August 2025

August 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

VIEW ALL PAYER LISTS →

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: Total Senior Care
CPIDs: 3037, 8288
Payer ID: 12288
Reason: Payer unavailable electronically

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

8/28/2025

New Electronic Claims and Remittance Connections Available
Effective Sept. 1, 2025, Optum has new electronic claims and remittance connections available:

Payer Name: Providence Health Plan Powered by Collective Health
Institutional CPID: 9015
Professional CPID: 3489
Payer-assigned Payer ID: 36481
Payer Claim Enrollment Required: No
Payer Remittance Enrollment Required: Yes
Secondary Claims Accepted: Yes
Payer Location: National
Claims Fee: N/A
Remittance Fee: N/A

Action Required:

Add the payer to your system to begin using the new payer connection.
When a payer requires claims enrollment, forms must be submitted and approved to begin submitting transactions.
Enrollment forms must be submitted and approved to begin receiving electronic remittance through Optum.

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

8/28/2025

New Electronic Claims and Remittance Connections Available
Effective Sept. 1, 2025, Optum has new electronic claims and remittance connections available:

Payer Name: Providence Health Plan Powered by Collective Health
Institutional CPID: 9015
Professional CPID: 3489
Payer-assigned Payer ID: 36481
Line of Business (LOB) Code: E29
Payer Claim Enrollment Required: No
Payer Remittance Enrollment Required: Yes
Secondary Claims Accepted: Yes
Payer Location: National

Action Required:

Add the payer to your system to begin using the new payer connection.
When a payer requires claims enrollment, forms must be submitted and approved to begin submitting transactions.
Enrollment forms must be submitted and approved to begin receiving electronic remittance through Optum.

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

8/28/2025

Electronic Routing Change for CPIDs 4116 and 3038 IntegraNet Health
Effective Aug. 28, 2025, Optum is changing electronic claims routing for the following payer:

Payer Name: IntegraNet Health
Professional CPID: 4116
Current Edit Master: PE_B800
New Edit Master: PE_T007
Institutional CPID: 3038
Current Edit Master: HE9B801
New Edit Master: HE0T007
Payer-assigned Payer ID: INET1
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 receive.

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.

8/28/2025

Report Generation Delay for multiple CPIDs
A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted since Aug. 21, 2025.

Payers impacted:

CPID 7045 AmeriHealth Caritas Ohio
CPID 7052 OhioRISE - Aetna Better Health of Ohio
CPID 9435 OhioRISE - Aetna Better Health of Ohio

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 09664021.

8/28/2025

Electronic Routing Change for CPIDs 4116 and 3038 IntegraNet Health
Effective Aug. 28, 2025, Optum is changing electronic claims routing for the following payer:

Payer Name: IntegraNet Health
Professional CPID: 4116
Institutional CPID: 3038
Payer-assigned Payer ID: INET1
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 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.

8/28/2025

Electronic Routing Change for CPID 7124 Valley Care IPA
Effective Aug. 28, 2025, Optum is changing electronic claims routing for the following payer:

Payer Name: Valley Care IPA
Professional CPID: 7124
Current Edit Master: PE_O007
New Edit Master: PE_T007
Payer-assigned Payer ID: VCIPA
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 receive.

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.

8/27/2025

Electronic Routing Change for CPID 7124 Valley Care IPA
Effective Aug. 28, 2025, Optum is changing electronic claims routing for the following payer:

Payer Name: Valley Care IPA
Professional CPID: 7124
Payer-assigned Payer ID: VCIPA
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 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.

8/28/2025

SFTP submitters please provide the following required fields:

2000A TRN-02 = (ACN – Attachment Control Number)
2000A REF with REF01=ZZ is required
2000A REF*ZZ REF02 should be 1052
2000A REF*ZZ REF4-01 should be YJ
2000A REF*ZZ REF4-02 is required (Claim ID)
2000A REF*ZZ REF4-02 length should not be longer than 32 characters (Claim ID)

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.

Original (Solicited) CSA sent 8/14/2025:

Optum is excited to announce we are now able to accept attachments for Medicare/MACs starting with the following payers:

New Medical Attachments Connections

Optum has new electronic medical attachment connections available:

Payer Name: Indiana Medicare

Professional CPID: 1445

Professional Payer-assigned Payer ID: 08102

Institutional CPID: 3500

Institutional Payer-assigned Payer ID: 08101

Accepted Attachment Type: Solicited

Payer Enrollment Required: No

Payer Location: Indiana

Payer Name: New York Medicare Empire

Professional CPID: 4442

Professional Payer-assigned Payer ID: 13202

Institutional CPID: 3519

Institutional Payer-assigned Payer ID: 13201

Accepted Attachment Type: Solicited

Payer Enrollment Required: No

Payer Location: New York

Payer Name: Michigan Medicare

Professional CPID: 1461

Professional Payer-assigned Payer ID: 08202

Institutional CPID: 3515

Institutional Payer-assigned Payer ID: 08201

Accepted Attachment Type: Solicited

Payer Enrollment Required: No

Payer Location: Michigan

Payer Name: Ohio Medicare

Professional CPID: 1447

Professional Payer-assigned Payer ID: 15202

Institutional CPID: 3507

Institutional Payer-assigned Payer ID: 15201

Accepted Attachment Type: Solicited

Payer Enrollment Required: No

Payer Location: Ohio

Payer Name: Utah Medicare

Professional CPID: 2458

Professional Payer-assigned Payer ID: 03502

Institutional CPID: 1527

Institutional Pay

Report Generation Delay for CPID 8624 HMC Healthworks

A payer is experiencing issues affecting Institutional report generation for some claims submitted on Aug. 15, 2025.

Payer impacted:

CPID 8624 HMC Healthworks

The payer 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 09662760.

8/27/2025

Report Generation Delay for CPID 9684 MotivHealth Insurance Company

A payer is experiencing issues affecting Institutional report generation for some claims submitted since Aug. 1, 2025.

Payer impacted:

CPID 9684 MotivHealth Insurance Company

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 09662616.

8/27/2025

Electronic Routing Change for CPIDs 3064 and 8466 Longevity Health Plan of New Jersey

Effective Aug. 28, 2025, Optum will be changing electronic claims routing for the following payer:

Payer Name: Longevity Health Plan of New Jersey
Professional CPID: 8466
Current Edit Master: PE_O007
New Edit Master: PE_T007
Institutional CPID: 3064
Current Edit Master: HE9O007
New Edit Master: HE9T007
Payer-assigned Payer ID: LNJ01
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 CPIDs are not changing.
When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.

8/27/2025

Electronic Routing Change for CPIDs 6095 and 2840 Physicians Care Network/Midland Mgmt

Effective Aug. 28, 2025, Optum will be changing electronic claims routing for the following payer:

Payer Name: Physicians Care Network/Midland Mgmt
Professional CPID: 2840
Current Edit Master: PE_E049
New Edit Master: PE_T007
Institutional CPID: 6095
Edit Master: HE9T007
Payer-assigned Payer ID: 36345
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.

8/27/2025

Electronic Routing Change for CPIDs 3064 and 8466 Longevity Health Plan of New Jersey

Effective Aug. 28, 2025, Optum will be changing electronic claims routing for the following payer:

Payer Name: Longevity Health Plan of New Jersey
Professional CPID: 8466
Institutional CPID: 3064
Payer-assigned Payer ID: LNJ01
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.

8/27/2025

Electronic Routing Change for CPIDs 6095 and 2840 Physicians Care Network/Midland Mgmt

Effective Aug. 28, 2025, Optum will be changing electronic claims routing for the following payer:

Payer Name: Physicians Care Network/Midland Mgmt
Professional CPID: 2840
Institutional CPID: 6095
Payer-assigned Payer ID: 36345
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.

8/27/2025

Electronic Routing Change for CPIDs 7536 and 5892 Redlands Yucaipa Medical Group

Effective Aug. 28, 2025, Optum will be changing electronic claims routing for the following payer:

Payer Name: Redlands Yucaipa Medical Group
Professional CPID: 5892
Current Edit Master: PE_O007
New Edit Master: PE_T007
Institutional CPID: 7536
Edit Master: HE9T007
Payer-assigned Payer ID: 18247
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.

8/27/2025

Medicare Eligibility (270/271) Connection Issues Resolved

The connection issue with Medicare Eligibility (270/271) has been resolved.

Transaction processing is functioning as normal.8/27/2025

Electronic Routing Change for CPIDs 7536 and 5892 Redlands Yucaipa Medical Group

Effective Aug. 28, 2025, Optum will be changing electronic claims routing for the following payer:

Payer Name: Redlands Yucaipa Medical Group
Professional CPID: 5892
Institutional CPID: 7536
Payer-assigned Payer ID: 18247
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.

8/27/2025

Resolved: Delay in Electronic Remittance Advice (ERA) for CPIDs 6286, 5648, Tricare West Region

This issue has been resolved. All impacted ERA files have been received and processed.

Original notify sent on August 26, 2025

Due to a processing issue, there has been a delay in Professional and Institutional Electronic Remittance Advice (ERA) for the following payers for file dates of August 21, 2025 through present:

CPID 6286 Tricare West Region
CPID 5648 Tricare West Region

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 09659538.

8/27/2025

New Electronic Claims Connections Available

Effective Sept. 1, 2025, Optum will have a new electronic claims connection available:

Payer Name: Evernorth Care Solutions
Professional CPID: 2789
Payer-assigned Payer ID: 62350
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.

8/27/2025

Restored Electronic Claim Status Connection

Effective August 14, 2025, Optum is pleased to announce connectivity has been restored for Real-time Claim Status (276/277) transactions for the below payer may now be submitted:

Payer Name: NaphCare, Inc.
Industry Payer ID: 58182
IMN Real Time ID: NAPHC
Exchange Real Time ID: NAPHC
CPID(s): 5602 / 6208
Optum iEDI Real Time ID: NAPHC
Payer Enrollment Required: No
Connection Type: X12

Search Options:

Claim Status Inquiry Subscriber

Member ID, first name, last name, date of birth

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.optum.com/public/home.html.

8/27/2025

Restored Electronic Claim Status Connection

Effective August 14, 2025, Optum is pleased to announce connectivity has been restored for Real-time Claim Status (276/277) transactions for the below payer may now be submitted:

Payer Name: HealthComp West
Industry Payer ID: 85729
IMN Real Time ID: 85729
Exchange Real Time ID: HLCOMP
CPID(s): 2934, 3206
Optum IEDi Real Time ID: 85729
Payer Enrollment Required: No
Connection Type: X12

Search Options:

Claim Status Inquiry Subscriber

Member ID, First Name, Last Name, Date of Birth

Claim Status Inquiry Dependent

Member ID, Subscriber Last Name, Dep First Name, Dep Last Name, Dep Date of Birth

Action Required by customer:

8/27/2025

Report Generation Delay for CPIDs 1985 and 4246 Capital Health Plan

A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted since Aug. 14, 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 09659627.

8/26/2025

835 Delivery Delay - CHAMPVA

The VA payer has notified Optum that they are aware of an issue related to missing 835s for check date August 12, 2025, for payer IDs 84146, 84147, and 80214. They are working to resolve the issue that is preventing the 835s from being generated.

Please hold any research requests for missing 835s related to that specific check date and Optum will update once the files are received from the VA.

8/26/2025

Report Generation Delay for CPID 6987 Veterans Affairs Financial Services Center

A payer intermediary is experiencing issues affecting Institutional report generation for some claims submitted on Aug. 20, 2025.

Payer impacted:

CPID 6987 Veterans Affairs Financial Services Center

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 09660872.

8/26/2025

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 April 28, 2025 to Aug. 23, 2025.

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

Original notify sent May 9, 2025:

A payer is experiencing issues affecting Professional report generation for some claims submitted since April 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 09496257.

8/26/2025

Update: Report Generation Delay for CPID 8920 Healthcare Management Administrators

Update: The payer intermediary has been unable to generate and deliver the reports for some claims submitted on July 29, 2025.

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

Original notify sent Aug. 12, 2025:

A payer intermediary is experiencing issues affecting Institutional report generation for some claims submitted since July 28, 2025.

Payer impacted:

CPID 8920 Healthcare Management 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 09638146.

8/26/2025

Electronic Routing Change for CPIDs 6182 and 4678 RightCare Scott & White Health Plan

Effective August 27, 2025, Optum will be changing electronic claims routing for the following payer:

Payer Name: RightCare Scott & White Health Plan
Professional CPID: 6182
Current Edit Master: PE_E049
New Edit Master: PE_T007
Institutional CPID: 4678
Current Edit Master: HE9E049
New Edit Master: HE9T007
Payer-assigned Payer ID: 74205
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.

8/26/2025

Electronic Routing Change for CPIDs 6182 and 4678 RightCare Scott & White Health Plan

Effective August 27, 2025, Optum will be changing electronic claims routing for the following payer:

Payer Name: RightCare Scott & White Health Plan
Professional CPID: 6182
Institutional CPID: 4678
Payer-assigned Payer ID: 74205
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.

8/26/2025

Delay in Electronic Remittance Advice (ERA) for CPIDs 6286, 5648, Tricare West Region

Due to a processing issue, there has been a delay in Professional and Institutional Electronic Remittance Advice (ERA) for the following payers for file dates of August 21, 2025 through present:

CPID 6286 Tricare West Region
CPID 5648 Tricare West Region

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 09659538.

8/26/2025

999 Payer Batch Rejections for CPID 1844 Wellcare Health Plans

Professional claims transmitted to the payer listed below from Optum on Aug. 21, 2025 were not processed by the payer due to a 999 Batch Rejection.

CPID 1844 Wellcare Health Plans

A resolution has been implemented and the claims were retransmitted to the payer on Aug. 26, 2025.

Action Required: None.

If you have any questions, please contact Customer Support and refer to Case Number 09659832.

8/26/2025

Delay in Electronic Remittance Advice (ERA) for CPIDs 6286, 5648, Tricare West Region

Due to a processing issue, there has been a delay in Professional and Institutional Electronic Remittance Advice (ERA) for the following payers for file dates of August 21, 2025 through present:

CPID 6286 Tricare West Region
CPID 5648 Tricare West Region

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 09659538.

8/26/2025

Electronic Routing Change for CPIDs 1114 and 9524 Summit Administrators Inc.

Effective August 26, 2025, Optum will be changing electronic claims routing for the following payer:

Payer Name: Summit Administrators Inc
Professional CPID: 1114
Current Edit Master: PE_T007
Institutional CPID: 9524
Current Edit Master: HE9T007
Payer-assigned Payer ID: 86083
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.

8/26/2025

Electronic Routing Change for CPIDs 1159 and 1975 Network Solutions IPA

Effective August 27, 2025, Optum will be changing electronic claims routing for the following payer:

Payer Name: Network Solutions IPA
Professional CPID: 1159
Current Edit Master: PE_O007
New Edit Master: PE_T007
Institutional CPID: 1975
Current Edit Master: HE9O007
New Edit Master: HE9T007
Payer-assigned Payer ID: NSIPA
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.

8/26/2025

Electronic Routing Change for CPIDs 1159 and 1975 Network Solutions IPA

Effective August 27, 2025, Optum will be changing electronic claims routing for the following payer:

Payer Name: Network Solutions IPA
Professional CPID: 1159
Institutional CPID: 1975
Payer-assigned Payer ID: NSIPA
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.

8/26/2025

Electronic Routing Change for CPIDs 1744 and 6591 Welfare Pension Administration Services (WPAS)

Effective August 27, 2025, Optum will be changing electronic claims routing for the following payer:

Payer Name: Welfare Pension Administration Services (WPAS)
Professional CPID: 1744
Current Edit Master: PE_E049
New Edit Master: PE_T007
Institutional CPID: 6591
Current Edit Master: HE9E049
New Edit Master: HE9T007
Payer-assigned Payer ID: 91136
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 CPIDs are not changing.
When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.

8/26/2025

Electronic Routing Change for CPIDs 1744 and 6591 Welfare Pension Administration Services (WPAS)

Effective August 27, 2025, Optum will be changing electronic claims routing for the following payer:

Payer Name: Welfare Pension Administration Services (WPAS)
Professional CPID: 1744
Institutional CPID: 6591
Payer-assigned Payer ID: 91136
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.

8/26/2025

Electronic Routing Change for CPIDs 4090 and 8832 Valley Presbyterian Hospital Preferred IPA VPRESPREF

Effective August 26, 2025, Optum will be changing electronic claims routing for the following payer:

Payer Name: Valley Presbyterian Hospital Preferred IPA VPRESPREF
Professional CPID: 8832
Current Edit Master: PE_O007
New Edit Master: PE_T007
Institutional CPID: 4090
Current Edit Master: HE9O007
New Edit Master: HE9T007
Payer-assigned Payer ID: MPM60
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.

8/26/2025

Electronic Routing Change for CPIDs 4090 and 8832 Valley Presbyterian Hospital Preferred IPA VPRESPREF

Effective August 26, 2025, Optum will be changing electronic claims routing for the following payer:

Payer Name: Valley Presbyterian Hospital Preferred IPA VPRESPREF
Professional CPID: 8832
Institutional CPID: 4090
Payer-assigned Payer ID: MPM60
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.

8/26/2025

Electronic Routing Change for CPIDs 7732 and 9681 Exceedent

Effective August 26, 2025, Optum will be changing electronic claims routing for the following payer:

Payer Name: Exceedent
Professional CPID: 7732
Current Edit Master:PE_E049
New Edit Master:PE_T007
Institutional CPID: 9681
Current Edit Master: HE9E049
New Edit Master: HE9T007
Payer-assigned Payer ID: 22344
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.

8/26/2025

Electronic Routing Change for CPIDs 7732 and 9681 Exceedent

Effective August 26, 2025, Optum will be changing electronic claims routing for the following payer:

Payer Name: Exceedent
Professional CPID: 7732
Institutional CPID: 9681
Payer-assigned Payer ID: 22344
Payer Claim Enrollment Required: No
Secondary Claims Accepted: Yes
Claims Fee: N/A

Enrollment Requirements:

Claims:

Payer enrollment for electronic claims is no] 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.

8/26/2025

Update: Report Generation Delay for CPIDs 3514 and 1421 Blue Cross Blue Shield of Michigan

Update: The payer intermediary has been unable to generate and deliver the reports for some claims submitted from July 26, 2025 through July 31, 2025.

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

Update sent Aug. 12, 2025:

A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted since July 26, 2025.

Payer impacted:

CPID 3514 Blue Cross Blue Shield of Michigan
CPID 1421 Blue Cross Blue Shield of Michigan

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09638113.

8/26/2025

Electronic Claim Status Connection Updated

Effective 7/11/25, Optum is pleased to announce that Real-time Claim Status Inquiry 276/277 Search Criteria for the below payer has been updated:

Payer Name: Martin's Point Health Care
Industry Payer ID: MPHC2
IMN Real Time ID: MRTPH
Exchange Real Time ID: MRTNP
CPID(s): 1639, 5701
Optum IEDi Real Time ID: MPHC2
Payer Enrollment Required: No
Connection Type: X12

Search Options:

Subscriber

Member ID, First Name, Last Name, Date of Birth
Optional additional criteria:
- Payer claim number
- Total submitted charges

Dependent

Member ID, Dependent First Name, Dependent Last Name, Dependent Date of Birth
Optional additional criteria:
- Payer claim number
- Total submitted charges

Provider Record Requirements:

Only an NPI is accepted as Receiver ID (NM1*41 segment) and Service Provider ID (NM1*1P segment) in the NM109 element.

Action Required by customer:

8/26/2025

Electronic Routing Change for CPIDs 8260 and 3011 Longevity Health Plan of New York

Effective August 25, 2025, Optum will be changing electronic claims routing for the following payer:

Payer Name: Longevity Health Plan of New York
Professional CPID: 8260
Current Edit Master: PE_O007
New Edit Master: PE_T007
Institutional CPID: 3011
Current Edit Master: HE9O007
New Edit Master: HE9T007
Payer-assigned Payer ID: LNY01
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 receive.

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.

8/25/2025

Electronic Routing Change for CPIDs 8260 and 3011 Longevity Health Plan of New York

Effective August 25, 2025, Optum will be changing electronic claims routing for the following payer:

Payer Name: Longevity Health Plan of New York
Professional CPID: 8260
Institutional CPID: 3011
Payer-assigned Payer ID: LNY01
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 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.

8/25/2025

Electronic Routing Change for CPID 7273 Accountable Healthcare IPA

Effective Aug. 25, 2025, Optum is changing electronic claims routing for the following payer:

Payer Name: Accountable Healthcare IPA
Professional CPID: 7273
Current Edit Master: PE_O007
New Edit Master: PE_T007
Payer-assigned Payer ID: AHIPA
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.

8/25/2025

Electronic Routing Change for CPID 7273 Accountable Healthcare IPA

Effective Aug. 25, 2025, Optum is changing electronic claims routing for the following payer:

Payer Name: Accountable Healthcare IPA
Professional CPID: 7273
Payer-assigned Payer ID: AHIPA
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.

8/25/2025

Electronic Routing Change for CPIDs 6731 and 6630 Zelis

Effective Aug. 25, 2025, Optum is changing electronic claims routing for the following payer:

Payer Name: Zelis
Professional CPID: 6731
Current Edit Master: PE_B800
New Edit Master: PE_T007
Institutional CPID: 6630
Current Edit Master: HE9B801
New Edit Master: HE9T007
Payer-assigned Payer ID: 88057
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 receive.

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.

8/25/2025

Electronic Routing Change and new Payer Name for CPIDs 7168 and 8609 Premier Healthcare Exchange (PHX)

Effective Aug. 25, 2025, Optum is changing electronic claims routing and payer name for the following payer:

Previous Payer Name: Premier Healthcare Exchange (PHX)
New Payer Name: Zelis - BSI
Professional CPID: 7168
Current Edit Master: PE_B800
New Edit Master: PE_T007
Institutional CPID: 8609
Current Edit Master: HE9B801
New Edit Master: HE9T007
Payer-assigned Payer ID: 88051
Payer Claim Enrollment Required: No
Secondary Claims Accepted: No

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.

Enrollment Requirements
Claims:

Payer enrollment for electronic claims is not required.

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:

Revalidate unreleased claims to edit correctly under new edit master
Modify any bridge routines based on edit masters.
You may choose to update the Payer Alias in your system to accommodate the new payer name.
When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.

8/25/2025

Electronic Routing Change for CPIDs 6731 and 6630 Zelis

Effective Aug. 25, 2025, Optum is changing electronic claims routing for the following payer:

Payer Name: Zelis
Professional CPID: 6731
Institutional CPID: 6630
Payer-assigned Payer ID: 88057
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 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.

8/25/2025

Previous Payer Name: Premier Healthcare Exchange (PHX)
New Payer Name: Zelis - BSI
Professional CPID: 7168
Institutional CPID: 8609
Payer-assigned Payer ID: 88051
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 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.

8/25/2025

999 Payer Batch Rejections for CPID 2560 Wellpoint

Institutional claims transmitted to the payer listed below from Optum Aug. 25, 2025 were not processed by the payer due to a 999 Batch Rejection.

CPID 2560 Wellpoint

A resolution has been implemented and the claims were retransmitted to the payer Aug. 25, 2025.

Action Required: None.

If you have any questions, please contact Customer Support and refer to Case Number 09658418.

8/25/2025

Electronic Routing Change for CPIDs 7006 and 9288 Valley Presbyterian Hospital

Effective Aug. 25, 2025, Optum is changing electronic claims routing for the following payer:

Payer Name: Valley Presbyterian Hospital
Professional CPID: 9288
Current Edit Master: PE_O007
New Edit Master: PE_T007
Institutional CPID: 7006
Current Edit Master: HE9O007
New Edit Master: HE9T007
Payer-assigned Payer ID: MPM53
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.

8/25/2025

Electronic Routing Change for CPIDs 7006 and 9288 Valley Presbyterian Hospital

Effective Aug. 25, 2025, Optum is changing electronic claims routing for the following payer:

Payer Name: Valley Presbyterian Hospital
Professional CPID: 9288
Institutional CPID: 7006
Payer-assigned Payer ID: MPM53
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.

8/25/2025

Report Generation Delay for CPIDs 7567 and 7499 Sentara Health Plans

A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted since Aug. 12, 2025.

Payer impacted:

CPID 7567 Sentara Health Plans
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 09658095.

8/25/2025

Report Generation Delay for CPIDs 8677 and 7264 Quartz ASO

A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted since Aug. 11, 2025.

Payer impacted:

CPID 8677 Quartz ASO
CPID 7264 Quartz ASO

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 09657985.

8/25/2025

Report Generation Delay for CPID 2824 The Health Plan of West Virginia, Inc

A payer is experiencing issues affecting Professional report generation for some claims submitted since Aug. 14, 2025.

Payer impacted:

CPID 2824 The Health Plan of West Virginia, 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 09657994.

8/25/2025

UPDATE: Remittance Changes for CPIDs 6847 and 7630 Neighborhood Health Partnership of Florida

It has come to Optum’s attention that you are receiving electronic remittance for the terminated payers listed below. Effective immediately, Optum will no longer process electronic remittance for the following payers:

Payer Name: Neighborhood Health Partnership of Florida
Professional CPID: 6847
Institutional CPID: 7630
Payer-assigned Payer ID: 96107

Payer Name: Neighborhood Health Partnership of Florida
Professional CPID: 2721
Institutional CPID: 1567
Payer-assigned Payer ID: 95123

In order to continue receiving electronic remittance, providers must login in to Enrollment Central immediately, to verify they are enrolled with the appropriate payer.

Enrollment Requirements
Remittance:

Payer enrollment for electronic remittance is required.

Action Required:

Please make the necessary enrollment changes, before the effective date, to continue receiving electronic remittance.
When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.

8/25/2025

Payer Name: Neighborhood Health Partnership of Florida
Professional CPID: 6847
Institutional CPID: 7630
Payer-assigned Payer ID: 96107
Line of Business Code (LOB): J44

Payer Name: Neighborhood Health Partnership of Florida
Professional CPID: 2721
Institutional CPID: 1567
Payer-assigned Payer ID: 95123
Line of Business Code (LOB): J10

In order to continue receiving electronic remittance, providers must login in to Enrollment Central immediately, to verify they are enrolled with the appropriate payer.

Enrollment Requirements
Remittance:

Payer enrollment for electronic remittance is required.

Action Required:

Please make the necessary enrollment changes, before the effective date, to continue receiving electronic remittance.
When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.

8/25/2025

Update: Report Generation Delay for CPIDs 6672 and 6733 Wellmark Blue Cross Blue Shield of Iowa Crossover

Update: The payer intermediary has been unable to generate and deliver the reports for some claims submitted from July 23, 2025 through July 25, 2025.

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

Update sent July 31, 2025:

A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted since July 23, 2025.

Payer impacted:

CPID 6672 Wellmark Blue Cross Blue Shield of Iowa Crossover
CPID 6733 Wellmark Blue Cross Blue Shield of Iowa 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 09622776.

8/25/2025

Electronic Routing Change for CPIDs 8471 and 3068 Texas Independence Health Plan Inc.

Effective August 25, 2025, Optum will be changing electronic claims routing for the following payer:

Payer Name: Texas Independence Health Plan Inc.
Professional CPID: 8471
Institutional CPID: 3068
Payer-assigned Payer ID: 31403
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 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.

8/25/2025

Electronic Routing Change for CPIDs 8471 and 3068 Texas Independence Health Plan Inc.

Effective August 25, 2025, Optum will be changing electronic claims routing for the following payer:

Payer Name: Texas Independence Health Plan Inc.
Professional CPID: 8471
Edit Master: PE_T007
Institutional CPID: 3068
Edit Master: HE9T007
Payer-assigned Payer ID: 31403
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 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.

8/25/2025

New Payer Product Available

Optum is pleased to announce the availability of Real-time Claim Status Inquiry and Response transactions for the below payer, effective August 15, 2025.

IMN ID: 23738/BCLAC
IEDI: LABLS
Exchange: LABCBS
CPIDS: 3580 & 2758
Payer Names: Louisiana Blue Cross Blue Shield
Transaction Types: Claims Status

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

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

8/22/2025

University Physicians Care Advantage Arizona - Real Time Eligibility 270/271, Claim Status Inquiry 276/277 Connection No Longer Available

Effective immediately, Real Time Eligibility 270/271 or Claim Status Inquiry 276/277 for the payer listed below will no longer be available at Optum.

Payer Name: University Physicians Care Advantage Arizona
IMN Real Time ID: UPCAA
Exchange Real Time ID: UPCADV
CPID(s): NONE
Optum IEDi Real Time ID: UPCAA
Connection Type: X12

Reason: Payer no longer offers an electronic connection

8/22/2025

Edit Master for CPID 7618 United Care Medical Group

Effective August 26, 2025, Optum will be changing Edit Masters for the following payer:

Payer Name: United Care Medical Group
Institutional CPID: 7618
Current Edit Master: HE9O007
New Edit Master: HE9T007
Payer-assigned Payer ID: ADCUC

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 CPID are not changing.

8/22/2025

Electronic Routing Change for CPID 6840 United Care Medical Group

Effective August 26, 2025, Optum will be changing electronic claims routing for the following payer:

Payer Name: United Care Medical Group
Professional CPID: 6840
Current Edit Master: PE_O007
New Edit Master: PE_T007
Payer-assigned Payer ID: ADCUC
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 receive.

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.

8/22/2025

Electronic Routing Change for CPID 6840 United Care Medical Group

Effective Aug. 26, 2025, Optum will be changing electronic claims routing for the following payer:

Payer Name: United Care Medical Group
Professional CPID: 6840
Payer-assigned Payer ID: ADCUC
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 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.

8/22/2025

Edit Master for CPID 9680 PIH Health

Effective August 26, 2025, Optum will be changing Edit Masters for the following payer:

Payer Name: PIH Health
Institutional CPID: 9680
Current Edit Master: HE9O007
New Edit Master: HE9T007
Payer-assigned Payer ID: BHP01

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 CPID are not changing.

8/22/2025

Electronic Routing Change for CPID 8229 PIH Health

Effective August 26, 2025, Optum will be changing electronic claims routing for the following payer:

Payer Name: PIH Health
Professional CPID: 8229
Current Edit Master: PE_O007
New Edit Master: PE_T007
Payer-assigned Payer ID: BHP01
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 CPID are not changing.
When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.

8/22/2025

Electronic Routing Change for CPID 8229 PIH Health

Effective August 26, 2025, Optum will be changing electronic claims routing for the following payer:

Payer Name: PIH Health
Professional CPID: 8229
Payer-assigned Payer ID: BHP01
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.

8/22/2025

New Electronic Claims Connections Available - M3TPA LLC (M3TPA)

Optum has new professional and institutional electronic claims connections available:

Payer Name: M3TPA LLC
Payer ID: M3TPA
Payer Enrollment Required: No
Secondary Claims Accepted: Yes
Payer Location: Texas

Action Required:

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

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

8/22/2025

New Electronic Claims Connections Available on Revenue Performance Advisor

Institutional claim transactions have recently been added to the Revenue Performance Advisor (RPA) system for the following payers:

13315 – Insurance Design Administrators
30070 – Keystone First - CHIP
PFIPA – Preferred IPA
UHSM1 – UHSM (Unite Health Share Ministries)

Professional claim transactions have recently been added to the Revenue Performance Advisor system for the following payers:

13315 – Insurance Design Administrators
30070 – Keystone First - CHIP
CNTY1 – Optum San Diego Public Sector County
UHSM1 – UHSM (Unite Health Share Ministries)

8/22/2025

Electronic Routing Change for CPIDs 1239 and 6023 PSKW LLC

Effective August 25, 2025, Optum will be changing electronic claims routing for the following payer:

Payer Name: PSKW LLC
Professional CPID: 1239
Institutional CPID: 6023
Payer-assigned Payer ID: PSKW0
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 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.

8/22/2025

Electronic Routing Change for CPIDs 1239 and 6023 PSKW LLC

Effective August 25, 2025, Optum will be changing electronic claims routing for the following payer:

Payer Name: PSKW LLC
Professional CPID: 1239
Edit Master: PE_T007
Institutional CPID: 6023
Edit Master: HE9T007
Payer-assigned Payer ID: PSKW0
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 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.

8/22/2025

New Real Time Eligibility 270/271 and Claim Status Inquiry and Response 276/277 Connection Available

Effective July 1, 2025, Optum is pleased to announce the availability of Real-time (Eligibility Inquiry and Response 270/271) and (Claim Status and Response 276/277) transactions for the Payer name and ID below:

Payer Name: Keystone First-CHIP
Real Time ID: 30070
CPID: 2897 and 8098
Exchange ID: KEYCH
IEDI ID: 30070

Action Required by customer:

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

8/22/2025

New Electronic Medical Attachment Connections Available (Medicare)

Optum is excited to announce we are now able to accept attachments for Medicare/MACs for the following payers:

Payer Name: Louisiana Medicare

Professional CPID: 1460

Professional Payer-assigned Payer ID: 07202

Institutional CPID: 3579

Institutional Payer-assigned Payer ID: 07201

Accepted Attachment Type: Solicited and Unsolicited

Payer Enrollment Required: No

Payer Location: Louisiana

Payer Name: Nevada Medicare

Professional CPID: 1446

Professional Payer-assigned Payer ID: 01312

Institutional CPID: 5907

Institutional Payer-assigned Payer ID: 01311

Accepted Attachment Type: Solicited and Unsolicited

Payer Enrollment Required: No

Payer Location: Nevada

Payer Name: Mississippi Medicare

Professional CPID: 2451

Professional Payer-assigned Payer ID: 07302

Institutional CPID: 5556

Institutional Payer-assigned Payer ID: 07301

Accepted Attachment Type: Solicited and Unsolicited

Payer Enrollment Required: No

Payer Location: Mississippi

Payer Name: Arkansas Medicare

Professional CPID: 2455

Professional Payer-assigned Payer ID: 07102

Institutional CPID: 1526

Institutional Payer-assigned Payer ID: 07101

Accepted Attachment Type: Solicited and Unsolicited

Payer Enrollment Required: No

Payer Location: Arkansas

Payer Name: South Dakota Medicare

Professional CPID: 2454

Professional Payer-assigned Payer ID: 03402

Institutional CPID: 5589

Institutional Payer-assigned Payer ID: 03401

Accepted Attachment Type: Solicited and Unsolicited

Payer Enrollment Required: No

Payer Location: South Dakota

Payer Name: Maryland Medicare

Professional CPID: 7402

Professional Payer-assigned Payer ID: 12302

Institutional CPID: 5554

Institutional Payer-assigned Payer ID: 12301

Accepted Attachment Type: Solicited and Unsolicited

Payer Enrollment Required: No

Payer Location: Maryland

Payer Name: Missouri Medicare Eastern

Professional CPID: 1441

Professional Payer-assigned Payer ID: 05302

Institutional CPID: 5572

Institutional Payer-assigned Payer ID: 05301

Accepted Attachment Type: Solicited and Unsolicited

Payer Enrollment Required: No

Payer Location: Missouri

Payer Name: Oregon Medicare

Professional CPID: 1459

Professional Payer-assigned Payer ID: 02302

Institutional CPID: 5515

Institutional Payer-assigned Payer ID: 02001

Accepted Attachment Type: Solicited and Unsolicited

Payer Enrollment Required: No

Payer Location: Oregon

Payer Name: Oklahoma Medicare

Professional CPID: 1458

Professional Payer-assigned Payer ID: 04312

Institutional CPID: 1558

Institutional Payer-assigned Payer ID: 04311

Accepted Attachment Type: Solicited and Unsolicited

Payer Enrollment Required: No

Payer Location: Oklahoma

Payer Name: South Carolina Medicare

Professional CPID: 2452

Professional Payer-assigned Payer ID: 11202

Institutional CPID: 1560

Institutional Payer-assigned Payer ID: 11001

Accepted Attachment Type: Solicited and Unsolicited

Payer Enrollment Required: No

Payer Location: South Carolina

Payer Name: Alabama Medicare

Professional CPID: 2468

Professional Payer-assigned Payer ID: 10112

Institutional CPID: 5559

Institutional Payer-assigned Payer ID: 10111

Accepted Attachment Type: Solicited and Unsolicited

Payer Enrollment Required: No

Payer Location: Alabama

Payer Name: Connecticut Medicare

Professional CPID: 1452

Professional Payer-assigned Payer ID: 13102

Institutional CPID: 3533

Institutional Payer-assigned Payer ID: 13101

Accepted Attachment Type: Solicited and Unsolicited

Payer Enrollment Required: No

Payer Location: Connecticut

Payer Name: Hawaii / Guam Medicare

Professional CPID: 2467

Professional Payer-assigned Payer ID: 01212

Accepted Attachment Type: Solicited and Unsolicited

Payer Enrollment Required: No

Payer Location: Hawaii / Guam

Payer Name: Maine Medicare

Professional CPID: 2472

Professional Payer-assigned Payer ID: 14112

Institutional CPID: 3547

Institutional Payer-assigned Payer ID: 14011

Accepted Attachment Type: Solicited and Unsolicited

Payer Enrollment Required: No

Payer Location: Maine

Payer Name: New Hampshire Medicare

Professional CPID: 2470

Professional Payer-assigned Payer ID: 14312

Institutional CPID: 2528

Institutional Payer-assigned Payer ID: 14013

Accepted Attachment Type: Solicited and Unsolicited

Payer Enrollment Required: No

Payer Location: New Hampshire

Payer Name: District of Columbia Metropolitan Area (DCMA) Medicare

Professional CPID: 2459

Professional Payer-assigned Payer ID: 12202

Accepted Attachment Type: Solicited and Unsolicited

Payer Enrollment Required: No

Payer Location: District of Columbia

Payer Name: New York Medicare Upstate

Professional CPID: 1463

Professional Payer-assigned Payer ID: 13282

Accepted Attachment Type: Solicited and Unsolicited

Payer Enrollment Required: No

Payer Location: New York

Payer Name: Idaho Medicare

Professional CPID: 2465

Professional Payer-assigned Payer ID: 02202

Institutional CPID: 5581

Institutional Payer-assigned Payer ID: 02001

Accepted Attachment Type: Solicited and Unsolicited

Payer Enrollment Required: No

Payer Location: Idaho

Payer Name: J5 National Part A

Institutional CPID: 2535

Institutional Payer-assigned Payer ID: 05901

Accepted Attachment Type: Solicited and Unsolicited

Payer Enrollment Required: No

Payer Location: National

Payer Name: JH Mutual of Omaha CO, NM, OK, TX

Institutional CPID: 3650

Institutional Payer-assigned Payer ID: 04911

Accepted Attachment Type: Solicited and Unsolicited

Payer Enrollment Required: No

Payer Location: Colorado, New Mexico, Oklahoma, Texas

Payer Name: Medicare DME MAC Jurisdiction D

Professional CPID: 7478

Professional Payer-assigned Payer ID: 19003

Accepted Attachment Type: Solicited and Unsolicited

Payer Enrollment Required: No

Payer Location: Multiple

Payer Name: New Mexico Medicare

Professional CPID: 1457

Professional Payer-assigned Payer ID: 04212

Institutional CPID: 5566

Institutional Payer-assigned Payer ID: 04211

Accepted Attachment Type: Solicited and Unsolicited

Payer Enrollment Required: No

Payer Location: New Mexico

Payer Name: Alaska Medicare

Professional CPID: 1455

Professional Payer-assigned Payer ID: 02102

Accepted Attachment Type: Solicited and Unsolicited

Payer Enrollment Required: No

Payer Location: Alaska

Payer Name: West Virginia Medicare

Professional CPID: 1450

Professional Payer-assigned Payer ID: 11402

Institutional CPID: 5530

Institutional Payer-assigned Payer ID: 11003

Accepted Attachment Type: Solicited and Unsolicited

Payer Enrollment Required: No

Payer Location: West Virginia

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.

Note: These Medicare payers accept solicited and unsolicited attachments for PDF documents only.

Solicited Attachments:

API submitters please provide the following required fields:

serviceLine.payerClaimControlNumber is required and should contain CMS Claim Number
serviceLine.procedureOrRevenueDetails.procedureOrRevenueCode = "ZZ"
serviceLine.procedureOrRevenueDetails.procedureOrRevenueValue = "1000"
serviceLine.procedureOrRevenueDetails.revenueCode is required (esMD Case Number)
serviceLine.procedureOrRevenueDetails.revenueCode length should not be longer than 32 characters (esMD Case Number)

SFTP submitters please provide the following required fields:

2000A TRN02 is required and should contain CMS Claim Number
2000A REF with REF01=ZZ is required
2000A REF*ZZ REF02 should be 1000
2000A REF*ZZ REF4-01 should be YJ
2000A REF*ZZ REF4-02 is required (esMD Case Number)
2000A REF*ZZ REF4-02 length should not be longer than 32 characters (esMD Case Number)

Unsolicited Attachments:

API submitters please provide the following required fields:

serviceLine.providerAttachmentControlNumber = (ACN - Attachment Control Number)
serviceLine.procedureOrRevenueDetails.procedureOrRevenueCode = "ZZ"
serviceLine.procedureOrRevenueDetails.procedureOrRevenueValue = "1052"
serviceLine.procedureOrRevenueDetails.revenueCode is required (Claim ID)
serviceLine.procedureOrRevenueDetails.revenueCode length should not be longer than 32 characters (Claim ID)

SFTP submitters please provide the following required fields:

2000A TRN-02 = (ACN – Attachment Control Number)
2000A REF with REF01=ZZ is required
2000A REF*ZZ REF02 should be 1052
2000A REF*ZZ REF4-01 should be YJ
2000A REF*ZZ REF4-02 is required (Claim ID)
2000A REF*ZZ REF4-02 length should not be longer than 32 characters (Claim ID)

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.

8/21/2025

Report Generation Delay for Multiple CPIDs

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted July 31, 2025-Aug. 12, 2025.

Payers impacted:

CPID 7765 Access Community Health Network
CPID 1893 American Health Resources
CPID 6135 Avesis TPA
CPID 3400 Community Care Health (CCH)
CPID 4471 Connecticare Medicare
CPID 6440 Connecticare, Inc.
CPID 2482 Cox HealthPlan
CPID 1819 Diversified Benefit Administrators
CPID 1896 EmblemHealth Insurance Company
CPID 2744 EmblemHealth Plan, Inc. (MCR)
CPID 6776 Eyequest
CPID 9196 Global Medical Management (GMMI)
CPID 6798 HCC Life Insurance Company
CPID 2105 Health Sun
CPID 1709 Horizon NJ Health
CPID 7790 Iowa Screening Programs
CPID 9222 Massachusetts Behavioral Health Partnership
CPID 2475 Monarch IPA
CPID 9197 New York Medical Indemnity Fund
CPID 2828 OSU Centene Oklahoma Complete Health
CPID 6763 OSU SoonerCare
CPID 1763 Parkland Community Healthplan
CPID 9198 Primary Care Coalition
CPID 1715 VitalCore Millette
CPID 8440 Vytra Healthcare
CPID 6804 Western Oregon Advanced Health CCO

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 09628596.

8/21/2025

Update: Report Generation Delay for CPID 9178 AIDS Healthcare Found

Update: The payer intermediary has been unable to generate and deliver the reports for some claims submitted June 21, 2025.

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

Original notify sent June 25, 2025:
A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted since June 10, 2025.

Payer impacted:

CPID 9178 AIDS Healthcare Foundation - PHC

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 09570857.

8/21/2025

Electronic Routing Change for CPIDs 1740 and 1916 Sonder Health Plans

Effective August 21, 2025, Optum will be changing electronic claims routing for the following payer:

Payer Name: Sonder Health Plans
Professional CPID: 1740
Current Edit Master: PE_B800
New Edit Master: PE_T007
Institutional CPID: 1916
Current Edit Master: HE9B801
New Edit Master: HE9T007
Payer-assigned Payer ID: A0339
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 receive.

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.

8/21/2025

Electronic Routing Change for CPIDs 1740 and 1916 Sonder Health Plans

Effective August 21, 2025, Optum is changing electronic claims routing for the following payer:

Payer Name: Sonder Health Plans
Professional CPID: 1740
Institutional CPID: 1916
Payer-assigned Payer ID: A0339
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 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.

8/21/2025

Payer Transmit Delay for CPID 5591 and 4478 South Dakota Medicaid

Due to a payer system issue, a delay occurred in some of the transmissions to the following payer Aug. 19, 2025-Aug. 20, 2025.

Payer impacted:

CPID 5591 South Dakota Medicaid
CPID 4478 South Dakota Medicaid

A resolution has been implemented and the claims were transmitted to the payer Aug. 20, 2025.

This delay affected claims released to Optum Aug. 18, 2025, 3:00 p.m.-Aug. 20, 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 09653956.

8/21/2025

999 Payer Batch Rejections for CPID 1782 North American Medical Management

Professional claims transmitted to the payer listed below from Optum Aug. 19, 2025 were not processed by the payer due to a 999 Batch Rejection.

Payer impacted:

CPID 1782 North American Medical Management (NAMM - N. CA)

A resolution has been implemented, and the claims were retransmitted to the payer Aug. 19, 2025.

Action Required: None.

If you have any questions, please contact Customer Support and refer to Case Number 09614690.

8/19/2025

New Real Time Eligibility 270/271 Connection Available

Effective June 24, 2025 Optum is pleased to announce the availability of Real-time Eligibility Inquiry and Response 270/271 for the below payer:

Payer Name: Commonwealth Care Alliance (DOS after 3/31/2023)
Industry Payer ID: A2793
IMN Real Time ID: A2793
Exchange Real Time ID: CWHCA
CPID(s): 4093, 8834
Optum IEDi Real Time ID: 14408
Payer Enrollment Required: No
Connection Type: X12

Search Options:

Subscriber

Member ID, First Name, Last Name, Date of Birth

Action Required by customer:

8/19/2025

999 Payer Batch Rejections for CPID 1844 Wellcare Health Plans

Professional claims transmitted to the payer listed below from Optum on Aug. 14, 2025 and Aug. 15, 2025 were not processed by the payer due to a 999 Batch Rejection.

CPID 1844 Wellcare Health Plans

A resolution has been implemented and the claims were retransmitted to the payer on Aug. 18, 2025.

Action Required: None.

If you have any questions, please contact Customer Support and refer to Case Number 09647754.

8/18/2025

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

Update: The payer has been unable to generate and deliver the reports for some claims submitted July 30, 2025.

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

Original notify sent Aug. 1, 2025:
The payer listed below is experiencing issues affecting Institutional and Professional report generation for some claims submitted July 30, 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 09625582.

8/18/2025

Electronic Routing Change for CPIDs 8168 and 2047 Solis Health Plans

Effective August 18, 2025, Optum will be changing electronic claims routing for the following payer:

Payer Name: Solis Health Plans
Professional CPID: 8168
Edit Master: PE_T007
Institutional CPID: 2047
Edit Master: HE9T007
Previous Payer-assigned Payer ID: 73581
New Payer-assigned Payer ID: SOLIS
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.

Providers only need to include the CPID (not Payer ID) in the claim. Optum will manage the Payer ID changes for our customers.

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.

8/18/2025

Electronic Routing Change for CPIDs 8168 and 2047 Solis Health Plans

Effective August 18, 2025, Optum will be changing electronic claims routing for the following payer:

Payer Name: Solis Health Plans
Professional CPID: 8168
Institutional CPID: 2047
Previous Payer-assigned Payer ID: 73581
New Payer-assigned Payer ID: SOLIS
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.

Providers only need to include the CPID (not Payer ID) in the claim. Optum will manage the Payer ID changes for our customers.

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.

8/18/2025

New Real Time Claim Status Inquiry 276/277 Connection Available

Optum is pleased to announce the availability of Real-time Claim Status Inquiry 276/277 for the below payer effective July 10, 2025:

Payer Name: Central California Alliance for Health
Industry Payer ID: SX169
IMN Real Time ID: CCA01
Exchange Real Time ID: CCALLH
CPID(s): 2149, 2997
Optum IEDi Real Time ID: 10884
Payer Enrollment Required: No
Connection Type: X12

Search Options:
Subscriber

Member ID, First Name, Last Name, Date of Birth

Optional additional elements:

Payer claim number; 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.

8/18/2025

Payer Name: Central California Alliance for Health
Industry Payer ID: SX169
IMN Real Time ID: CCA01
Exchange Real Time ID: CCALLH
CPID(s): 2149, 2997
Optum IEDi Real Time ID: 10884
Payer Enrollment Required: No
Connection Type: X12

Search Options
Subscriber:

Member ID, First Name, Last Name, Date of Birth

Optional additional elements:

Payer claim number; Total submitted charges

8/18/2025

Update: Report Generation Delay for CPID 2830 CarePlus Health Plans

Update: The payer intermediary has been unable to generate and deliver the reports for some claims submitted on July 17, 2025.

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

Original notify sent July 30, 2025:

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted on July 17, 2025.

Payer impacted:

CPID 2830 CarePlus 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 09620722.

8/18/25

Report Generation Delay for CPID 9688 CountyCare Health Plan

A payer intermediary is experiencing issues affecting Institutional report generation for some claims submitted Aug. 11, 2025.

Payer impacted:

CPID 9688 CountyCare Health Plan

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 09647302.

8/18/2025

Report Generation Delay for CPID 6060 Everpointe

A payer intermediary is experiencing issues affecting Institutional report generation for some claims submitted Aug. 11, 2025.

Payer impacted:

CPID 6060 Everpointe

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 09647262.

8/18/2025

Report Generation Delay for CPID 2426 Blue Care Network of Michigan

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted Aug. 8, 2025.

Payer impacted:

CPID 2426 Blue Care Network of Michigan

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 09647141.

8/18/2025

Electronic Routing Change for CPIDs 7142 and 7687 Physicians Choice Medical Group of Santa Maria

Effective August 18, 2025, Optum is changing electronic claims routing for the following payer:

Payer Name: Physicians Choice Medical Group of Santa Maria
Professional CPID: 7142
Current Edit Master: PE_O007
New Edit Master: PE_T007
Institutional CPID: 7687
Current Edit Master: HE9O007
New Edit Master: HE9T007
Payer-assigned Payer ID: MCI01
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.

8/18/2025

Electronic Routing Change for CPIDs 7142 and 7687 Physicians Choice Medical Group of Santa Maria

Effective August 18, 2025, Optum is changing electronic claims routing for the following payer:

Payer Name: Physicians Choice Medical Group of Santa Maria
Professional CPID: 7142
Institutional CPID: 7687
Payer-assigned Payer ID: MCI01
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.

8/18/2025

New Electronic Claims Connections Available

Optum has new electronic claims connections available:

Payer Name: M3TPA LLC
Institutional CPID: 9018
Professional CPID: 3494
Payer-assigned Payer ID: M3TPA
Payer Enrollment Required: No
Secondary Claims Accepted: Yes
Payer Location: Texas
Claims Fee: N/A

Action Required:

Add the payers to your system to begin using the new payer connection.
When a payer requires enrollment, forms must be submitted and approved to begin submitting transactions.

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

8/18/2025

Report Generation Delay for CPID 6181 Children's Special Health Care Services (CSHCS)

A payer is experiencing issues affecting Professional report generation for some claims submitted on Aug. 6, 2025.

Payer impacted:

CPID 6181 Children's Special Health Care Services (CSHCS)

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 09646670.

8/18/2025

Update to Electronic Eligibility Search Options

Effective 7/31/25 Optum would like to announce changes to Real-time Eligibility Inquiry and Response 270/271 Search Options for the below payer:

Inquiries are now limited to the Search Options specified below:

Search Options

Subscriber

Member ID, First Name, Last Name, Date of Birth

Dependent

Member ID, Dependent First Name, Dependent Last Name, Dependent Date of Birth

Action Required by customer:

Please update your system to include the changes for 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.

8/15/2025

Report Generation Delay for multiple CPIDs

The payers listed below are experiencing issues affecting Institutional and Professional report generation for some claims submitted on Aug. 7, 2025.

Payers impacted:

CPID 5558 Blue Cross Blue Shield of Alabama
CPID 2423 Blue Cross Blue Shield of Alabama
CPID 1002 Blue Cross Blue Shield of Alabama Medicare Advantage

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 09645611.

8/15/2025

Payer Processing Issue for CPID 4480 SelectHealth

Due to a payer processing issue, some Professional claims transmitted to the payer listed below August 6, 2025 and August 8, 2025 were not processed by the payer.

Payer impacted:

CPID 4480 SelectHealth

A resolution has been implemented and the claims were retransmitted to the payer August 15, 2025.

This delay affected claims released to Optum Aug. 5, 2025, 7:00 p.m.-Aug. 6, 2025, 7:00 p.m. CT and August 7, 2025, 7:00 p.m.-Aug. 8, 2025, 7:00 p.m. CT.

Action Required: Be aware of the processing issue above and of possible invalid duplicate rejections.

If you have any questions, please contact Customer Support and refer to Case Number 09644753.

8/15/2025

Payer Processing Issue for CPID 4480 SelectHealth

Due to a payer processing issue, some Professional claims transmitted to the payer listed below on August 1, 2025 were not processed by the payer.

Payer impacted:

CPID 4480 SelectHealth

A resolution has been implemented and the claims were retransmitted to the payer on August 15, 2025.

This delay affected claims released to Optum between 7 p.m. CT on July 31st, 2025 and 7 p.m. CT on August 1, 2025.

Action Required: Be aware of the processing issue above and of possible invalid duplicate rejections.

If you have any questions, please contact Customer Support and refer to Case Number 09644753.

8/15/2025

Electronic Routing Change for CPIDs 8660 and 6777 Centers Plan for Healthy Living

Effective August 19, 2025, Optum will be changing electronic claims routing for the following payer:

Payer Name: Centers Plan for Healthy Living
Professional CPID: 6777
Edit Master: PE_T007
Institutional CPID: 7660
Edit Master: HE9T007
Payer-assigned Payer ID: CPHL1
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:

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.

8/15/2025

Electronic Routing Change for CPIDs 8660 and 6777 Centers Plan for Healthy Living

Effective August 19, 2025, Optum will be changing electronic claims routing for the following payer:

Payer Name: Centers Plan for Healthy Living
Professional CPID: 6777
Institutional CPID: 7660
Payer-assigned Payer ID: CPHL1
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.

8/15/2025

New Real Time Eligibility 270/271 Connection - Search Options Updated

Optum would like to announce changes to Real-time Eligibility Inquiry and Response 270/271 Search Options for the below payer effective July 31, 2025:

Payer Name: HealthComp North
Industry Payer ID: 36149
IMN Real Time ID: 36149
Exchange Real Time ID: BASYS
CPID(s): 2984, 4287
Optum IEDi Real Time ID: 36149
Payer Enrollment Required: No
Connection Type: X12

Inquiries are now limited to the Search Options specified below:

Search Options
Subscriber

Member ID, First Name, Last Name, Date of Birth

Dependent

Member ID, Dependent First Name, Dependent Last Name, Dependent Date of Birth

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

8/15/2025

Pacificare Oklahoma - Real Time Eligibility 270/271 Connection No Longer Available

Effective immediately, Real Time Eligibility 270/271 for the payer listed below will no longer be available at Optum.

Payer Name: PACIFICARE OKLAHOMA
Optum IEDi Real Time ID: PCAOK
Connection Type: X12/ Portal

Reason: Payer no longer offers an electronic connection

Action Required: None

8/15/2025

New Electronic Eligibility Connection Available

Effective July 24, 2025 Optum is pleased to announce the availability of Real-time Eligibility Inquiry and Response 270/271 for the below payer:

Payer Name: OPTIMUM HEALTHCARE SERVICES
Industry Payer ID: 20133
IMN Real Time ID: 20133
Exchange Real Time ID: OPTHLT
CPID(s): 4680 / 4227
Optum iEDI Real Time ID: 20133
Payer Enrollment Required: No
Connection Type: X12

Search Options:

Eligibility Subscriber

Member ID, Last Name, First Name, Date of Birth
Member ID, Last Name, First Name
Member ID, Last Name, Date of Birth
Last Name, First Name, Date of Birth
Member ID, Date of Birth
Member ID

Action Required by customer:

For assistance with submitting Real-Time transactions, please contact your Practice Management System Vendor or Optum Customer Care Hub ticket.

8/15/2025

Report Generation Delay for CPID 4480 SelectHealth

A payer is experiencing issues affecting Professional report generation for some claims submitted since August 1, 2025.

Payer impacted:

CPID 4480 SelectHealth

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 09644753.

8/15/2025

Eligibility payer termination

Effective August 13, Real Time Eligibility 270/271 for the payer listed below is no longer available at Optum.

Payer Name: Evergreen Health
IMN Real Time ID: EVRGN
Optum IEDi Real Time ID: 93240
Connection Type: X12

Reason: Payer no longer offers an electronic connection

Action Required by customer

For assistance with submitting Real-Time transactions, please contact your Practice Management System Vendor or Optum Customer Care Hub ticket.

8/15/2025

Pacificare Arizona - Real Time Eligibility 270/271 Connection No Longer Available

Effective immediately, Real Time Eligibility 270/271 for the payer listed below will no longer be available at Optum.

Payer Name: Pacificare Arizona
Optum IEDi Real Time ID: PCAAZ

Reason: Payer no longer offers an electronic connection

Action Required: None

8/15/2025

Pacificare Washington - Real Time Eligibility 270/271 Connection No Longer Available

Effective immediately, Real Time Eligibility 270/271 for the payer listed below will no longer be available at Optum.

Payer Name: Pacificare Washington
Optum IEDi Real Time ID: PCAWA

Reason: Payer no longer offers an electronic connection

Action Required: None

8/15/2025

New Real Time Connections Available on Revenue Performance Advisor

Eligibility transactions have recently been added to the Revenue Performance Advisor system for the following payers:

30070 – Keystone First - CHIP
55892 – NextBlue of North Dakota
A2793 – Commonwealth Care Alliance
AUX01 – Adventist Health System
GATHP – Gateway Health Plan
RP103 – TrueCare Mississippi Medicaid
UHSM1 – UHSM [Unite Health Share Ministries]

Claim Status Inquiry transactions have recently been added to the Revenue Performance Advisor system for the following payers:

30070 – Keystone First - CHIP
36066 – Bankers Life and Casualty Company
CCA01 – Central California Alliance of Health
RP103 – TrueCare Mississippi Medicaid

8/15/2025

Update: Report Generation Delay for CPID 2490 Blue Cross Blue Shield of South Dakota

Update: The payer intermediary has been unable to generate and deliver the reports for some claims submitted July 15, 2025-July 25, 2025.

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

Original notify sent July 29, 2025:
A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted since July 15, 2025.

Payer impacted:

CPID 2490 Blue Cross Blue Shield of South Dakota

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 09618813.

8/15/2025

VA payer delay in certain 835s

The VA payer has identified an issue with generating the 835 files for Aug. 4, and Aug. 5 check dates for payer IDs 84146,84147, or 80214. They are currently working internally to resolve the issue. Please hold missing 835 research requests for these two dates until the VA can further update us with the missing file(s).

8/14/2025

New Electronic Claims Auth Inquiry Connection Available

Effective July 14, 2025 Optum is pleased to announce the availability of Real-time Auth Inquiry and Response 278/215 & 217 for the below payer.

Payer Name: ANTHEM BLUE CROSS BLUE SHIELD OF KENTUCKY
IMN Real Time ID: SB660
Payer Enrollment Required: No
Connection Type: X12

8/14/2025

New Electronic Claims Auth Inquiry Connection Available

Effective July 17, 2025 Optum is pleased to announce the availability of Real-time Auth Inquiry and Response 278/215 & 217 for the below payer.

Payer Name: ANTHEM BLUE CROSS BLUE SHIELD OF INDIANA
IMN Real Time ID: SB630
Payer Enrollment Required: No
Connection Type: X12

8/14/2025

Payer Name: ANTHEM BLUE CROSS BLUE SHIELD OF MISSOURI
IMN Real Time ID: SB741
Payer Enrollment Required: No
Connection Type: X12

8/14/2025

Plan Changes for CPIDs 5663, 6862 Peak PACE Solutions

Optum has been notified of recent changes in Third Party Administrators for certain Peak PACE Solutions plans. Providers must verify the Plan Name and Payer ID on member ID cards to ensure claims are submitted to the correct CPIDs, preventing rejections.

Please review the Optum payer list to confirm Payer IDs and their associated CPIDs. If a Payer ID is not listed, providers may submit a New Payer Request for further review.

Continue using the following for members associated with payer ID 27034:

Payer Name: Peak PACE Solutions
Professional CPID: 6862
Institutional CPID: 5663
Payer-assigned Payer ID: 27034

Action Required: Please review member ID cards and submit claims to the correct payer IDs.

8/14/2025

Report Generation Delay for multiple CPIDs

The payers listed below are experiencing issues affecting Professional report generation for some claims submitted on Aug. 7, 2025.

Payers impacted:

CPID 2438 Tufts Health Plan
CPID 5475 Tufts Health Public Plans

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 09643951.

8/14/2025

999 Payer Batch Rejections CPID 1782 North American Medical Management (NAMM - N. CA)

Professional claims transmitted to the payer listed below from Optum on Aug. 14, 2025 were not processed by the payer due to a 999 Batch Rejection.

Payer impacted:

CPID 1782 North American Medical Management (NAMM - N. CA)

A resolution has been implemented, and the claims were retransmitted to the payer on Aug. 14, 2025.

Action Required: None.

If you have any questions, please contact Customer Support and refer to Case Number 09614690.

8/14/2025

999 Payer Batch Rejections for CPID 1844 Wellcare Health Plans

Professional claims transmitted to the payer listed below from Optum on Aug. 13, 2025 were not processed by the payer due to a 999 Batch Rejection.

CPID 1844 Wellcare Health Plans

A resolution has been implemented and the claims were retransmitted to the payer on Aug. 14, 2025.

Action Required: None.

If you have any questions, please contact Customer Support and refer to Case Number 09643735.

8/14/2025

Electronic Routing Change for CPIDs 1729, 6583, 2783, and 1911 Texas Childrens Health Plan - Multiple Payers

Effective August 14, 2025, Optum is changing electronic claims routing for the following payers:

Payer Name: Texas Childrens Health Plan (CHIP)
Professional CPID: 1729
Current Edit Master: PE_E049
New Edit Master: PE_T007
Institutional CPID: 6583
Current Edit Master: HE9B801
New Edit Master: HE9T007
Payer-assigned Payer ID: 76048
Payer Claim Enrollment Required: No
Secondary Claims Accepted: Yes

Payer Name: Texas Childrens Health Plan (STAR Medicaid)
Professional CPID: 2483
Current Edit Master: PE_E049
New Edit Master: PE_T007
Institutional CPID: 1911
Current Edit Master: HE9E049
New Edit Master: HE9T007\
Payer-assigned Payer ID: 75228\
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 names and CPIDs are not changing.
When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.

8/14/2025

Payer Name: Texas Childrens Health Plan (CHIP)
Professional CPID: 1729
Institutional CPID: 6583
Payer-assigned Payer ID: 76048
Payer Claim Enrollment Required: No
Secondary Claims Accepted: Yes
Claims Fee: N/A

Payer Name: Texas Childrens Health Plan (STAR Medicaid)
Professional CPID: 2483
Institutional CPID: 1911
Payer-assigned Payer ID: 75228
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.

8/14/2025

New Payer Edit for CPID 8606 Blue Cross Community Health Plans.

The payer listed below has informed Optum of a new edit requirement effective immediately. In order to meet the new requirement, we will add the following edit August 21, 2025:

IHI-012242: INVALID ADMITTING DIAGNOSIS - When the Type of Bill is 28x, 65x, 66x, or 86x, the Admitting Diagnosis Code is not allowed. Exception: When the CPID is 9688 and Type of Bill is 65x, this requirement does not apply. LOOP 2300 HI01-2

Edit applies to:

CPID 8606 Blue Cross Community Health Plan

Action Required: Please be aware of updated edit requirements.

8/14/2025

Electronic Routing Change for CPIDs 8270 and 3020 Longevity Health Plan of Illinois

Effective August 14, 2025, Optum will be changing electronic claims routing for the following payer:

Payer Name: Longevity Health Plan of Illinois
Professional CPID: 8270
Current Edit Master: PE_O007
New Edit Master: PE_T007
Institutional CPID: 3020
Current Edit Master: HE9O007
New Edit Master: HE9T007
Payer-assigned Payer ID: LIL01
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.

8/14/2025

Electronic Routing Change for CPIDs 8270 and 3020 Longevity Health Plan of Illinois

Effective August 14, 2025, Optum will be changing electronic claims routing for the following payer:

Payer Name: Longevity Health Plan of Illinois
Professional CPID: 8270
Institutional CPID: 3020
Payer-assigned Payer ID: LIL01
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.

8/14/2025

Report Generation Delay for CPID 5607 Century PHO

A payer intermediary is experiencing issues affecting Institutional report generation for some claims submitted on Aug. 7, 2025.

Payer impacted:

CPID 5607 Century PHO

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 09643100.

8/14/2025

Electronic Routing Change for CPIDs 7797 and 8557 Dignity HCLA

Effective August 13, 2025, Optum is changing electronic claims routing for the following payer:

Payer Name: Dignity HCLA
Professional CPID: 7797
Current Edit Master: PE_O007
New Edit Master: PE_T007
Institutional CPID: 8557
Current Edit Master: HE9O007
New Edit Master: HE9T007
Payer-assigned Payer ID: MPM28
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 CPIDs are not changing.
When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.

8/13/2025

Electronic Routing Change for CPIDs 7797 and 8557 Dignity HCLA

Effective August 13, 2025, Optum is changing electronic claims routing for the following payer:

Payer Name: Dignity HCLA
Professional CPID:7797
Institutional CPID: 8557
Payer-assigned Payer ID: MPM28
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.

8/13/2025

New Payer Edit for multiple CPIDs

The payers listed below have informed Optum of a new edit requirement effective immediately. In order to meet the new requirement, we will add the following edit Aug. 19, 2025:

ISV202A366: MISSING PROCEDURE DESCRIPTION - When the associated HCPCS/CPT-4 Code is a Non-Specific or Not Otherwise Classified (NOC) Procedure, the Procedure Description is required.

Notes:

If this requirement does not apply to your billing situation, you can override the edit within the Error Text.
Edit is based on the KMAP General Bulletin 15103, June 2015.
Edit is also based on the KMAP General Bulletin 16048, May 2016. LOOP 2400 SV202-7

Edit applies to:

CPID 5520 KANSAS MEDICAID
CPID 5613 SUNFLOWER HEALTH PLAN

Action Required: Please be aware of updated edit requirements. 

8/13/2025

Electronic Routing Change for CPIDs 2499 and 7565 Mountain Health CO-OP

Effective August 14, 2025, Optum will be changing electronic claims routing for the following payer:

Payer Name: Mountain Health CO-OP
Professional CPID: 2499
Institutional CPID: 7565
Payer-assigned Payer ID: MHC01
Payer Claim Enrollment Required: No
Secondary Claims Accepted: Yes
Claims Fee: N/A

Enrollment Requirements:

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.

8/13/2025

Electronic Routing Change for CPIDs 2499 and 7565 Mountain Health CO-OP

Effective August 14, 2025, Optum will be changing electronic claims routing for the following payer:

Payer Name: Mountain Health CO-OP
Professional CPID: 2499
Edit Master: PE_T007
Institutional CPID: 7565
Edit Master: HE9T007
Payer-assigned Payer ID: MHC01
Payer Claim Enrollment Required: No
Secondary Claims Accepted: Yes

Enrollment Requirements:

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.

8/13/2025

Real Time Eligibility 270/271 Connection No Longer Available

Effective August 23, Real Time Eligibility 270/271 for the payer listed below will no longer be available at Optum.

Payer Name: ROCKY MOUNTAIN
Industry Payer ID: SX141
IMN Real Time ID: SX141
Exchange Real Time ID: RKYMHP / RKYMH1 (Portal)
CPID(s): 7470
Optum IEDi Real Time ID: RMNHP
Connection Type: X12/ Portal

Reason: Payer no longer offers an electronic connection

Action Required by customer
For assistance with submitting Real-Time transactions, please contact your Practice Management System Vendor or Optum Customer Care Hub ticket.

8/13/2025

Real Time Eligibility 270/271 Connection No Longer Available

Effective August 27th , Real Time Eligibility 270/271 for the legacy payer IDs listed below will no longer be available at Optum.

Payer Name: Tricare Care East, Champus and Tricare West
IMN Legacy Payer IDs: 68299/TREST, 00080/TRICE.
iEDI Legacy Payer ID: TRICE, TREST, 00080
Will be removed from the payer list and terminated effective August 27th.

Action Required: Effective immediately, begin using the new Payer IDs.

Tricare West 99726 and Tricare East, Champus 99727

8/12/2025

Electronic Routing Change for CPIDs 8129 And 1099 Florida Community Care

Effective August 12, 2025, Optum will be changing electronic claims routing for the following payer:

Payer Name: Florida Community Care
Professional CPID: 8219
Current Edit Master: PE_O007
New Edit Master: PE_T007
Institutional CPID: 1099
Current Edit Master: HE9O007
New Edit Master: HE9T007
Payer-assigned Payer ID: FLCCR
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.

8/12/2025

Electronic Routing Change for CPIDs 8129 And 1099 Florida Community Care

Effective August 12, 2025, Optum will be changing electronic claims routing for the following payers:

Payer Name: Florida Community Care
Professional CPID: 8129
Institutional CPID: 1099
Payer-assigned Payer ID: FLCCR
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.

8/12/2025

Real Time Eligibility 270/271 Connection No Longer Available

Effective immediately, Real Time Eligibility 270/271 for the payer listed below will no longer be available at Optum.

Payer Name: STAR HRG
Optum IEDI Real Time ID: STARH
Reason: Payer no longer offers an electronic connection

Action Required: None

8/12/2025

Real Time Eligibility 270/271 Connection No Longer Available

Effective immediately, Real Time Eligibility 270/271 for the payer listed below will no longer be available at Optum.

Payer Name: PHCS SAVILITY
IMN Real Time ID: PHCSS
Optum IEDi Real Time ID: PHCSS

Reason: Payer no longer offers an electronic connection

Action Required: None

Report Generation Delay for CPID 3531 Blue Cross Blue Shield of Michigan Federal Employee Program

A payer intermediary is experiencing issues affecting Institutional report generation for some claims submitted on July 28, 2025 and July 30, 2025.

Payer impacted:

CPID 3531 Blue Cross Blue Shield of Michigan Federal Employee 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 09638272.

8/12/2025

999 Payer Batch Rejections for CPID 1844 Wellcare Health Plans

Professional claims transmitted to the payer listed below from Optum Aug. 11, 2025 were not processed by the payer due to a 999 Batch Rejection.

Payer impacted:

CPID 1844 Wellcare Health Plans

A resolution has been implemented and the claims were retransmitted to the payer Aug. 12, 2025.

Action Required: None.

If you have any questions, please contact Customer Support and refer to Case Number 09638584.

8/12/2025

Payer impacted:

CPID 1844 Wellcare Health Plans

A resolution has been implemented and the claims were retransmitted to the payer Aug. 12, 2025.

Action Required: None.

If you have any questions, please contact Customer Support and refer to Case Number 09638536.

8/12/2025

Electronic Routing Change for CPIDs 5217 and 9683 Affinity Medical Group

Effective August 13, 2025, Optum will be changing electronic claims routing for the following payer:

Payer Name: Affinity Medical Group
Professional CPID: 5217
Current Edit Master: PE_E049
New Edit Master: PE_T007
Institutional CPID: 9683
Current Edit Master: HE9O007
New Edit Master: HE9T007
Payer-assigned Payer ID: 46594
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.

8/12/2025

Electronic Routing Change for CPIDs 5217 and 9683 Affinity Medical Group

Effective August 13, 2025, Optum will be changing electronic claims routing for the following payer:

Payer Name: Affinity Medical Group
Professional CPID: 5217
Institutional CPID: 9683
Payer-assigned Payer ID: 46594
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.

8/12/2025

Report Generation Delay for CPID 4252 Presbyterian Salud

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted since July 28, 2025.

Payer impacted:

CPID 4252 Presbyterian Salud

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09638198.

8/12/2025

Report Generation Delay for CPID 8920 Healthcare Management Administrators

A payer intermediary is experiencing issues affecting Institutional report generation for some claims submitted since July 28, 2025.

Payer impacted:

CPID 8920 Healthcare Management 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 09638146.

8/12/2025

Report Generation Delay for CPIDs 3514 and 1421 Blue Cross Blue Shield of Michigan

A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted since July 26, 2025.

Payer impacted:

CPID 3514 Blue Cross Blue Shield of Michigan
CPID 1421 Blue Cross Blue Shield of Michigan

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09638113.

8/12/2025

Update: Report Generation Delay for CPID 2842 Alexian PACE

Update: The payer intermediary has been unable to generate and deliver the reports for some claims submitted on July 12, 2025.

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

Original notify sent July 23, 2025:

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted on July 12, 2025.

Payer impacted:

CPID 2842 Alexian PACE

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 09610447.

8/12/2025

Update: Report Generation Delay for CPID 2254 Scott & White Health

Update: The payer intermediary has been unable to generate and deliver the reports for some claims submitted from July 11, 2025 through Aug. 1, 2025.

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

Original notify sent July 23, 2025:

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted since July 11, 2025.

Payer impacted:

CPID 2254 Scott & White 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 09610367.

8/12/2025

New Electronic Claims Connections Available

Optum has new electronic claims connections available:

Payer Name: Inspira Health Network Life
Institutional CPID: 9021
Professional CPID: 3497
Payer-assigned Payer ID: R3482
Payer Enrollment Required: No
Secondary Claims Accepted: No
Payer Location: National
Claims Fee: N/A
Remittance Available: Yes

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.

8/12/2025

New Electronic Claims Connections Available

Optum has new electronic claims connections available:

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.

8/12/2025

Update: Report Generation Delay for CPIDs 1510 and 1404 Wellmark Blue Cross Blue Shield of Iowa

Update: The payer intermediary has been unable to generate and deliver the reports for some claims submitted from July 1, 2025 through July 30, 2025.

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

Update sent July 23, 2025:

Update: A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted since July 1, 2025.

Original notify sent July 14, 2025:

A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted on July 1, 2025.

Payer impacted:

CPID 1510 Wellmark Blue Cross Blue Shield of Iowa
CPID 1404 Wellmark Blue Cross Blue Shield of Iowa

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 09595363.

8/12/2025

999 Payer Batch Rejections for CPID 1782 North American Medical Management (NAMM - N. CA)

Professional claims transmitted to the payer listed below from Optum on Aug. 11, 2025 were not processed by the payer due to a 999 Batch Rejection.

Payer impacted:

CPID 1782 North American Medical Management (NAMM - N. CA)

A resolution has been implemented, and the claims were retransmitted to the payer on Aug. 11, 2025.

Action Required: None.

If you have any questions, please contact Customer Support and refer to Case Number 09614690.

8/11/2025

Electronic Routing Change for CPID 1206 Desert Valley Medical Group

Effective August 13, 2025, Optum will be changing electronic claims routing for the following payer:

Payer Name: Desert Valley Medical Group
Professional CPID: 1206
Current Edit Master: PE_O007
New Edit Master: PE_T007
Payer-assigned Payer ID: DVMC1
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 is not changing.
When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.

8/11/2025

Electronic Routing Change for CPID 1206 Desert Valley Medical Group

Effective August 13, 2025, Optum will be changing electronic claims routing for the following payer:

Payer Name: Desert Valley Medical Group
Professional CPID: 1206
Payer-assigned Payer ID: DVMC1
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.

8/11/2025

Electronic Routing Change for CPIDs 7703 and 9646 Hemet Community Medical Group

Effective August 11, 2025, Optum is changing electronic claims routing for the following payer:

Payer Name: Hemet Community Medical Group
Professional CPID: 7703
Current Edit Master: PE_O007
New Edit Master: PE_T007
Institutional CPID: 9646
Current Edit Master: HE9O007
New Edit Master: HE9T007
Payer-assigned Payer ID: HCMG1
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 CPID(s) are not changing.
When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.

8/11/2025

Electronic Routing Change CPIDs 7703 and 9646 Hemet Community Medical Group

Effective August 11, 2025, Optum is changing electronic claims routing for the following payer:

Payer Name: Hemet Community Medical Group
Professional CPID: 7703
Institutional CPID: 9646
Payer-assigned Payer ID: HCMG1
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.

8/11/2025

Update: Report Generation Delay for CPID 2234 Illinois Health Partners

Update: The payer intermediary has been unable to generate and deliver the reports for some claims submitted July 11, 2025-July 28, 2025.

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

Original notify sent July 23, 2025:
A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted July 11, 2025.

Payer impacted:

CPID 2234 Illinois Health Partners

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09610301.

8/11/2025

Update: Report Generation Delay for CPID 7829 Passport Advantage

Update: The payer intermediary has been unable to generate and deliver the reports for some claims submitted July 10, 2025-July 12, 2025.

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

Original notify sent July 22, 2025:
A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted July 10, 2025-July 12, 2025.

Payer impacted:

CPID 7829 Passport Advantage

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09607814.

8/11/2025

Update: Report Generation Delay for CPID 3577 Regence Group Administrators

Update: The payer intermediary has been unable to generate and deliver the reports for some claims submitted July 10, 2025 and July 14, 2025.

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

Original notify sent July 22, 2025:
A payer intermediary is experiencing issues affecting Institutional report generation for some claims submitted July 10, 2025 and July 14, 2025.

Payer impacted:

CPID 3577 Regence Group 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 09607908.

8/11/2025

MedCare Partners Electronic Claims Connection No Longer Available

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

Payer Name: MedCare Partners
Claims CPIDs: 1875, 3948
Payer-assigned Payer ID: MCP01
Reason: Payer no longer offers an electronic connection to which Optum can connect.

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

After the edit release date above, revalidate unreleased claims to edit correctly to send paper claims.
Modify any bridge routines based on Edit Masters for paper claims.

8/11/2025

MedCare Partners Electronic Claims Connection No Longer Available

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

Payer Name: MedCare Partners
Claim CPIDs: 1875, 3948
Payer-assigned Payer ID: MCP01
Reason: Payer no longer offers an electronic connection to which Optum can connect.

Action Required: None.

8/11/2025

New Electronic Eligibility Connection Available

Effective July 1, 2025 Optum is pleased to announce the availability of Real-time Eligibility Inquiry and Response 270/271 and Claim Status 276/277 for the below payer:

Payer Name: TrueCare Mississippi Medicaid
Industry Payer ID: MSMCDCS1
IMN Real Time ID: RP103
Exchange Real Time ID: TMSMC
CPID(s): 9014 / 3488
Optum iEDI Real Time ID: RP103
Payer Enrollment Required: No
Connection Type: X12

Search Options:
Eligibility Subscriber

Member ID, First Name, Last Name, 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

Action Required by customer:
For assistance with submitting Real-Time transactions, please contact your Practice Management System Vendor or Optum Customer Care Hub ticket.

8/11/2025

Update: Report Generation Delay for CPIDs 4093 and 8834 Commonwealth Care Alliance

Update: The payer intermediary has been unable to generate and deliver the reports for some claims submitted July 10, 2025-July 29, 2025.

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

Original notify sent July 22, 2025:
A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted since July 10, 2025.

Payer impacted:

CPID 4093 Commonwealth Care Alliance DOS after 3/31/2023
CPID 8834 Commonwealth Care Alliance DOS after 3/31/2023

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 09607960.

8/11/2025

Update: Report Generation Delay for CPIDs 3532 and 2426 Blue Care Network of Michigan

Update: The payer intermediary has been unable to generate and deliver the reports for some claims submitted July 9, 2025-July 23, 2025.

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

Original notify sent July 22, 2025:
A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted since July 9, 2025.

Payer impacted:

CPID 3532 Blue Care Network of Michigan
CPID 2426 Blue Care Network of Michigan

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09607748.

8/11/2025

Update: Report Generation Delay for CPID 9747 Delaware First Health

Update: The payer intermediary has been unable to generate and deliver the reports for some claims submitted July 10, 2025.

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

Original notify sent July 23, 2025:
A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted July 10, 2025.

Payer impacted:

CPID 9747 Delaware First 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 09610216.

8/11/2025

New Electronic Eligibility Connection Available

Effective July 16, 2025 Optum is pleased to announce the availability of Real-time Eligibility Inquiry and Response 270/271 for the below payer:

Payer Name: GATEWAY HEALTH PLAN
Industry Payer ID: 10629T
IMN Real Time ID: GATHP
Exchange Real Time ID: GATHP
CPID(s): GATH
Optum iEDI Real Time ID: GATHP
Payer Enrollment Required: No
Connection Type: X12

Search Options
Eligibility Subscriber

Member ID, First Name, Last Name, Date of Birth
Member ID, Last Name, Date of Birth
Member ID, First name, Last Name
Member ID, Date of Birth
Member ID

Action Required by customer:
For assistance with submitting Real-Time transactions, please contact your Practice Management System Vendor or Optum Customer Care Hub ticket.

8/11/2025

Update: Report Generation Delay for CPID 1402 Blue Cross Blue Shield of Minnesota

Update: The payer intermediary has been unable to generate and deliver the reports for some claims submitted July 2, 2025.

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

Original notify sent July 15, 2025:
A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted July 2, 2025.

Payer impacted:

CPID 1402 Blue Cross Blue Shield of Minnesota

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 09597254.

8/11/2025

Update: Report Generation Delay for CPID 4258 VNS Health

Update: The payer intermediary has been unable to generate and deliver the reports for some claims submitted July 7, 2025 and July 12, 2025.

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

Original notify sent July 21, 2025:
A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted July 7, 2025 and July 12, 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 09606130.

8/11/2025

Update: Report Generation Delay for CPIDs 3679 and 5882 Kane County IPA

Update: The payer intermediary has been unable to generate and deliver the reports for some claims submitted from July 2, 2025-July 30, 2025.

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

Original notify sent July 15, 2025:
A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted since July 2, 2025.

Payer impacted:

CPID 3679 Kane County IPA
CPID 5882 Kane County IPA

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 09596980.

8/11/2025

Update: Report Generation Delay for CPID 3757 IMAGINE360 ADMINISTRATORS (GPA)

Update: The payer intermediary has been unable to generate and deliver the reports for some claims submitted from June 26, 2025-July 29, 2025.

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

Update sent July 23, 2025:
Update: A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted since June 24, 2025.

Update sent July 15, 2025:
Update: A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted June 24, 2025 and July 1, 2025.

Original notify sent July 8, 2025:
A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted June 24, 2025.

Payer impacted:

CPID 3757 IMAGINE360 ADMINISTRATORS (GPA)

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 09586555.

8/11/2025

Update: Report Generation Delay for CPIDs 7567 and 7499 Sentara Health Plans

Update: The payer intermediary has been unable to generate and deliver the reports for some claims submitted May 28, 2025-July 29, 2025.

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

Original notify sent June 9, 2025:
A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted since May 28, 2025.

Payer impacted:

CPID 7567 Sentara Health Plans
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 09545318.

8/11/2025

Resolved: Delay in Electronic Remittance Advice (ERA) for RMCX

Due to a Remittance Management Customization (RMCX) processing issue, there has been a delay in Professional and Institutional Electronic Remittance Advice (ERA) for all payers for file dates of Aug. 7, 2025-Aug. 8, 2025.

Action Required: None. Issue is now resolved. Please be aware of the possible 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 09634498.

8/8/2025

Electronic Routing Change for CPIDs 8888 and 5041 Presence ERC

Effective August 12, 2025, Optum will be changing electronic claims routing for the following payer:

Payer Name: Presence ERC
Professional CPID: 8888
Edit Master: PE_T007
Institutional CPID: 5041
Edit Master: HE9T007
Payer-assigned Payer ID: 46311
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:

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.

8/8/2025

Electronic Routing Change for CPIDs 8888 and 5041 Presence ERC

Effective August 12, 2025, Optum will be changing electronic claims routing for the following payer:

Payer Name: Presence ERC
Professional CPID: 8888
Institutional CPID: 5041
Payer-assigned Payer ID: 46311
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.

8/8/2025

New Electronic Remittance (ERA) Connections Available on Revenue Performance Advisor

ERA (Remittance) transactions have recently been added to the Revenue Performance Advisor system for the following payers:

23641 – GMP Employers Retiree Trust
35600 – IN Dept of Health (Children)
62179 – Health Choice of Arizona
R3482 – Inspira Health Network Life
SBMCO – Staff Benefits Management & Administrators (SBMA)

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.

8/8/2025

Report Generation Delay for CPID 9435 OhioRISE - Aetna Better Health of Ohio

A payer is experiencing issues affecting Professional report generation for some claims submitted on Aug 4, 2025.

Payer impacted:

CPID 9435 OhioRISE - Aetna Better Health of Ohio

The payer has been unable to generate and deliver the reports for some claims submitted on Aug 4, 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 09634455.

8/8/2025

999 Payer Batch Rejections for CPID 1844 Wellcare Health Plan

Professional claims transmitted to the payer listed below from Optum on Aug. 7, 2025 were not processed by the payer due to a 999 Batch Rejection.

CPID 1844 Wellcare Health Plan

A resolution has been implemented and the claims were retransmitted to the payer on Aug. 8, 2025.

Action Required: None.

If you have any questions, please contact Customer Support and refer to Case Number 09634269.

8/8/2025

New Electronic Claims Connections Available

Optum has new electronic claims connections available:

Payer Name: Blue Cross Community Health Plans
Institutional CPID: 9020
Professional CPID: 3498
Payer-assigned Payer ID: 66012
Payer Enrollment Required: No
Secondary Claims Accepted: Yes
Payer Location: Illinois
Claims Fee: N/A

Action Required: 

Add the payer 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.

8/7/2025

Electronic Routing Change for CPIDs 1967 and 6275 Beaver Medical Group

Effective August 11, 2025, Optum will be changing electronic claims routing for the following payer:

Payer Name: Beaver Medical Group
Professional CPID: 6275
Current Edit Master: PE_O007
New Edit Master: PE_T007
Institutional CPID: 1967
Edit Master: HE9T007
Payer-assigned Payer ID: 45967
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.

8/7/2025

Electronic Routing Change for CPIDs 1967 and 6275 Beaver Medical Group

Effective August 11, 2025, Optum will be changing electronic claims routing for the following payer:

Payer Name: Beaver Medical Group
Professional CPID: 6275
Institutional CPID: 1967
Payer-assigned Payer ID: 45967
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.

8/7/2025

Electronic Routing Change for CPIDs 7871 and 1044 Brand New Day

Effective August 7, 2025, Optum is changing electronic claims routing for the following payer:

Payer Name: Brand New Day
Professional CPID: 7871
Current Edit Master: PE_O007
New Edit Master: PE_T007
Institutional CPID: 1044
Current Edit Master: HE9O007
New Edit Master: HE9T007
Payer-assigned Payer ID: UC001
Payer Claim Enrollment Required: No
Secondary Claims Accepted: No

Brand New Day is joining Central Health Medicare Plan. Brand New Day, Payer ID UC001 is only for claims with DOS prior to Jan. 1, 2025. Please review member ID cards for the correct Payer ID for DOS Jan. 1, 2025 and after.

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.

8/7/2025

Electronic Routing Change for CPIDs 7871 and 1044 Brand New Day

Effective August 7, 2025, Optum is changing electronic claims routing for the following payer:

Payer Name: Brand New Day
Professional CPID: 7871
Institutional CPID: 1044
Payer-assigned Payer ID: UC001
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.

8/7/2025

New Payer Edit for CPID 8232

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 August 14, 2025:

PNM109A147: MISSING SERVICE FACILITY NPI- When the Service Facility Name is entered and is different than the Billing Provider Name, the Service Facility NPI is required.

Exception: When the CPID is other than 8232 and the Place of Service is in the following list, this requirement does not apply:

03 12
04 16
09 33

Note: If this requirement does not apply to your billing situation, you can override the edit within the Error Text.

LOOP 2310C NM109

Edit applies to:

CPID 8232 DIGNITY HEALTH SACRAMENTO HOSPITAL

Action Required: Please be aware of updated edit requirements.

8/7/2025

Report Generation Delay for multiple CPIDs

A payer intermediary is experiencing issues affecting Professional and Institutional report generation for some claims submitted since Aug. 1, 2025.

Payers impacted:

CPID 2459 District of Columbia Metropolitan Area (DCMA) Medicare
CPID 2456 Delaware Medicare
CPID 5912 Delaware Medicare
CPID 1448 Florida Medicare
CPID 2464 Maryland Medicare (Montgomery,Prince George)
CPID 2451 Mississippi Medicare
CPID 5556 Mississippi Medicare
CPID 1440 Texas Medicare
CPID 5502 Texas Medicare
CPID 2461 Virginia Medicare (Alexandria,Arlington,Fairfax)

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 09632781.

8/7/2025

Update: Electronic Claims Connection Suspended

Update: This payer has been reactivated. Providers may submit claims to this payer.

Original notification sent June 12, 2025
Effective immediately, the payer listed below has been suspended at Optum for claim processing and removed from the payer list.

Payer Name: Buenaventura Affiliated Physicians
CPID: 3439
Payer ID: BVAP1
Reason: Payer processing issue.

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

8/7/2025

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: California Department of Corrections
CPID: 7222
Payer ID: MCS04
Reason: Payer unavailable electronically

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

8/7/2025

Electronic Routing Change for CPIDs 2722 and 3926 HealthSmart Benefit Solutions

Effective August 6, 2025, Optum is changing electronic claims routing for the following payer:

Payer Name: HealthSmart Benefit Solutions
Professional CPID: 2722
Institutional CPID: 3926
Payer-assigned Payer ID: 37283
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.

8/6/2025

Electronic Routing Change for CPIDs 2722 and 3926 HealthSmart Benefit Solutions

Effective August 6, 2025, Optum is changing electronic claims routing for the following payer:

Payer Name: HealthSmart Benefit Solutions
Professional CPID: 2722
Edit Master: PE_T007
Institutional CPID: 3926
Edit Master: HE9T007
Payer-assigned Payer ID: 37283
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:

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.

8/6/2025

Electronic Routing Change for CPIDs 3473 and 5683 Chinese Community Health Plan

Effective August 6, 2025, Optum will be changing electronic claims routing for the following payer:

Payer Name: Chinese Community Health Plan
Professional CPID: 3473
Institutional CPID: 5683
Payer-assigned Payer ID: 94302
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.

8/6/2025

Electronic Routing Change for CPIDs 3473 and 5683 Chinese Community Health Plan

Effective August 6, 2025, Optum will be changing electronic claims routing for the following payer:

Payer Name: Chinese Community Health Plan
Professional CPID: 3473
Current Edit Master: PE_O007
New Edit Master: PE_T007
Institutional CPID: 5683
Current Edit Master: HE9O007
New Edit Master: HE9T007
Payer-assigned Payer ID: 94302
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.

8/6/2025

Electronic Routing Change for CPIDs 1742 and 6588 Point C

Effective August 11, 2025, Optum will be changing electronic claims routing for the following payer:

Payer Name: Point C
Professional CPID: 1742
Institutional CPID: 6588
Payer-assigned Payer ID: 47080
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.

8/6/2025

Electronic Routing Change for CPIDs 1742 and 6588 Point C

Effective August 11, 2025, Optum will be changing electronic claims routing for the following payer:

Payer Name: Point C
Professional CPID: 1742
Current Edit Master: PE_N000
New Edit Master: PE_T007
Institutional CPID: 6588
Current Edit Master: HE9N000
New Edit Master: HE9T007
Payer-assigned Payer ID: 47080
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.

8/6/2025

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

Original notify sent June 25, 2025:
A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted since June 10, 2025.

Payer impacted:

CPID 9178 AIDS Healthcare Foundation - PHC

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 09570857.

8/6/2025

Electronic Routing Change for CPIDs 9271 and 6093 Simpra Advantage Inc.

Effective August 7, 2025, Optum is changing electronic claims routing for the following payer:

Payer Name: Simpra Advantage Inc.
Professional CPID: 9271
Edit Master: PE_T007
Institutional CPID: 6093
Edit Master: HE9T007
Payer-assigned Payer ID: SIM02
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:

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.

8/6/2025

Electronic Routing Change for CPIDs 9271 and 6093 Simpra Advantage Inc.

Effective August 7, 2025, Optum is changing electronic claims routing for the following payer:

Payer Name: Simpra Advantage Inc.
Professional CPID: 9271
Institutional CPID: 6093
Payer-assigned Payer ID: SIM02
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.

8/6/2025

Electronic Routing Change for CPIDs 7144 and 7689 Amida Care Medicare

Effective August 05, 2025, Optum will be changing electronic claims routing for the following payer:

Payer Name: Amida Care Medicare
Professional CPID: 7144
Institutional CPID: 7689
Payer-assigned Payer ID: 79966
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.

8/5/2025

Report Generation Delay for Multiple CPIDs

A payer intermediary is experiencing issues affecting Professional and Institutional report generation for some claims submitted since July 21, 2025.

Payers impacted:

CPID 1865 Multiplan New Orleans Division
CPID 8556 Multiplan New Orleans Division
CPID 6482 Associates for Healthcare, Inc
CPID 4592 Associates for Healthcare, Inc
CPID 3899 Health Care Network of WI (HCN)
CPID 4571 Health Care Network of WI (HCN)
CPID 3823 WI Preferred Provider Network (WPPN)
CPID 2971 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 09522989.

8/5/2025

Claims Fee Change for Multiple Payers

Effective immediately the Claims Fee is changing from $0.10 to No Fee for the following payers:

Payer Name: Alignment Health Care

Industry ID: CCHPC

CPID(s): 7235, 8653

Payer Name: All American Medical Group

Industry ID: AAMG1

CPID(s): 1124, 1572

Payer Name: Allcare IPA

Industry ID: AC101

CPID(s): 7247

Payer Name: Allegiance Benefit Plan Management

Industry ID: 81040

CPID(s): 2295, 1651

Payer Name: Alphacare Medical Group

Industry ID: NMM04

CPID(s): 8247, 3000

Payer Name: Bakersfield Family Medical Center

Industry ID: BKRFM

CPID(s): 4241, 6614

Payer Name: Banner - University Family Care

Industry ID: 66901

CPID(s): 1290, 6548

Payer Name: CareFirst BlueCross BlueShield Community Health Plan Maryland

Industry ID: 45281

CPID(s): 6749, 6647

Payer Name: CenterLight Healthcare

Industry ID: 13360

CPID(s): 6820, 7613

Payer Name: Community First Health Plan

Industry ID: COMMF

CPID(s): 3809, 8925

Payer Name: Community Health Center Network

Industry ID: CHCN1

CPID(s): 3119

Payer Name: ComPsych

Industry ID: 37363

CPID(s): 6206, 6644

Payer Name: Desert Medical Group

Industry ID: DESRT

CPID(s): 3285

Payer Name: Downey Select IPA (AppleCare Medical Management)

Industry ID: APP01

CPID(s): 4152, 3071

Payer Name: Facey Medical Foundation

Industry ID: 95432

CPID(s): 4896

Payer Name: Gateway Health Plan Medicare Assured Pennsylvania

Industry ID: 60550

CPID(s): 2298, 2912

Payer Name: Geisinger Health Plan

Industry ID: 75273

CPID(s): 5473, 2559

Payer Name: GEMCare - Kern County

Industry ID: MCS03

CPID(s): 6100, 4607

Payer Name: Global Care Medical Group IPA

Industry ID: MPM05

CPID(s): 5870, 8692

Payer Name: Health Care LA IPA

Industry ID: MPM06

CPID(s): 5840, 9676

Payer Name: Imperial Health Holdings Medical Group

Industry ID: IHHMG

CPID(s): 1295, 6560

Payer Name: Johns Hopkins - USFHP

Industry ID: 52123

CPID(s): 4750, 4959

Payer Name: Kaiser Foundation Health Plan of Washington

Industry ID: 91051

CPID(s): 8405, 6511

Payer Name: Kelsey-Seybold

Industry ID: KELSE

CPID(s): 1428, 5982

Payer Name: Medsolutions

Industry ID: 62160

CPID(s): 1825, 8973

Payer Name: MedStar Family Choice, Inc (DC)

Industry ID: RP062

CPID(s): 8819, 4076

Payer Name: MedStar Family Choice, Inc (MD)

Industry ID: RP063

CPID(s): 4775, 3614

Payer Name: Optum Care Network - Monarch

Industry ID: IP095

CPID(s): 6606

Payer Name: Oscar Health

Industry ID: OSCAR

CPID(s): 7468, 9638

Payer Name: Peak PACE Solutions

Industry ID: 27034

CPID(s): 6862, 5663

Payer Name: Preferred IPA

Industry ID: PFIPA

CPID(s): 3225, 6623

Payer Name: Prospect Medical Systems

Industry ID: PROSP

CPID(s): 3287, 8684

Payer Name: QualCare IPA

Industry ID: QCP01

CPID(s): 7717, 9658

Payer Name: Regal Medical Group

Industry ID: REGAL

CPID(s): 3292, 6621

Payer Name: Southern California Physicians Managed Care Services

Industry ID: SCP01

CPID(s): 5828, 2978

Payer Name: UCare Plans

Industry ID: 55413

CPID(s): 7867, 1038

Payer Name: VGM Homelink

Industry ID: 50701

CPID(s): 6767

Payer Name: WelbeHealth

Industry ID: WBHCA

CPID(s): 9477, 7076

Action Required: None.

8/5/2025

Electronic Routing Change for CPIDs 7144 and 7689 Amida Care Medicare

Effective August 5, 2025, Optum is changing electronic claims routing for the following payer:

Payer Name: Amida Care Medicare
Professional CPID: 7144
Current Edit Master: PE_E049
New Edit Master: PE_T007
Institutional CPID: 7689
Current Edit Master: HE9E049
New Edit Master: HE9T007
Payer-assigned Payer ID: 79966
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.

8/5/2025

Remittance Reactivation for CPIDs 1744, 6591 Welfare Pension Administration Services (WPAS)

Optum recently restored electronic remittance connectivity for the following payer:

Payer Name: Welfare Pension Administration Services (WPAS)
Professional CPID: 1744
Institutional CPID: 6591
Payer-assigned Payer ID: 91136
Line of Business (LOB) Code: J3A

Remittance Enrollment Requirements:

Payer enrollment for electronic remittance is required:
- Providers currently receiving electronic remittance for this payer do not need to complete a new enrollment form.
- Providers who moved their enrollment to another clearinghouse or have not received remittance will need to re-enroll to receive remittance for this payer from Optum.
- 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.

8/5/2025

Remittance Reactivation for CPIDs 1744, 6591 Welfare Pension Administration Services (WPAS)

Optum recently restored electronic remittance connectivity for the following payer:

Payer Name: Welfare Pension Administration Services (WPAS)
Professional CPID: 1744
Institutional CPID: 6591
Payer-assigned Payer ID: 91136

Remittance Enrollment Requirements:

Payer enrollment for electronic remittance is required:
- Providers currently receiving electronic remittance for this payer do not need to complete a new enrollment form.
- Providers who moved their enrollment to another clearinghouse or have not received remittance will need to re-enroll to receive remittance for this payer from Optum.
- 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.

8/5/2025

Remittance Changes for 8480 & 3070 Northwest Community Health Partners

Update: In order to continue receiving electronic remittance, providers must login in to Enrollment Central prior to August 18, 2025, to verify they are enrolled with the appropriate payer.

Original Notify sent Aug. 4, 2025:
It has come to Optum’s attention that you are receiving electronic remittance for the terminated payer(s) listed below. Effective August 18, 2025, Optum will no longer process electronic remittance for the following payer:

Payer Name: Northwest Community Health Partners
Professional CPID: 8480
Institutional CPID: 3070
Payer-assigned Payer ID: NWCHP
Line of Business Code (LOB): H26

In order to continue receiving electronic remittance, providers must login in to Enrollment Central prior to August 18, 2025, to verify they are enrolled with the payer listed below. .

Enrollment Requirements:
Remittance:

Payer enrollment for electronic remittance is required.

Action Required:

Please make the necessary enrollment changes, before the effective date, to continue receiving electronic remittance.
When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.

8/5/2025

Electronic Routing Change for CPIDs 4283 and 8023 Choice Medical Group

Effective August 6, 2025, Optum will be changing electronic claims routing for the following payer:

Payer Name: Choice Medical Group
Professional CPID: 4283
Institutional CPID: 8023
Payer-assigned Payer ID: CMG01
Payer Claim Enrollment Required: No
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.

8/4/2025

Electronic Routing Change for CPIDs 3845 and 6610 Banner Health Network

Effective August 4, 2025, Optum is changing electronic claims routing for the following payer:

Payer Name: Banner Health Network
Professional CPID: 3845
Current Edit Master: PE_E049
New Edit Master: PE_T007
Institutional CPID: 6610
Current Edit Master: HE9E049
New Edit Master: HE9T007
Payer-assigned Payer ID: 12X42
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.

8/4/2025

Electronic Routing Change for CPIDs 3845 and 6610 Banner Health Network

Effective August 4, 2025, Optum will be changing electronic claims routing for the following payer:

Payer Name: Banner Health Network
Professional CPID: 3845
Institutional CPID: 6610
Payer-assigned Payer ID: 12X42
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.

8/4/2025

999 Payer Batch Rejections CPID 1782 North American Medical Management

Professional claims transmitted to the payer listed below from Optum Aug. 4, 2025 were not processed by the payer due to a 999 Batch Rejection.

Payer impacted:

CPID 1782 North American Medical Management (NAMM - N. CA)

A resolution has been implemented, and the claims were retransmitted to the payer Aug. 4, 2025.

Action Required: None.

If you have any questions, please contact Customer Support and refer to Case Number 09614690.

8/4/2025

Remittance Changes for 8480 & 3070 Northwest Community Health Partners

It has come to Optum’s attention that you are receiving electronic remittance for the terminated payer(s) listed below. Effective August 18, 2025, Optum will no longer process electronic remittance for the following payer:

Payer Name: Northwest Community Health Partners
Professional CPID: 8480
Institutional CPID: 3070
Payer-assigned Payer ID: NWCHP
Line of Business Code (LOB): H26

In order to continue receiving electronic remittance, providers must login in to Enrollment Central prior to August 18, 2025, to verify they are enrolled with the payer listed below.

Enrollment Requirements:

Remittance:

Payer enrollment for electronic remittance is required.

Action Required:

Please make the necessary enrollment changes, before the effective date, to continue receiving electronic remittance.
When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.

8/4/2025

Electronic Routing Change for CPIDs 2150 and 3693 Florida Health Care Plans

Effective August 4, 2025, Optum is changing electronic claims routing for the following payer:

Payer Name: Florida Health Care Plans
Professional CPID: 2150
Institutional CPID: 3693
Payer-assigned Payer ID: 59322
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.

8/4/2025

Electronic Routing Change for CPIDs 2150 and 3693 Florida Health Care Plans

Effective August 4, 2025, Optum is changing electronic claims routing for the following payer:

Payer Name: Florida Health Care Plans
Professional CPID: 2150
Edit Master: PE_T007
Institutional CPID: 3693
Edit Master: HE9T007
Payer-assigned Payer ID: 59322
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:

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.

8/4/2025

Payer Processing Issue for Multiple CPIDs

Due to a payer processing issue, some Professional and Institutional claims transmitted to the payers listed below July 23, 2025 and July 24, 2025 were not processed by the payers.

Payers impacted:

CPID 2758 LA BCBS
CPID 3580 LA BCBS
CPID 5008 LA Blue Advantage
CPID 8853 LA Blue Advantage
CPID 8046 Vantage Health Plan

A resolution has been implemented and the claims were retransmitted to the payers Aug. 4, 2025.

This delay affected claims released to Optum July 22, 2025, 1:00 p.m.-July 24, 2025, 1:00 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 09626720.

8/4/2025

Report Generation Delay for CPIDs 6705 and 9679 Prime Community Care of Central Valley
A payer intermediary is experiencing issues affecting Professional and Institutional report generation for some claims submitted since July 16, 2025.

Payer impacted:

CPID 6705 Prime Community Care of Central Valley
CPID 9679 Prime Community Care of Central Valley

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 09626743.

8/4/2025

New Payer Edit for CPID 5596

The payer listed below has informed Optum of a new edit requirement effective immediately. In order to meet the new requirement, we will add the following edit on 08/07/2025:

ISV202B112: MISSING HCPCS/CPT-4 CODE: When the following conditions are present, the HCPCS/CPT-4 Code is required.

The Type of Bill is 13x, 14x, or 85x; and
The associated Revenue Code is 270-274, 276-277, 279, 290-294 or 94x.

Notes:

If this requirement does not apply to your billing situation, you can override the edit within the Error Text.
Edit is based on AR BCBS Provider News, page 5, June 2025.

LINK: https://www.arkansasbluecross.com/providers/medical-providers/providers-news

LOOP 2400 SV202-2

Edit applies to:

CPID 5596 Arkansas Blue Cross

Action Required: Please be aware of updated edit requirements.

8/4/2025

Electronic Routing Change for CPIDs 5982 and 1428 Kelsey-Seybold

Effective August 5, 2025, Optum will be changing electronic claims routing for the following payer:

Payer Name: Kelsey-Seybold
Professional CPID: 1428
Edit Master: PE_T007
Institutional CPID: 5982
Edit Master: HE9T007
Payer-assigned Payer ID: KELSE
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:

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.

8/1/2025

Electronic Routing Change for CPIDs 5982 and 1428 Kelsey-Seybold

Effective August 5, 2025, Optum will be changing electronic claims routing for the following payer:

Payer Name: Kelsey-Seybold
Professional CPID: 1428
Institutional CPID: 5982
Payer-assigned Payer ID: KELSE
Payer Claim Enrollment Required: No
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.

8/1/2025

Electronic Routing Change for CPIDs 8819 and 4076 MedStar Family Choice, Inc (DC)

Effective August 5, 2025, Optum will be changing electronic claims routing for the following payer:

Payer Name: MedStar Family Choice, Inc (DC)
Professional CPID: 8819
Edit Master: PE_T007
Institutional CPID: 4076
Edit Master: HE9T007
Payer-assigned Payer ID: RP062
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:

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.

8/1/2025

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 July 30, 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 09625582.

8/1/2025

Report Generation Delay for CPID 1913 Medicare Plus Blue of MI(MAP)

A payer intermediary is experiencing issues affecting Institutional report generation for some claims submitted July 25, 2025.

Payer impacted:

CPID 1913 Medicare Plus Blue of MI(MAP)

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 09625545.

8/1/2025

Electronic Routing Change for CPIDs 8819 and 4076 MedStar Family Choice, Inc (DC)

Effective August 5, 2025, Optum will be changing electronic claims routing for the following payer:

Payer Name: MedStar Family Choice, Inc (DC)
Professional CPID: 8819
Institutional CPID: 4076
Payer-assigned Payer ID: RP062
Payer Claim Enrollment Required: No
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.

8/1/2025

Eligibility payer termination

Effective July 29, 2025, the electronic Real Time eligibility 270/271 connection for the payer below is longer available.

Payer Name: KAISER PERMANENTE KPIC
Optum iEDI Real Time ID: KPIC1

Action Required by customer
For assistance with submitting Real-Time transactions, please contact your Practice Management System Vendor or Optum Customer Care Hub ticket.

8/1/2025

New Electronic Claims Auth Inquiry Connection Available Platform

Optum is pleased to announce the availability of Real-time Auth Inquiry and Response 278/215 & 217 for the below payer, effective May 9, 2025:

Payer Name: ANTHEM BLUE CROSS BLUE SHIELD OF OHIO
IMN Real Time ID: SB338
Payer Enrollment Required: No
Connection Type: X12

8/1/2025

Eligibility payer termination

Effective July 7, 2025, the electronic Real Time eligibility 270/271 connection for the payer below is longer available.

Payer Name: Kaiser Foundation Health Plan of Ohio
Optum iEDI Real Time ID: KSFOH

Action Required by customer:
For assistance with submitting Real-Time transactions, please contact your Practice Management System Vendor or Optum Customer Care Hub ticket.

8/1/2025

Electronic Routing Change for CPIDs 6206 and 6644 ComPsych

Effective August 4, 2025, Optum is changing electronic claims routing for the following payer:

Payer Name: ComPsych
Professional CPID: 6206
Edit Master: PE_T007
Institutional CPID: 6644
Edit Master: HE9T007
Payer-assigned Payer ID: 37363
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:

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.

8/1/2025

Electronic Routing Change for CPIDs 6206 and 6644 ComPsych

Effective August 4, 2025, Optum will be changing electronic claims routing for the following payer:

Payer Name: ComPsych
Professional CPID: 6206
Institutional CPID: 6644
Payer-assigned Payer ID: 37363
Payer Claim Enrollment Required: No
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.

8/1/2025

New Payer Name

Effective immediately, please be aware of the following payer name changes:

Previous Payer Name: Change Healthcare Comp Billing
New Payer Name: Optum Comp Billing
Professional CPID: 5861
Professional Edit Master: PE_R002
Institutional CPID: 3657
Institutional Edit Master: HE9R002
Remit Line of Business (LOB) Code: U2F

Action Required:

You may choose to update the Payer Alias in your system to accommodate the new payer name.

8/1/2025

New Payer Name

Effective immediately, please be aware of the following payer name changes:

Previous Payer Name: Change Healthcare Comp Billing
New Payer Name: Optum Comp Billing
Professional CPID: 5861
Institutional CPID: 3657

Action Required: Please make the appropriate changes to accommodate the name change.

8/1/2025

New Electronic Eligibility Connection Available

Effective July 15, 2025 Optum is pleased to announce the availability of Real-time Eligibility Inquiry and Response 270/271 for the below payer:

Payer Name: NextBlue of North Dakota
Industry Payer ID: 55892
IMN Real Time ID: 55892
Exchange Real Time ID: NBOND
CPID(s): 5016, 8864
Optum IEDi Real Time ID: 55892
Payer Enrollment Required: No
Connection Type: X12

Search Options:
Subscriber

Member ID, First Name, Last Name, Date of Birth

Dependent

Member ID, Dependent First Name, Dependent Last Name, Dependent Date of Birth

8/1/2025

New Real Time Eligibility Connection Available

Optum is pleased to announce the availability of Real-time Eligibility Inquiry and Response 270/271 for the below payer:

Payer Name: AUXIANT
Industry Payer ID: AUX01; 10900; 92645; 76079
IMN Real Time ID: 10900
Exchange Real Time ID: AUXANT
CPID(s): Prof: 1121, 8833, 1108 / Inst: 8059, 9520, 4092
Optum IEDi Real Time ID: 10900
Payer Enrollment Required: No
Connection Type: X12

Search Options:
Subscriber

Member ID, First Name, Last Name, Date of Birth

Dependent

Member ID, Dependent First Name, Dependent Last Name, Dependent Date of Birth

8/1/2025

Swedish Covenant Hospital Electronic Claims Connection No Longer Available

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

Payer Name: Swedish Covenant Hospital
Claim CPIDs: 6848, 9510
Payer-assigned Payer ID: 36411
Reason: Payer no longer in business.

Payer will no longer accept paper claims.

Action Required: None.

8/1/2025

Older Payer Updates

Click the link below to access payer updates prior to August 1st, 2025.

GET OLDER UPDATES

CHC Payer Updates (August 2025)

August 2025

August Payer Processing Issues

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