required:
- Exchange providers must be contracted with Optum to submit electronic medical attachments. Please contact Support at 1-800-527-8133 option 2, or by emailing [email protected] for additional information.
- 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 update your system and procedures to take advantage of the new connection. For assistance with Medical Attachments, please contact your Practice Management System Vendor.
NOTE: The above Payer ID(s) is for Medical Attachments and may require Providers and/or their vendor be contracted with Optum for the Medical Attachment transaction services.
REF 17394800 4/24/2025
New Assurance Attach Assist Medical Attachment Connections Available
Optum has new electronic medical attachment connections available:
Payer Name: United Medical Resources
Professional CPID: 5402
Institutional CPID: 4590
Payer-assigned Payer ID: 39026
Accepted Attachment Type: Unsolicited
Payer Enrollment Required: No
Payer Location: National
Payer Name: HealthChoice Oklahoma
Professional CPID: 7748
Institutional CPID: 7511
Payer-assigned Payer ID: 71064
Accepted Attachment Type: Unsolicited
Payer Enrollment Required: No
Payer Location: National
Payer Name: HealthSCOPE
Professional CPID: 9725
Institutional CPID: 8011
Payer-assigned Payer ID: 40026
Accepted Attachment Type: Unsolicited
Payer Enrollment Required: No
Payer Location: National
Payer Name: Oklahoma Department of Corrections
Professional CPID: 7750
Institutional CPID: 7513
Payer-assigned Payer ID: 71065
Accepted Attachment Type: Unsolicited
Payer Enrollment Required: No
Payer Location: National
Action Required:
- 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 17394801 4/24/2025
Report Generation Delay for Multiple CPIDs
A payer intermediary is experiencing issues affecting Professional and Institutional report generation for some claims submitted April 11, 2025 and April 14, 2025.
Payers impacted:
- CPID 3088 Lake County Physicians Association
- CPID 7245 Oak West Physician Association
- CPID 8664 Oak West Physician Association
- CPID 1851 St. Therese Physician Associates
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.
If you have any questions, please contact Customer Support and refer to Case Number 09474392.
REF 17391809 4/23/2025
Report Generation Delay for CPIDs 3770 and 1029 Physician Health Associates/Midland Mgmt
A payer is experiencing issues affecting Professional and Institutional report generation for some claims submitted since April 14, 2025.
Payer impacted:
- CPID 3770 Physician Health Associates/Midland Mgmt
- CPID 1029 Physician Health Associates/Midland Mgmt
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.
If you have any questions, please contact Customer Support and refer to Case Number 09474341.
REF 17391808 4/23/2025
Update: Report Generation Delay for CPID 2712 The Alliance
Update: The payer has been unable to generate and deliver the reports for some claims submitted on April 4, 2025 and April 5, 2025.
Action Required: Please resubmit claims if payment has not been received.
Original notify sent April 10, 2025:
A payer is experiencing issues affecting Professional report generation for some claims submitted since April 4, 2025.
Payer impacted:
- CPID 2712 The Alliance
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.
If you have any questions, please contact Customer Support and refer to Case Number 09457863.
REF 17389911 4/23/2025
Electronic Routing Change for CPIDs 6551 and 1291 Umpqua Health Alliance
Effective March 28, 2025, Optum has changed electronic remittance routing for the following payer:
Payer Name: Umpqua Health Alliance
Professional CPID: 1291
Institutional CPID: 6551
Payer-assigned Payer ID: 77505
Line of Business Code (LOB): H2D
Payer Remittance Enrollment Required: Yes
Enrollment Requirements:
Remittance:
- Payer enrollment for electronic remittance is required.
- Providers currently receiving electronic remittance through Optum do not need to complete a new enrollment form.
- Providers that have not received remittance since March 28, 2025, must review the enrollment instructions and ensure ‘Change Healthcare Medical’ is selected as the clearinghouse. If not, please complete a new enrollment form to receive remittance for this payer from Optum.
- New providers must complete a new enrollment form.
Action Required: Please make the following changes to accommodate the routing change:
- 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 17387210 4/23/2024
Report Generation Delay for CPID 3433 Mercy Care Plan
A payer is experiencing issues affecting Professional report generation for some claims submitted on April 21, 2025.
Payer impacted:
- CPID 3433 Mercy Care 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.
If you have any questions, please contact Customer Support and refer to Case Number 09473375.
REF 17384458 4/23/2025
Electronic Claims Connection Suspended
Effective immediately, the payer listed below has been suspended at Optum for claim processing and removed from the payer list.
Payer Name: Guardian Life
CPIDs: 4517, 6409
Payer ID: 64246
Reason: Payer unavailable electronically
Action Required: Please refrain from submitting claims until further notice.
REF 17387209 4/23/2025
Electronic Routing Change for CPIDs 6551 and 1291 Umpqua Health Alliance
Effective March 28, 2025, Optum changed electronic remittance routing for the following payer:
Payer Name: Umpqua Health Alliance
Professional CPID: 1291
Institutional CPID: 6551
Payer-assigned Payer ID: 77505
Payer Remittance Enrollment Required: Yes
Remittance Fee: N/A
Enrollment Requirements:
Remittance:
- Payer enrollment for electronic remittance is required.
- Providers currently receiving electronic remittance through Optum do not need to complete a new enrollment form.
- Providers that have not received remittance since March 28, 2025, must review the enrollment instructions and ensure ‘Change Healthcare Medical’ is selected as the clearinghouse. If not, please complete a new enrollment form to receive remittance for this payer from Optum.
- 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 17387211 4/23/2025
Electronic Routing Change for CPIDs 3555 and 6434 Marrick Medical Finance
Effective April 23, 2025, Optum will be reactivating and changing electronic claims routing for the following payer:
Payer Name: Marrick Medical Finance
Professional CPID: 6434
Institutional CPID: 3555
Payer-assigned Payer ID: 20805
Payer Claim Enrollment Required: No
Secondary Claims Accepted: Yes
Claims Fee: N/A
Enrollment Requirements:
Claims:
Payer enrollment for electronic claims is not required.
Report Changes:
Payer does not currently generate reports.
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 17385461 4/23/2025
Electronic Routing Change for CPIDs 3555 and 6434 Marrick Medical Finance
Effective April 23, 2025, Optum is reactivating and changing electronic claims routing for the following payer:
Payer Name: Marrick Medical Finance
Professional CPID: 6434
Current Edit Master: PE_E049
New Edit Master: PE_T007
Institutional CPID: 3555
Current Edit Master: HE9T007
Payer-assigned Payer ID: 20805
Payer Claim Enrollment Required: No
Secondary Claims Accepted: Yes
Enrollment Requirements:
Claims:
Payer enrollment for electronic claims is not required.
Report Changes:
Payer does not currently generate reports.
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 master.
- 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 17385460 4/23/2025
Remittance (ERA) Delay for CPIDs 1631 and 2173 Alameda Alliance for Health
Due to a processing issue, there has been a delay in Institutional and Professional Electronic Remittance Advice (ERA) for the following payers for check dates of April 17, 2025 through present:
Payer Impacted:
- CPID 1631 Alameda Alliance for Health
- CPID 2173 Alameda Alliance for Health
Additional updates will be forwarded as more information becomes available.
Action Required: Please be aware of a delay in the delivery of ERA for receive dates above.
If you have any questions, please contact Customer Support and refer to Case Number 09472593.
REF 17374036 4/22/2025
New Electronic Remittance Connections Available
Optum has new electronic remittance connections available:
Payer Name: Illinois Health Partners
Other plan names:
- Dupage Medical Group
- Boncura Health Solutions
Institutional CPID: 5994
Professional CPID: 2234
Payer-assigned Payer ID: 57140
Line of Business (LOB) Code: E11
Payer Enrollment Required: Yes
Payer Location: Illinois
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 17371662 4/22/2025
New Electronic Remittance Connections Available
Optum has new electronic remittance connections available:
Payer Name: Illinois Health Partners
Other plan names:
- Dupage Medical Group
- Boncura Health Solutions
Institutional CPID: 5994
Professional CPID: 2234
Payer-assigned Payer ID: 57140
Payer Enrollment Required: Yes
Remittance Fee: N/A
Payer Location: Illinois
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 17371661 4/22/2025
Payer Change for CPIDs 5805, 3627 PacificSource Administrators (PSA)
Effective immediately, claims currently exchanged with the following payer must use different CPIDs.
Payer Name: PacificSource Administrators (PSA)
Professional CPID: 5805
Professional Edit Master: PE_T007
Institutional CPID: 3627
Institutional Edit Master: HE9T007
Payer-assigned Payer ID: 93031
Claims must begin using the following:
Payer Name: PacificSource Health
Professional CPID: 5441
Professional Edit Master: PE_P006
Institutional CPID: 6575
Institutional Edit Master: HE9P006
Payer-assigned Payer ID: 93029
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 5441, 6575 PacificSource Health do not need to complete a new enrollment form.
- Providers not receiving electronic remittance through Optum for CPIDs 5441, 6575 PacificSource Health must complete a new enrollment form.
- New providers must complete a new enrollment form.
CPIDs 5805, 3627 PacificSource Administrators (PSA) will be terminated effective May 6, 2025.
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 17367559 4/22/2025
Payer Change for CPIDs 5805, 3627 PacificSource Administrators (PSA)
Effective immediately, claims currently exchanged with the following payer must use different CPIDs.
Payer Name: PacificSource Administrators (PSA)
Professional CPID: 5805
Institutional CPID: 3627
Payer-assigned Payer ID: 93031
Claims must begin using the following:
Payer Name: PacificSource Health
Professional CPID: 5441
Institutional CPID: 6575
Payer-assigned Payer ID: 93029
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 5441, 6575 PacificSource Health do not need to complete a new enrollment form.
- Providers not receiving electronic remittance through Optum for CPIDs 5441, 6575 PacificSource Health must complete a new enrollment form.
- New providers must complete a new enrollment form.
CPIDs 5805, 3627 PacificSource Administrators (PSA) will be terminated effective May 6, 2025.
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 17367558 4/22/2025
Report Generation Delay for CPID 5563 Washington Labor and Industry Workers Compensation
A payer is experiencing issues affecting Institutional report generation for some claims submitted April 11, 2025-April 16, 2025.
Payer impacted:
- CPID 5563 Washington Labor and Industry Workers Compensation
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.
If you have any questions, please contact Customer Support and refer to Case Number 09465031.
REF 17367508 4/22/2025
Report Generation Delay for CPIDs 1865 and 8556 Multiplan New Orleans Division
A payer is experiencing issues affecting Professional and Institutional report generation for some claims submitted April 10, 2025.
Payer(s) impacted:
- CPID 1865 Multiplan New Orleans Division
- CPID 8556 Multiplan New Orleans Division
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.
If you have any questions, please contact Customer Support and refer to Case Number 09462536.
REF 17365058 4/22/2025
Report Generation Delay for CPIDs 1876 and 8990 Group Health Cooperative of South Central Wisconsin
A payer is experiencing issues affecting Institutional and Professional report generation for some claims submitted since April 15, 2025.
Payer impacted:
- CPID 1876 Group Health Cooperative of South Central Wisconsin
- CPID 8990 Group Health Cooperative of South Central Wisconsin
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.
If you have any questions, please contact Customer Support and refer to Case Number 09471570.
REF 17363908 4/22/2025
Univera Healthcare Electronic Claims Connection No Longer Available
Update: Effective immediately, the payer listed below will no longer be available at Optum for claims processing.
Payer Name: Univera Healthcare
Claims CPID: 1655
Payer-assigned Payer ID: 12X18
Reason: Payer no longer offers an electronic institutional claims 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.
Original sent 4/3/2025:
Effective immediately, the payer listed below has been temporarily suspended at Optum for claim processing and removed from the payer list.
Payer Name: Univera Healthcare
CPID: 1655
Payer ID: 12X18
Reason: Payer unavailable electronically
Action Required: Please refrain from submitting claims until further notice.
REF 17364882 4/22/2025
Update: Univera Healthcare Electronic Claims Connection No Longer Available
Update: Effective immediately, the payer listed below will no longer be available at Optum for claims processing.
Payer Name: Univera Healthcare
Claim CPID: 1655
Payer-assigned Payer ID:12X18
Reason: Payer no longer offers an electronic institutional claims connection to which Optum can connect.
Action Required: Claims must be submitted to Optum on paper.
Original sent 4/3/2025:
Effective immediately, the payer listed below has been temporarily suspended at Optum for claim processing and removed from the payer list.
Payer Name: Univera Healthcare
CPID: 1655
Payer ID: 12X18
Reason: Payer unavailable electronically
Action Required: Please refrain from submitting claims until further notice.
REF 17364883 4/22/2025
Report Generation Delay for CPID 9253 Pacific Administrators, Inc.
The payer listed below is experiencing issues affecting Professional report generation for some claims submitted from April 3, 2025 through April 8, 2025.
Payer impacted:
- CPID 9253 Pacific Administrators, Inc.
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.
If you have any questions, please contact Customer Support and refer to Case Number 09470607.
REF 17351208 4/21/2025
Report Generation Delay for CPIDs 2916 and 1798 EVV State of Nevada
The payer listed below is experiencing issues affecting Institutional and Professional report generation for some claims submitted April 16, 2025.
Payer impacted:
- CPID 2916 EVV State of Nevada
- CPID 1798 EVV State of Nevada
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.
If you have any questions, please contact Customer Support and refer to Case Number 09470491.
REF 17348210 4/21/2025
Report Generation Delay for multiple CPIDs
A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted since April 11, 2025.
Payers impacted:
- CPID 1510 Iowa Wellmark Blue Cross Blue Shield
- CPID 1404 Iowa Wellmark Blue Cross Blue Shield
- CPID 6672 Iowa Wellmark Blue Cross Blue Shield Crossover
- CPID 6733 Iowa Wellmark Blue Cross Blue Shield Crossover
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.
If you have any questions, please contact Customer Support and refer to Case Number 09470102.
REF 17342309 4/21/2025
Report Generation Delay for CPIDs 3693 and 2150 Florida Health Care Plans
A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted on April 11, 2025.
Payer impacted:
- CPID 3693 Florida Health Care Plans
- CPID 2150 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.
If you have any questions, please contact Customer Support and refer to Case Number 09470047.
REF 17341919 4/21/2025
Report Generation Delay for CPID 4258 VNS Health
A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted on April 10, 2025.
Payer impacted:
- 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.
If you have any questions, please contact Customer Support and refer to Case Number 09470014.
REF 17341409 4/21/2025
Report Generation Delay for CPID 7493 Vermont Blue Cross Blue Shield
A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted on April 10, 2025.
Payer impacted:
- CPID 7493 Vermont Blue Cross Blue Shield
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.
If you have any questions, please contact Customer Support and refer to Case Number 09470030.
REF 17341411 4/21/2025
Electronic Routing Change for CPIDs 2872 and 5979 TRICARE East Region
Effective April 21, 2025, Optum will be changing electronic claims and remittance routing for the following payer:
Payer Name: TRICARE East Region
Professional CPID: 2872
Institutional CPID: 5979
Payer-assigned Payer ID: 99727
Payer Claim Enrollment Required: Yes
Payer Remittance Enrollment Required: Yes
Secondary Claims Accepted: Yes
Claims Fee: N/A
Remittance Fee: N/A
Enrollment Requirements:
Claims:
- Payer enrollment for electronic claims is not required. However, PGBA requires an Electronic Data Interchange (EDI) Provider Trading Partner Agreement to be on file.
- If the provider is credentialed with PGBA and has an Electronic Data Interchange (EDI) Provider Trading Partner Agreement on file with PGBA the Optum Enrollment is not required and providers may continue to send claims.
- If the provider is not credentialed with PGBA, please complete the Optum Enrollment form process prior to sending claims.
Remittance:
- Payer enrollment for electronic remittance is required.
- Providers currently receiving electronic remittance through Optum do not need to 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 receive.
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 17331516 4/18/2025
Electronic Routing Change for CPIDs 2872 and 5979 TRICARE East Region
Effective April 21, 2025, Optum will be changing electronic claims and remittance routing for the following payer:
Payer Name: TRICARE East Region
Professional CPID: 2872
Edit Master: PE_B026
Institutional CPID: 5979
Edit Master: HE9B023
Payer-assigned Payer ID: 99727
Line of Business Code (LOB): M08
Payer Claim Enrollment Required: Yes
Payer Remittance Enrollment Required: Yes
Secondary Claims Accepted: Yes
Enrollment Requirements:
Claims:
- Payer enrollment for electronic claims is not required. However, PGBA requires an Electronic Data Interchange (EDI) Provider Trading Partner Agreement to be on file.
- If the provider is credentialed with PGBA and has an Electronic Data Interchange (EDI) Provider Trading Partner Agreement on file with PGBA the Optum Enrollment is not required and providers may continue to send claims.
- If the provider is not credentialed with PGBA, please complete the Optum Enrollment form process prior to sending claims.
Remittance:
- Payer enrollment for electronic remittance is required.
- Providers currently receiving electronic remittance through Optum do not need to 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 receive.
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 CPIDs are not changing.
- When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.
REF 17331515 4/18/2025
Update: Report Generation Delay for CPIDs 6423 and 5661 RevClaims
Update: The payer intermediary has been unable to generate and deliver the reports for some claims submitted on March 6, 2025 and March 19, 2025.
Action Required: Please resubmit claims if payment has not been received.
Update sent March 31, 2025:
Update: A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted on March 6, 2025 and March 19, 2025.
Payer impacted:
- CPID 5661 RevClaims
- CPID 6423 RevClaims
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 March 18, 2025:
A payer intermediary is experiencing issues affecting Institutional report generation for some claims submitted on March 6, 2025.
Payer impacted:
- CPID 5661 RevClaims
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.
If you have any questions, please contact Customer Support and refer to Case Number 09425744.
REF 17324271 4/18/2025
Electronic Claims Connection Suspended
Effective immediately, the payer listed below has been temporarily suspended at Optum for claim processing and removed from the payer list.
Payer Name: Truli for Health
CPIDs: 4098, 8841
Payer ID: TRULI
Reason: Payer unavailable electronically
Action Required: Please refrain from submitting claims until further notice.
REF 17310009 4/17/2025
Electronic Reactivation and Routing Change for CPID 6559 Chino Valley Medical Group
Effective April 22, 2025, Optum will be reactivating and changing electronic claims routing for the following payer:
Payer Name: Chino Valley Medical Group
Institutional CPID: 6559
Payer-assigned Payer ID: CVMC1
Payer Claim Enrollment Required: No
Secondary Claims Accepted: No
Claims Fee: $0.10
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 17307378 4/17/2025
Electronic Reactivation and Routing Change for CPID 6559 Chino Valley Medical Group
Effective April 22, 2025, Optum will be reactivating and changing electronic claims routing for the following payer:
Payer Name: Chino Valley Medical Group
Institutional CPID: 6559
Current Edit Master: HE9O007
New Edit Master: HE9T007
Payer-assigned Payer ID: CVMC1
Payer Claim Enrollment Required: No
Secondary Claims Accepted: No
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 17307379 4/17/2025
Payer Transmit Delay for CPID 9280 Medequip
Due to a payer system issue, a delay occurred in some of the transmissions to the following payer since April 16, 2025.
Payer impacted:
- CPID 9280 Medequip
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 4 a.m. CT on April 15, 2025.
Action Required: Be aware of the transmit delay above.
If you have any questions, please contact Customer Support and refer to Case Number 09466382.
REF 17308161 4/17/2025
Report Generation Delay for CPIDs 5036 and 8883 Collective Health
A payer is experiencing issues affecting Professional and Institutional report generation for some claims submitted since April 14, 2025.
Payer impacted:
- CPID 8883 Collective Health
- CPID 5036 Collective 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.
If you have any questions, please contact Customer Support and refer to Case Number 09466398.
REF 17308163 4/17/2025
New Payer Connection
Optum Insight is now live with the World Trade Center Health Program Nationwide Provider Network (Payer Name is “MCA-Sedgwick WTCHP NPN)). We began submitting EDI claims in January 2025 under Published Payer ID LV371. If you have any questions you can contact the MCA-Sedgwick call center at 800-416-2898, Option 2 from 8am to 8pm ET Monday through Friday.
REF 17306458 4/17/2025
Electronic Routing Change for CPIDs 2048, 8187, 9640, 7471 Multiple Payers
Effective April 16, 2025, Optum will be reactivating and changing electronic claims routing for the following payers:
Payer Name: Delano IPA
Professional CPID: 8187
Institutional CPID: 2048
Payer-assigned Payer ID: 77124
Secondary Claims Accepted: No
Claims Fee: $0.10
Payer Name: Ingalls Provider Group
Professional CPID: 7471
Institutional CPID: 9640
Payer-assigned Payer ID: 85578
Secondary Claims Accepted: Yes
Claims Fee: $0.10
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 17297959 4/16/2025
Electronic Routing Change for CPIDs 8187, 2048 Delano IPA
Effective April 16, 2025, Optum will be reactivating and changing electronic claims routing for the following payer:
Payer Name: Delano IPA
Professional CPID: 8187
Edit Master: PE_T007
Institutional CPID: 2048
Edit Master: HE9T007
Payer-assigned Payer ID: 77124
Payer Claim Enrollment Required: No
Secondary Claims Accepted: No
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:
- Edit Masters are not changing, no modification to the bridge routines needed.
- 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 17297960 4/16/2025
Electronic Routing Change for CPIDs 7471, 9640 Ingalls Provider Group
Effective April 16, 2025, Optum will be reactivating and changing electronic claims routing for the following payer:
Payer Name: Ingalls Provider Group
Professional CPID: 7471
Current Edit Master: PE_E049
New Edit Master: PE_T007
Institutional CPID: 9640
Current Edit Master: HE9E049
New Edit Master: HE9T007
Payer-assigned Payer ID: 85578
Payer Claim Enrollment Required: No
Secondary Claims Accepted: Yes
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/ Edit Masters are not changing, no modification to the bridge routines needed].
- 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 17297961 4/16/2025
Electronic Routing Change for claims and Reactivating and Routing Change for remittance for CPIDs 2121 and 5953 Healthy Blue South Carolina
Effective April 16, 2025, Optum is changing electronic claims routing and reactivating and changing remittance routing for the following payer:
Payer Name: Healthy Blue South Carolina
Professional CPID: 2121
Current Edit Master: PE_T007
New Edit Master: PE_B152
Institutional CPID: 5953
Current Edit Master: HE9T007
New Edit Master: HE9B023
Payer-assigned Payer ID: 00403
Line of Business Code (LOB): U2O
Payer Claim Enrollment Required: No
Payer Remittance Enrollment Required: Yes
Secondary Claims Accepted: Yes
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 and CPIDs are not changing.
- When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.
REF 17292109 4/16/2025
Electronic Routing Change for claims and Reactivating and Routing Change for remittance for CPIDs 2121 and 5953 Healthy Blue South Carolina
Effective April 16, 2025, Optum is changing electronic claims routing and reactivating and changing remittance routing for the following payer:
Payer Name: Healthy Blue South Carolina
Professional CPID: 2121
Institutional CPID: 5953
Payer-assigned Payer ID: 00403
Secondary Claims Accepted: Yes
Claims Fee: N/A
Remittance 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 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 17292108 4/16/2025
Report Generation Delay for CPID 6802 Center for Elders Independence
A payer is experiencing issues affecting Professional report generation for some claims submitted March 21, 2025-March 24, 2025.
Payer impacted:
- CPID 6802 Center for Elders Independence
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.
If you have any questions, please contact Customer Support and refer to Case Number 09082004.
REF 17291408 4/16/2025
Update: Report Generation Delay for CPID 8796 Liberty Advantage Health Plan
Update: The payer has been unable to generate and deliver the reports for some claims submitted Feb. 27, 2025.
Action Required: Please resubmit claims if payment has not been received.
Original notify sent March 11, 2025:
A payer is experiencing issues affecting Professional report generation for some claims submitted since Feb. 27, 2025.
Payer impacted:
- CPID 8796 Liberty Advantage 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.
If you have any questions, please contact Customer Support and refer to Case Number 09416487.
REF 17290758 4/16/2025
Report Generation Delay for CPID 7110 Community Health Group
A payer is experiencing issues affecting Professional report generation for some claims submitted April 10, 2025.
Payer impacted:
- CPID 7110 Community Health Group
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.
If you have any questions, please contact Customer Support and refer to Case Number 09464525.
REF 17289558 4/16/2025
New Electronic Claims Connections Available
Optum has new electronic claims connections available:
Payer Name: Klyre Payments Network
Institutional CPID: 7926
Professional CPID: 2749
Payer-assigned Payer ID: RP132
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 17286960 4/16/2025
Health First Health Plans – Oscar Electronic Claims and Remittance Connections No Longer Available
Effective immediately, the payer listed below will no longer be available at Optum for claims and remittance processing.
Payer Name: Health First Health Plans – Oscar
Claim and Remittance CPIDs: 6084, 9245
Payer-assigned Payer ID: RP039
Reason: All claims with DOS on or after Jan. 1, 2023 need to be sent to payer ID 95019, CPIDs 6685, 3205.
Action Required: None.
REF 17286008 4/16/2025
Health First Health Plans – Oscar Electronic Claims and Remittance Connections No Longer Available
This message is intended for Assurance Reimbursement Management customers.
Effective immediately, the payer listed below will no longer be available at Optum for claims and remittance processing.
Payer Name: Health First Health Plans – Oscar
Claims and Remittance CPIDs: 6084, 9245
Remittance LOB: H9P
Payer-assigned Payer ID: RP039
Reason: All claims with DOS on or after Jan. 1, 2023 need to be sent to payer ID 95019, CPIDs 6685, 3205.
Action Required: None.
REF 17286009 4/16/2025
New Assurance Attach Assist Medical Attachment Connections Available
Optum has new electronic medical attachment connections available:
Payer Name: Klyre Payments Network
Professional CPID: 2749
Institutional CPID: 7926
Payer-assigned Payer ID: RP132
Accepted Attachment Type: Unsolicited
Payer Enrollment Required: No
Payer Location: National
Action Required:
- 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 17285579 4/16/2025
Report Generation Delay for CPID 2770 Fidelis Care New York Encounters
A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted since April 4, 2025.
Payer impacted:
- CPID 2770 Fidelis Care New York Encounters
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.
If you have any questions, please contact Customer Support and refer to Case Number 09464331.
REF 17285577 4/16/2025
New Electronic Medical Attachment Connections Available
Optum has new electronic medical attachment connections available:
Payer Name: Klyre Payments Network
Professional CPID: 2749
Institutional CPID: 7926
Payer-assigned Payer ID: RP132
Accepted Attachment Type: Unsolicited
Payer Enrollment Required: No
Payer Location: National
Action Required:
- Exchange providers must be contracted with Optum to submit electronic medical attachments. Please contact Support at 1-800-527-8133 option 2, or by emailing [email protected] for additional information.
- 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 update your system and procedures to take advantage of the new connection. For assistance with Medical Attachments, please contact your Practice Management System Vendor.
NOTE: The above Payer ID(s) is for Medical Attachments and may require Providers and/or their vendor be contracted with Optum for the Medical Attachment transaction services.
REF 17285578 4/16/2025
Report Generation Delay for CPID 7499 Sentara Health Plans
A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted on April 3, 2025.
Payer impacted:
- CPID 7499 Sentara 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.
If you have any questions, please contact Customer Support and refer to Case Number 09464322.
REF 17285490 4/16/2025
Fee Change for Multiple Payers
Effective immediately, the following fees will change:
|
Payer Name |
Industry ID |
Transaction |
IMN |
Exchange |
Old Fee |
New Fee |
|
Arkansas Blue Cross Blue Shield |
00520 |
CLAIM INQUIRY |
SB520 |
N/A |
0.01 |
0.00 |
|
Arkansas Blue Cross Blue Shield |
00520 |
ELIGIBILITY |
SB520 |
ARBCBS |
0.01 |
0.00 |
|
Automated Benefit Services |
38259 |
ELIGIBILITY |
38259 |
ABSERV |
0.07 |
0.00 |
|
Blue Cross Blue Shield Mississippi State and Teacher Employees |
00230 |
CLAIM INQUIRY |
XSEHP |
N/A |
0.045 |
0.00 |
|
Blue Cross Blue Shield Mississippi State and Teacher Employees |
00230 |
ELIGIBILITY |
XSEHP |
MSSEHP |
0.045 |
0.00 |
|
Blue Cross of Washington (Premera) |
BCWAC |
ELIGIBILITY |
BCWAC |
N/A |
0.01 |
0.00 |
|
Boon Chapman Administrators |
74238 |
ELIGIBILITY |
74238 |
BNCHAP |
0.01 |
0.00 |
|
Bright Healthcare |
BRGHT |
ELIGIBILITY |
BRGHT |
BRIGHT |
0.02 |
0.00 |
|
California Blue Shield |
94036 |
CLAIM INQUIRY |
94036 |
CABS |
0.01 |
0.00 |
|
California Blue Shield |
94036 |
CLAIM INQUIRY |
94036 |
CABS |
0.01 |
0.00 |
|
California Blue Shield |
94036 |
ELIGIBILITY |
94036 |
CABS |
0.01 |
0.00 |
|
California Blue Shield |
94036 |
ELIGIBILITY |
94036 |
CABS |
0.01 |
0.00 |
|
Carelon Health |
CARMO |
ELIGIBILITY |
CARMO |
CRMRE |
0.01 |
0.00 |
|
District of Columbia Medicaid |
77033 |
ELIGIBILITY |
SKDC0 |
DCCAID |
0.0325 |
0.03 |
|
Harvard Pilgrim Health Care |
04271 |
ELIGIBILITY |
04271 |
HRVPGM |
0.01 |
0.00 |
|
Hawaii Medicaid |
SKHI0 |
ELIGIBILITY |
SKHI0 |
HICAID |
0.03 |
0.00 |
|
Hawaii Medicaid |
SKHI0 |
ELIGIBILITY |
SKHI0 |
HICAID |
0.03 |
0.00 |
|
Health Alliance Plan of Michigan |
38224 |
ELIGIBILITY |
38224 |
HAPMI |
0.05 |
0.00 |
|
Health Alliance Plan of Michigan |
38224 |
ELIGIBILITY |
38224 |
HAPMI |
0.05 |
0.00 |
|
Health Plan of San Joaquin |
68035 |
ELIGIBILITY |
68035 |
SJHP |
0.01 |
0.00 |
|
Health Plan of San Joaquin |
68035 |
ELIGIBILITY |
68035 |
SJHP |
0.01 |
0.00 |
|
Horizon New Jersey Health |
22326 |
ELIGIBILITY |
22326 |
HZMRCY |
0.03 |
0.00 |
|
Iowa Medicaid |
18049 |
ELIGIBILITY |
SKIA0 |
IACAID |
0.08 |
0.00 |
|
Managedcare-America |
MGDCA |
ELIGIBILITY |
MGDCA |
N/A |
0.05 |
0.00 |
|
Mass General Brigham Health Plan |
04293 |
ELIGIBILITY |
04293 |
NGHBHP |
0.05 |
0.00 |
|
Mass General Brigham Health Plan |
04293 |
ELIGIBILITY |
04293 |
NGHBHP |
0.04 |
0.00 |
|
Meridian Medicare Medicaid Plan |
MHPIL |
ELIGIBILITY |
MCCIL |
MCCIL |
0.02 |
0.00 |
|
Michigan Blue Cross Blue Shield |
00210 |
ELIGIBILITY |
BCMIC |
MIBCSI |
0.06 |
0.00 |
|
Mississippi Medicaid |
77032 |
CLAIM INQUIRY |
SKMS0 |
MSCAID |
0.045 |
0.00 |
|
Mississippi Medicaid |
77032 |
CLAIM INQUIRY |
SKMS0 |
MSCAID |
0.0525 |
0.00 |
|
Mississippi Medicaid |
77032 |
ELIGIBILITY |
SKMS0 |
MSCAID |
0.045 |
0.00 |
|
Mississippi Medicaid |
77032 |
ELIGIBILITY |
SKMS0 |
MSCAID |
0.0525 |
0.00 |
|
Montana Medicaid |
SKMT0 |
ELIGIBILITY |
SKMT0 |
MTCAID |
0.0325 |
0.03 |
|
Montefiore Contract Management Organization |
13174 |
ELIGIBILITY |
13174 |
MOCMO |
0.07 |
0.00 |
|
New Mexico Medicaid |
77048 |
CLAIM INQUIRY |
SKNM0 |
N/A |
0.0325 |
0.00 |
|
New Mexico Medicaid |
77048 |
ELIGIBILITY |
SKNM0 |
NMCAID |
0.0325 |
0.03 |
|
New York Blue Cross Blue Shield Northeastern |
00800 |
ELIGIBILITY |
00800 |
NYBCNE |
0.07 |
0.05 |
|
New York Blue Cross Blue Shield Western |
00801 |
ELIGIBILITY |
SB801 |
NYBCBS |
0.09 |
0.05 |
|
Partnership HealthPlan of California |
SX140 |
ELIGIBILITY |
SX140 |
PRTHP |
0.01 |
0.00 |
|
Partnership HealthPlan of California |
SX140 |
ELIGIBILITY |
SX140 |
PRTHP |
0.01 |
0.00 |
|
QualChoice of Arkansas |
35174 |
ELIGIBILITY |
35174 |
QUCHO |
0.01 |
0.00 |
|
SCAN Health Plan |
72261 |
ELIGIBILITY |
00350 |
SCNHMO |
0.18 |
0.00 |
|
SCAN Health Plan |
72261 |
ELIGIBILITY |
00350 |
SCNHMO |
0.18 |
0.00 |
|
Scott & White Health Plan |
88030 |
ELIGIBILITY |
TH002 |
SAWHP |
0.01 |
0.00 |
|
Sierra Health Services |
76342 |
ELIGIBILITY |
76342 |
SIERA |
0.18 |
0.00 |
|
Sutter and Aetna Insurance Company |
60624 |
ELIGIBILITY |
60624 |
SUTAET |
0.02 |
0.00 |
|
Tennessee BlueCare/TennCare |
00390 |
ELIGIBILITY |
SKTN2 |
TNCAID |
0.04 |
0.02 |
|
The Loomis Company |
23223 |
ELIGIBILITY |
23223 |
LOOMCO |
0.02 |
0.00 |
|
WellSense Health Plan |
13337 |
ELIGIBILITY |
13337 |
BMCHLT |
0.01 |
0.00 |
|
WellSense Health Plan |
13337 |
ELIGIBILITY |
13337 |
BMCHLT |
0.01 |
0.00 |
|
Western Health Advantage |
68039 |
CLAIM INQUIRY |
WSTHA |
WSTHA |
0.18 |
0.00 |
|
Western Health Advantage |
68039 |
ELIGIBILITY |
WSTHA |
WSTHA |
0.18 |
0.00 |
|
Wyoming Medicaid |
77046 |
CLAIM INQUIRY |
SKWY0 |
N/A |
0.0325 |
0.00 |
|
Wyoming Medicaid |
77046 |
ELIGIBILITY |
SKWY0 |
WYCAID |
0.0325 |
0.00 |
Action Required: Please be aware of the fee changes.
REF 17282508 4/16/2025
Eligibility Fee Change for Multiple Payers
|
Action Required: Please be aware of the fee changes.
REF 17282209 4/16/2025
Electronic Routing Change for CPIDs 4517 and 6409 Guardian Life
Effective April 16, 2025, Optum will be reactivating and changing electronic claims routing for the following payer:
Payer Name: Guardian Life
Professional CPID: 6409
Current Edit Master: PE_E049
New Edit Master: PE_C051
Institutional CPID: 4517
Current Edit Master: HE9E049
New Edit Master: HE9C051
Payer-assigned Payer ID: 64246
Secondary Claims Accepted: Yes
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 17285309 4/16/2025
Electronic Routing Change for CPIDs 4517 and 6409 Guardian Life
Effective April 16, 2025, Optum will be reactivating and changing electronic claims routing for the following payer:
Payer Name: Guardian Life
Professional CPID: 6409
Institutional CPID: 4517
Payer-assigned Payer ID: 64246
Secondary Claims Accepted: Yes
Claims Fee: $0.10
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 17285308 4/16/2025
Electronic Routing and Reactivation Change for CPIDs 7822 and 9533 Florida Hospital VBR
Effective April 15, 2025, Optum will be reactivating and changing electronic claims routing for the following payer:
Payer Name: Florida Hospital VBR
Professional CPID: 7822
Institutional CPID: 9533
Payer-assigned Payer ID: VB001
Secondary Claims Accepted: No
Claims Fee: N/A
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 17280009 4/15/2025
Electronic Routing and Reactivation Change for CPIDs 7822 and 9533 Florida Hospital VBR
Effective April 15, 2025, Optum will be reactivating and changing electronic claims routing for the following payer:
Payer Name: Florida Hospital VBR
Professional CPID: 7822
Edit Master: PE_T007
Institutional CPID: 9533
Edit Master: HE9T007
Payer-assigned Payer ID: VB001
Payer Claim Enrollment Required: No
Secondary Claims Accepted: No
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:
- Edit Masters are not changing, no modification to the bridge routines needed.
- 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 17280011 4/15/2025
HealthSmart Benefit Solutions West Virginia fka Wells Fargo TPA Electronic Remittance Connection No Longer Available
Effective immediately, the payer listed below will no longer be available at Optum for remittance processing.
Payer Name: HealthSmart Benefit Solutions West Virginia fka Wells Fargo TPA
Remittance CPIDs: 6410, 6593
Remittance LOB: H37
Payer-assigned Payer ID: 87815
Reason: Providers must use CPIDs 3926, 2722 HealthSmart Benefit Solutions; LOB Code J8V.
Action Required: None.
REF 17276059 4/15/2025
HealthSmart Benefit Solutions West Virginia fka Wells Fargo TPA Electronic Remittance Connection No Longer Available
Effective immediately, the payer listed below will no longer be available at Optum for remittance processing.
Payer Name: HealthSmart Benefit Solutions West Virginia fka Wells Fargo TPA
Remittance CPIDs: 6410, 6593
Payer-assigned Payer ID: 87815
Reason: Providers must use CPIDs 3926, 2722 HealthSmart Benefit Solutions.
REF 17276058 4/15/2025
Report Generation Delay for CPID 5976 Carelon Behavioral Health Maryland
A payer intermediary is experiencing issues affecting Institutional report generation for some claims submitted April 4, 2025.
Payer impacted:
- CPID 5976 Carelon Behavioral Health Maryland
The payer intermediary has been unable to generate and deliver the reports.
Action Required: None. Please resubmit claims if payment has not been received.
If you have any questions, please contact Customer Support and refer to Case Number 09462911.
REF 17271058 4/15/2025
Lasso Healthcare Electronic Claims and 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: Lasso Healthcare
Claims and Remittance CPIDs: 2018, 8153
Remittance LOB: K19
RTE Payer ID: LASSO
Payer-assigned Payer ID: 10550
Reason: Payer has gone out of business.
Payer will no longer accept paper claims.
Action Required: None.
REF 17270559 4/15/2025
Lasso Healthcare Electronic Claims and 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: Lasso Healthcare
Claim and Remittance CPIDs: 2018, 8153
Payer-assigned Payer ID: 10550
Reason: Payer has gone out of business.
Payer will no longer accept paper claims.
Action Required: None.
REF 17270558 4/15/2025
Report Generation Delay for CPIDs 4936 and 3476 Masters, Mates and Pilots
A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted since April 2, 2025.
Payer impacted:
- CPID 4936 Masters, Mates and Pilots
- CPID 3476 Masters, Mates and Pilots
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.
If you have any questions, please contact Customer Support and refer to Case Number 09462813.
REF 17269699 4/15/2025
New Electronic Remittance Connections Available
Optum has new electronic remittance connections available:
Payer Name: Central Health Medicare Plan
Institutional CPID: 4666
Professional CPID: 6198
Payer-assigned Payer ID: CHCPI
Payer Enrollment Required: Yes
Remittance Fee: N/A
Payer Location: California
Payer Name: Sage
Institutional CPID: 7924
Professional CPID: 2746
Payer-assigned Payer ID: SAGE1
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 17269711 4/15/2025
New Electronic Remittance Connections Available
Optum has new electronic remittance connections available:
Payer Name: Central Health Medicare Plan
Institutional CPID: 4666
Professional CPID: 6198
Payer-assigned Payer ID: CHCPI
Line of Business (LOB) Code: N29
Payer Enrollment Required: Yes
Payer Location: California
Payer Name: Sage
Institutional CPID: 7924
Professional CPID: 2746
Payer-assigned Payer ID: SAGE1
Line of Business (LOB) Code: N28
Payer Enrollment Required: Yes
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 17269709 4/15/2025
Resolved: Delay in Electronic Remittance Advice (ERA) for CPIDs 4480, 1532 SELECTHEALTH
Resolved: This issue has been resolved. All impacted ERAs have been processed.
Original Notice Sent on April 03, 2025:
Due to a payer intermediary processing issue, there has been a delay in Professional and Institutional Electronic Remittance Advice (ERA) for the following payers for file dates of March 12, 2025, through March 16, 2025:
- CPID 4480 SELECTHEALTH
- CPID 1532 SELECTHEALTH
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.
If you have any questions, feel free to contact your Customer Support Team and refer to Case Number INC-000002504.
REF 17267861 4/15/2025
Update: Report Generation Delay for CPID 7493 Vermont Blue Cross Blue Shield
Update: The payer intermediary has been unable to generate and deliver the reports for some claims submitted on March 14, 2025.
Action Required: Please resubmit claims if payment has not been received.
Original notify sent March 25, 2025:
A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted on March 14, 2025.
Payer impacted:
- CPID 7493 Vermont Blue Cross Blue Shield
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.
If you have any questions, please contact Customer Support and refer to Case Number 09435637.
REF 17267851 4/15/2025
Update: Report Generation Delay for CPID 1532 Select Health
Update: A payer is experiencing issues affecting Institutional report generation for some claims submitted March 18, 2025, April 10, 2025.
Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.
Original notify sent March 26, 2025:
A payer is experiencing issues affecting Institutional report generation for some claims submitted March 18,2025.
Payer impacted:
- CPID 1532 Select 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.
If you have any questions, please contact Customer Support and refer to Case Number 09438185.
REF 17268014 4/15/2025
Update: Report Generation Delay for CPID 7499 Sentara Health Plans
Update: The payer intermediary has been unable to generate and deliver the reports for some claims submitted March 15, 2025, and March 31, 2025.
Action Required: Please resubmit claims if payment has not been received.
Update sent April 10, 2025:
Update: A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted March 15, 2025, and March 31, 2025.
Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.
Original notify sent March 26, 2025:
A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted March 15, 2025.
Payer impacted:
- CPID 7499 Sentara 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.
If you have any questions, please contact Customer Support and refer to Case Number 09437489.
REF 17268958 4/15/2025
Report Generation Delay for CPID 7110 Community Health Group
A payer is experiencing issues affecting Professional report generation for some claims submitted April 2, 2025.
Payer impacted:
- CPID 7110 Community Health Group
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.
If you have any questions, please contact Customer Support and refer to Case Number 09455209.
REF 17268261 4/15/2025
Update: Report Generation Delay for CPIDs 1507 and 3887 Veterans Administration Fee Basis Programs
Update: The payer intermediary has been unable to generate and deliver the reports for some claims submitted March 4, 2025-March 20, 2025.
Action Required: Please resubmit claims if payment has not been received.
Update sent March 19, 2025:
A payer intermediary is experiencing issues affecting Professional and Institutional report generation for some claims submitted since March 4, 2025.
Payer impacted:
- CPID 1507 Veterans Administration Fee Basis Programs
- CPID 3887 Veterans Administration Fee Basis Programs
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.
If you have any questions, please contact Customer Support and refer to Case Number 09419928.
Update: The payer intermediary has been unable to generate and deliver the reports for some claims submitted March 4, 2025-March 20, 2025.
Action Required: Please resubmit claims if payment has not been received.
Original notify sent March 19, 2025:
A payer intermediary is experiencing issues affecting Professional and Institutional report generation for some claims submitted since March 4, 2025.
Payer impacted:
- CPID 1507 Veterans Administration Fee Basis Programs
- CPID 3887 Veterans Administration Fee Basis Programs
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.
If you have any questions, please contact Customer Support and refer to Case Number 09419928.
REF 17268260 4/15/2025
Update: Report Generation Delay for CPIDs 4626 and 6145 CSI Network Services
Update: The payer intermediary has been unable to generate and deliver the reports for some claims submitted March 12, 2025, March 13, 2025, and March 31, 2025.
Action Required: Please resubmit claims if payment has not been received.
Original notify sent March 25, 2025:
A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted March 12, 2025 and March 13, 2025.
Payer impacted:
- CPID 4626 CSI Network Services
- CPID 6145 CSI Network 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.
If you have any questions, please contact Customer Support and refer to Case Number 09435517.
REF 17267850 4/15/2025
New Electronic Claims Connections Available
Optum has new electronic claims connections available:
Payer Name: AdventHealth Rocky Mountain Foundation
Institutional CPID: 8962
Professional CPID: 3427
Payer-assigned Payer ID: RMR01
Payer Enrollment Required: No
Secondary Claims Accepted: No
Payer Location: Colorado
Claims Fee: $0.10
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 17255409 4/14/2025
New Electronic Claims Connections Available
Optum has new electronic claims connections available:
Payer Name: AdventHealth Rocky Mountain Foundation
Institutional CPID: 8962
Professional CPID: 3427
Payer-assigned Payer ID: RMR01
Payer Enrollment Required: No
Secondary Claims Accepted: No
Payer Location: Colorado
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 17255412 4/14/2025
Electronic Routing Change for CPIDs 3803 and 9500 Kern Health Systems
Effective April 11, 2025, Optum changed electronic claims routing for the following payer:
Payer Name: Kern Health Systems
Professional CPID: 3083
Edit Master: PE_N000
Institutional CPID: 9500
Edit Master: HE9N000
Payer-assigned Payer ID: 77039
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:
- Edit Masters are not changing, no modification to the bridge routines needed.
- 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 17249656 4/14/2025
Electronic Routing Change for CPIDs 3803 and 9500 Kern Health Systems
Effective April 16, 2025, Optum is changing electronic claims routing for the following payer:
Payer Name: Kern Health Systems
Professional CPID: 3803
Institutional CPID: 9500
Payer-assigned Payer ID: 77039
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 17249655 4/14/2025
New edit for Aetna Better Health of Maryland
The payer below has informed Optum of a new edit requirement effective immediately. In order to meet the new requirement, we will add the following edit April 17, 2025:
- IDTP03A047: INVALID ADMISSION HOUR - When the Type of Bill is 21x, the Admission Hour is not allowed. LOOP 2300 DTP03
Edit applies to:
- CPID 7554 AETNA BETTER HEALTH OF MARYLAND
Action Required: Please be aware of updated edit requirements.
REF 17252358 4/14/2025
Commonwealth Care Alliance Eligibility and Claim Status Connection No Longer Available
Effective immediately, the payer listed below will no longer be available at Optum for 270 Eligibility or 276 Claim Status
Payer Name: Commonwealth Care Alliance
Eligibility Portal ID: CWCAL1
CPID’s 1604 and 3437
Reason: Payer no longer offers these connections.
REF 17245308 4/14/2025
Report Generation Delay for CPID 6671 HealthSun
A payer intermediary is experiencing issues affecting Institutional report generation for some claims submitted on March 26, 2025.
Payer impacted:
- CPID 6671 HealthSun
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.
If you have any questions, please contact Customer Support and refer to Case Number 09454048.
REF 17181858 4/11/2025
Report Generation Delay for CPIDs 2589 and 3793 Alliant Health Plans
A payer is experiencing issues affecting Professional and Institutional report generation for some claims submitted since April 2, 2025.
Payer impacted:
- CPID 2589 Alliant Health Plans
- CPID 3793 Alliant Health Plans
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.
If you have any questions, please contact Customer Support and refer to Case Number 09452028.
REF 17186708 4/11/2025
New Payer Name
Effective immediately, please be aware of the following payer name changes:
Previous Payer Name: Asserta Health
New Payer Name: Frontier Direct
Professional CPID: 1424
Institutional CPID: 1515
Action Required: Please make the appropriate changes to accommodate the name change.
REF 17186813 4/11/2025
New Payer Name
Effective immediately, please be aware of the following payer name changes:
Previous Payer Name: Asserta Health
New Payer Name: Frontier Direct
Professional CPID: 1424
Institutional CPID: 1515
Edit Masters: PE_T007, HE9T007
Your existing Payer Alias entries will continue to work as they do currently; the new payer name is being provided for your reference. Be aware all future communications for these CPIDs will reference the new payer name only.
Action Required: Please be aware of the updated payer name.
REF 17186814 4/11/2025
New Assurance Attach Assist Medical Attachment Connections Available
Optum has new electronic medical attachment connections available:
Payer Name: Unified Health Services
Professional CPID: 5420
Institutional CPID: 7576
Payer-assigned Payer ID: 62170
Accepted Attachment Type: Unsolicited
Payer Enrollment Required: No
Payer Location: National
Action Required:
- 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 17209258 4/11/2025
New Electronic Claims Connections Available
Optum has new electronic claims connections available:
Payer Name: Cenpatico Behavioral Health - Louisiana
Institutional CPID: 8959
Professional CPID: 3418
Payer-assigned Payer ID: 68068
Payer Enrollment Required: No
Secondary Claims Accepted: Yes
Payer Location: Louisiana
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 17213208 4/11/2025
Report Generation Delay for CPIDs 5909 and 4743 Carelon Behavioral Health
A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted since March 28, 2025.
Payer impacted:
- CPID 5909 Carelon Behavioral Health
- 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.
If you have any questions, please contact Customer Support and refer to Case Number 09457355.
REF 17214062 4/11/2025
Dialysis TPA Electronic Claims Connection No Longer Available
Effective immediately, the payer listed below will no longer be available at Optum for claims processing.
Payer Name: Dialysis TPA
Claim CPIDs: 8178, 2040
Payer-assigned Payer ID: 82435
Reason: Payer no longer offers an electronic connection.
Action Required: Claims must be submitted to Optum on paper.
REF 17219861 4/11/2025
Dialysis TPA Electronic Claims Connection No Longer Available
Effective immediately, the payer listed below will no longer be available at Optum for claims processing.
Payer Name: Dialysis TPA
Claims CPIDs: 8178, 2040
Payer-assigned Payer ID:82435
Reason: Payer no longer offers an electronic connection.
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 17219862 4/11/2025
Report Generation Delay for CPID 9581 Division of Immigration Health Services
A payer intermediary is experiencing issues affecting Institutional report generation for some claims submitted April 3, 2025.
Payer impacted:
- CPID 9581 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.
If you have any questions, please contact Customer Support and refer to Case Number 09453794.
REF 17179366 4/8/2025
Update: Payer Transmit Delay for CPIDs 2478 and 7096 North Carolina Medicaid
Update: A resolution has been implemented and the claims were transmitted to the payer April 8, 2025.
This delay affected claims released to Optum April 2, 2025, 3:00 p.m.-Apr. 7, 2025, 3:00 p.m. CT.
Action Required: Please be aware of the transmit delay.
Original Notify sent April 7, 2025:
Due to a payer system issue, a delay occurred in some of the transmissions to the following payer since April 2, 2025.
Payer impacted:
- CPID 2478 North Carolina Medicaid
- CPID 7096 North Carolina Medicaid
Optum is working with the payer to resolve this issue. We will notify you as soon as additional information becomes available.
This delay affects claims released to Optum since April 2, 2025, 3:00 p.m. CT.
Action Required: Be aware of the transmit delay above.
If you have any questions, please contact Customer Support and refer to Case Number 09452224.
REF 17178609 4/8/2025
Payer Transmit Delay for CPIDs 2478 and 7096 North Carolina Medicaid
Due to a payer system issue, a delay occurred in some of the transmissions to the following payer since March 2, 2025.
Payer impacted:
- CPID 2478 North Carolina Medicaid
- CPID 7096 North Carolina 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 3 p.m. CT on March 2, 2025.
Action Required: Be aware of the transmit delay above.
If you have any questions, please contact Customer Support and refer to Case Number 09452224.
REF 17162715 4/7/2025
Payer Termination
Effective immediately, the payer transactions listed below will no longer be available at OPTUM for 270/271 Eligibility or 276/277 Claim Status. .
Payer Name: Health First Health Plans -OSCAR
Eligibility and Claim Status ID: RP039
Exchange ID: HFHPO
CPID’s 6084 and 9425
Industry ID: RP039
Reason: Payer no longer offers these connections.
REF 17153251 4/7/2025
Report Generation Delay for CPIDs 1708 and 4561 Meritain Health
A payer is experiencing issues affecting Professional and Institutional report generation for some claims submitted March 26, 2025-March 31, 2025.
Payers impacted:
- CPID 1708 Meritain Health
- CPID 4561 Meritain 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.
If you have any questions, please contact Customer Support and refer to Case Number 09448651.
REF 17161809 4/7/2025
Report Generation Delay for CPID 7736 Direct Care Administrators
A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted March 26, 2025.
Payer impacted:
- CPID 7736 Direct Care Administrators
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.
If you have any questions, please contact Customer Support and refer to Case Number 09452053.
REF 17161808 4/7/2025
New Payer Name
Effective immediately, please be aware of the following payer name change:
Previous Payer Name: Vitori Health
New Payer Name: Tribado
Professional CPID: 9420
Institutional CPID: 7036
Edit Master: PE_T007 / HE9T007
Your existing Payer Alias entries will continue to work as they do currently; the new payer name is being provided for your reference. Be aware all future communications for these CPIDs will reference the new payer name only.
Action Required: You may choose to update the Payer Alias in your system to accommodate the new payer name.
REF 17161160 4/7/2025
New Payer Name
Effective immediately, please be aware of the following payer name change:
Previous Payer Name: Vitori Health
New Payer Name: Tribado
Professional CPID: 9420
Institutional CPID: 7036
Action Required: Please make the appropriate changes to accommodate the name change.
REF 17161159 4/7/2025
Report Generation Delay for CPID 9581 Division of Immigration Health Services
A payer intermediary is experiencing issues affecting Institutional report generation for some claims submitted April 3, 2025.
Payer impacted:
- CPID 9581 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.
If you have any questions, please contact Customer Support and refer to Case Number 09453794.
REF 17179366 4/8/2025
Update: Payer Transmit Delay for CPIDs 2478 and 7096 North Carolina Medicaid
Update: A resolution has been implemented and the claims were transmitted to the payer April 8, 2025.
This delay affected claims released to Optum April 2, 2025, 3:00 p.m.-Apr. 7, 2025, 3:00 p.m. CT.
Action Required: Please be aware of the transmit delay.
Original Notify sent April 7, 2025:
Due to a payer system issue, a delay occurred in some of the transmissions to the following payer since April 2, 2025.
Payer impacted:
- CPID 2478 North Carolina Medicaid
- CPID 7096 North Carolina Medicaid
Optum is working with the payer to resolve this issue. We will notify you as soon as additional information becomes available.
This delay affects claims released to Optum since April 2, 2025, 3:00 p.m. CT.
Action Required: Be aware of the transmit delay above.
If you have any questions, please contact Customer Support and refer to Case Number 09452224.
REF 17178609 4/8/2025
Payer Transmit Delay for CPIDs 2478 and 7096 North Carolina Medicaid
Due to a payer system issue, a delay occurred in some of the transmissions to the following payer since March 2, 2025.
Payer impacted:
- CPID 2478 North Carolina Medicaid
- CPID 7096 North Carolina 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 3 p.m. CT on March 2, 2025.
Action Required: Be aware of the transmit delay above.
If you have any questions, please contact Customer Support and refer to Case Number 09452224.
REF 17162715 4/7/2025
Payer Termination
Effective immediately, the payer transactions listed below will no longer be available at OPTUM for 270/271 Eligibility or 276/277 Claim Status. .
Payer Name: Health First Health Plans -OSCAR
Eligibility and Claim Status ID: RP039
Exchange ID: HFHPO
CPID’s 6084 and 9425
Industry ID: RP039
Reason: Payer no longer offers these connections.
REF 17153251 4/7/2025
Report Generation Delay for CPIDs 1708 and 4561 Meritain Health
A payer is experiencing issues affecting Professional and Institutional report generation for some claims submitted March 26, 2025-March 31, 2025.
Payers impacted:
- CPID 1708 Meritain Health
- CPID 4561 Meritain 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.
If you have any questions, please contact Customer Support and refer to Case Number 09448651.
REF 17161809 4/7/2025
Report Generation Delay for CPID 7736 Direct Care Administrators
A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted March 26, 2025.
Payer impacted:
- CPID 7736 Direct Care Administrators
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.
If you have any questions, please contact Customer Support and refer to Case Number 09452053.
REF 17161808 4/7/2025
New Payer Name
Effective immediately, please be aware of the following payer name change:
Previous Payer Name: Vitori Health
New Payer Name: Tribado
Professional CPID: 9420
Institutional CPID: 7036
Edit Master: PE_T007 / HE9T007
Your existing Payer Alias entries will continue to work as they do currently; the new payer name is being provided for your reference. Be aware all future communications for these CPIDs will reference the new payer name only.
Action Required: You may choose to update the Payer Alias in your system to accommodate the new payer name.
REF 17161160 4/7/2025
New Payer Name
Effective immediately, please be aware of the following payer name change:
Previous Payer Name: Vitori Health
New Payer Name: Tribado
Professional CPID: 9420
Institutional CPID: 7036
Action Required: Please make the appropriate changes to accommodate the name change.
REF 17161159 4/7/2025
New Electronic Remittance Connections Available
Optum has new electronic remittance connections available:
Payer Name: Freedom Life Insurance Company
Institutional CPID: 4669
Professional CPID: 2134
Payer-assigned Payer ID: 62324
Payer Enrollment Required: Yes
Remittance Fee: N/A
Payer Location: Texas
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 17146410 4/4/2025
New Electronic Remittance Connections Available
Optum has new electronic remittance connections available:
Payer Name: Freedom Life Insurance Company
Institutional CPID: 4669
Professional CPID: 2134
Payer-assigned Payer ID: 62324
Line of Business (LOB) Code: H5K
Payer Enrollment Required: Yes
Remittance Fee: N/A
Payer Location: Texas
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 17146411 4/4/2025
Restored Electronic Eligibility and Claim Status Connection
Effective January 28, 2025, Optum is pleased to announce connectivity has been restored and Real-time Eligibility (270/271) and Claim Status (276/277) transactions for the below payer may now be submitted:
Payer Name: Western Health Advantage
Industry Payer ID: WSTHA
IMN Real Time ID: WSTHA
Exchange Real Time ID: WSTHA
CPID(s): 5634 / 6267
Optum iEDI Real Time ID: WSTHA
Payer Enrollment Required: No
Connection Type: X12
Search Options:
Eligibility Subscriber
- Member ID, First Name, Last Name, Date of Birth
- Member ID, Last Name, First Name
- First Name, Last Name, Date of Birth
- Member ID, Date of Birth
Eligibility Dependent
- Member ID, Dependent First Name, Dependent Last Name, Dependent Date of Birth
- Member ID, Dependent First Name, Dependent Last Name
- Dependent First Name, Dependent Last Name, Dependent Date of Birth
- Member ID, Dependent Date of Birth
Claim Status Inquiry Subscriber
- Member id, first name, last name, date of birth
Optional additional elements:
Payer claim number; Total submitted charges
Claim Status Inquiry Dependent
- Member ID, subscriber last name, dep first name, dep last name, dep date of birth
Required Additional elements:
Payer claim number or Total submitted charges
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.
REF 17149559 4/4/2025
Electronic Claims Connection Suspended
Effective immediately, the payer listed below has been temporarily suspended at Optum for claim processing and removed from the payer list.
Payer Name: Centurion Managed Health
CPIDs: 5681, 6700
Payer ID: 42140
Reason: Payer no longer supports this Payer ID number.
Action Required: Please refrain from submitting claims until further notice.
REF 17151793 4/4/2025
Report Generation Delay for CPIDs 7543 and 2803 UPMC Health Plan
The payer listed below is experiencing issues affecting Institutional and Professional report generation for some claims submitted since April 2, 2025.
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.
If you have any questions, please contact Customer Support and refer to Case Number 09451031.
REF 17152708 4/4/2025
OPTUM Payer Termination
Effective immediately, the payer transactions listed below will no longer be available at OPTUM for 270/271 Eligibility or 276/277 Claim Status. .
Payer Name: Health First Health Plans -OSCAR
Eligibility and Claim Status ID: RP039
Exchange ID: HFHPO
CPID’s: 6084 and 9425
Industry ID: RP039
Reason: Payer no longer offers these connections.
REF 17153251 4/4/2025
New Electronic Remittance Connections Available
Optum has new electronic remittance connections available:
Payer Name: St. Lukes Health Plan
Professional CPID: 3415
Payer-assigned Payer ID: 92170
Payer Enrollment Required: Yes
Remittance Fee: N/A
Payer Location: Idaho
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 17145264 4/4/2025
New Electronic Remittance Connections Available
Optum has new electronic remittance connections available:
Payer Name: St. Lukes Health Plan
Professional CPID: 3415
Payer-assigned Payer ID: 92170
Line of Business (LOB) Code: E09
Payer Enrollment Required: Yes
Payer Location: Idaho
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 17145265 4/4/2025
Delay in Electronic Remittance Advice (ERA) for CPIDs 4480, 1532 SELECTHEALTH
Due to a payer intermediary processing issue, there has been a delay in Professional and Institutional Electronic Remittance Advice (ERA) for the following payers for file dates of March 12, 2025, through March 16, 2025:
- CPID 4480 SELECTHEALTH
- CPID 1532 SELECTHEALTH
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.
If you have any questions, feel free to contact your Customer Support Team and refer to Case Number INC-000002504.
REF 17142058 4/4/2025
Report Generation Delay for CPID 2457 Pennsylvania Medicare
A payer is experiencing issues affecting Professional report generation for some claims submitted since March 27, 2025.
Payer impacted:
- CPID 2457 Pennsylvania 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.
If you have any questions, please contact Customer Support and refer to Case Number 09449464.
REF 17144459 4/4/2025
Update: Report Generation Delay for CPIDs 1985 and 4246 Capital Health Plan
Update: The payer intermediary has been unable to generate and deliver the reports for some claims submitted on March 4, 2025 and March 5, 2025.
Action Required: Please resubmit claims if payment has not been received.
Original notify sent March 18, 2025:
A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted since March 4, 2025.
Payer impacted:
- CPID 1985 Capital Health Plan
- CPID 4246 Capital 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.
If you have any questions, please contact Customer Support and refer to Case Number 09425381.
REF 16901320 17145408 4/4/2025
Important Announcement from Optum - Intelligent EDI - Claims for PID SECUR
New Payer Announcement - The following items are covered in this announcement:
Optum Intelligent EDI is pleased to announce new claim payer connectivity for the following transaction types. Please incorporate claims into existing files you submit to Optum today.
Example:
SECURE Health Plan (Payer ID SECUR)
Transactions: 837 Professional/Institutional
Effective Date: April 2, 2025
Please direct any questions to the Support Team at 1-866-OptumGo.
REF 17135912 4/3/2025
Electronic Claims Connection Suspended
Effective immediately, the payer listed below has been temporarily suspended at Optum for claim processing and removed from the payer list.
Payer Name: Univera Healthcare
CPID: 1655
Payer ID: 12X18
Reason: Payer unavailable electronically
Action Required: Please refrain from submitting claims until further notice.
REF 17129259 4/3/2025
Update: Report Generation Delay for CPIDs 8029 and 9745 El Paso Health Advantage Dual SNP
Update: The payer intermediary has been unable to generate and deliver the reports for some claims submitted on Feb. 27, 2025 and March 3, 2025.
Action Required: Please resubmit claims if payment has not been received.
Original notify sent March 10, 2025:
A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted on Feb. 27, 2025 and March 3, 2025.
Payer impacted:
- CPID 8029 El Paso Health Advantage Dual SNP
- CPID 9745 El Paso Health Advantage Dual SNP
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.
If you have any questions, please contact Customer Support and refer to Case Number 09414234.
REF 17129258 4/3/2025
Update: Report Generation Delay for CPID 6760 Virgin Islands Medicaid
Update: The payer has been unable to generate and deliver the reports for some claims submitted on March 14, 2025.
Action Required: Please resubmit claims if payment has not been received.
Original notify sent March 28, 2025:
A payer is experiencing issues affecting Professional report generation for some claims submitted on March 14, 2025.
Payer impacted:
- CPID 6760 Virgin Islands 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.
If you have any questions, please contact Customer Support and refer to Case Number 09441411.
REF 17128693 4/3/2025
835 File Delivery Issue VA
The VA payer is researching possible delivery issue with an 835 file for 84146, 80214, and 84147 for checks date March 14, 2025. Optum is working with the VA to identify the files and verify if they were received.
REF 17125208 4/3/2025
Reminder: Payer Change for CPIDs 2836, 7528 Key Benefit Administrators (Ft. Mill, SC)
Reminder: Providers must begin using CPIDs 2821 and 7505 Key Benefit Administrators by
April 11, 2025 to avoid claim rejections and interruptions with remittance delivery for Key Benefit Administrators (Ft. Mill, SC) transactions.
Original sent Mar. 26, 2025:
Effective immediately, claims and remittance currently exchanged with the following payer must use different CPIDs:
Payer Name: Key Benefit Administrators (Ft. Mill, SC)
Professional CPID: 2836
Institutional CPID: 7528
Remittance Available: Yes
Payer-assigned Payer ID: 37216
Claims and Remittance must begin using the following payer by April 11, 2025 to avoid claim rejections:
Payer Name: Key Benefit Administrators
Professional CPID: 2821
Institutional CPID: 7505
Remittance Available: Yes
Payer-assigned Payer ID: 37217
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 2821, 7505 Key Benefit Administrators do not need to complete a new enrollment form.
- Providers not receiving electronic remittance through Optum for CPIDs 2821, 7505 Key Benefit Administrators 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 17128008 4/3/2025
Reminder: Payer Change for CPIDs 2836, 7528 Key Benefit Administrators (Ft. Mill, SC)
Reminder: Providers must begin using CPIDs 2821 and 7505 Key Benefit Administrators by April 11, 2025 to avoid claim rejections and interruptions with remittance delivery for Key Benefit Administrators (Ft. Mill, SC) transactions.
Original sent Mar. 26, 2025:
Effective immediately, claims and remittance currently exchanged with the following payer must use different CPIDs:
Payer Name: Key Benefit Administrators (Ft. Mill, SC)
Professional CPID: 2836
Professional Edit Master: PE_E049
Institutional CPID: 7528
Institutional Edit Master: HE9E049
Payer-assigned Payer ID: 37216
Line of Business Code (LOB): U9H
Claims and Remittance must begin using the following payer by April 11, 2025 to avoid claim rejections:
Payer Name: Key Benefit Administrators
Professional CPID: 2821
Professional Edit Master: PE_B800
Institutional CPID: 7505
Institutional Edit Master: HE9B801
Payer-assigned Payer ID: 37217
Line of Business Code (LOB): U7Y
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 2821, 7505 Key Benefit Administrators do not need to complete a new enrollment form.
- Providers not receiving electronic remittance through Optum for CPIDs 2821, 7505 Key Benefit Administrators 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 17128009 4/3/2025
Electronic Routing Change for CPIDs 5293 and 3523 Medical Reimbursements of America
Effective April 2, 2025, Optum will be changing electronic claims routing for the following payer:
Payer Name: Medical Reimbursements of America (DBA Revecore)
Professional CPID: 5293
Institutional CPID: 3523
Payer-assigned Payer ID: 62177
Secondary Claims Accepted: Yes
Claims Fee: N/A
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 17122058 4/2/2025
999 Payer Batch Rejections for CPID 8551 Wellcare Health Plans
Institutional claims transmitted to the payer listed below from Optum on April 2, 2025 were not processed by the payer due to a 999 Batch Rejection.
- CPID 8551 Wellcare Health Plans
A resolution has been implemented and the claims were retransmitted to the payer on April 2, 2025.
Action Required: None.
If you have any questions, please contact Customer Support and refer to Case Number 09447522.
REF 17122158 4/2/2025
Electronic Routing Change for CPIDs 5293 and 3523 Medical Reimbursements of America
Effective April 2, 2025, Optum will be changing electronic claims routing for the following payer:
Payer Name: Medical Reimbursements of America (DBA Revecore)
Professional CPID: 5293
Current Edit Master: PE_E049
New Edit Master: PE_T007
Institutional CPID: 3523
Current Edit Master: HE9E049
New Edit Master: HE9T007
Payer-assigned Payer ID: 62177
Payer Claim Enrollment Required: No
Secondary Claims Accepted: Yes
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 17122059 4/2/2025
Payer Processing Issue for CPIDs 2017 and 8152 Altura MSO
Due to a payer processing issue, some Professional and Institutional claims transmitted to the payer listed below on March 31, 2025 were not processed by the payer.
Payer impacted:
- CPID 2017 Altura MSO
- CPID 8152 Altura MSO
A resolution has been implemented, and the claims were retransmitted to the payer on April 2, 2025.
This delay affected claims released to Optum between 2 a.m. March 28, 2025 and 2 a.m. March 31, 2025 .
Action Required: Be aware of the processing issue above.
If you have any questions, please contact Customer Support and refer to Case Number 09447202.
REF 17121360 4/2/2025
Access 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: Access Administrators
Claim CPIDs: 3421, 1993
Payer-assigned Payer ID: AHS01
Reason: Payer no longer offers an electronic connection.
Optum has received information that claims can now be sent to Healthcare Management Administrators, Payer ID HMA01, CPIDs 5243 and 8920.
Action Required: None.
REF 17114958 4/2/2025
Update: Report Generation Delay for CPID 1871 Aetna Employee Assistance Program
Update: The payer intermediary has been unable to generate and deliver the reports for some claims submitted from Feb. 28, 2025 through March 12, 2025.
Action Required: Please resubmit claims if payment has not been received.
Original notify sent March 11, 2025:
A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted since Feb. 28, 2025.
Payer impacted:
- CPID 1871 Aetna Employee Assistance Program
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.
If you have any questions, please contact Customer Support and refer to Case Number 09394755.
REF 17115769 4/2/2025
Transchoice Key Benefit 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: Transchoice Key Benefit Administrators
Claim CPIDs: 4677, 3249
Payer-assigned Payer ID: 37284
Reason: Payer no longer in business.
Payer will no longer accept paper claims.
Action Required: None.
REF 17117908 4/2/2025
Report Generation Delay for CPID 9701 Humana Ohio Medicaid Vision
A payer is experiencing issues affecting Professional report generation for some claims submitted since March 26, 2025.
Payer impacted:
- CPID 9701 Humana Ohio Medicaid Vision
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.
If you have any questions, please contact Customer Support and refer to Case Number 09446507.
REF 17110908 4/2/2025
John Muir Mt. Diablo Health System, Payer ID JMH01, Claim Rejection Issue
John Muir Mt. Diablo Health System, Payer ID JMH01, CPIDs 7653 and 6747, does not require enrollment for claims submission. If you submitted claims to this payer between 2/1/2025 and 3/24/2025 and received the rejection “not authorized to submit to payer”, please resubmit the rejected claims.
REF 17097376 4/1/2025
Report Generation Delay for CPID 3530 Mercy Care Plan
A payer is experiencing issues affecting Institutional report generation for some claims submitted on March 27, 2025.
Payer impacted:
- CPID 3530 Mercy Care 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.
If you have any questions, please contact Customer Support and refer to Case Number 09444620.
REF 17096208 4/1/2025
Report Generation Delay for CPIDs 1573 and 3802 AvMed
A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted since March 25, 2025.
Payer impacted:
- CPID 1573 AvMed
- CPID 3802 AvMed
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.
If you have any questions, please contact Customer Support and refer to Case Number 09445186.
REF 17102360 4/1/2025
New Electronic Medical Attachment Connections Available
Optum has new electronic medical attachment connections available:
Payer Name: Unified Health Services
Professional CPID: 5420
Institutional CPID: 7576
Payer-assigned Payer ID: 62170
Accepted Attachment Type: Unsolicited
Payer Enrollment Required: No
Payer Location: National
Action Required:
- Exchange providers must be contracted with Optum to submit electronic medical attachments. Please contact Support at 1-800-527-8133 option 2, or by emailing [email protected] for additional information.
- 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 update your system and procedures to take advantage of the new connection. For assistance with Medical Attachments, please contact your Practice Management System Vendor.
NOTE: The above Payer ID(s) is for Medical Attachments and may require Providers and/or their vendor be contracted with Optum for the Medical Attachment transaction services.
REF 17103608 4/1/2025
Report Generation Delay for CPID 2424 Blue Cross Blue Shield of Massachusetts
A payer is experiencing issues affecting Professional report generation for some claims submitted on March 26, 2025.
Payer impacted:
- CPID 2424 Blue Cross Blue Shield of Massachusetts
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.
If you have any questions, please contact Customer Support and refer to Case Number 09444528.
REF 17095058 4/1/2025
Electronic Connection No Longer Available
Effective immediately, the payer listed below will no longer be available at Optum for 270 Eligibility or 278 Inquiry processing.
Payer Name: Carefirst BC BS Community Health Plan
Eligibility ID: TRSTH1,
INQ ID=TRSTH1 and TRSTH2
CPIDs 6611, 6720
Reason: Payer no longer offers these connections.
REF 17089858 4/1/2025
Electronic Connection No Longer Available
Effective immediately, the payer listed below will no longer be available at Optum for 270 Eligibility or 278 Inquiry processing.
Payer Name: Carefirst BC BS Community Health Plan
Eligibility ID: TRSTH1,
INQ ID=TRSTH1 and TRSTH2
CPIDs 6611, 6720
Reason: Payer no longer offers these connections.
REF 17089859 4/1/2025
BCBSSC Delayed Responses
The Blue Cross and Blue Shield of South Carolina EDI Gateway is currently experiencing a system issue. There is currently a delay in processing of files resulting in backlog of fie processing. You may drop batch files into your mailbox but there may be a delay in delivering your responses (TA1, 999, RSP, RPT, 277CA).
As of 3/31 the payer advised they have resolved the system issue
REF 17090908 4/1/2025
First Health Network (Coventry Health Care National Network) Claims and Remittance Connections No Longer Available
Effective immediately, the payer listed below will no longer be available at Optum for claims and remittance processing.
Payer Name: First Health Network (Coventry Health Care National Network)
Claim and Remittance CPIDs: 4557, 2875
Payer-assigned Payer ID: 73159
Reason: Payer no longer in business.
Payer will no longer accept paper claims.
Action Required: None.
REF 17094758 4/1/2025
First Health Network (Coventry Health Care National Network) Claims and Remittance Connections No Longer Available
Effective immediately, the payer listed below will no longer be available at Optum for claims and remittance processing.
Payer Name: First Health Network (Coventry Health Care National Network)
Claim and Remittance CPIDs: 4557, 2875
Remittance LOB: E04
Payer-assigned Payer ID: 73159
Reason: Payer no longer in business.
Payer will no longer accept paper claims.
Action Required: None.
REF 17094759 4/1/2025
Older Payer Updates
Click the link below to access payer updates prior to April 1st, 2025.