New Electronic Remittance Connections Available

Optum has new electronic remittance connections available: 

Payer Name: Element Care
Institutional CPID: 6977
Professional CPID: 6811
Payer-assigned Payer ID: 04326
Payer Enrollment Required: Yes
Remittance Fee: N/A
Payer Location: MA

Action Required: 

• Add the payers to your system to begin using the new payer connection.
• Enrollment forms must be submitted and approved to begin receiving electronic remittance through Optum.

REF 15714218 12/31/2024

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New Electronic Remittance Connections Available

Optum has new electronic remittance connections available: 

Payer Name: Element Care
Institutional CPID: 6977
Professional CPID: 6811
Payer-assigned Payer ID: 04326
Line of Business (LOB) Code: H60
Payer Enrollment Required: Yes
Remittance Fee: N/A
Payer Location: MA

Action Required: 

• Add the payers to your system to begin using the new payer connection.
• Enrollment forms must be submitted and approved to begin receiving electronic remittance through Optum.

REF 15714219 12/31/2024

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Eligibility and Claim Status Payer Termination Update

Eligibility and Claims Status Message to Optum Intelligent EDI Providers and Clearinghouse Partners

Effective Jan. 1, 2025, The below payers will no longer be available for the following transactions: 270/271 and/or 276/277.

Payer ID: TRSEL/SMLTC

CPID: N/A

Payer Name: Selman Tricare Supplement

Transaction: Eligibility Inquiry and Response 270/271 and Claim Status 276/277

Payer ID: TRCLF/MNTAL

CPID: N/A

Payer Name: Transamerica Premier Life Insurance Company

Transaction: Eligibility Inquiry and Response 270/271 and Claim Status 276/277

Payer ID: 82288

CPID: 8572 and 7803

Payer Name: True Health Mexico

Transaction: Eligibility Inquiry and Response 270/271

Payer ID: 34136

CPID: 2578 and 3771

Payer Name: JP Farley 

Transaction: Eligibility Inquiry and Response 270/271 and Claim Status 276/277 

Action Required by Customer: Please update your system to the new payer ID effective Jan. 1, 2024. For assistance with submitting real-time transactions, please contact your Practice Management System Vendor.

Technical Information:

Real-Time New Payer Transactions

Thank You for your attention and cooperation.

REF 15714982 12/31/2024

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Rocky Mountain HMO Electronic Claims/Remittance Connections No Longer Available

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

Assurance Reimbursement Management:

Payer Name: Rocky Mountain HMO 

Claim CPIDs: 3556, 7470 

Remittance LOB: U6B 

Payer-assigned Payer ID: SX141, 84065 

Reason: Claims should be sent to Payer ID 87726, CPID 3550, 3429. All remittances now come under UnitedHealthcare Community Plan, Payer ID 04567, CPID 6893. 

Assurance EDI:

Payer Name: Rocky Mountain HMO

Claim and Remittance CPIDs: 3556, 7470

Payer-assigned Payer ID: SX141, 84065

Reason: Claims should be sent to Payer ID 87726, CPID 3550, 3429. All remittances now come under UnitedHealthcare Community Plan, Payer ID 04567, CPID 6893.

Action Required: None.

REF 15713558_15710257 12/31/2024

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Electronic Claims Connection Suspended for CPIDs 4643 and 6162 Healthscope Benefits 

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

Payer Name:  Healthscope Benefits

CPIDs:  4643 and 6162

Payer ID:  52429

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

REF 15713559 12/31/2024

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Delay in Electronic Remittance Advice (ERA) and 277CAs for CPIDs 3887/1507 & 3807/1503 Veterans Administration Fee Basis Programs & CHAMPVA - HAC

Due to Payer scheduled maintenance, there will been a delay in Professional and Institutional Electronic Remittance Advice (ERA) and 277CAs for the below mentioned payer(s). The delay is expected to last two weeks from this notification (12/31/2024). 

• CPID 3887/1507 - Veterans Administration Fee Basis Programs
• CPID 3807/1503 - CHAMPVA - HAC

Action Required: Please be aware of a delay in the delivery of ERA and 277CAs. 

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

REF 15706484 12/31/2024

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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 Dec. 23, 2024.

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.

REF 15713409 12/31/2024

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Report Generation Delay for CPID 1475 Louisiana Medicaid

A payer is experiencing issues affecting Professional report generation for some claims submitted on Dec. 26, 2024.

Payer impacted: 

• CPID 1475 Louisiana Medicaid

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

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

REF 15713408 12/31/2024

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Report Generation Delay for multiple CPIDs

A payer intermediary is experiencing issues affecting Professional and Institutional report generation for some claims submitted on Dec. 20, 2024.

Payers impacted:

• CPID 2786 Prime West
• CPID 1942 IMCare
• CPID 3764 IMCare
• CPID 1039 South Country Health Alliance
• CPID 7868 South Country Health Alliance 

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

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

REF 15713109 12/30/2024

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VA payer delay of 277CA and 835 responses

The Veteran Affairs (VA) payer has stated that there will be a delay in the delivery of 277CAs and 835 electronic remittance advice transactions.  This delay is expected to be a minimum of two weeks and into the New Year, 2025.  The cause of the delay is due to a scheduled migration of a critical system from a legacy process to a cloud-based process.

REF 15699577 12/31/2024

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UCARE Plans & Aspirus Medicare Advantage - Participating Status Update

This message is intended for Assurance Reimbursement Management, Assurance EDI, Intelligent EDI, Intelligent Medical Network, and Revenue Performance Advisor customers.

Please be advised of the below payers have had a participating status change to NON-PAR effective immediately:

Payer Name: UCare Individual and Family Plan
Real Time Payer ID: 55413, MNUCAR
Payer Enrollment Required: No
Participating Status: NON-PAR

Payer Name: ASPIRUS MEDICARE ADVANTAGE
Real Time Payer ID: 36483, ASPRS
Payer Enrollment Required: No
Participating Status: NON-PAR

Action Required by Customer: Update your records to reflect the change in this payer status.

REF 15699308 12/31/2024

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VA Payer 999 Delivery Delay

The VA payer has stated that there will be a delay in the delivery of 999s acknowledgments between January 1st and the 6th. This delay is due to normal beginning of the year system synchronization.

REF 15699576 12/31/2024

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New Electronic Claims Connections Available

Optum has new electronic claims connections available:

Payer Name: Know the Costs

Institutional CPID: 8087

Professional CPID: 2884

Payer-assigned Payer ID: 04430

Payer Enrollment Required: No

Secondary Claims Accepted: Yes

Payer Location: National

Claims Fee: N/A

Action Required:

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

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

REF 15699579 12/30/2024

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Payer Change for TRICARE East Region

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

Optum has been informed that PGBA will begin administering electronic claims and remittances for the payer identified below effective January 1, 2025. We are currently working to add this payer to the Revenue Performance Advisor (RPA) system. Please watch for an announcement when payer is live before sending claim transactions to avoid rejections.

Optum would like to inform providers that while a claim enrollment form is not needed for submitting claims electronically, an Electronic Data Interchange (EDI) Provider Trading Partner Agreement is required to be on file with PGBA. Please see Enrollment instructions below. Providers may now begin completing the necessary enrollment forms for payer ID 99727 claims or electronic remittance.

Effective January 1, 2025, claims and remittance currently exchanged with the following payer must use different payer IDs based on your new TRICARE contract (**For 99727, once available on RPA):

Claims and Remittance containing Dates of Service on or prior to December 31, 2024 must continue to use the following through April 30, 2025:

Payer Name: TRICARE East Region DOS before 1/1/25
RPA Payer ID: 68299
Payer-assigned Payer ID: TREST

Claims and Remittance containing Dates of Service on or after January 1, 2025 must begin using the following based on your TRICARE contract:

Payer Name: TRICARE East Region
RPA Payer ID: 99727
Payer-assigned Payer ID: 99727

NOTES:

• Beginning May 1, 2025, submit 2024 claims to 99727 TRICARE East Region.
• The following states are moving to the TRICARE West Region: Arkansas, Illinois, Louisiana, Oklahoma, Texas, and Wisconsin. TRICARE West providers should use RPA IDs 12C01 for institutional and SCWI0 for professional transactions.
• For additional information regarding this change please see Humana Military’s Provider Update page - Provider Updates.

Enrollment Requirements for TRICARE East Region ID 99727:

Claims:

• Payer enrollment for electronic claims is not required. However, PGBA requires an Electronic Data Interchange (EDI) Provider Trading Partner Agreement to be on file.
  • If the provider is credentialed with PGBA and has an Electronic Data Interchange (EDI) Provider Trading Partner Agreement on file with PGBA the Optum Enrollment is not required. 
  • If the provider is not credentialed with PGBA, please complete the Optum Enrollment form process prior to sending claims.

Remittance:

• Payer enrollment for electronic remittance is required.
  • Providers currently receiving electronic remittance through Optum must complete a new enrollment form.
  • New providers must complete a new enrollment form.

ERA enrollment/set up is required for all ERA transactions on RPA. 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 RPA, you can also open the RPA Resource Center, click the Quick Reference Guides tab, and then click the Billing Provider Enrollment link to find the payer enrollment intake form.

REF 15710168 12/30/2024

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Report Generation Delay for multiple CPIDs

Due to a payer intermediary processing issue, some Professional claims transmitted to the payers listed below on Dec. 27, 2024 were not processed by the payers.

Payers impacted: 

CPID Payer Name 

9267 Align Senior Care of Florida

2113 Allcare Health Plan

1764 Ambetter From Absolute Total Care

9278 Ambetter from Nebraska Total Care

9431 Ambetter from WellCare of Kentucky

9432 Ambetter from WellCare of New Jersey

9775 Ambetter of Alabama

9433 Ambetter of Oklahoma

2138 American Family Insurance

9142 American Health Advantage of Mississippi

7854 American Health Advantage of Oklahoma

9117 American Health Advantage of Texas

1741 Amerigroup

1412 Anthem Blue Cross and Blue Shield - Indiana

2421 Anthem Blue Cross and Blue Shield - Kentucky

1413 Anthem Blue Cross and Blue Shield (Virginia)

2418 Anthem Blue Cross and Blue Shield of Ohio

4437 Anthem Blue Cross Blue Shield New York

8749 Anthem MaineHealth

4881 Asuris Northwest Regence

7272 Axminster Medical Group

3845 Banner Health Network

1415 Blue Cross Blue Shield of Colorado

1407 Blue Cross Blue Shield of Georgia

7496 Blue Cross Blue Shield of Nevada

1169 Blue Cross Blue Shield of Western New York Medicaid/CHP

1401 Blue Cross Blue Shield of Wisconsin

1243 Blue Cross Community Centennial

1167 Blue Cross Medicare Advantage PPO/HMO

9162 Blue Medicare Advantage

6779 Bridgespan Regence

6165 Bridgeview

1750 Brown & Toland Physicians

4246 Capital Health Plan

2810 Capitol Administrators

8146 Care N Care Insurance Co.

2289 Care1st Health Plan of Arizona Medicaid DOS after 11/30/2022

9759 Care1st Health Plan of Arizona Medicaid DOS before 12/01/2022

9762 Care1st Health Plan of Arizona Medicare

4743 Carelon Behavioral Health

6127 Carelon Behavioral Health, MBHP

3293 Carelon Health

2830 CarePlus Health Plans

1194 CareSource of Georgia

7143 CareSource of Indiana

3826 CareSource of Ohio

7263 CareSource of West Virginia

6777 Centers Plan for Healthy Living

9765 Central Valley Medical Providers

7275 Citrus Valley Physicians Group

8123 Clear Health Alliance

7763 Columbine Health Plan

8834 Commonwealth Care Alliance DOS after 3/31/2023

8477 Community Care Plan

2160 Community Care Plan (Commercial)

6865 Community Care Plan (Medicaid)

8147 Community Care Plan (Palm Beach Health District)

1420 Connecticut Anthem Blue Cross Blue Shield

3419 Connecticut Federal Employee Health Benefits

6795 Contra Costa Health Plan

6241 Correctional Health Partners

7738 CountyCare Health Plan

9747 Delaware First Health

2433 Denver Health and Hospital Authority

8135 Doctors HealthCare Plans

3477 Early Intervention Central Billing

1119 Easy Choice Health Plan of California

4289 El Paso Health-CHIP

5483 Employee Benefit Management Services (EBMS)

1834 Employee Plans

8137 Empower Healthcare Solutions

1795 Envolve Benefit Options

9215 Everpointe

5238 Evolent Specialty Cardiology

3792 Fidelis Care

2875 First Health Network (Coventry Health Care National Network)

7435 FirstCare Health Plans

1414 Florida Blue Cross Blue Shield

3417 Florida Blue Cross Blue Shield Health Options HMO

9417 Florida Complete Care

2150 Florida Health Care Plans

5440 Fox Valley Medicine

6851 Friday Health Plans

8189 Gemcare IPA

8879 Georgia Health Advantage

2720 GlobalCare

9766 Gold Kidney Health Plan

1797 HAP CareSource Michigan Dual Medicare/Medicaid

5243 Healthcare Management Administrators

1723 HealthCare Partners IPA

4448 HealthLink PPO

7760 Healthy Blue Louisiana

8867 Healthy Blue Missouri

9133 Healthy Blue North Carolina

7715 Hopkins Health Advantage

6259 Humana - CareSource of Kentucky

7426 Idaho Regence Blue Shield

1405 Illinois Blue Cross Blue Shield

5865 Indian Health Services

4445 Insurance Management Services TX

4116 IntegraNet Health

1107 Integrated Health Partners (IHP)

8814 Integrated Homecare Services

1404 Iowa Wellmark Blue Cross Blue Shield

6733 Iowa Wellmark Blue Cross Blue Shield Crossover

5479 IU Health Plan Medicare Advantage

5432 Johns Hopkins Healthcare / Priority Partners

5882 Kane County IPA

7782 Kansas Health Advantage

9412 Leon Health Plans

7446 Maine Anthem Blue Cross Blue Shield

8812 Maryland Physicians Care

8860 Medica Government Programs

7859 Medica Health Plan Solutions

6799 Medica Individual and Family (IFB)

2287 Medicare Plus Blue of MI(MAP)

3475 Memorial Hermann Health Solutions

9102 Meridian Medicare Medicaid Plan

9118 MeridianComplete Michigan

2426 Michigan Blue Care Network

1421 Michigan Blue Cross Blue Shield

1402 Minnesota Blue Cross Blue Shield

1410 Minnesota Blue Cross Blue Shield CC Systems

7892 Minnesota Blue Cross Blue Shield Health Care Programs

1429 Minnesota Blue Cross Blue Shield HMO

5871 Mission Community IPA Medical Group

1408 Missouri Anthem Blue Cross Blue Shield

7450 Montana Blue Cross Blue Shield

7422 New Hampshire Anthem Blue Cross Blue Shield

7403 New Mexico Blue Cross Blue Shield

8864 NextBlue of North Dakota

1213 NHC Advantage

2411 North Dakota Blue Cross Blue Shield

1403 Oklahoma Blue Cross Blue Shield

2404 Oregon Regence Blue Cross Blue Shield

7829 Passport Advantage

9123 Perennial Advantage

9199 Piedmont Community Health Plan

8128 Pool Administrators, Inc.

4252 Presbyterian Salud

8468 Procare Advantage of TX

4253 Prominence Administrative Services

7281 PruittHealth Premier Medicare Advantage

5428 QualChoice of Arkansas

7264 Quartz ASO

1209 Regence Group Administrators

6879 RHA VestaCare

1776 RIS Rx

6246 Riverside Medical Clinic

4464 SCAN Health Plan

2254 Scott & White Health Plan

9438 Shared Health Mississippi

7225 Sharp Community Medical Group

8124 Simply Healthcare Plans, Inc.

8816 SOMOS Emblem

1740 Sonder Health Plans

2490 South Dakota Blue Cross Blue Shield

8134 Summit Community Care

1406 Texas Blue Cross Blue Shield

1729 Texas Childrens Health Plan (CHIP)

2483 Texas Childrens Health Plan (STAR Medicaid)

4278 The Boon Group

8763 U.S. Networks and Administrative Services

8473 Unicare (TX,MA,KS,WV,RI,IL)

2412 Utah Regence Blue Cross Blue Shield

2788 Utah Regence Blue Cross Blue Shield Federal Employee Program

7493 Vermont Blue Cross Blue Shield

4258 VNS Health

7451 Washington Regence Blue Shield

9430 Wellcare by Allwell of Oklahoma

1844 Wellcare Health Plans

3211 Wellcare Health Plans (Encounters)

1775 Wellpoint

9441 Wellspace NEXUS LLC

7489 Wyoming Blue Cross Blue Shield

A resolution has been implemented and the claims were retransmitted to the payer intermediary on Dec. 30, 2024.

This delay affected claims released to Optum between 2 p.m. CT and 6 p.m. CT on Dec. 27, 2024.

Action Required: Be aware of the processing issue above.

REF 15708205 12/30/2024

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Update: Processing resumed to Rhode Island Medicaid

Updated message as of Dec. 30, 2024: Effective immediately, real time transaction processing to Rhode Island Medicaid has resumed for the payer IDs below. Claims and ERA transaction processing will be turned on Dec. 30, 2024, at 5 pm CT. Please monitor your claims processing and resubmit any claim submitted after Dec. 13, 2024, at 2 pm CT, that you did not receive a payer acknowledgement.  

Claims and ERA Payer IDs:  

Payer ID: SKRI0  

Professional CPID: 7421, 2405

Institutional CPID: 3647, 6075

Intelligent EDI Payer ID: RIMCD, 12K74, SKRI0  

Real Time Payer IDs:  

Intelligent Medical Network and Revenue Performance Advisor Payer ID: SKRI0  

Legacy Change Healthcare Payer ID: 12K74  

Action Required: Please be aware that eligibility transactions may be slow or result in an error message as Optum has restored its connection back to Rhode Island. Please also review any claims sent to the payer on or after Dec. 13, 2024, at 2 pm CT, for possible valid rejections. Claims may need to be resubmitted for payment.

Original message sent on Dec. 16, 2024 REF# 15634972: Out of an abundance of caution, Optum's Medical Network clearinghouse has suspended all transactions to Rhode Island Medicaid. Please see Governor McKee Issues Update on Cybersecurity Breach of RIBridges System | Governor's Office, State of Rhode Island for additional information. Please see the impacted payer IDs below.

Optum is actively monitoring the situation and will work to restore processing for this payer as soon as possible.

Claims and ERA Payer IDs:
Payer ID: SKRI0
Professional CPID: 7421, 6075
Institutional CPID: 3647, 2405
Legacy Change Healthcare Payer ID: 12K74

Action Required: Please be aware of the changes above and make any necessary changes in your system.

REF  15710308 12/30/2024

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Electronic Remittance Routing Change for CPIDs 5934 and 4799, Atrio Health Plans

This message is intended for Assurance EDI customers.

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

Payer Name: Atrio Health Plans

Professional CPID: 4799

Institutional CPID: 5934

Payer-assigned Payer ID: ATRIO

Enrollment Requirements:

Remittance:

• Payer enrollment for electronic remittance is required.
  • Providers currently receiving electronic remittance through Optum must complete a new enrollment form.
  • New providers must complete a new enrollment form. 

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

• Make any necessary system changes.
• When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.

REF 15709437 12/30/2024

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Electronic Remittance Routing Change for CPIDs 5934 and 4799, Atrio Health Plans

This message is intended for Assurance Reimbursement Management customers.

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

Payer Name: Atrio Health Plans

Professional CPID: 4799

Institutional CPID: 5934

Line of Business Code (LOB): U6Y

Payer-assigned Payer ID: ATRIO

Enrollment Requirements:

Remittance:

• Payer enrollment for electronic remittance is required.
  • Providers currently receiving electronic remittance through Optum must complete a new enrollment form.
  • New providers must complete a new enrollment form. 

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

• Make any necessary system changes.
• When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.

REF 15709438 12/30/2024

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Report Generation Delay for CPIDs 9435 and 7052 OhioRISE - Aetna Better Health of Ohio

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

Payer impacted: 

• CPID 7052 OhioRISE - Aetna Better Health of Ohio
• CPID 9435 OhioRISE - Aetna Better Health of Ohio

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

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

REF 15708204 12/30/2024

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Payer Processing Issue for CPID 8152 Altura

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

Payer impacted: 

• CPID 8152 Altura

A resolution has been implemented and the claims were retransmitted to the payer on Dec. 30, 2024.

This delay affected claims released to Optum between 4 a.m. CT on Dec 20, 2024 and 4 a.m. CT on Dec. 23, 2024.

Action Required: Be aware of the processing issue above.

REF 15710625 12/20/2024

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New Electronic Claims Connections Available

Optum has new electronic claims connections available:

Payer Name:  Unified Health Plan TPA

Institutional CPID: 8063

Professional CPID: 9780

Payer-assigned Payer ID: IHS12

Payer Enrollment Required: No

Secondary Claims Accepted: Yes

Payer Location: National

Claims Fee: N/A

Action Required:

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

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

REF 15709060 12/30/2024

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Aetna Better Health of California Electronic Claims and Remittance Connections No Longer Available

Effective Jan. 1, 2025, the payer listed below will no longer be available at Optum for claims and remittance processing. 

Assurance Reimbursement Management

Payer Name: Aetna Better Health of California 

Claim and Remittance CPIDs: 1015, 7838 

Remittance LOB: H4A 

Payer-assigned Payer ID: 128CA 

Reason: Payer no longer offers an electronic connection. 

Assurance EDI: 

Payer Name: Aetna Better Health of California 

Claim and Remittance CPIDs: 1015, 7838 

Payer-assigned Payer ID: 128CA 

Reason: Payer no longer offers an electronic connection. 

Action Required: None.

REF 15707262_15707263 12/30/2024

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2025 Quarterly Database and Network Maintenance Schedule

The Optum 2025 quarterly database and network maintenance schedule for the clearinghouse is provided below.

Action Required:

Please be advised of the maintenance schedules above. Additional communication will be sent to you 30 days prior to each event.

REF 15682761 12/30/2024

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New Electronic Remittance Connections Available

This message is intended for Assurance Reimbursement Management customers.

Optum has new electronic remittance connections available:

Payer Name: Valir Pace      

Institutional CPID: 2515

Professional CPID: 1131

Payer-assigned Payer ID: 48123

Line of Business (LOB) Code: H4R

Payer Enrollment Required: Yes

Remittance Fee: N/A

Payer Location: Oklahoma

Payer Name: Pace Southwest Iowa      

Institutional CPID: 2519

Professional CPID: 1170

Payer-assigned Payer ID: 53534

Line of Business (LOB) Code: J1Z

Payer Enrollment Required: Yes

Remittance Fee: N/A

Payer Location: Iowa

Action Required:

• Add the payers to your system to begin using the new payer connection.
• Enrollment forms must be submitted and approved to begin receiving electronic remittance through Optum.

REF 15709059 12/30/2024

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New Electronic Remittance Connections Available

This message is intended for Assurance EDI customers.

Optum has new electronic remittance connections available:

Payer Name: Valir Pace      

Institutional CPID: 2515

Professional CPID: 1131

Payer-assigned Payer ID: 48123

Payer Enrollment Required: Yes

Remittance Fee: N/A

Payer Location: Oklahoma

Payer Name: Pace Southwest Iowa      

Institutional CPID: 2519

Professional CPID: 1170

Payer-assigned Payer ID: 53534

Payer Enrollment Required: Yes

Remittance Fee: N/A

Payer Location: Iowa

Action Required:

• Add the payers to your system to begin using the new payer connection.
• Enrollment forms must be submitted and approved to begin receiving electronic remittance through Optum.

REF 15709058 12/30/2024

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New Electronic Claim Connections Available on RPA

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

Institutional claim transactions have recently been added for the following payers:

40459 – Benefits Support

AVANT– Avanta IPA

CLICA – Companion Life Insurance Company of California

DCRSS – Clearwater

RP115 – American Health Advantage of Indiana

RP128 – Promise Health Plan

SX071 – Evernorth Behavioral Health, Inc

TRYMC – Troy Medicare

Professional claim transactions have recently been added for the following payers:

40459 – Benefits Support

AVANT– Avanta IPA

CLICA – Companion Life Insurance Company of California

DCRSS – Clearwater

OSUCE – OSU Centene Oklahoma Complete Health

RP115 – American Health Advantage of Indiana

RP128 – Promise Health Plan

TRYMC – Troy Medicare

REF 15706472 12/27/2024

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Reminder: Payer Change for CPIDs 1253, 4585 TRICARE East Region - Assurance Reimbursement Management 

This message is intended for Assurance Reimbursement Management customers.

Effective Jan. 1, 2025, providers must use the appropriate TRICARE East Region CPIDs based on Dates of Service for electronic claim submissions to Optum. Providers must also complete the necessary claims or electronic remittance enrollment forms prior to exchanging transactions. Steps to complete the appropriate enrollment can be completed immediately.

Update:
Optum would like to inform providers that while a claim enrollment form is not needed for submitting claims electronically, an Electronic Data Interchange (EDI) Provider Trading Partner Agreement is required to be on file with PGBA. Please see updated Enrollment instructions. Providers may now begin completing the necessary enrollment forms for payer ID 99727 claims or electronic remittance.

Original:
Optum has been informed that PGBA will begin administering electronic claims and remittances for the payer identified below effective Jan. 1, 2025. We are currently working to obtain transition details and will send additional information regarding electronic remittance enrollment as soon as it becomes available.

Effective Jan. 1, 2025, claims and remittance currently exchanged with the following payer must use different CPIDs based on your new TRICARE contract:

Claims and Remittance containing Dates of Service on or prior to Dec. 31, 2024 must continue to use the following through April 30, 2025:

Payer Name: TRICARE East Region DOS before 1/1/25
Professional CPID: 1253
Professional Edit Master: PE_B026
Institutional CPID: 4585
Institutional Edit Master: HE9B023
Payer-assigned Payer ID: TREST
Line of Business Code (LOB): M08

Claims and Remittance containing Dates of Service on or after Jan. 1, 2025, must begin using the following based on your TRICARE contract:

Payer Name: TRICARE East Region
Professional CPID: 2872
Professional Edit Master: PE_B026
Institutional CPID: 5979
Institutional Edit Master: HE9B023
Payer-assigned Payer ID: 99727
Line of Business Code (LOB): M08

NOTES: 

• Beginning May 1, 2025, submit 2024 claims to CPIDs 2872 and 5979 TRICARE East Region. 
• The following states are moving to the TRICARE West Region: Arkansas, Illinois, Louisiana, Oklahoma, Texas, and Wisconsin. TRICARE West providers should use CPIDs 5648 for institutional and 6286 for professional transactions. Enrollment forms can be accessed through Enrollment Central.
• For additional information regarding this change please see Humana Military’s Provider Update page - Provider Updates.

Enrollment Requirements for TRICARE East Region CPIDs 2872 and 5979:
Claims:

• Payer enrollment for electronic claims is not required. However, PGBA requires an Electronic Data Interchange (EDI) Provider Trading Partner Agreement to be on file.
  • If the provider is credentialed with PGBA and has an Electronic Data Interchange (EDI) Provider Trading Partner Agreement on file with PGBA the Optum Enrollment is not required.  
  • If the provider is not credentialed with PGBA, please complete the Optum Enrollment form process prior to sending claims.
  • Providers may now complete the EDI Provider Trading Partner Agreement, if not already on file with PGBA, for CPIDs 2872 and 5979.

Remittance:

• Payer enrollment for electronic remittance is required.
  • Providers currently receiving electronic remittance through Optum must complete a new enrollment form for CPIDs 2872 and 5979. 
  • New providers must complete a new enrollment form. 
  • Providers may now enroll for electronic remittance for CPIDs 2872 and 5979.

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

• Please be aware of the changes above and make necessary updates. 
• Revalidate unreleased claims to edit correctly under new edit master. 
• Modify any bridge routines based on edit masters.
• Modify related Payer Alias names to the new CPIDs.

REF 15698975 12/27/2024

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Reminder: Payer Change for CPIDs 1253, 4585 TRICARE East Region - Assurance EDI

This message is intended for Assurance EDI customers.

Effective Jan. 1, 2025, providers must use the appropriate TRICARE East Region CPIDs based on Dates of Service for electronic claim submissions to Optum. Providers must also complete the necessary claims or electronic remittance enrollment forms prior to exchanging transactions. Steps to complete the appropriate enrollment can be completed immediately.

Update:
Optum would like to inform providers that while a claim enrollment form is not needed for submitting claims electronically, an Electronic Data Interchange (EDI) Provider Trading Partner Agreement is required to be on file with PGBA. Please see updated Enrollment instructions. Providers may now begin completing the necessary enrollment forms for payer ID 99727 claims or electronic remittance.

Original:
Optum has been informed that PGBA will begin administering electronic claims and remittances for the payer identified below effective Jan. 1, 2025. We are currently working to obtain transition details and will send additional information regarding electronic remittance enrollment as soon as it becomes available. 

Effective Jan. 1, 2025, claims and remittance currently exchanged with the following payer must use different CPIDs based on your new TRICARE contract:

Claims and Remittance containing Dates of Service on or prior to Dec. 31, 2024, must continue to use the following through April 30, 2025:

Payer Name: TRICARE East Region DOS before Jan. 1, 2025
Professional CPID: 1253
Institutional CPID: 4585
Remittance Available: Yes
Payer-assigned Payer ID: TREST

Claims and Remittance containing Dates of Service on or after Jan. 1, 2025, must begin using the following based on your TRICARE contract:

Payer Name: TRICARE East Region
Professional CPID: 2872
Institutional CPID: 5979
Remittance Available: Yes
Payer-assigned Payer ID: 99727
Claim Fee: No

NOTES: 

• Beginning May 1, 2025, submit 2024 claims to CPIDs 2872 and 5979 TRICARE East Region. 
• The following states are moving to the TRICARE West Region: Arkansas, Illinois, Louisiana, Oklahoma, Texas, and Wisconsin. TRICARE West providers should use CPIDs 5648 for institutional and 6286 for professional transactions. Enrollment forms can be accessed through Enrollment Central.
• For additional information regarding this change please see Humana Military’s Provider Update page - Provider Updates.

Enrollment Requirements for TRICARE East Region CPIDs 2872 and 5979:
Claims:

• Payer enrollment for electronic claims is not required. However, PGBA requires an Electronic Data Interchange (EDI) Provider Trading Partner Agreement to be on file.
  • If the provider is credentialed with PGBA and has an Electronic Data Interchange (EDI) Provider Trading Partner Agreement on file with PGBA the Optum Enrollment is not required.  
  • If the provider is not credentialed with PGBA, please complete the Optum Enrollment form process prior to sending claims.
  • Providers may now complete the EDI Provider Trading Partner Agreement, if not already on file with PGBA, for CPIDs 2872 and 5979.

Remittance:

• Payer enrollment for electronic remittance is required.
  • Providers currently receiving electronic remittance through Optum must complete a new enrollment form for CPIDs 2872 and 5979. 
  • New providers must complete a new enrollment form.
  • Providers may now enroll for electronic remittance for CPIDs 2872 and 5979.

Action Required: 

• Please be aware of the changes above and watch for future notifications regarding this transition and remittance enrollment.  

REF 15698973 12/27/2024

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Report Generation Delay for multiple CPIDs

Due to a payer intermediary processing issue, some Professional claims transmitted to the payers listed below on Dec. 26, 2024 were not processed by the payers.

Payers impacted: 

CPID	Payer Name
9267	Align Senior Care of Florida
2113	Allcare Health Plan
1764	Ambetter From Absolute Total Care
9278	Ambetter from Nebraska Total Care
9431	Ambetter from WellCare of Kentucky
9432	Ambetter from WellCare of New Jersey
9775	Ambetter of Alabama
9433	Ambetter of Oklahoma
2138	American Family Insurance
9142	American Health Advantage of Mississippi
7854	American Health Advantage of Oklahoma
9117	American Health Advantage of Texas
1741	Amerigroup
1412	Anthem Blue Cross and Blue Shield - Indiana
2421	Anthem Blue Cross and Blue Shield - Kentucky
1413	Anthem Blue Cross and Blue Shield (Virginia)
2418	Anthem Blue Cross and Blue Shield of Ohio
4437	Anthem Blue Cross Blue Shield New York
8749	Anthem MaineHealth
4881	Asuris Northwest Regence
7272	Axminster Medical Group
3845	Banner Health Network
1415	Blue Cross Blue Shield of Colorado
1407	Blue Cross Blue Shield of Georgia
7496	Blue Cross Blue Shield of Nevada
1169	Blue Cross Blue Shield of Western New York Medicaid/CHP
1401	Blue Cross Blue Shield of Wisconsin
1243	Blue Cross Community Centennial
1167	Blue Cross Medicare Advantage PPO/HMO
9162	Blue Medicare Advantage
6779	Bridgespan Regence
6165	Bridgeview
1750	Brown & Toland Physicians
4246	Capital Health Plan
2810	Capitol Administrators
8146	Care N Care Insurance Co.
2289	Care1st Health Plan of Arizona Medicaid DOS after 11/30/2022
9759	Care1st Health Plan of Arizona Medicaid DOS before 12/01/2022
9762	Care1st Health Plan of Arizona Medicare
4743	Carelon Behavioral Health
6127	Carelon Behavioral Health, MBHP
3293	Carelon Health
2830	CarePlus Health Plans
1194	CareSource of Georgia
7143	CareSource of Indiana
3826	CareSource of Ohio
7263	CareSource of West Virginia
6777	Centers Plan for Healthy Living
9765	Central Valley Medical Providers
7275	Citrus Valley Physicians Group
8123	Clear Health Alliance
7763	Columbine Health Plan
8834	Commonwealth Care Alliance DOS after 3/31/2023
8477	Community Care Plan
2160	Community Care Plan (Commercial)
6865	Community Care Plan (Medicaid)
8147	Community Care Plan (Palm Beach Health District)
1420	Connecticut Anthem Blue Cross Blue Shield
3419	Connecticut Federal Employee Health Benefits
6795	Contra Costa Health Plan
6241	Correctional Health Partners
7738	CountyCare Health Plan
9747	Delaware First Health
2433	Denver Health and Hospital Authority
8135	Doctors HealthCare Plans
3477	Early Intervention Central Billing
1119	Easy Choice Health Plan of California
4289	El Paso Health-CHIP
5483	Employee Benefit Management Services (EBMS)
1834	Employee Plans
8137	Empower Healthcare Solutions
1795	Envolve Benefit Options
9215	Everpointe
5238	Evolent Specialty Cardiology
3792	Fidelis Care
2875	First Health Network (Coventry Health Care National Network)
7435	FirstCare Health Plans
1414	Florida Blue Cross Blue Shield
3417	Florida Blue Cross Blue Shield Health Options HMO
9417	Florida Complete Care
2150	Florida Health Care Plans
5440	Fox Valley Medicine
6851	Friday Health Plans
8189	Gemcare IPA
8879	Georgia Health Advantage
2720	GlobalCare
9766	Gold Kidney Health Plan
1797	HAP CareSource Michigan Dual Medicare/Medicaid
5243	Healthcare Management Administrators
1723	HealthCare Partners IPA
4448	HealthLink PPO
7760	Healthy Blue Louisiana
8867	Healthy Blue Missouri
9133	Healthy Blue North Carolina
7715	Hopkins Health Advantage
6259	Humana - CareSource of Kentucky
7426	Idaho Regence Blue Shield
1405	Illinois Blue Cross Blue Shield
5865	Indian Health Services
4445	Insurance Management Services TX
4116	IntegraNet Health
1107	Integrated Health Partners (IHP)
8814	Integrated Homecare Services
1404	Iowa Wellmark Blue Cross Blue Shield
6733	Iowa Wellmark Blue Cross Blue Shield Crossover
5479	IU Health Plan Medicare Advantage
5432	Johns Hopkins Healthcare / Priority Partners
5882	Kane County IPA
7782	Kansas Health Advantage
9412	Leon Health Plans
7446	Maine Anthem Blue Cross Blue Shield
8812	Maryland Physicians Care
8860	Medica Government Programs
7859	Medica Health Plan Solutions
6799	Medica Individual and Family (IFB)
2287	Medicare Plus Blue of MI(MAP)
3475	Memorial Hermann Health Solutions
9102	Meridian Medicare Medicaid Plan
9118	MeridianComplete Michigan
2426	Michigan Blue Care Network
1421	Michigan Blue Cross Blue Shield
1402	Minnesota Blue Cross Blue Shield
1410	Minnesota Blue Cross Blue Shield CC Systems
7892	Minnesota Blue Cross Blue Shield Health Care Programs
1429	Minnesota Blue Cross Blue Shield HMO
5871	Mission Community IPA Medical Group
1408	Missouri Anthem Blue Cross Blue Shield
7450	Montana Blue Cross Blue Shield
7422	New Hampshire Anthem Blue Cross Blue Shield
7403	New Mexico Blue Cross Blue Shield
8864	NextBlue of North Dakota
1213	NHC Advantage
2411	North Dakota Blue Cross Blue Shield
1403	Oklahoma Blue Cross Blue Shield
2404	Oregon Regence Blue Cross Blue Shield
7829	Passport Advantage
9123	Perennial Advantage
9199	Piedmont Community Health Plan
8128	Pool Administrators, Inc.
4252	Presbyterian Salud
8468	Procare Advantage of TX
4253	Prominence Administrative Services
7281	PruittHealth Premier Medicare Advantage
5428	QualChoice of Arkansas
7264	Quartz ASO
1209	Regence Group Administrators
6879	RHA VestaCare
1776	RIS Rx
6246	Riverside Medical Clinic
4464	SCAN Health Plan
2254	Scott & White Health Plan
9438	Shared Health Mississippi
7225	Sharp Community Medical Group
8124	Simply Healthcare Plans, Inc.
8816	SOMOS Emblem
1740	Sonder Health Plans
2490	South Dakota Blue Cross Blue Shield
8134	Summit Community Care
1406	Texas Blue Cross Blue Shield
1729	Texas Childrens Health Plan (CHIP)
2483	Texas Childrens Health Plan (STAR Medicaid)
4278	The Boon Group
8763	U.S. Networks and Administrative Services
8473	Unicare (TX,MA,KS,WV,RI,IL)
2412	Utah Regence Blue Cross Blue Shield
2788	Utah Regence Blue Cross Blue Shield Federal Employee Program
7493	Vermont Blue Cross Blue Shield
4258	VNS Health
7451	Washington Regence Blue Shield
9430	Wellcare by Allwell of Oklahoma
1844	Wellcare Health Plans
3211	Wellcare Health Plans (Encounters)
1775	Wellpoint
9441	Wellspace NEXUS LLC
7489	Wyoming Blue Cross Blue Shield

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

This delay affected claims released to Optum between 2 p.m. CT and 6 p.m. CT on Dec. 26, 2024.

Action Required: Be aware of the processing issue above.

REF 15698970 12/27/2024

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Claim Processing Suspended for CPIDs 1632, 6118 Benefit Management of Kansas and CPIDs 4514, 1219 Benefit Management LLC/VBA

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

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

Payer Name: Benefit Management of Kansas
CPIDs: 1632, 6118
Payer ID: 48611
Reason: Payer unavailable electronically

Payer Name: Benefit Management LLC/VBA
CPIDs: 4514, 1219
Payer ID: 88092
Reason: Payer unavailable electronically

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

REF 15698878 12/26/2024

---

New Electronic Claims Connections Available

Optum has new electronic claims connections available: 

Assurance Reimbursement Management:

Payer Name:  Imagine Health

Institutional CPID: 4545

Professional CPID: 1231

Payer-assigned Payer ID: 43123

Payer Enrollment Required: No

Secondary Claims Accepted: Yes

Payer Location: Utah

Claims Fee: N/A

Assurance EDI:

Payer Name:  Imagine Health

Institutional CPID: 4545

Professional CPID: 1231

Payer-assigned Payer ID: 43123

Payer Enrollment Required: No

Secondary Claims Accepted: Yes

Payer Location: Utah

Claims Fee: $0.10

Action Required:

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

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

REF 15691159 12/23/2024

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Payer Change for CPIDs 4589, 8473 Unicare (TX,MA,KS,WV,RI,IL)

Effective January 1, 2025, claims for Unicare Health Plan of West Virginia currently exchanged with the following payer must use different CPIDs.

Current Payer Name: Unicare (TX,MA,KS,WV,RI,IL)
New Payer Name:  Unicare
Professional CPID: 8473
Institutional CPID: 4589
Payer-assigned Payer ID: 80314

Claims must begin using the following:

Payer Name: Wellpoint
Professional CPID: 1775
Institutional CPID:  2560
Payer-assigned Payer ID: WLPNT
Claim Fee: NA

NOTE: This only applies to UniCare Health Plan of West Virginia.  All other plans can continue to submit claims to CPIDs 8473, 4589 Unicare 

Enrollment Requirements: 

Claims:

• Payer enrollment for electronic claims is not required.

Remittance:

• Payer enrollment for electronic remittance is required.
  • Providers currently receiving electronic remittance through Optum for CPIDs 8473, 4589 Unicare do not need to complete a new enrollment form for CPIDs 1775, 2560 Wellpoint. 
  • New providers enrolling after Dec 14, 2024, must complete a new enrollment form for CPIDs 1775, 2560 Wellpoint.

Action Required: 

• Please be aware of the changes above and make any necessary changes in your system.
• To access the new enrollment forms, please visit Enrollment Central.

REF 15684724 12/23/2024

---

Payer Change for CPIDs 4589, 8473 Unicare (TX,MA,KS,WV,RI,IL)

Effective January 1, 2025, Unicare Health Plan of West Virginia claims currently exchanged with the following payer must use different CPIDs.

Current Payer Name: Unicare (TX,MA,KS,WV,RI,IL)
New Payer Name:  Unicare
Professional CPID: 8473
Professional Edit Master:  PE_N000
Institutional CPID:  4589
Institutional Edit Master: HE9N000
Payer-assigned Payer ID: 80314
Line of Business(LOB) Code: H27

Claims must begin using the following:

Payer Name: Wellpoint
Professional CPID: 1775
Professional Edit Master: PE_B800
Institutional CPID:  2560
Institutional Edit Master: HE9B801
Payer-assigned Payer ID: WLPNT
Line of Business(LOB) Code:  H1K

NOTE: This only applies to UniCare Health Plan of West Virginia.  All other plans can continue to submit claims to CPIDs 8473, 4589 Unicare 

Enrollment Requirements: 

Claims:

• Payer enrollment for electronic claims is not required.

Remittance:

• Payer enrollment for electronic remittance is required.
  • Providers currently receiving electronic remittance through Optum for CPIDs 8473, 4589 Unicare do not need to complete a new enrollment form for CPIDs 1775, 2560 Wellpoint. 
  • New providers enrolling after Dec 14, 2024, must complete a new enrollment form for CPIDs 1775, 2560 Wellpoint.

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

• Revalidate unreleased claims to edit correctly under new edit master. 
• Modify any bridge routines based on edit masters.
• Modify related Payer Alias names to the new CPIDs.
• To access the new enrollment forms, please visit Enrollment Central.

REF 15684725 12/23/2024

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Delay in NGS Electronic Remittance Advice (ERA)

There were issues that impacted clearinghouse delivery of remits from NGS (various payer IDs – see below) beginning Feb. 19, 2024, through April 19, 2024. NGS completed reprocessing remits for this period as of Dec. 20, 2024. If you are missing any remits from NGS for the above period, contact the payer to post the remits manually.

Payers Affected:

• CPID 3519 New York Medicare Empire
• CPID 1452 Connecticut Medicare
• CPID 3547 Maine Medicare
• CPID 5578 Rhode Island Medicare
• CPID 5506 Illinois Medicare

Action Required: Please be aware of a delay in the delivery of ERA for the dates above and contact the payer to post the remits manually.

REF 15686623 12/23/2024

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New Electronic Remittance (ERA) Connections Available on RPA

ERA (Remittance) transactions have recently been added for the following payers:

36423 – Zurich American Insurance Company
58213 – Healthways WholeHealth Network
AUX01 – Auxiant
TRDP1 – TRPN Direct Pay, Inc.
TRYMC – TROY MEDICARE

ERA enrollment/set up is required for all ERA transactions on RPA. 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 RPA, you can also open the RPA Resource Center, click the Quick Reference Guides tab, and then click the Billing Provider Enrollment link to find the payer enrollment intake form.

REF 15684608 12/20/2024

New Electronic Remittance Connections Available - Assurance EDI

This message is intended for Assurance EDI customers.

Optum has new electronic remittance connections available:

Payer Name: VillageCareMax
Institutional CPID: 7620
Professional CPID: 6834
Payer-assigned Payer ID: 26545
Payer Enrollment Required: Yes
Remittance Fee: N/A
Payer Location: New York

Action Required: 

• Add the payers to your system to begin using the new payer connection.
• Enrollment forms must be submitted and approved to begin receiving electronic remittance through Optum.

REF 15665917 12/19/2024

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New Electronic Remittance Connections Available - Assurance Reimbursement Management

This message is intended for Assurance Reimbursement Management customers.

Optum has new electronic remittance connections available:

Payer Name: VillageCareMax
Institutional CPID: 7620
Professional CPID: 6834
Payer-assigned Payer ID: 26545
Line of Business (LOB) Code: H2H
Payer Enrollment Required: Yes
Remittance Fee: N/A
Payer Location: New York

Action Required: 

• Add the payers to your system to begin using the new payer connection.
• Enrollment forms must be submitted and approved to begin receiving electronic remittance through Optum.

REF 15665918 12/19/2024

---

Palo Alto Medical Foundation Electronic Claims Connection No Longer Available

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

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

Assurance EDI:
Payer Name: Palo Alto Medical Foundation
Claim CPIDs: 9653, 6858
Payer-assigned Payer ID: 94115
Reason: Optum no longer has an electronic connection

Action Required: Claims must be submitted to Change Healthcare on paper.

Assurance Reimbursement Management:
Payer Name: Palo Alto Medical Foundation
Claim CPIDs: 9653, 6858
Payer-assigned Payer ID: 94115
Reason: Optum no longer has an electronic connection

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

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

REF 15675758 12/19/2024

---

Electronic Routing and Payer Name Change for CPIDs 7664 and 6437 Loyal American Life Insurance (Medicare Supplement)

This message is intended for Intelligent EDI customers.

Effective Dec. 19, 2024, Optum will be changing electronic claims routing for the following payer:

Current Payer Name: Loyal American Life Insurance (Medicare Supplement)
New Payer Name: Cigna Supplemental
Professional CPID: 6437
Institutional CPID: 7664
Industry Payer ID: 13193

Enrollment Requirements:
Claims:

• Payer enrollment for electronic claims is not required.

Report Changes:

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

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

• Make any necessary system changes.
• When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.

REF 15668560 12/18/2024

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Electronic routing change for CPID 8165 Oncology Physicians Network - Assurance EDI

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

Payer Name: Oncology Physicians Network

Professional CPID:  8165

Payer-assigned Payer ID: OPNC1

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.

REF 15667072 12/19/2024

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Electronic routing change for CPID 8165 Oncology Physicians Network - Assurance Reimbursement Management

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

Payer Name: Oncology Physicians Network

Professional CPID:  8165

Current Edit Master: PE_O007

New Edit Master:  PE_B800

Payer-assigned Payer ID: OPNC1

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 CPID are not changing.

REF 15667071 12/19/2024

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Payer Deactivation Notice - True Health New Mexico

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

Payer Name: True Health New Mexico
Payer ID: 82288

Reason: Health plan has been discontinued.

Action Required:

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

REF 15669573 12/19/2024

---

Update: Report Generation Delay for CPIDs 4581 and 2137 Michigan Medicaid

Update: It has been determined that the report delay below was due to a payer claims processing issue. We have retransmitted the impacted claims to the payer on Dec. 19, 2024.  Reports will be delivered once the claims have successfully processed at the payer.

Action Required: Please be aware of delays.

Original Notice Sent 12/18/24:

The payer listed below is experiencing issues affecting Institutional and Professional report generation for some claims submitted on Dec. 12, 2024.

Payer impacted: 

• CPID 4581 Michigan Medicaid
• CPID 2137 Michigan Medicaid

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

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

REF 15661611 / 15664071 12/19/2024

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New Electronic Claims Connections Available

This message is intended for Assurance EDI customers.

Optum has new electronic claims connections available:

Payer Name: Iowa Screening Programs

Institutional CPID: 8086

Payer-assigned Payer ID: USMBS

Payer Enrollment Required: No

Secondary Claims Accepted: No

Payer Location: Iowa

Claims Fee: $0.10

Action Required:

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

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

REF 15668508 12/19/2024

---

New Electronic Claims Connections Available

This message is intended for Assurance Reimbursement Management customers.

Optum has new electronic claims connections available:

Payer Name: Iowa Screening Programs

Institutional CPID: 8086

Payer-assigned Payer ID: USMBS

Payer Enrollment Required: No

Secondary Claims Accepted: No

Payer Location: Iowa

Claims Fee: N/A

Action Required:

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

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

REF 15668509 12/19/2024

---

Update: Report Generation Delay for CPID 2234 Illinois Health Partners

A payer intermediary is experiencing issues affecting professional report generation for some claims submitted on Dec. 10, 2024 and Dec. 11, 2024.

Payer impacted: 

• CPID 2234 Illinois Health Partners

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

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

REF 15668458 12/19/2024

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New Payer Name - Assurance Reimbursement Management

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

Previous Payer Name: River City Medical Group

New Payer Name: Vivant Health

Professional CPID: 6296

Institutional CPID: 5654

Edit Master:  PE_T007, HE9T007

Remit Line of Business (LOB) Code: U7V

Your existing Payer Alias entries will continue to work as they do currently; the new payer name is being provided for your reference. Be aware, all future communications for these CPIDs will reference the new payer name only.

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

REF 15661634 12/19/2024

---

New Payer Name - Assurance EDI

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

Previous Payer Name: River City Medical Group

New Payer Name: Vivant Health

Professional CPID: 6296

Institutional CPID: 5654

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

REF 15661633 12/19/2024

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Centers for Medicare & Medicaid Services HIPAA eligibility transaction system (HETS) attestation for Optum providers

You have a required action by Dec. 31, 2024 to attest your relationship to exchange HIPAA Eligibility Transaction System (HETS) 270/271 Beneficiary Eligibility transactions on your behalf.  

Centers for Medicare & Medicaid Services (CMS) has recently announced an initiative whereby HETS 270/271 suppliers / providers are required to submit attestation via these websites and use the code: VQAS

1. Durable Medical Equipment Medicare Administrative Contractor (DME MAC) (operated by National Government Services as CEDI) form
2. National Government Services Jurisdiction J6 and Jurisdiction JK form  

For questions please contact HETS at [email protected] or 1-866-324-7315.  

We value your partnership and encourage you to act soon.

Action required: Complete attestation by Dec. 31, 2024: HIPAA Eligibility Transaction System (HETS) attestation with Unique ID number: VQAS

REF 15655909 12/19/2024

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Claim and Remit Processing Termination for OptumCare Network of Connecticut (Payer ID E3287, CPID 1068, 7895)

Effective Jan. 1, 2025, the payer listed below will no longer accept claims. The last check run for OptumCare Network of Connecticut will run Jan. 8, 2025 for claims received prior to Jan. 1, 2025 and ERAs files will be processed shortly after.

Payer Name: OptumCare Network of Connecticut
CPIDs: 1068, 7895
Payer ID: E328
Reason: Payer runout period ended. This payer has completed its 2-year post-migration runout period and will no longer be accepting or processing claims for OptumCare Network of Connecticut. Claims for this payer with a Date of Service on or before Dec. 31, 2022 should be sent before the runout period ends Dec. 31, 2024.

Action Required: Send claims before runout period ends Dec. 31, 2024.

REF 15667408  12/19/2024

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New Electronic Claims Connections Available

Optum has new electronic claims connections available:

Payer Name: Fidelis Care New York Encounters
Professional CPID: 2770
Payer-assigned Payer ID: FIDENC
Payer Enrollment Required: No
Secondary Claims Accepted: Yes
Payer Location: New York
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.

REF 15666332  12/19/2024

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Electronic Routing Change for CPIDs 2164, 5976  Optum Maryland Behavior Health

Effective December 23, 2024, Optum will be changing electronic claims routing for the following payer:

Old Payer Name: Optum Maryland Behavior Health

New Payer Name: Carelon Behavioral Health Maryland

Professional CPID: 2164

Institutional CPID: 5976

Old Payer-assigned Payer ID: OMDBH

New Payer-assigned Payer ID: BHOMD

Please be aware that claims submitted December 20, 2024, through December 23, 2024, will be held and submitted to Carelon Behavioral Health Maryland on December 24, 2024.

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.

REF 15658928 12/19/2024

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Real-Time Notice - Utah Medicaid

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

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

Utah Medicaid UDOH0

Please note the enrollment requirements for new providers. In addition, providers who are not enrolled under the correct trading partner ID: HT000270-001 will need to re enroll.  

This payer requires provider registration directly through their "PRISM" UT Medicaid system for Enrollment. Please use this link to register with UT Medicaid “PRISM” for EDI/Transactions:
https://medicaid.utah.gov/prism

If you have questions regarding their website or enrollment process, please contact them directly at https://medicaid.utah.gov/contact

REF 15657010 12/18/2024

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Report Generation Delay for CPIDs 4581 and 2137 Michigan Medicaid

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

The payer listed below is experiencing issues affecting Institutional and Professional report generation for some claims submitted on Dec. 12, 2024.

Payer impacted:

• CPID 4581 Michigan Medicaid
• CPID 2137 Michigan Medicaid

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

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

REF 15661611 12/18/2024

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Report generation delay for CPIDs 2423 and 5558 Alabama Blue Cross Blue Shield

The payer listed below is experiencing issues affecting institutional and professional report generation for some claims submitted on Dec. 13, 2024.

Payer impacted: 

• CPID 2423 Alabama Blue Cross Blue Shield
• CPID 5558 Alabama Blue Cross Blue Shield

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

Action Required: Please be aware of delays in the report generation for claims submitted during the time frame above.

REF 15661610  12/18/2024

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Electronic Routing and Payer Name Change for CPIDs 7664 and 6437 Loyal American Life Insurance (Medicare Supplement)

This message is intended for Assurance Reimbursement Management customers.

Effective December 19, 2024, Optum will be changing electronic claims routing for the following payer:

Current Payer Name: Loyal American Life Insurance (Medicare Supplement)

New Payer Name: Cigna Supplemental

Professional CPID: 6437

Current Edit Master: PE_E049

New Edit Master: PE_T007

Institutional CPID: 7664

Current Edit Master: HE9E049

New Edit Master: HE9T007

Payer-assigned Payer ID: 13193

Enrollment Requirements:

Claims:

• Payer enrollment for electronic claims is not required. 

Report Changes:

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

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

• Revalidate unreleased claims to edit correctly under new edit master.
• Modify any bridge routines based on edit masters.
• No Payer Alias changes are required. Payer name and CPIDs are not changing.
• When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.

REF 15661020 12/18/2024

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Electronic Routing and Payer Name Change for CPIDs 7664 and 6437 Loyal American Life Insurance (Medicare Supplement)

Effective December 19, 2024, Optum will be changing electronic claims routing for the following payer:

Current Payer Name: Loyal American Life Insurance (Medicare Supplement)

New Payer Name: Cigna Supplemental

Professional CPID: 6437

Institutional CPID: 7664

Payer-assigned Payer ID: 13193

Enrollment Requirements:

Claims:

• Payer enrollment for electronic claims is not required. 

Report Changes:

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

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

• Make any necessary system changes.
• When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.

REF 15661021 12/18/2024

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Payer Transmit Delay for CPIDs 7421 and 3647 Rhode Island Medicaid

Due to a payer system issue, a delay is occurring in the transmissions to the following payer since Dec. 14, 2024.

Payer impacted:

• CPID 7421 Rhode Island Medicaid
• CPID 3647 Rhode Island Medicaid

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

This delay affects claims released to Optum since Dec. 13, 2024, 2:00 p.m. CT.

Action Required: Be aware of the transmit delay above.

REF 15661608  12/18/2024

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Payer Change for CPID 3040 Carelon Aetna Home Health

Effective January 1, 2025, Aetna will begin managing the Carelon Medicare Advantage network for Aetna members receiving services in Connecticut, Pennsylvania and West Virginia.  Providers will need to submit claims for these states to a different CPID starting with Dates of Service on or after January 1, 2025.

Claims and Remittance containing Dates of Service on or prior to December 31, 2024, must continue to use the following:

Payer Name: Carelon Aetna Home Health

Institutional CPID:  3040

Remittance Available: Yes

Payer-assigned Payer ID: 34010

NOTE: For the states of Connecticut, Pennsylvania and West Virginia, Carelon will continue to accept payer ID 34010 claims with DOS through 12/31/2024, however all 2024 claims need to be submitted to Carelon prior to 6/30/2025.

Claims and Remittance containing Dates of Service on or after January 1, 2025, must begin using the following:

Payer Name: Aetna

Institutional CPID:  4500

Remittance Available: Yes

Payer-assigned Payer ID: 60054

Claim Fee: No

NOTE: This only affects members receiving services in the states of Connecticut, Pennsylvania and West Virginia, all other states will continue to submit to CPID 3040 Carelon Aetna Home Health, payer ID 34010.

Enrollment Requirements:

Claims:

•   Payer enrollment for electronic claims is not required.

Remittance:

•   Payer enrollment for electronic remittance is required.

o   Providers currently receiving electronic remittance through Optum for CPID 4500 Aetna do not need to complete a new enrollment form.

o   Providers not receiving electronic remittance through Optum for CPID 4500 Aetna must complete a new enrollment form.

o   New providers must complete a new enrollment form.

For additional information, please refer to the payer website.

Action Required:

• Please be aware of the changes above and make any necessary changes in your system.
• To access the new enrollment forms, please visit Enrollment Central.

REF 15655658 12/18/2024

---

Electronic Claims Connection Suspended

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

Payer Name: Peak Pace Solutions

CPIDs: 5663

Payer ID: 27034

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

REF 15655508 12/18/2024

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Electronic Routing Change for CPIDs 2588 and 1780 - Managed Care Advisors - Sedgwick - Assurance EDI

This message is intended for Assurance EDI customers.

Effective Dec. 18, 2024, Optum will be changing electronic claims routing for the following payer:

Payer Name: Managed Care Advisors – Sedgwick
New Payer Name: MCA-Sedgwick WTCHP NPN
Professional CPID: 1780
Institutional CPID: 2588
Payer-assigned Payer ID: LV371

Enrollment Requirements:
Claims:

• Payer enrollment for electronic claims is not required.

Report Changes:

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

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

• Make any necessary system changes.
• When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.

REF 15652429 12/17/2024

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Electronic Routing Change for CPIDs 2588 and 1780 - Managed Care Advisors - Sedgwick - Assurance Reimbursement Management

This message is intended for Assurance Reimbursement Management customers.

Effective Dec. 18, 2024, Optum will be changing electronic claims routing for the following payer:

Payer Name: Managed Care Advisors – Sedgwick
New Payer Name: MCA-Sedgwick WTCHP NPN
Professional CPID: 1780
Current Edit Master: PE_O007
New Edit Master: PE_T007
Institutional CPID: 2588
Current Edit Master: HE9O007
New Edit Master: HE9T007
Payer-assigned Payer ID: LV371

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.

REF 15652428 12/17/2024

---

Electronic Routing Change for Multiple Payers - Assurance Reimbursement Management

This message is intended for Assurance Reimbursement Management customers.

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

Payer Name: Rightchoice Benefits Administrators
Professional CPID: 5807
Current Edit Master: PE_E049
New Edit Master: PE_T007
Institutional CPID: 2677
Current Edit Master: HE9E049
New Edit Master: HE9T007
Payer-assigned Payer ID: 37331

Payer Name: Wenatchee Valley Medical Center
Institutional CPID: 5992
Current Edit Master: HE9E049
New Edit Master: HE9T007
Payer-assigned Payer ID: 91064

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.

REF 15651509 12/17/2024

---

Electronic Routing Change for Multiple Payers - Assurance EDI

This message is intended for Assurance EDI customers.

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

Payer Name: Rightchoice Benefits Administrators
Professional CPID: 5807
Institutional CPID: 2677
Payer-assigned Payer ID: 37331
Claims Fee: $0.10

Payer Name: Wenatchee Valley Medical Center
Institutional CPID: 5992
Payer-assigned Payer ID: 91064
Claims Fee: $0.10

Enrollment Requirements:
Claims:

• Payer enrollment for electronic claims is not required.

Report Changes:

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

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

• Make any necessary system changes.
• When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.

REF 15651508 12/17/2024

---

Payer Change for CPIDs 2923, 8455 Peoples Health Network - Assurance EDI

This message is intended for Assurance EDI customers.

Effective immediately, claims currently exchanged with the following payer must use different CPIDs.

Claims and Remittance containing Dates of Service on or prior to Dec. 31, 2023, must continue to use the following. After Jan. 1, 2025, this payer will be terminated:

Payer Name: Peoples Health Network

Professional CPID: 8455

Institutional CPID: 2923

Remittance Available: Yes

Payer-assigned Payer ID: 72126

All Claims and Remittance must begin using the following on Jan. 1, 2025:

Payer Name: UnitedHealthcare

Professional CPID: 3429

Institutional CPID: 3550

Remittance Available: Yes

Payer-assigned Payer ID: 87726

Claim Fee: N/A

Enrollment Requirements: 

Claims:

• Payer enrollment for electronic claims is not required.

Remittance:

• Payer enrollment for electronic remittance is required.
• Providers currently receiving electronic remittance through Optum for CPIDs 3429, 3550 UnitedHealthcare do not need to complete a new enrollment form.  
• Providers not receiving electronic remittance through Optum for CPIDs 3429, 3550 UnitedHealthcare must complete a new enrollment form.
• New providers must complete a new enrollment form.

Action Required:  

• Please be aware of the changes above and make any necessary changes in your system.
• To access the new enrollment forms, please visit Enrollment Central.

REF 15644439 12/17/2024

---

Payer Change for CPIDs 2923, 8455 Peoples Health Network - Assurance Reimbursement Management 

This message is intended for Assurance Reimbursement Management customers.

Effective immediately, claims currently exchanged with the following payer must use different CPIDs.

Claims and Remittance containing Dates of Service on or prior to Dec. 31, 2023, must continue to use the following. After Jan. 1, 2025, this payer will be terminated:

Payer Name: Peoples Health Network

Professional CPID: 8455

Professional Edit Master: PE_E049

Institutional CPID: 2923

Institutional Edit Master: HE9E049

Payer-assigned Payer ID: 72126

Line of Business Code (LOB): U1V 

All Claims and Remittance must begin using the following on Jan. 1, 2025:

Payer Name: UnitedHealthcare

Professional CPID: 3429

Professional Edit Master: PE_U012

Institutional CPID: 3550

Institutional Edit Master: HE9U012

Payer-assigned Payer ID: 87726

Line of Business Code (LOB): U39

Enrollment Requirements: 

Claims:

• Payer enrollment for electronic claims is not required.

Remittance:

• Payer enrollment for electronic remittance is required.
• Providers currently receiving electronic remittance through Optum for CPIDs 3429, 3550 UnitedHealthcare do not need to complete a new enrollment form.  
• Providers not receiving electronic remittance through Optum for CPIDs 3429, 3550 UnitedHealthcare must complete a new enrollment form.
• New providers must complete a new enrollment form.

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

• Revalidate unreleased claims to edit correctly under new edit master.  
• Modify any bridge routines based on edit masters.
• Modify related Payer Alias names to the new CPIDs.
• To access the new enrollment forms, please visit Enrollment Central.

REF 15644438 12/17/2024

---

Electronic Routing Change for CPIDs 5642 and 6273 Lifepath Hospice

This message is intended for Assurance Reimbursement Management customers.

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

Payer Name: Lifepath Hospice

Professional CPID: 6273

Current Edit Master: PE_E049

New Edit Master: PE_B800

Institutional CPID: 5642

Current Edit Master: HE9E049

New Edit Master: HE9B801

Payer-assigned Payer ID: 76870

Enrollment Requirements:

Claims:

• Payer enrollment for electronic claims is not required.

Report Changes:

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

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

• Revalidate unreleased claims to edit correctly under new edit master.
• Modify any bridge routines based on edit masters.
• No Payer Alias changes are required. Payer name and CPIDs are not changing.
• When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.

REF 15651511 12/17/2024

---

Report Generation Delay for Multiple CPIDs

A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted since Dec. 3, 2024.

Payers impacted:

• CPID 8286 Cofinity Group Resources
• CPID 3035 Cofinity Group Resources
• CPID 3705 Employee Benefit Concepts Michigan

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

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

REF 15651478  12/17/2024

---

Electronic Routing Change for CPIDs 5642 and 6273 Lifepath Hospice

This message is intended for Assurance EDI customers.

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

Payer Name: Lifepath Hospice

Professional CPID: 6273

Institutional CPID: 5642

Payer-assigned Payer ID: 76870

Claims Fee: $0.10

Enrollment Requirements:

Claims:

• Payer enrollment for electronic claims is not required. 

Report Changes:

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

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

• Make any necessary system changes.
• When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.

REF 15651510 12/17/2024

---

New Electronic Claims Connections Available

Optum has new electronic claims connections available: 

Payer Name:  Northwell Direct

Institutional CPID: 8084

Professional CPID: 2881

Payer-assigned Payer ID: 88987

Payer Enrollment Required: No

Secondary Claims Accepted: No

Payer Location: New York

Claims Fee: N/A

Action Required: 

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

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

REF 15651513 12/17/2024

---

New Electronic Claims Connections Available

Optum has new electronic claims connections available: 

Payer Name:  Northwell Direct

Institutional CPID: 8084

Professional CPID: 2881

Payer-assigned Payer ID: 88987

Payer Enrollment Required: No

Secondary Claims Accepted: No

Payer Location: New York

Claims Fee: $0.10

Action Required: 

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

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

REF 15651512 12/17/2024

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Report Generation Delay for Multiple CPIDs

The payers listed below are experiencing issues affecting Institutional and Professional report generation for some claims submitted on Nov. 27, 2024,  and  Dec. 4, 2024.

Payers impacted: 

• CPID 1411 North Carolina Blue Cross Blue Shield
• CPID 3562 North Carolina Blue Cross Blue Shield
• CPID 7514 Blue Medicare PPO/HMO of North Carolina

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

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

REF 15651477 12/17/2024

---

New Electronic Claims and Remittance Connections Available

Optum has new electronic claims and remittance connections available:

Payer Name: Altais Care Network
Institutional CPID: 7944
Professional CPID: 2778
Payer-assigned Payer ID: ACN90
Line of Business(LOB) Code: U9X
Payer Claim Enrollment Required: No
Payer Remittance Enrollment Required: Yes
Secondary Claims Accepted: Yes
Payer Location: California
Claims Fee: N/A
Remittance Fee: N/A

Action Required:

• Add the payers 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.

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

REF 15649273  12/17/2024

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New Electronic Claims and Remittance Connections Available

Optum has new electronic claims and remittance connections available:

Payer Name: Altais Care Network
Institutional CPID: 7944
Professional CPID: 2778
Payer-assigned Payer ID: ACN90
Payer Claim Enrollment Required: No
Payer Remittance Enrollment Required: Yes
Secondary Claims Accepted: Yes
Payer Location: California
Claims Fee: N/A
Remittance Fee: N/A

Action Required:

• Add the payers 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.

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

REF 15639272  12/17/2024

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WPP Eldercare Electronic Claims Connection No Longer Available

Effective immediately, the connection listed below is no longer available for claims processing.

Payer Name: WPP Eldercare

Claim CPIDs: 3202, 5983

Payer-assigned Payer ID: 77080

Reason: Payer no longer offers an electronic connection for which Optum can build connectivity.

Action Required: None.

REF 15641146 12/17/2024

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Report Generation Delay for CPID 4448 HealthLink PPO

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

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted on Dec. 5, 2024, and Dec. 6, 2024.

Payer impacted:

• CPID 4448 HealthLink PPO

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

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

REF 15636263 12/16/2024

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New Electronic Remittance Connections Available - Assurance EDI

This message is intended for Assurance EDI customers.

Optum has new electronic remittance connections available:   

Payer Name: Troy Medicare

Institutional CPID: 7953

Professional CPID: 2812

Payer-assigned Payer ID: TRYMC

Payer Enrollment Required: Yes

Remittance Fee: N/A

Payer Location: North Carolina

Action Required: 

• Add the payers to your system to begin using the new payer connection.
• Enrollment forms must be submitted and approved to begin receiving electronic remittance through Optum.

REF 15635008 12/16/2024

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Payer Change for CPIDs 7107, 7683, Med Pay - Assurance Reimbursement Management

This message is intended for Assurance Reimbursement Management customers.

Payer Name: Med Pay
Professional CPID: 7107
Professional Edit Master: PE_E049
Institutional CPID: 7683
Institutional Edit Master: HE9E049
Payer-assigned Payer ID: 88058

Claims must begin using the following:
Payer Name: Med Pay
Professional CPID: 7480
Professional Edit Master: PE_T007
Institutional CPID: 7075
Institutional Edit Master: HE9T007
Payer-assigned Payer ID: 88058

Payer enrollment for electronic claims is not required.

Remittance:

• Payer enrollment for electronic remittance is required.
  • Providers currently receiving electronic remittance through Optum for CPIDs 7107, 7683, Med Pay, do not need to complete a new enrollment form. 
  • Providers not receiving electronic remittance through Optum for CPIDs 7107, 7683, Med Pay must complete a new enrollment form.
  • New providers must complete a new enrollment form.

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

• Revalidate unreleased claims to edit correctly under new edit master. 
• Modify any bridge routines based on edit masters.
• Modify related Payer Alias names to the new CPIDs.
• To access the new enrollment forms, please visit Enrollment Central.

REF 15631396 12/16/2024

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999 Payer Batch Rejections for CPID 5575 New Jersey Charity Care Inpatient

Institutional claims transmitted to the payer listed below from Optum Dec. 13, 2024 were not processed by the payer due to a 999 Batch Rejection.

• CPID 5575 New Jersey Charity Care Inpatient

A resolution has been implemented and the claims were retransmitted to the payer Dec. 16, 2024.

Action Required: None.

REF 15638129  12/16/2024

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St. Barnabas Health Plan Electronic Claims Connection No Longer Available

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

Payer Name: St. Barnabas Health Plan

Claim CPIDs: 1897, 8590

Payer-assigned Payer ID: 22240

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

Action Required: None.

REF 15631007 12/16/2024

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Report Generation Delay for CPIDs 2936 and 3757 IMAGINE360 ADMINISTRATORS (GPA)

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

Payer impacted:

• CPID 2936 IMAGINE360 ADMINISTRATORS (GPA)
• 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.

REF 15636261 12/16/2024

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Electronic Claims Connection Suspended

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

Payer Name: Rhode Island Medicaid

CPID: 3647, 7421, 2405, 6075

Payer ID: SKRI0

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

REF 15636158 12/16/2024

---

New Electronic Remittance Connections Available

Optum has new electronic remittance connections available:

Payer Name: Troy Medicare

Institutional CPID: 7953

Professional CPID: 2812

Payer-assigned Payer ID: TRYMC

Line of Business (LOB) Code: N40

Payer Enrollment Required: Yes

Remittance Fee: N/A

Payer Location: North Carolina

Action Required: 

• Add the payers to your system to begin using the new payer connection.
• Enrollment forms must be submitted and approved to begin receiving electronic remittance through Optum.

REF 15635009 12/16/2024

---

Optum Alert: Report Generation Delay for CPID 5428 QualChoice of Arkansas

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

Payer impacted: 

• CPID 5428 QualChoice of Arkansas

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

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

REF 15636260 12/16/2024

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Optum Alert: Rhode Island Medicaid Suspended

Out of an abundance of caution, Optum's Medical Network clearinghouse has suspended all transactions to Rhode Island Medicaid. Please see Governor McKee Issues Update on Cybersecurity Breach of RIBridges System | Governor's Office, State of Rhode Island for additional information. Please see the impacted payer IDs below.

Optum is actively monitoring the situation and will work to restore processing for this payer as soon as possible.

Claims and ERA Payer IDs:
Payer ID: SKRI0
Professional CPID: 7421, 2405
Institutional CPID: 3647, 6075
intelligent EDI Payer ID: RIMCD, 12K74, SKRI0

Real Time Payer IDs:
Intelligent Medical Network and Revenue Performance Advisor Payer ID: SKRI0
Legacy Change Healthcare Payer ID: 12K74

Action Required:

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

REF 15634972  12/16/2024

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Payer Change for CPIDs 7107, 7683, Med Pay

Effective immediately, claims currently exchanged with the following payer must use different CPIDs.

Payer Name: Med Pay
Professional CPID: 7107
Institutional CPID: 7683
Payer-assigned Payer ID: 88058 

Claims must begin using the following:

Payer Name: Med Pay
Professional CPID: 7480
Institutional CPID:  7075
Payer-assigned Payer ID: 88058
Claim Fee: N/A

Enrollment Requirements: 

Claims:

• Payer enrollment for electronic claims is not required.

Remittance:

• Payer enrollment for electronic remittance is required.
  • Providers currently receiving electronic remittance through Optum for CPIDs 7107, 7683, Med Pay, do not need to complete a new enrollment form. 
  • Providers not receiving electronic remittance through Optum for CPIDs 7107, 7683, Med Pay must complete a new enrollment form.
  • New providers must complete a new enrollment form.

Action Required: 

• Please be aware of the changes above and make any necessary changes in your system.
• To access the new enrollment forms, please visit Enrollment Central.

REF 15631395 12/16/2024

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Update: Report Generation Delay for CPIDs 4557 and 2875 First Health Network (Coventry Health Care National Network)

Update: The payer intermediary has been unable to generate and deliver the reports for some claims submitted Nov. 21, 2024 and Nov. 22, 2024.

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

Original notify REF 828450 sent Dec. 2, 2024:
A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted Nov. 21, 2024 and Nov. 22, 2024.

Payer impacted:

• CPID 4557 First Health Network (Coventry Health Care National Network)
• CPID 2875 First Health Network (Coventry Health Care National Network)

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

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

REF 15631853  12/16/2024

---

Eligibility Fee Change for Multiple Payers

Effective Jan. 1, 2025, the following Eligibility fees will change:

Payer Name: Boon Chapman Administrators

Real Time Payer ID: 74238        

Industry Payer ID: 74238

Current Fee: $0.00

New Fee: $0.01

Payer Name: Health Plan of San Joaquin

Real Time Payer ID: 68035               

Industry Payer ID: 68035

Current Fee: $0.00

New Fee: $0.01

Payer Name: MS State Employee Health Plan

Real Time Payer ID: XSEHP              

Industry Payer ID: 00230

Current Fee: $0.00

New Fee: $0.03

Action Required: Please be aware of the fee changes.

REF 15633214 12/16/2024

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Report Generation Delay for CPID 7489 Wyoming Blue Cross Blue Shield

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

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted on Dec. 6, 2024.

Payer impacted:

• CPID 7489 Wyoming Blue Cross Blue Shield

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

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

REF 15626311 12/13/2024

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Report Generation Delay for CPIDs 7070 and 9458 CareSource Ohio Medicaid

A payer is experiencing issues affecting Professional and Institutional report generation for some claims submitted since Dec. 10, 2024.

Payer impacted:

• CPID 7070 CareSource Ohio Medicaid
• CPID 9458 CareSource Ohio Medicaid

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

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

REF 15629271 12/13/2024

---

Eligibility Fee Change for Multiple Payers

Effective Jan. 1, 2025, the following Eligibility fees will change:

Payer Name: Boon Chapman Administrators

Real Time Payer ID: BNCHAP

Industry Payer ID: 74238

Current Fee: $0.00

New Fee: $0.01

Payer Name: Health Plan of San Joaquin

Real Time Payer ID: SJHP

Industry Payer ID: 68035

Current Fee: $0.00

New Fee: $0.01

Payer Name: MS State Employee Health Plan

Real Time Payer ID: MSSEHP

Industry Payer ID: 00230

Current Fee: $0.00

New Fee: $0.03

Action Required: Please be aware of the fee changes.

REF 15623664 12/12/2024

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New Electronic Claims and Remittance Connections Available - Assurance EDI

This message is intended for Assurance EDI customers.

Optum has new electronic claims and remittance connections available:

Payer Name: Wellstar Health Plan
Institutional CPID: 7955
Professional CPID: 2813
Payer-assigned Payer ID: RP129
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 payers 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

REF 15613466 12/12/2024

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New Electronic Claims and Remittance Connections Available - Assurance Reimbursement Management

This message is intended for Assurance Reimbursement Management customers.

Optum has new electronic claims and remittance connections available:

Payer Name: Wellstar Health Plan
Institutional CPID: 7955
Professional CPID: 2813
Payer-assigned Payer ID: RP129
Line of Business (LOB) Code: N42
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 payers 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.

REF 15613467 12/12/2024

---

Electronic Remittance Routing Change for CPIDs 6467 and 1579, Government Employees Health Association

This message is intended for Assurance EDI customers.

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

Payer Name:  Government Employees Health Association

Professional CPID:  6467

Institutional CPID:  1579

Payer-assigned Payer ID: 44054  

Enrollment Requirements: 

Remittance: 

Payer enrollment for electronic remittance is required.

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

New providers must complete a new enrollment form. 

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.

REF15614008 12/12/2024

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Electronic Remittance Routing Change for CPIDs 6467 and 1579, Government Employees Health Association

This message is intended for Assurance Reimbursement Management customers.

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

Payer Name: Government Employees Health Association

Professional CPID:  6467

Institutional CPID:   1579

Line of Business Code (LOB): H45

Payer-assigned Payer ID: 44054

Enrollment Requirements: 

Remittance: 

• Payer enrollment for electronic remittance is required. 
  • Providers currently receiving electronic remittance through Optum must complete a new enrollment form. 
  • New providers must complete a new enrollment form. 

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: 

• 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.

REF15614009 12/12/2024

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Payer Change for CPIDs 1253, 4585 TRICARE East Region

This message is intended for Assurance Reimbursement Management customers.

Optum has been informed that PGBA will begin administering electronic claims and remittances for the payer identified below effective Jan. 1, 2025. We are currently working to obtain transition details and will send additional information regarding electronic remittance enrollment as soon as it becomes available.

Effective Jan. 1, 2025, claims and remittance currently exchanged with the following payer must use different CPIDs based on your new TRICARE contract:

Claims and Remittance containing Dates of Service (DOS) on or prior to Dec. 31, 2024, must continue to use the following through April 30, 2025:

Payer Name: TRICARE East Region DOS before Jan. 1, 2025

Professional CPID: 1253

Professional Edit Master: PE_B026

Institutional CPID:  4585

Institutional Edit Master: HE9B023

Payer-assigned Payer ID: TREST

Line of Business Code (LOB): M08

Claims and Remittance containing Dates of Service on or after January 1, 2025, must begin using the following based on your TRICARE contract:

Payer Name: TRICARE East Region

Professional CPID: 2872

Professional Edit Master: PE_B026

Institutional CPID: 5979

Institutional Edit Master: HE9B023

Payer-assigned Payer ID: 99727

Line of Business Code (LOB): M08

NOTES:

• Beginning May 1, 2025, submit 2024 claims to CPIDs 2872 and 5979 TRICARE East Region.
• The following states are moving to the TRICARE West Region: Arkansas, Illinois, Louisiana, Oklahoma, Texas, and Wisconsin. TRICARE West providers should use CPIDs 5648 for institutional and 6286 for professional transactions. Enrollment forms can be accessed through Enrollment Central.
• For additional information regarding this change please see Humana Military’s Provider Update page - Provider Updates.

Enrollment Requirements for TRICARE East Region CPIDs 2872 and 5979:

Claims:

Payer enrollment for electronic claims is not required.

Remittance:

• Payer enrollment for electronic remittance is required.
  • Providers currently receiving electronic remittance through Optum must complete a new enrollment form for CPIDs 2872 and 5979.
  • New providers must complete a new enrollment form.
  • Optum will send an updated notification informing providers when they can begin enrolling for electronic remittance for CPIDs 2872 and 5979.

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

• Please be aware of the changes above and watch for future notifications regarding this transition and remittance enrollment. 
• Revalidate unreleased claims to edit correctly under new edit master.
• Modify any bridge routines based on edit masters.
• Modify related Payer Alias names to the new CPIDs.

REF 15613468 12/12/2024

---

Christus Spohn Electronic Claims Connection No Longer Available

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

Payer Name: Christus Spohn
Claim CPIDs: 8927, 3282
Payer-assigned Payer ID: SPOHN
Reason: Electronic connection no longer available.

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

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

REF 15619360  12/12/2024

---

Payer Change for CPIDs 1253, 4585 TRICARE East Region

This message is intended for Assurance EDI customers.

Optum has been informed that PGBA will begin administering electronic claims and remittances for the payer identified below effective Jan. 1, 2025. We are currently working to obtain transition details and will send additional information regarding electronic remittance enrollment as soon as it becomes available.

Effective Jan. 1, 2025, claims and remittance currently exchanged with the following payer must use different CPIDs based on your new TRICARE contract:

Claims and Remittance containing Dates of Service (DOS) on or prior to Dec. 31, 2024 must continue to use the following through April 30, 2025:

Payer Name: TRICARE East Region DOS before Jan. 1, 2025

Professional CPID: 1253

Institutional CPID: 4585

Remittance Available: Yes

Payer-assigned Payer ID: TREST

Claims and Remittance containing Dates of Service on or after Jan. 1, 2025 must begin using the following based on your TRICARE contract:

Payer Name: TRICARE East Region

Professional CPID: 2872

Institutional CPID: 5979

Remittance Available: Yes

Payer-assigned Payer ID: 99727

Claim Fee: No

NOTES:

• Beginning May 1, 2025, submit 2024 claims to CPIDs 2872 and 5979 TRICARE East Region.
• The following states are moving to the TRICARE West Region: Arkansas, Illinois, Louisiana, Oklahoma, Texas, and Wisconsin. TRICARE West providers should use CPIDs 5648 for institutional and 6286 for professional transactions. Enrollment forms can be accessed through Enrollment Central.
• For additional information regarding this change please see Humana Military’s Provider Update page - Provider Updates.

Enrollment Requirements for TRICARE East Region CPIDs 2872 and 5979:

Claims:

• Payer enrollment for electronic claims is not required.

Remittance:

• Payer enrollment for electronic remittance is required.
• Providers currently receiving electronic remittance through Optum must complete a new enrollment form for CPIDs 2872 and 5979.
• New providers must complete a new enrollment form.
• Optum will send an updated notification informing providers when they can begin enrolling for electronic remittance for CPIDs 2872 and 5979.

Action Required:

• Please be aware of the changes above and watch for future notifications regarding this transition and remittance enrollment. 

REF 15617871 12/12/2024

---

Payer Change for CPID 6117 Independence Medical Group – Kern County and CPID 6119 Independence Medical Group – Tulare County

Effective immediately, claims currently exchanged with the following payers must use different CPIDs.

Assurance Reimbursement Management:

Payer Name: Independence Medical Group - Kern County

Professional CPID: 6117

Professional Edit Master: PE_O007 

Payer-assigned Payer ID: IMG01

 

Payer Name: Independence Medical Group - Tulare County

Professional CPID: 6119

Professional Edit Master: PE_O007 

Payer-assigned Payer ID: IMG02

Claims must begin using the following:

Payer Name: GEMCare - Kern County

Professional CPID:  6100

Professional Edit Master: PE_O007 

Institutional CPID:  4607

Institutional Edit Master:  HE9O007

Payer-assigned Payer ID: MCS03

• Payer enrollment for electronic claims is not required.

Remittance:

• Payer enrollment for electronic remittance is required.

o Providers currently receiving electronic remittance through Optum for CPIDs 6100, 4607 GEMCare - Kern County do not need to complete a new enrollment form. 

o Providers not receiving electronic remittance through Optum for CPIDs 6100, 4607 GEMCare - Kern County) must complete a new enrollment form.

o New providers must complete a new enrollment form.

Effective December 23, 2024, Independence Medical Group - Kern County Payer ID IMG01 and Independence Medical Group - Tulare County – Payer ID IMG02 will no longer be available at Optum for claims.  

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

• Revalidate unreleased claims to edit correctly under new edit master. 
• Modify any bridge routines based on edit masters.
• Modify related Payer Alias names to the new CPIDs.
• To access the new enrollment forms, please visit Enrollment Central.

REF 15621312 12/12/2024

---

Payer Change for CPID 6117 Independence Medical Group – Kern County and CPID 6119 Independence Medical Group – Tulare County

Effective immediately, claims currently exchanged with the following payers must use different CPIDs.

Assurance EDI:

Payer Name: Independence Medical Group - Kern County

Professional CPID: 6117

Payer-assigned Payer ID: IMG01

 

Payer Name: Independence Medical Group - Tulare County

Professional CPID: 6119

Payer-assigned Payer ID: IMG02 

 

Claims must begin using the following:

Payer Name: GEMCare - Kern County

Professional CPID: 6100

Institutional CPID: 4607

Payer-assigned Payer ID: MCS03

Claim Fee: N/A

Enrollment Requirements: 

Claims:

• Payer enrollment for electronic claims is not required.

Remittance:

• Payer enrollment for electronic remittance is required.

o Providers currently receiving electronic remittance through Optum for CPIDs 6100, 4607 GEMCare - Kern County do not need to complete a new enrollment form. 

o Providers not receiving electronic remittance through Optum for CPIDs 6100, 4607 GEMCare - Kern County must complete a new enrollment form.

o New providers must complete a new enrollment form.

Effective December 23, 2024, Independence Medical Group - Kern County Payer ID IMG01 and Independence Medical Group - Tulare County – Payer ID IMG02 will no longer be available at Optum for claims.  

Action Required: 

• Please be aware of the changes above and make any necessary changes in your system.
• To access the new enrollment forms, please visit Enrollment Central.

REF 15621311 12/12/2024

---

Payer Processing Issue for Clover Health 6433,5666

Due to a payer processing issue, Professional and Institutional claims submitted to the payer listed below may have received the following rejections for claims submitted October 1, 2024, through present:

• REJECTED BY ADJUDICATION SYSTEM: DIAGNOSIS CODE
• REJECTED BY ADJUDICATION SYSTEM: PROCEDURE CODE
• REJECTED BY ADJUDICATION SYSTEM: PRINCIPAL DIAGNOSIS CODE

Payers Affected:

• CPID 6433 Clover Health
• CPID 5666 Clover Health

Additional updates will be forwarded as more information becomes available.

Action Required: Please be aware of the processing issue.

We apologize for any inconvenience as we work to resolve. If you have any questions, feel free to contact your Customer Support Team and refer to case 09146856.

REF 15619960 12/12/2024

---

Update: UCARE Plans & Aspirus Medicare Advantage - Real Time Payer Update

This message is to all submitters sending eligibility transactions through Optum.

Update: Real time eligibility transactions (270/271) for the following payers below have been restored. Please disregard the original message below. We will keep you updated if there are any changes to this payer connection.

Original message sent Dec. 12, 2024, 10:19 a.m.
Effective Dec. 13, 2024, real-time transactions (270/271) will be unavailable. This impacts current real-time eligibility transactions for the Payer IDs listed below. We are working to restore this connection as soon as possible and will continue to keep you posted on our progress.

The affected payers are:

• UCare Individual And Famly Plan (55413/MNUCAR)
  • ASPIRUS MEDICARE ADVANTAGE (36483/ASPRS)
  • UCARE OF MINNESOTA - DOS BEFORE 1/1/2022 (SX178/12X50/SX178/UCARM)

Action Required by Customer:
Effective Dec. 13, 2024 270/271 transactions sent to the above payers may result in an error until connection has been restored. We will keep you updated on restoration of this connections as soon as it is available.

Action Taken by Optum:
Optum is working to restore new connectivity to these payers.

REF 15617066  12/12/24

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Payer Change for CPIDs 4589, 8473 Unicare (TX,MA,KS,WV,RI,IL)

This message is intended for Assurance EDI customers.

Effective January 1, 2025, Unicare Health Plan of West Virginia claims currently exchanged with the following payer must use different CPIDs.

Current Payer Name: Unicare (TX, MA, KS, WV, RI, IL)

New Payer Name: Unicare

Professional CPID: 8473

Institutional CPID: 4589

Payer-assigned Payer ID: 80314

Claims must begin using the following:

Payer Name: Wellpoint

Professional CPID: 1775

Institutional CPID: 2560

Payer-assigned Payer ID: WLPNT

Claim Fee: N/A

NOTE: This only applies to UniCare Health Plan of West Virginia. All other plans can continue to submit claims to CPIDs 8473, 4589 Unicare.

Enrollment Requirements:

Claims:

• Payer enrollment for electronic claims is not required.

Remittance:

• Payer enrollment for electronic remittance is required.
  • Providers currently receiving electronic remittance through Optum for CPIDs 8473, 4589 Unicare do not need to complete a new enrollment form for CPIDs 1775, 2560 Wellpoint.
  • New providers enrolling after Dec 14, 2024, must complete a new enrollment form for CPIDs 1775, 2560 Wellpoint.

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

• Please be aware of the changes above and make any necessary changes in your system.
• To access the new enrollment forms, please visit Enrollment Central.

REF 15617108 12/12/2024

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Payer Change for CPIDs 4589, 8473 Unicare (TX,MA,KS,WV,RI,IL)

This message is intended for Assurance Reimbursement Management customers.

Effective January 1, 2025, Unicare Health Plan of West Virginia claims currently exchanged with the following payer must use different CPIDs.

Current Payer Name: Unicare (TX, MA, KS, WV, RI, IL)

New Payer Name: Unicare

Professional CPID: 8473

Professional Edit Master: PE_N000

Institutional CPID: 4589

Institutional Edit Master: HE9N000

Payer-assigned Payer ID: 80314

Line of Business (LOB) Code: H27

Claims must begin using the following:

Payer Name: Wellpoint

Professional CPID: 1775

Professional Edit Master: PE_B800 

Institutional CPID: 2560

Institutional Edit Master: HE9B801

Payer-assigned Payer ID: WLPNT

Line of Business (LOB) Code: H1K

NOTE:  This only applies to UniCare Health Plan of West Virginia. All other plans can continue to submit claims to CPIDs 8473, 4589 Unicare.

Enrollment Requirements:

Claims:

• Payer enrollment for electronic claims is not required.

Remittance:

• Payer enrollment for electronic remittance is required.
  • Providers currently receiving electronic remittance through Optum for CPIDs 8473, 4589 Unicare do not need to complete a new enrollment form for CPIDs 1775, 2560 Wellpoint.
  • New providers enrolling after Dec 14, 2024, must complete a new enrollment form for CPIDs 1775, 2560 Wellpoint.

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

• Revalidate unreleased claims to edit correctly under new edit master.
• Modify any bridge routines based on edit masters.
• Modify related Payer Alias names to the new CPIDs.
• To access the new enrollment forms, please visit Enrollment Central.

REF 15617109 12/12/2024

---

Update: Report Generation Delay for CPID 1253 TRICARE East Region DOS before 1/1/25

It has been determined that the report delay below was due to a WPS claims processing issue. We have retransmitted the impacted claims to WPS on Dec. 12, 2024.  Reports will be delivered once the claims have successfully processed at the payer.

Action Required: Please be aware of delays.

Original Notice Sent Dec. 12, 2024:

WPS is experiencing issues affecting Professional report generation for some claims submitted on Dec. 6, 2024, and Dec. 9, 2024.

Payer impacted:

• CPID 1253 TRICARE East Region DOS before Jan. 1, 2025.

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

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

REF 15614012 12/12/24

---

New Payer Name

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

Previous Payer Name: Neighborhood Health Plan Rhode Island – Exchange, Unity, Integrity

New Payer Name: Neighborhood Health Plan Rhode Island – INTEGRITY (MMP)

Professional CPID:  7171

Institutional CPID:  8612

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

REF 15611358 12/12/2024

---

Electronic Claims Connection Reactivated

Effective immediately, the payer listed below has been reactivated at Optum for claims processing and will be added back to the payer list. The trading partner confirmed there was an issue with this payer which caused invalid rejections and has now been corrected.

Rejected claims submitted from the date the invalid rejections started, through the date the CPID was suspended: Nov. 14, 2024 - Nov. 26, 2024, will be resubmitted by Optum.

Payer Name: Peak Pace Solutions

CPIDs: 5663

Payer ID: 27034

Action Required: None.

REF 15607925 12/12/2024

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Report Generation Delay for CPID 1253 TRICARE East Region Date of Service (DOS) before Jan. 1, 2025

WPS is experiencing issues affecting Professional report generation for some claims submitted on Dec. 6, 2024 and Dec. 9, 2024.

Payer impacted: 

• CPID 1253 TRICARE East Region DOS before Jan. 1, 2025

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

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

REF 15600552 12/12/2024

---

UCARE Plans & Aspirus Medicare Advantage - Real Time Payer Update

Effective Dec. 13, 2024, real-time transactions (270/271) will be unavailable. This impacts current real-time eligibility transactions for the Payer IDs listed below.

The affected payers are:

• UCare Individual and Family Plan (55413/MNUCAR)
• ASPIRUS MEDICARE ADVANTAGE (36483/ASPRS)
• UCARE OF MINNESOTA - DOS BEFORE 1/1/2022 (SX178/12X50/SX178/UCARM)

Action Required by Customer:

Please do not send 270/271 transactions to the above payers until connection has been restored. We will keep you updated on restoration of this connections as soon as it is available.

Action Taken by Optum:

Optum continues to work closely with the payers to re-establish these connections for our customers.

REF 15612858 12/12/2024

---

New Payer Name

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

Previous Payer Name: Neighborhood Health Plan Rhode Island – Exchange, Unity, Integrity
New Payer Name: Neighborhood Health Plan Rhode Island – INTEGRITY (MMP)
Professional CPID:  7171
Institutional CPID:  8612
Edit Master:  PE_T007, HE9T007
Remit Line of Business (LOB) Code:  J2L

Your existing Payer Alias entries will continue to work as they do currently;  the new payer name is being provided for your reference. Be aware all future communications for these CPIDs will reference the new payer name only.

Action Required:

• You may choose to update the Payer Alias in your system to accommodate the new payer name.
• Please make the appropriate changes to accommodate the name change.

REF 15611359  12/12/24

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Report Generation Delay for multiple CPIDs

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

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted from Oct. 1, 2024, through Dec. 10, 2024.

Payers impacted:

• CPID 2781 Pennsylvania Independence Blue Cross/Blue Shield
• CPID 2800 AmeriHealth New Jersey/Delaware/Pennsylvania HMO
• CPID 2893 AmeriHealth Administrators 
• CPID 4716 AmeriHealth New Jersey PPO
• CPID 5113 Independence Administrators 
• CPID 7417 Keystone East HMO

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

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

REF 15589047 12/11/2024

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Report Generation Delay for CPIDs 7105, 7619 Harvard Pilgrim Medicare Advantage

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

A payer experienced issues affecting Professional and Institutional report generation for some claims submitted on Oct. 16, 2024.

Payer impacted:

• CPID 7105 Harvard Pilgrim Medicare Advantage 
• CPID 7619 Harvard Pilgrim Medicare Advantage

The payer is unable to generate and deliver the reports.

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

REF 15595696 12/11/2024

---

Eligibility inquiry and response for Health Alliance Plan of Michigan 

This message is for Intelligent Medical Netork customers. 

Effective Dec. 6, 2024, Optum is pleased to announce the availability of Real-time (270/271) transactions for the below payer: 

IMN Payer ID: 38224

Payer Name:   Health Alliance Plan of Michigan 

Action required by customer: 

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

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

REF 15603909 12/11/2024

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Report Generation Delay for CPIDs 3509 and 2481 Ohio Medicaid

A payer is experiencing issues affecting Institutional and Professional report generation for some claims submitted on Nov. 26, 2024, and Dec. 4, 2024.

Payer impacted:

• CPID 3509 Ohio Medicaid
• CPID 2481 Ohio Medicaid

The payer has been unable to generate and deliver the reports for some claims submitted on Nov. 26, 2024, and Dec. 4, 2024.

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

REF 15600014 12/11/2024

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Report Generation Delay for CPIDs 4557 and 2875 First Health Network (Coventry Health Care National Network)

A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted since Dec. 2, 2024.

Payer impacted:

• CPID 4557 First Health Network (Coventry Health Care National Network)
• CPID 2875 First Health Network (Coventry Health Care National Network)

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

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

REF 15589046 12/11/24

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Payer Processing Issue for CPID 3501 Indiana Medicaid

Due to a payer processing issue, some Institutional claims transmitted to the payer listed below on Dec. 8, 2024 and Dec. 9, 2024 were not processed by the payer.

Payer impacted: 

• CPID 3501 Indiana Medicaid

A resolution has been implemented and the claims were retransmitted to the payer on Dec. 11, 2024.

This delay affected claims released to Optum between 10 a.m. CT on Dec. 7, 2024 and 10 a.m. CT on Dec. 9, 2024.

Action Required: Be aware of the processing issue above.

REF 15600010 12/11/2024

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New Electronic Claims and Remittance Connections Available

Optum has new electronic claims and remittance connections available: 

Payer Name: JVHL - HAP CareSource - FFS
Institutional CPID: 7908
Professional CPID: 2709
Payer-assigned Payer ID: MT
Line of Business(LOB) Code: U77
Payer Claim Enrollment Required: Yes
Payer Remittance Enrollment Required: Yes
Secondary Claims Accepted: Yes
Payer Location: Michigan
Claims Fee: N/A
Remittance Fee: N/A

Payer Name: JVHL - Physicians Health Plan (Medicare Advantage)
Institutional CPID: 7909
Professional CPID: 2710
Payer-assigned Payer ID: MQ
Line of Business(LOB) Code: U77
Payer Claim Enrollment Required: Yes
Payer Remittance Enrollment Required: Yes
Secondary Claims Accepted: Yes
Payer Location: Michigan
Claims Fee: N/A
Remittance Fee: N/A

Action Required: 

• Add the payers 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.

REF 15582422 12/11/2024

---

New Electronic Remittance Connections Available

Optum has new electronic remittance connections available: 

Assurance EDI:

Payer Name: Unified Health Services

Institutional CPID: 7576

Professional CPID: 5420

Payer-assigned Payer ID: 62170

Payer Enrollment Required: Yes

Remittance Fee: N/A

Payer Location: National

Assurance Reimbursement Management:

Payer Name: Unified Health Services

Institutional CPID: 7576

Professional CPID: 5420

Payer-assigned Payer ID: 62170

Line of Business (LOB) Code: H63

Payer Enrollment Required: Yes

Remittance Fee: N/A

Payer Location: National

Action Required: 

• Add the payers to your system to begin using the new payer connection.
• Enrollment forms must be submitted and approved to begin receiving electronic remittance through Optum.

REF15597706 12/11/2024

---

Remittance Fee Change for Multiple Payers

Effective Jan. 1, 2025, the following remittance payer fees will change:
Current Fee: $0.00
New Fee: $0.0045

Action Required: None. Please be aware of the fee changes.

REF15586038 12/11/2024

---

New Electronic Claims Connection Available

Optum has new electronic claims connections available:

Payer Name:  Zurich American Insurance Company

Institutional CPID: 7992

Professional CPID: 2852

Payer-assigned Payer ID: 36423

Payer Enrollment Required: No

Secondary Claims Accepted: Yes

Payer Location: National

Action Required:

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

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

REF 15597672 12/11/2024

---

New Electronic Remittance Connections Available

Optum has new electronic remittance connections available:

Payer Name: Pace of Southwest Michigan

Institutional CPID: 1586

Professional CPID: 1150

Payer-assigned Payer ID: 45114

Payer Enrollment Required: Yes

Remittance Fee: N/A

Payer Location: Michigan

Action Required:

• Add the payers to your system to begin using the new payer connection.
• Enrollment forms must be submitted and approved to begin receiving electronic remittance through Optum.

REF 15588632 12/10/2024

---

New Electronic Claims Connections Available - Assurance Reimbursement Management

This message is intended for Assurance Reimbursement Management customers.

Optum has new electronic claims connections available:

Payer Name: AllCare Family Medical Group

Institutional CPID: 8080

Professional CPID: 2876

Payer-assigned Payer ID: ALLCA

Payer Enrollment Required: No

Secondary Claims Accepted: No

Payer Location: California

Claims Fee: N/A 

Action Required:

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

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

REF 15586168 12/10/2024

---

New Electronic Claims Connections Available - Assurance EDI

This message is intended for Assurance EDI customers.

Optum has new electronic claims connections available:  

Payer Name: AllCare Family Medical Group

Institutional CPID: 8080

Professional CPID: 2876

Payer-assigned Payer ID: ALLCA

Payer Enrollment Required: No

Secondary Claims Accepted: No

Payer Location: California

Claims Fee: $0.10

Action Required:

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

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

REF 15586167 12/10/2024

---

New Electronic Claims Connections Available - Assurance EDI

This message is intended for Assurance EDI customers.

Optum has new electronic claims connections available:  

Payer Name: OSU Aetna Better Health

Institutional CPID: 8082

Professional CPID: 2877

Payer-assigned Payer ID: OSUAE

Payer Enrollment Required: Yes

Secondary Claims Accepted: Yes

Payer Location: Oklahoma

Claims Fee: $0.10

Action Required:

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

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

REF 15586169 12/10/2024

---

New Electronic Remittance Connections Available - Assurance EDI

This message is intended for Assurance EDI customers.

Optum has new electronic remittance connections available:

Payer Name: Pace Nebraska
Institutional CPID: 2530
Professional CPID: 1172
Payer-assigned Payer ID: 35416
Payer Enrollment Required: Yes
Remittance Fee: N/A
Payer Location: Nebraska

Action Required: 

• Add the payers to your system to begin using the new payer connection.
• Enrollment forms must be submitted and approved to begin receiving electronic remittance through Optum.

REF 15589336 12/10/2024

---

New Electronic Remittance Connections Available - Assurance Reimbursement Management

This message is intended for Assurance Reimbursement Management customers.

Optum has new electronic remittance connections available:

Payer Name: Pace Nebraska
Institutional CPID: 2530
Professional CPID: 1172
Payer-assigned Payer ID: 35416
Line of Business (LOB) Code: N44
Payer Enrollment Required: Yes
Remittance Fee: N/A
Payer Location: Nebraska

Action Required: 

• Add the payers to your system to begin using the new payer connection.
• Enrollment forms must be submitted and approved to begin receiving electronic remittance through Optum.

REF 15589337 12/10/2024

---

Update: Report Generation Delay for CPIDs 5661 and 6423 RevClaims

Update: The payer intermediary has been unable to generate and deliver the reports for some claims submitted on Nov. 11, 2024.

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

Original notify sent Nov. 20, 2024:

A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted Nov. 11, 2024.

Payer impacted:

• CPID 5661 RevClaims
• CPID 6423 RevClaims

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

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

REF 824150 15586166 12/10/2024

---

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

Resolved: The issue has been resolved. All affected remittance files for check dates of October 15, 2024, through present, have been sent.

Action required: None

Original Message sent Nov. 27, 2024

Due to a processing issue, there has been a delay in Professional and Institutional Electronic Remittance Advice (ERA) for the following payers beginning on Oct. 15, 2024 to present:

• CPID 1913 Medicare Plus Blue of MI(MAP)
• CPID 2287 Medicare Plus Blue of MI(MAP)
• CPID 3514 Michigan Blue Cross Blue Shield
• CPID 3531  Michigan Blue Cross Blue Shield Federal Employee Program
• CPID 3532  Michigan Blue Care Network
• CPID 1421 Michigan Blue Cross Blue Shield
• CPID 2426 Michigan Blue Care Network

Additional updates will be forwarded as more information becomes available. 

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

If you have any questions, feel free to contact your Customer Support Team and refer to case 09269679.

REF 828050 15592471 12/10/2024

---

Report Generation Delay for CPID 4491 Massachusetts Medicaid Format 9

The payer listed below is experiencing issues affecting Professional report generation for some claims submitted on Dec. 6, 2024.

Payer impacted: 

• CPID 4491 Massachusetts Medicaid Format 9

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

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

REF 15590058 12/10/2024

---

Report Generation Delay for CPIDs 2936 and 3757 IMAGINE360 ADMINISTRATORS (GPA)

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

Payer impacted: 

• CPID 2936 IMAGINE360 ADMINISTRATORS (GPA)
• CPID 3757 IMAGINE360 ADMINISTRATORS (GPA)

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

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

REF 15586172 12/10/2024

---

Update: Report Generation Delay for CPIDs 6992 and 4110 Bollinger Inc

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

Payer impacted: 

• CPID 2936 IMAGINE360 ADMINISTRATORS (GPA)
• CPID 3757 IMAGINE360 ADMINISTRATORS (GPA)

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

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

REF 15586172 12/10/2024

---

Update: The payer intermediary has been unable to generate and deliver the reports for some claims submitted from Nov. 8, 2024 through Nov. 11, 2024.

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

Original notify sent Nov. 19, 2024:

A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted since Nov. 8, 2024.

Payer impacted: 

• CPID 6992 Bollinger Inc
• CPID 4110 Bollinger Inc

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

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

REF 15586164 12/10/2024

---

Electronic Routing Change for JVHL/Multiple Payers

This message intended for Assurance Reimbursement Management customers.

Effective December 9, 2024, Optum will be changing electronic claims and remittance routing for the following payers:

JVHL - Aetna Better Health Premier Plan M5 8683 7270
JVHL - Aetna Better Health of MI (Coventry/Omni) J8 4995 2759
JVHL - Aetna U.S. Healthcare J1 4978 2760
JVHL - AmeriHealth Caritas VIP Care Plus MD 4596 1256
JVHL - BCBSM Medicare Plus Blue PPO KC 8942 5273
JVHL - Blue Care Network (BCN Commercial Labs) JJ 4981 2277
JVHL - Blue Care Network (Critical Access/Small Volume) MJ 2030 8166
JVHL - Blue Care Network (JVHL Network) J9 4980 2732
JVHL - Blue Care Network (Reimbursable Labs) JQ 4982 4268
JVHL - Blue Cross Complete KP 4587 1255
JVHL - CIGNA (Health Partners) KQ 4648 6170
JVHL - Cigna (Non-HAP and CIGNA-HAP) KD 3653 5858
JVHL - Community Care Associates (Healthchoice) JW 4991 4261
JVHL - Genesee County Health Plan MB 7538 7755
JVHL - Health Alliance Plan (Capitated Contracts) JG 4988 2769
JVHL - Health Alliance Plan (Fee for Service) JH 4989 5270
JVHL - Humana KV 6629 6730
JVHL - McLaren Health Plan K7 5929 4795
JVHL - Meridian Health Plan of MI (Health Plan of Michigan) J2 4990 3213
JVHL - Physicians Health Plan MN 4071 8815
JVHL - Priority Health JZ 4998 4260
JVHL - Provider Network of America MP 8058 9776
JVHL - Reliance HMO MK 4033 8761
JVHL - United Healthcare (Golden Rule) KR 4647 6169
JVHL - United Healthcare (Non-Golden Rule) J5 4996 3215
JVHL - United Healthcare Community Plan (GLHP) JR 4987 3216
JVHL - VA Community Care Network MS 8056 9772
JVHL - Wellcare MM 4032 8760
JVHL HAP (CareSource) JB 4992 2764

Enrollment Requirements:

Claims:

• Payer enrollment for electronic claims is required.
• Providers currently sending claims through Optum do not need to complete a new enrollment form.
• New providers must complete a new enrollment form.

Remittance:

• Payer enrollment for electronic remittance is required.
• Providers currently receiving electronic remittance through Optum do not need to complete a new enrollment form.
• New providers must complete a new enrollment form.

Report Changes:

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

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

• 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.

REF 15582427 12/10/2024

---

New Electronic Remittance Connections Available

Optum has new electronic remittance connections available:

Payer Name: Pace of Southwest Michigan

Institutional CPID: 1586

Professional CPID: 1150

Payer-assigned Payer ID: 45114

Line of Business (LOB) Code: N48

Payer Enrollment Required: Yes

Remittance Fee: N/A

Payer Location: Michigan

Action Required:

• Add the payers to your system to begin using the new payer connection.
• Enrollment forms must be submitted and approved to begin receiving electronic remittance through Optum.

REF 15588633 12/10/2024

---

New Electronic Claims Connections Available

Optum has new electronic claims connections available: 

Payer Name:  OSU Aetna Better Health

Institutional CPID: 8082

Professional CPID: 2877

Payer-assigned Payer ID: OSUAE

Payer Enrollment Required: Yes

Secondary Claims Accepted: Yes

Payer Location: Oklahoma

Claims Fee: N/A

Action Required: 

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

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

REF 15586170 12/10/2024

---

New Payer Edit for CPID 3531

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 on December 16, 2024:

• IHI-01B061: MISSING VALUE CODE: For an electronic claim, Value Code A3, B3, or C3 is required. LOOP 2300 HI

Edit applies to:

• CPID 3531 MICHIGAN BLUE CROSS (FEP)

 Action Required: Please be aware of updated edit requirements. 

REF 15589459 12/10/2024

---

Electronic Routing Change for CPID 4740 Healthways WholeHealth Networks

This message intended for Assurance EDI customers.

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

Payer Name: Healthways WholeHealth Networks

Professional CPID: 4740

Payer-assigned Payer ID: 58213

Claim Fee: $0.10

Enrollment Requirements: 

Claims:

Payer enrollment for electronic claims is not required.

Report Changes:

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

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

• Make any necessary system changes.
• When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.

REF 15586160 12/10/2024

---

Electronic Routing Change for CPID 4740 Healthways WholeHealth Networks

This message intended for Assurance Reimbursement Management customers.

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

Payer Name: Healthways WholeHealth Networks

Professional CPID: 4740

Current Edit Master: PE_E049

New Edit Master: PE_B800

Payer-assigned Payer ID: 58213

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.

REF 15586161 12/10/2024

---

Electronic Routing Change for JVHL/Multiple Payers - Assurance EDI

This message is intended for Assurance EDI customers.

Effective Dec. 9, 2024, Optum will be changing electronic claims and remittance routing for the following payers:

Payer Name | Payer ID | CPID
JVHL - Aetna Better Health Premier Plan M5 8683 7270
JVHL - Aetna Better Health of MI (Coventry/Omni) J8 4995 2759
JVHL - Aetna U.S. Healthcare J1 4978 2760
JVHL - AmeriHealth Caritas VIP Care Plus MD 4596 1256
JVHL - BCBSM Medicare Plus Blue PPO KC 8942 5273
JVHL - Blue Care Network (BCN Commercial Labs) JJ 4981 2277
JVHL - Blue Care Network (Critical Access/Small Volume) MJ 2030 8166
JVHL - Blue Care Network (JVHL Network) J9 4980 2732
JVHL - Blue Care Network (Reimbursable Labs) JQ 4982 4268
JVHL - Blue Cross Complete KP 4587 1255
JVHL - CIGNA (Health Partners) KQ 4648 6170
JVHL - Cigna (Non-HAP and CIGNA-HAP) KD 3653 5858
JVHL - Community Care Associates (Healthchoice) JW 4991 4261
JVHL - Genesee County Health Plan MB 7538 7755
JVHL - Health Alliance Plan (Capitated Contracts) JG 4988 2769
JVHL - Health Alliance Plan (Fee for Service) JH 4989 5270
JVHL - Humana KV 6629 6730
JVHL - McLaren Health Plan K7 5929 4795
JVHL - Meridian Health Plan of MI (Health Plan of Michigan) J2 4990 3213
JVHL - Physicians Health Plan MN 4071 8815
JVHL - Priority Health JZ 4998 4260
JVHL - Provider Network of America MP 8058 9776
JVHL - Reliance HMO MK 4033 8761
JVHL - United Healthcare (Golden Rule) KR 4647 6169
JVHL - United Healthcare (Non-Golden Rule) J5 4996 3215
JVHL - United Healthcare Community Plan (GLHP) JR 4987 3216
JVHL - VA Community Care Network MS 8056 9772
JVHL - Wellcare MM 4032 8760
JVHL HAP (CareSource) JB 4992 2764

Enrollment Requirements:
Claims:

• Payer enrollment for electronic claims is required.
• Providers currently sending claims through Optum do not need to complete a new enrollment form.
• New providers must complete a new enrollment form.

Remittance:

• Payer enrollment for electronic remittance is required.
• Providers currently receiving electronic remittance through Optum do not need to complete a new enrollment form.
• New providers must complete a new enrollment form.

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

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

• 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.

REF 15582423 12/10/2024

---

New Electronic Claims Connection Available

This message is intended for Assurance Reimbursement Management customers.

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

Payer Name: AHP Provider Network

Institutional CPID: 8079

Payer-assigned Payer ID: MPM38

Payer Enrollment Required: No

Secondary Claims Accepted: Yes

Payer Location: California, Oregon, Washington

Claims Fee: N/A

Action Required: 

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

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

REF 15575062 12/10/2024

---

New Electronic Claims Connection Available

This message intended for Assurance EDI customers.

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

Payer Name: AHP Provider Network

Institutional CPID: 8079

Payer-assigned Payer ID: MPM38

Payer Enrollment Required: No

Secondary Claims Accepted: Yes

Payer Location: California, Oregon, Washington

Claims Fee: $0.10

Action Required: 

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

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

REF 15575061 12/10/2024

---

Electronic Routing Change for CPIDs 9285 and 7003 Sutter East Bay Regional Hospital - Assurance EDI

This message is intended for Assurance EDI customers.

Effective Dec. 9, 2024, Optum will be changing electronic claims routing for the following payer:

Payer Name: Sutter East Bay Regional Hospital
Professional CPID: 9285
Institutional CPID: 7003
Payer-assigned Payer ID: 96176

Claims:

• Payer enrollment for electronic claims is not required.

Report Changes:

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

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

• Make any necessary system changes.
• When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.

REF 15576266 12/9/2024

---

Report Generation Delay for CPID 2426 Michigan Blue Care Network

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

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

Payer impacted:

• CPID 2426 Michigan Blue Care Network

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

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

REF 15575896 12/9/2024

---

Report Generation Delay for multiple CPIDs

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

The payers listed below are experiencing issues affecting Institutional and Professional report generation for some claims submitted on Dec. 5, 2024.

Payers impacted:

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

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

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

REF 15579109 12/9/2024

---

Edit Master for CPIDs 4619 and 6133 ProviDRs Care Network

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

Payer Name:  ProviDRs Care Network

Professional CPID:  6133

Current Edit Master: PE_E049

New Edit Master:  PE_T007

Institutional CPID:  4619

Current Edit Master: HE9E049

New Edit Master:  HE9T007

Payer-assigned Payer ID:  48100

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

• Revalidate unreleased claims to edit correctly under new edit master. 
• Modify any bridge routines based on the edit master. 
• No Payer Alias changes are required. Payer name and CPIDs are not changing.

REF 15515553 12/9/2024

---

Electronic Routing Change for CPIDs 9285 and 7003 Sutter East Bay Regional Hospital

Effective December 9, 2024, Optum will be changing electronic claims routing for the following payer:

Payer Name: Sutter East Bay Regional Hospital
Professional CPID:  9285
Edit Master: PE_T007
Institutional CPID:  7003
Edit Master: HE9T007
Payer-assigned Payer ID: 96176

Claims:

• Payer enrollment for electronic claims is not required.

Report Changes:

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

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

• Edit Masters are not changing, no modification to the bridge routines needed. 
• No Payer Alias changes are required. Payer name and CPIDs are not changing.
• When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.

REF 15576267 12/9/2024

---

Electronic Routing Change for CPIDs 9653 and 6858 Palo Alto Medical Foundation

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

Payer Name: Palo Alto Medical Foundation

Professional CPID: 6858

Current Edit Master: PE_T007

New Edit Master:  N/A

Institutional CPID:  9653

Current Edit Master:  HE9E049

New Edit Master:  HE9T007

Payer-assigned Payer ID: 94115

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:

• Revalidate unreleased claims to edit correctly under new edit master.
• Modify any bridge routines based on edit masters.
• No Payer Alias changes are required. Payer name and CPIDs are not changing.
• When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.

REF 15515540 12/9/2024

---

Resolved: Assurance Attachments Performance Issues

This message is intended for Assurance Reimbursement Management customers.

Assurance Attachments experienced an issue with intermittent performance. 

This may have result in:

• Error Message: Access to assuranceattachments.changehealthcare.com can’t be reached
• Inability to log in 

This issue has been resolved. We apologize for any inconvenience. 

Action Required: None.

REF 15575363 12/9/2024

---

Electronic Routing Change for CPID 5816 Brown & Toland Sutter Select

Effective Dec. 9, 2024, Optum will be changing electronic claims routing for the following payer:

Payer Name: Brown & Toland Sutter Select
Professional CPID: 5816
Edit Master: PE_T007
Payer-assigned Payer ID: BTSS1

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 CPID are not changing.
• When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.

REF 15578265  12/9/2024

---

Electronic Routing Change for CPID 5816 Brown & Toland Sutter Select

Effective Dec. 9, 2024, Optum will be changing electronic claims routing for the following payer:

Payer Name: Brown & Toland Sutter Select
Professional CPID: 5816
Payer-assigned Payer ID: BTSS1

Claims:

• Payer enrollment for electronic claims is not required.

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

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

• Make any necessary system changes.
• When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.

REF 15578264  12/9/2024

---

Electronic Routing Change for CPIDs 9653 and 6858 Palo Alto Medical Foundation

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

Payer Name: Palo Alto Medical Foundation

Professional CPID: 6858

Institutional CPID: 9653

Payer-assigned Payer ID: 94115

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.

REF 15515541 12/9/2024

---

Electronic Routing Change for CPIDs 8150 & 2016 BayCare Plus Medicare Advantage Health Plan

Effective Dec. 9, 2024, Optum will be changing electronic remittance routing for the following payer:

Payer Name: BayCare Plus Medicare Advantage
Professional CPID: 8150
Institutional CPID: 2016
Line of Business Code (LOB): H7F
Payer-assigned Payer ID: 81079

Remittance:

• Payer enrollment for electronic remittance is required.
• Providers currently receiving electronic remittance through Optum must complete a new enrollment form.
• New providers must complete a new enrollment form.

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

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

REF 15576261  12/9/2024

---

Electronic Routing Change for CPIDs 8150 & 2016 BayCare Plus Medicare Advantage

Effective December 9, 2024, Optum will be changing electronic remittance routing for the following payer:

Payer Name: BayCare Plus Medicare Advantage
Professional CPID: 8150
Institutional CPID: 2016
Payer-assigned Payer ID: 81079

Remittance:

• Payer enrollment for electronic remittance is required.
  • Providers currently receiving electronic remittance through Optum must complete a new enrollment form.
  • New providers must complete a new enrollment form.

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

• Make any necessary system changes.
• When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.

REF 15576260 12/9/2024

---

Update: Report Generation Delay for CPIDs 8900 and 2113 Allcare Health Plan

The payer intermediary has been unable to generate and deliver the reports for some claims submitted on Nov. 7, 2024 and Nov. 8, 2024.

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

Original message sent Nov. 19, 2024:

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

Payer impacted:

• CPID 8900 Allcare Health Plan
• CPID 2113 Allcare Health Plan

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

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

REF 15575209 12/9/2024

---

Eligibility Inquiry and Response

This message is intended for Intelligent Medical Network customers.

Effective Nov. 15, 2024, Optum is pleased to announce the availability of Real-time (270/271) transactions for the below payer:

Payer Name: Flume Health, Inc.

IMN Payer ID:  FH105

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

REF 831751 12/6/2024

---

Generation Delay for CPIDs 4936 and 3476 Masters, Mates and Pilots

A payer intermediary is experiencing issues affecting institutional and professional report generation for some claims submitted since Nov. 25, 2024.

Payer impacted: 

• CPID 4936 Masters, Mates and Pilots
• CPID 3476 Masters, Mates and Pilots

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

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

REF 832155 12/6/2024

---

Electronic Claims Connection No Longer Available for University Healthcare Marketplace

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

Payer Name: University Healthcare Marketplace

Claim CPIDs: 6871, 8605

Reason: Payer no longer contracted.

Payer will no longer accept paper claims.

Action Required: None

REF 832102 12/6/2024

---

New Electronic Remittance Connections Available on Revenue Performance Advisor

ERA (Remittance) transactions have recently been added for the following payers:

Payer ID	Payer Name
16307	CarePartners of Connecticut
22823	Point C/Mid-American Benefits
41222	Care To Care
75191	NCAS - Charlotte, North Carolina
8422E	Clever Care Health Plan Encounters
EXC01	Physicians Medical Group of San Jose
MVMM1	Inland Faculty Medical Group
NMM05	Community Family Care

ERA enrollment/set up is required for all ERA transactions on Revenue Performance Advisor. You can access the payer enrollment intake form on the Revenue Performance Advisor (RPA) restoration resources page in the User Community.

If you’re in Revenue Performance Advisor, you can also open the Revenue Performance Advisor Resource Center, click the Quick Reference Guides tab, and then click the Billing Provider Enrollment link to find the payer enrollment intake form.

REF 832156  12/6/2024

---

Update: Report Generation Delay for CPIDs 2526 and 3826 CareSource of Ohio

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

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

Original message sent Nov. 19, 2024:

A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted on Nov. 6, 2024.

Payer impacted:

• CPID 2526 CareSource of Ohio
• CPID 3826 CareSource 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.

REF 832154 12/6/2024

---

Multiple Payers Electronic Claims/Remittance Connections No Longer Available

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

Payer Name: OrthoNet Aetna

Claim and Remittance CPIDs: 2263, 3582

Reason: Payer no longer contracted.

Payer will no longer accept paper claims.

Action Required: None.

Payer Name: TDS/SRRIPA/CLOVER

Claim and Remittance CPIDs: 6049, 9202

Reason: Payer no longer contracted. 

Payer will no longer accept paper claims.

Action Required: None.

Payer Name: True Health New Mexico

Claim and Remittance CPIDs: 7803, 8572

Reason: Health plan has been discontinued.

Payer will no longer accept paper claims.

Action Required: None.

Payer Name: True Health New Mexico (SS&C)

Claim and Remittance CPIDs: 3028, 8277

Reason: Health plan has been discontinued.

Payer will no longer accept paper claims.

Action Required: None.

REF 832103 12/6/2024

---

Multiple Payers Electronic Claims/Remittance Connections No Longer Available

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

Payer Name: OrthoNet Aetna

Claim and Remittance CPIDs: 2263, 3582

Remittance LOB: H07

Reason: Payer no longer contracted.

Payer will no longer accept paper claims.

Action Required: None.

Payer Name: TDS/SRRIPA/CLOVER

Claim and Remittance CPIDs: 6049, 9202

Remittance LOB: K77

Reason: Payer no longer contracted. 

Payer will no longer accept paper claims.

Action Required: None.

Payer Name: True Health New Mexico

Claim and Remittance CPIDs: 7803, 8572

Remittance LOB: H16

Reason: Health plan has been discontinued.

Payer will no longer accept paper claims.

Action Required: None.

Payer Name: True Health New Mexico (SS&C)

Claim and Remittance CPIDs: 3028, 8277

Remittance LOB: H8W

Reason: Health plan has been discontinued.

Payer will no longer accept paper claims.

Action Required: None.

REF 832104 12/6/2024

---

StandardHealth with Health Choice (HCS) Electronic Remittance Connection No Longer Available

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

Payer Name: StandardHealth with Health Choice (HCS)

Remittance CPIDs: 2708, 7595

Remittance LOB: N22

Reason: Payer no longer offers an electronic connection.

Action Required: None.

REF 832101 12/6/2024

---

StandardHealth with Health Choice (HCS) Electronic Remittance Connection No Longer Available

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

Payer Name: StandardHealth with Health Choice (HCS)

Remittance CPIDs: 2708, 7595

Reason: Payer no longer offers an electronic connection.

Action Required: None.

REF 832100 12/6/2024

---

Multiple Payers Electronic Claims Connections No Longer Available - Assurance Reimbursement Management

This message is intended for Assurance Reimbursement Management customers.

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

Payer Name: Monitor Life Insurance Company of New York

Claim CPIDs: 5621, 6256

Remittance LOB: U5K

Reason: Payer no longer contracted.  

Action Required: None.

 

Payer Name: TDS/TP-ACO

Claim CPIDs: 6058, 9212

Remittance LOB: K82

Reason: Payer no longer contracted.  

Action Required: None.

 

Payer Name: New Mexico Public Schools Insurance Authority

Claim CPIDs: 4521, 1224  

Remittance LOB: U34

Reason: Payer no longer contracted.  

Action Required: None.

REF 831351 12/5/2024

---

Multiple Payers Electronic Claims Connections No Longer Available - Assurance EDI

This message is intended for Assurance EDI customers.

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

Payer Name: Monitor Life Insurance Company of New York

Claim and Remittance CPIDs: 5621, 6256

Reason: Payer no longer contracted.  

Action Required: None. 

Payer Name: TDS/TP-ACO  

Claim and Remittance CPIDs: 6058, 9212

Reason: Payer no longer contracted.  

Action Required: None.

Payer Name: New Mexico Public Schools Insurance Authority

Claim and Remittance CPIDs: 4521, 1224

Reason: Payer no longer contracted.  

Action Required: None.

REF 831350 12/5/2024

---

Electronic Routing Change for CPIDs 4551 and 5405 1199SEIU Family of Funds - Assurance Reimbursement Management

This message is intended for Assurance Reimbursement Management customers.

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

Payer Name: 1199SEIU Family of Funds
Professional CPID: 5405
Institutional CPID: 4551
Line of Business Code (LOB): U92
Payer-assigned Payer ID: 13162

Enrollment Requirements:

Remittance:

• Payer enrollment for electronic remittance is required.
  • Providers currently receiving electronic remittance through Optum do not need to complete a new enrollment form.
  • New providers must complete a new enrollment form.

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

• No Payer Alias changes are required. Payer name and CPIDs are not changing.
• When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.

REF 831556 12/5/2024

---

Electronic Routing Change for CPIDs 4551 and 5405 1199SEIU Family of Funds - Assurance EDI

This message is intended for Assurance EDI customers.

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

Payer Name: 1199SEIU Family of Funds
Professional CPID: 5405
Institutional CPID: 4551
Payer-assigned Payer ID: 13162

Enrollment Requirements:

Remittance:

• Payer enrollment for electronic remittance is required.
  • Providers currently receiving electronic remittance through Optum do not need to complete a new enrollment form.
  • New providers must complete a new enrollment form.

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

• Make any necessary system changes.
• When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.

REF 831555 12/5/2024

---

Invalid Error Message for 1199 SEIU Family of Funds (13162)

This message is intended for Revenue Performance Advisor customers.

Due to a payer intermediary processing issue, professional and institutional claims from July 25, 2024-Nov. 12, 2024 for the payer listed below may have received:

• Erroneous rejections
• Claim not on file error

Payer Name: 1199 SEIU Family of Funds
Payer ID: 13162

Action Required: Please be aware of the invalid error messages. Please resubmit any impacted claims.

REF 831907  12/5/2024

---

Update: Payer Transmit Delay for CPIDs 4427 and 5586 Montana Medicaid

Update: A resolution has been implemented and the claims were transmitted to the payer Dec. 5, 2024.

Action Required: Please be aware of the transmit delay.

Original Notify REF 829100 sent Dec. 3, 2024:
Due to a payer system issue, a delay occurred in some of the transmissions to the following payer since Dec. 2, 2024.

Payer impacted:

• CPID 4427 Montana Medicaid
• CPID 5586 Montana Medicaid

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

This delay affected claims released to Optum since Nov. 29, 2024, 2:00 p.m. CT.

Action Required: Be aware of the transmit delay above.

REF 831607  12/5/2024

---

Report Generation Delay for CPID 2481 Ohio Medicaid

A payer is experiencing issues affecting professional report generation for some claims submitted on Nov. 26, 2024.

Payer impacted:

• CPID 2481 Ohio Medicaid

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

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

REF 831608 12/5/2024

---

New Electronic Remittance Connection Available – Re-enrollment required

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

Effective immediately, Optum has new electronic remittance connection available: 

Payer Name: Inland Faculty Medical Group 

Professional CPID: 6219 

Institutional CPID: 9678 

Industry Payer ID: MVMM1 

Remittance Enrollment Requirements: 

• Payer enrollment for electronic remittance is required: 

Action Required: All providers must complete a new enrollment form to receive electronic remittance for Inland Faculty Medical Group.

• Make any necessary system changes. 
• When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.

REF 831901 12/5/2024

---

New Electronic Remittance Connection Available – Re-enrollment required

Effective immediately, Optum has new electronic Remittance connection available:

Payer Name: Community Health Center Network

Professional CPID: 3119

Industry Payer ID: CHCN1

Remittance Enrollment Requirements:

• Payer enrollment for electronic remittance is required:

Action Required:

• All providers must complete a new enrollment form to receive electronic remittance for Hopkins Health Advantage.
• Make any necessary system changes.
• When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.

REF 831900 12/5/2024

---

New Payer Edit

Effective Dec. 9, 2024, at 5:00 p.m. CT, Professional and Institutional claims for the payer listed below must be submitted with a 9 alpha character Member ID in the 2010BA Loop, NM109*IL segment. Claims submitted with more than a 9 alpha character member ID will reject with the following message:

Edit INM10911DZ - INVALID SUBSCRIBER MEMBER ID - The Active Subscriber Member ID must not begin with 3 alpha characters.

Edit PNM10903DZ - INVALID SUBSCRIBER MEMBER ID - The Active Subscriber Member ID must not begin with 3 alpha characters.

Payers affected:

• CPID 7617 Keenan Associates, payer ID 95279
• CPID 6838 Keenan Associates, payer ID 95279

NOTE: Providers should start submitting the correct Member ID effective immediately. Claims will start rejecting on Dec. 9, 2024.

Action Required: Please be aware of this new requirement.

REF 831554  12/5/2024

---

Update: Report Generation Delay for CPIDs 4949 and 3211 Wellcare Health Plans (Encounters)

A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted on Nov. 19, 2024 and Nov. 23, 2024.

Payer impacted:

• CPID 4949 Wellcare Health Plans (Encounters)
• CPID 3211 Wellcare Health Plans (Encounters)

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

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

Original message sent Dec. 2, 2024:

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted since Nov. 19, 2024.

Payer impacted:

• CPID 3211 Wellcare Health Plans (Encounters)

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

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

REF 831500 12/5/2024

---

Electronic Routing Change for CPID 8163 Brand New Day Encounters

This message is intended for Assurance EDI  customers.

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

Payer Name: Brand New Day Encounters

Professional CPID: 8163

Payer-assigned Payer ID: UC002

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.

REF831300 12/5/2024

---

Electronic Routing Change for CPID 8163 Brand New Day Encounters

This message is intended for Assurance Reimbursement Management customers.

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

Payer Name: Brand New Day Encounters

Professional CPID:  8163

Current Edit Master: PE_O007

New Edit Master:  PE_T007

Payer-assigned Payer ID: UC002

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.

REF 831301 12/5/2024

---

Electronic Claims Connection No Longer Available for Pacific Administrators, Inc. 

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

Payer Name: Pacific Administrators, Inc.

Claim CPIDs: 8005

Reason: Payer only processes Professional claims electronically.

Action Required: None.

REF 813200 12/5/2024

---

New Electronic Medical Attachment Connections Available

Optum has new electronic medical attachment connections available:

Payer Name: EnableComp

Professional CPID: 7147

Institutional CPID: 5636

Payer-assigned Payer ID: ECOMP

Accepted Attachment Type: Unsolicited

Payer Enrollment Required: No

Payer Location: National

Payer Name: EnableCompMVA

Professional CPID: 8458

Institutional CPID: 3059

Payer-assigned Payer ID: L0241

Accepted Attachment Type: Unsolicited

Payer Enrollment Required: No

Payer Location: National

Payer Name: EnableCompVET

Professional CPID: 8459

Institutional CPID: 3062

Payer-assigned Payer ID: L0242

Accepted Attachment Type: Unsolicited

Payer Enrollment Required: No

Payer Location: National

Payer Name: EnableComp OOS Medicaid

Professional CPID: 9411

Institutional CPID: 7027

Payer-assigned Payer ID: L0243

Accepted Attachment Type: Unsolicited

Payer Enrollment Required: No

Payer Location: National

Payer Name: EnableComp Commercial

Professional CPID: 1821

Institutional CPID: 3576

Payer-assigned Payer ID: L0244

Accepted Attachment Type: Unsolicited

Payer Enrollment Required: No

Payer Location: National

Action Required:

• Exchange providers must be contracted with Optum to submit electronic medical attachments.  Please contact Support at 1-800-527-8133 option 2, or by emailing [email protected] for additional information.
• Add the payers to your system to begin using the new payer connection.
• When a payer requires enrollment, forms must be submitted and approved to begin submitting transactions. 

NOTE: The above Payer ID(s) is for Medical Attachments and may require Providers and/or their vendor be contracted with Optum for the Medical Attachment transaction services.

REF 830253 12/5/2024

---

New Assurance Attach Assist Medical Attachment Connections Available

Optum has new electronic medical attachment connections available:

Payer Name: EnableComp
Professional CPID: 7147
Institutional CPID: 5636
Payer-assigned Payer ID: ECOMP
Accepted Attachment Type: Unsolicited
Payer Enrollment Required: No
Payer Location: National

Payer Name: EnableCompMVA
Professional CPID: 8458
Institutional CPID: 3059
Payer-assigned Payer ID: L0241
Accepted Attachment Type: Unsolicited
Payer Enrollment Required: No
Payer Location: National

Payer Name: EnableCompVET
Professional CPID: 8459
Institutional CPID: 3062
Payer-assigned Payer ID: L0242
Accepted Attachment Type: Unsolicited
Payer Enrollment Required: No
Payer Location: National

Payer Name: EnableComp OOS Medicaid
Professional CPID: 9411
Institutional CPID: 7027
Payer-assigned Payer ID: L0243
Accepted Attachment Type: Unsolicited
Payer Enrollment Required: No
Payer Location: National

Payer Name: EnableComp Commercial
Professional CPID: 1821
Institutional CPID: 3576
Payer-assigned Payer ID: L0244
Accepted Attachment Type: Unsolicited
Payer Enrollment Required: No
Payer Location: National

Action Required:

• Inform users of this change.
• Assurance providers must be contracted with Assurance Attach Assist to submit electronic medical attachments. Please contact support at 1-800-457-1209 option 2, or by emailing [email protected] for additional information.
• If you have not yet contracted for Attach Assist, contact your Client Executive to learn more about Attach Assist functionality.
• When a payer requires enrollment, forms must be submitted and approved to begin submitting transactions.

NOTE: The above Payer ID(s) is for Medical Attachments and may require Providers and/or their vendor be contracted with Optum for the Medical Attachment transaction services.

REF 830254  12/4/2024

---

New Electronic Claims Connections Available

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

Optum has new electronic claims connections available:

 

Payer Name: Empire Healthcare IPA
Institutional CPID: 8075
Professional CPID: 2864
Payer-assigned Payer ID: EHI01
Payer Enrollment Required: No
Secondary Claims Accepted for professional claims: No
Secondary Claims Accepted for institutional claims: Yes 
Payer Location: California
Claims Fee: N/A

 

Action Required:

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

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

REF 829067 12/4/2024

---

Electronic Routing Change for CPIDs 2936 and 3757, Imagine360 Administrators (GPA) - Assurance Reimbursement Management

This message is intended for Assurance Reimbursement Management customers.

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

 

Payer Name: Imagine360 Administrators (GPA)
Professional CPID: 3757
Current Edit Master: PE_N000
New Edit Master: PE_B800
Institutional CPID: 2936
Current Edit Master: HE9T007
New Edit Master: HE9B801
Payer-assigned Payer ID: 48143

 

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.

REF 831050 12/4/2024

---

Electronic Routing Change for CPIDs 2936 and 3757  Imagine360 Administrators (GPA) - Assurance EDI

This message is intended for Assurance EDI customers.

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

 

Payer Name: Imagine360 Administrators (GPA)
Professional CPID: 3757
Institutional CPID: 2936
Payer-assigned Payer ID: 48143

 

Enrollment Requirements:

Claims:

• Payer enrollment for electronic claims 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.

REF 831051 12/4/2024

---

Electronic Routing Change for CPIDs 2041 and 7138 Sierra Medical Group - Assurance Reimbursement Management

This message is intended for Assurance Reimbursement Management customers.

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

 

Payer Name: Sierra Medical Group

Professional CPID: 7138

Current Edit Master: PE_T007

Institutional CPID: 2041

Current Edit Master: HE9T007

Payer-assigned Payer ID: 30891

 

Enrollment Requirements: 

Claims:

• Payer enrollment for electronic claims is not required.

Report Changes:

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

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

• Edit Masters are not changing, no modification to the bridge routines needed.  
• No Payer Alias changes are required. Payer name and CPIDs are not changing.
• When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.

REF 830301 12/4/2024

---

Electronic Routing Change for CPIDs 4554 and 4298 AmeraPlan

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

Payer Name: AmeraPlan

Professional CPID: 4298

Institutional CPID: 4554

Payer-assigned Payer ID: 38219

Claims Fee: $0.10

Enrollment Requirements:

Claims:

• Payer enrollment for electronic claims is not required.

Report Changes:

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

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

• Make any necessary system changes.
• When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.

REF 829856 12/4/2024

---

Electronic Routing Change for CPIDs 4554 and 4298 AmeraPlan

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

Payer Name: AmeraPlan

Professional CPID: 4298

Current Edit Master: PE_E049

New Edit Master: PE_B800

Institutional CPID: 4554

Current Edit Master: HE9E049

New Edit Master:  HE9B801

Payer-assigned Payer ID: 38219

Enrollment Requirements:

Claims:

• Payer enrollment for electronic claims is not required.

Report Changes:

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

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

• Revalidate unreleased claims to edit correctly under new edit master.
• Modify any bridge routines based on edit masters.
• No Payer Alias changes are required. Payer name and CPIDs are not changing.
• When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.

REF 829855 12/4/2024

---

New Electronic Claims Connections Available for CPIDs 2869 and 8078 Millette Administrators

Optum has new electronic claims connections available:

Payer Name: Millette Administrators

Institutional CPID: 8078

Professional CPID: 2869

Payer-assigned Payer ID: MAI60

Payer Enrollment Required: No

Secondary Claims Accepted: Yes

Payer Location: Alabama, Michigan, Mississippi

Claims Fee: N/A

Action Required:

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

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

REF 829066 12/4/2024

---

Centers for Medicare & Medicaid Services HIPAA eligibility transaction system (HETS) attestation for Optum providers

This message is intended for Assurance Reimbursement Management, Exchange, Revenue Performance Advisor, Clearance Patient Access Suite, and Intelligent Medical Network (IMN) customers. 

You have a required action by Dec. 31, 2024 to attest your relationship to exchange HIPAA Eligibility Transaction System (HETS) 270/271 Beneficiary Eligibility transactions on your behalf. 

Centers for Medicare & Medicaid Services (CMS) has recently announced an initiative whereby HETS 270/271 suppliers / providers are required to submit attestation via these websites and use the code: VQAS 

1. Durable Medical Equipment Medicare Administrative Contractor (DME MAC) (operated by National Government Services as CEDI) form
2. National Government Services Jurisdiction J6 and Jurisdiction JK form  

For questions please contact HETS at [email protected] or 1-866-324-7315.  

We value your partnership and encourage you to act soon.

Action Required: Complete attestation by Dec. 31, 2024: HIPAA Eligibility Transaction System (HETS) attestation with Unique ID number: VQAS 

REF 828507 12/04/2024

---

Electronic Routing Change for CPIDs 2041 and 7138 Sierra Medical Group

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

Payer Name: Sierra Medical Group

Professional CPID: 7138

Institutional CPID: 2041

Payer-assigned Payer ID: 30891

Enrollment Requirements: 

Claims:

• Payer enrollment for electronic claims [is/is not] required.

Report Changes:

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

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

• Make any necessary system changes.
• When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.

REF 830300 12/4/2024

---

Payer Transmit Delay for CPIDs 4425 and 5550 District of Columbia Medicaid

Due to a payer system issue, a delay occurred in some of the transmissions to the following payer since Dec. 2, 2024.

Payer impacted:

• CPID 4425 District of Columbia Medicaid
• CPID 5550 District of Columbia Medicaid

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

This delay affected claims released to Optum since 10 p.m. ET on Nov. 29, 2024.

Action Required: Be aware of the transmit delay above.

REF 830200 12/4/2024

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New Electronic Remittance Connection Available – Re-enrollment required

Effective immediately, Optum has new electronic Remittance connection available:

Payer Name: Hopkins Health Advantage

Professional CPID: 7715

Institutional CPID: 9656

Industry Payer ID: 66003

Remittance Enrollment Requirements:

• Payer enrollment for electronic remittance is required:

Action Required:

• All providers must complete a new enrollment form to receive electronic remittance for Hopkins Health Advantage.
• Make any necessary system changes.
• When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.

REF 828209 12/4/2024

---

November 21, 2024 - Important Announcement from Optum - Intelligent EDI - Claims for PID 88023

New Payer Announcement - The following items are covered in this announcement:

Optum Intelligent EDI is pleased to announce new claim payer connectivity for the following transaction types.

Please incorporate claims into existing files you submit to Optum today.

Hometown Health (Payer ID 88023)

Transaction Types:  837 Dental

Effective Date: Nov. 21, 2024

Please direct any questions to the Support Team at 1-866-OptumGo. Please do not reply to this email directly.

REF 830001 12/3/2024

---

Update: Report generation delay for multiple CPIDs

Update: WPS is unable to generate and deliver the reports for some claims submitted on Nov. 25, 2024.

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

Original notify sent Dec. 2, 2024  (REF 828402):

WPS is experiencing issues affecting Professional and Institutional report generation for some claims submitted on Nov. 25, 2024.

Payers impacted: 

• CPID 3975 Indiana Medicare
• CPID 2120 Missouri Medicare Eastern
• CPID 2127 Nebraska Medicare

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

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

REF 829102 12/3/2024

---

Report Generation Delay for CPID 7403 New Mexico Blue Cross Blue Shield

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

Payer impacted: 

• CPID 7403 New Mexico Blue Cross Blue Shield

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

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

REF829154 12/4/2024

---

New Payer Announcement 

Optum Intelligent EDI is pleased to announce new claim payer connectivity for the following transaction types. Please incorporate claims into existing files you submit to Optum today.

• Zurich American Insurance Company (Payer ID 36423)
• Transactions: 837 professional/institutional
• Effective Date: Nov. 21, 2024

Please direct any questions to the Support Team at 1-866-OptumGo.

REF 83000  12/3/2024

---

Report Generation Delay for CPID 1795 Envolve Benefit Options

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

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

Payer impacted:

• CPID 1795 Envolve Benefit Options

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

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

REF 829155 12/3/2024

---

Report Generation Delay for CPID 3273 Companion Life

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted on between Nov. 1, 2024, and Nov. 4, 2024.

Payer impacted:

• CPID 3273 Companion Life

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

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

REF 829753 12/3/2024

---

Report Generation Delay for CPID 5835 Trilogy Health Network

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted Oct. 31, 2024.

Payer impacted:

• CPID 5835 Trilogy Health Network

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

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

REF 829673  12/3/2024

---

New Electronic Claims Connections Available

Optum has new electronic claims connections available: 

Payer Name: Stork Club Fertility, Inc.

Professional CPID: 2777

Payer-assigned Payer ID: STORK

Payer Enrollment Required: No

Secondary Claims Accepted: No

Payer Location: California

Claims Fee: N/A

Action Required: 

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

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

REF 829101 12/3/2024

---

Claim Fee Change for Multiple Payers

Effective January 1, 2025, a non-par claim surcharge fee will appear on your February invoice when generated, for the below list of payers.

Current Non-Par Surcharge: $0.00

New Non-Par Surcharge: $0.10*

Reason for the change:

Optum (formerly Change Healthcare) restoration efforts in 2024 have focused solely on re-establishing claim connections as quickly as possible for our customers, waiving any associated non-par claim surcharge fees.   Beginning January 1st, the non-par fee will no longer be waived, but we will continuously re-evaluate our payer connections to eliminate them when possible.

Action Required: None. Please be aware of the claim payer fee changes.

*Fee amount may be different based on individual submitter contracts.

CPID	Industry Payer ID	Payer Name
8215	2020E	2020 Eyecare
8119	INTEG	Access Integra
4027	59314	Advanzeon Solutions
8756	59314	Advanzeon Solutions
1667	27344	Affiliated Doctors of Orange County (ADOC)
9683	46594	Affinity Medical Group
1744	91136	AGC-IUOE Local 701 Trust Funds
6591	91136	AGC-IUOE Local 701 Trust Funds
1744	91136	Alaska Laborers Trust Funds
6591	91136	Alaska Laborers Trust Funds
1069	44423	Alexian Brothers Community Services of Tennessee
7897	44423	Alexian Brothers Community Services of Tennessee
8744	ALIVI	Alivi Health
8743	ATNET	Alivi Therapy Network
3089	C1037	Allstate - Except New Jersey
8714	C1037	Allstate - Except New Jersey
3000	NMM04	Alpha Care Medical Group NMM
6064	31130	American Health Advantage of Tennessee
9218	31130	American Health Advantage of Tennessee
5071	31155	American Health Advantage of Texas
9117	31155	American Health Advantage of Texas
4468	20029	Americas Choice Healthplan
1744	91136	APEA AFT Health and Welfare Trust
6591	91136	APEA AFT Health and Welfare Trust
5596	00520	Arkansas Blue Cross Blue Shield
3845	12X42	Banner Health Network
6610	12X42	Banner Health Network
5874	MPM10	Bella Vista Medical Group
3864	25145	Benefit Coordinators Corporation
7526	37118	Benefit Plan Administrators - Roanoke, VA
8482	37118	Benefit Plan Administrators - Roanoke, VA
1167	66006	Blue Cross Medicare Advantage PPO/HMO
2513	66006	Blue Cross Medicare Advantage PPO/HMO
8051	BSN01	Brain and Spine Network
9769	BSN01	Brain and Spine Network
1830	51037	Brokerage Concepts
8562	51037	Brokerage Concepts
3511	47198	California Anthem Blue Cross
2013	66010	Care N Care Insurance Co.
8146	66010	Care N Care Insurance Co.
1744	91136	Cement Masons & Plasterers Trust Funds
6591	91136	Cement Masons & Plasterers Trust Funds
1744	91136	Cement Masons and Plasterers Training Trust of Washington
6591	91136	Cement Masons and Plasterers Training Trust of Washington
6777	CPHL1	Centers Plan for Healthy Living
8660	CPHL1	Centers Plan for Healthy Living
8047	CVM02	Central Valley Medical Providers
9765	CVM02	Central Valley Medical Providers
2231	16600	Chautauqua Healthcare Plan
1133	33070	ChiroMetrics
1511	33070	ChiroMetrics
8929	95348	Choicecare of Ohio HMO
7275	IP055	Citrus Valley Physicians Group
8930	IP055	Citrus Valley Physicians Group
6625	51579	Coastal Communities Physician Network (CCPN)
1036	COCHA	Colorado Community Health Alliance
7865	COCHA	Colorado Community Health Alliance
4751	CCHP1	Cook Childrens Health Plan
8924	CCHP1	Cook Childrens Health Plan
4752	CCHP9	Cook Childrens Star Plan
9580	CCHP9	Cook Childrens Star Plan
7738	06541	CountyCare Health Plan
9688	06541	CountyCare Health Plan
3581	39113	Dean Health Plan by Medica
2433	84133	Denver Health and Hospital Authority
2943	84133	Denver Health and Hospital Authority
1232	84131	Denver Health Medical Plan, Inc. - Medicare Choice
4549	84131	Denver Health Medical Plan, Inc. - Medicare Choice
5869	MPM04	El Proyecto Del Barrio
4410	SX110	EMI Health
5879	74234	Erisa Administrative Services
6060	32052	Everpointe
9215	32052	Everpointe
5817	31165	EyeMed Vision Care
1744	91136	Fairbanks North Star Borough/Fairbanks North Star School District
6591	91136	Fairbanks North Star Borough/Fairbanks North Star School District
2875	73159	First Health Network (Coventry Health Care National Network)
4557	73159	First Health Network (Coventry Health Care National Network)
1656	94998	Firstcare STAR Medicaid MCO/Firstcare & Firstcare Advantage HMO
5854	94998	Firstcare STAR Medicaid MCO/Firstcare & Firstcare Advantage HMO
2150	59322	Florida Health Care Plans
3693	59322	Florida Health Care Plans
2975	30005	Galveston County Indigent Healthcare
7712	30005	Galveston County Indigent Healthcare
2050	27133	Gemcare IPA
8189	27133	Gemcare IPA
5870	MPM05	Global Care Medical Group IPA
1937	07689	GlobalCare
2720	07689	GlobalCare
4919	47083	GMS Insurance
5853	47083	GMS Insurance
7288	47738	Hamaspik Choice
9664	47738	Hamaspik Choice
5840	MPM06	Health Care LA IPA
6476	59087	Health Help Networks
2121	00403	Healthy Blue South Carolina
5953	00403	Healthy Blue South Carolina
1744	91136	Heating Piping & Refrigeration Medical Fund
6591	91136	Heating Piping & Refrigeration Medical Fund
7703	HCMG1	Hemet Community Medical Group
1048	30862	Heritage Victor Valley Medical Group
7274	30862	Heritage Victor Valley Medical Group
7715	66003	Hopkins Health Advantage
9656	66003	Hopkins Health Advantage
9589	61102	Humana Encounters
3240	22175	I E Shaffer
3993	22175	I E Shaffer
1879	IECCA	IEHP Covered (Covered California)
3950	IECCA	IEHP Covered (Covered California)
1563	SKIL0	Illinois Medicaid
2488	SKIL0	Illinois Medicaid
6219	MVMM1	Inland Faculty Medical Group
2531	38254	Insight Benefit Administrators
5404	38254	Insight Benefit Administrators
1040	72091	Insurance Management Administrators
2571	18049	Iowa Medicaid
1744	91136	Iron Workers Local 5 Health and Welfare Trust Fund
6591	91136	Iron Workers Local 5 Health and Welfare Trust Fund
2502	95444	IU Health Plan Medicare Advantage
5479	95444	IU Health Plan Medicare Advantage
2015	47262	IU Health Transplant
8149	47262	IU Health Transplant
2676	01911	JE Mutual of Omaha CA, HI, NV
1428	KELSE	Kelsey-Seybold
5982	KELSE	Kelsey-Seybold
4167	IP082	Key Medical Group
4150	IP083	Key Medical Group Medicare Advantage
6061	66127	Lakeside Comprehensive Healthcare
9216	66127	Lakeside Comprehensive Healthcare
3844	41136	Life Trac
3907	41136	Life Trac
1744	91136	Locals 302 & 612 IUOE Trust Funds
6591	91136	Locals 302 & 612 IUOE Trust Funds
6090	LNC01	Longevity Health Plan of North Carolina
9268	LNC01	Longevity Health Plan of North Carolina
4082	MP330	Lutheran Preferred
8826	MP330	Lutheran Preferred
1744	91136	Machinists Health and Welfare Trust Fund
6591	91136	Machinists Health and Welfare Trust Fund
2419	00690	Maryland CareFirst Blue Cross Blue Shield
1880	56205	Medcost Benefit Services
8974	56205	Medcost Benefit Services
1270	43185	Mercy Provider Network
6506	43185	Mercy Provider Network
1744	91136	Middletown Works Hourly & Salaried Union Retirees Health Care Fund
6591	91136	Middletown Works Hourly & Salaried Union Retirees Health Care Fund
5871	PHM10	Mission Community IPA Medical Group
1148	74256	North Carolina Department of Public Safety
1580	74256	North Carolina Department of Public Safety
1744	91136	Northwest I.A.M. Benefit Trust
6591	91136	Northwest I.A.M. Benefit Trust
1744	91136	Northwest Insulation Workers Welfare Trust
6591	91136	Northwest Insulation Workers Welfare Trust
1744	91136	Northwest Ironworkers Trust Funds
6591	91136	Northwest Ironworkers Trust Funds
1744	91136	Northwest Plumbing and Pipefitting Industry Health, Welfare and Vacation Trust
6591	91136	Northwest Plumbing and Pipefitting Industry Health, Welfare and Vacation Trust
1744	91136	Northwest Roofers & Employers Health and Security Trust Fund
6591	91136	Northwest Roofers & Employers Health and Security Trust Fund
2475	IP095	Optum Care Network - Monarch
6606	IP095	Optum Care Network - Monarch
1171	72436	Pace Central Iowa
2527	72436	Pace Central Iowa
3010	70454	PACE CNY
8258	70454	PACE CNY
1172	35416	Pace Nebraska
2530	35416	Pace Nebraska
1150	45114	Pace of Southwest Michigan
1586	45114	Pace of Southwest Michigan
1170	53534	Pace Southwest Iowa
2519	53534	Pace Southwest Iowa
4877	37268	Palladian Muscular Skeletal Health
1004	66008	Passport Advantage
7829	66008	Passport Advantage
6045	55768	Piedmont Community Health Plan
9199	55768	Piedmont Community Health Plan
1272	81502	Prime Health Choice
6510	81502	Prime Health Choice
2979	88022	Prominence Administrative Services
4253	88022	Prominence Administrative Services
1744	91136	Puget Sound Benefits Trust
6591	91136	Puget Sound Benefits Trust
1744	91136	Puget Sound Electrical Workers Trust Funds
6591	91136	Puget Sound Electrical Workers Trust Funds
2593	35174	QualChoice of Arkansas
5428	35174	QualChoice of Arkansas
1776	RISRX	RIS Rx
2568	RISRX	RIS Rx
9434	AMM23	River City Medical Group Senior
6246	RMC01	Riverside Medical Clinic
7025	SNTCC	Sante Community Medical Centers
9410	SNTCC	Sante Community Medical Centers
1266	15682	Senior Network Health-Utica
5574	15682	Senior Network Health-Utica
6085	SWHMA	Senior Whole Health of Massachusetts
9246	SWHMA	Senior Whole Health of Massachusetts
7226	SHP01	Sharp Health Plan
7227	SRS83	Sharp Rees-Stealy Medical Group
7138	30891	Sierra Medical Group
1740	A0339	Sonder Health Plans
1916	A0339	Sonder Health Plans
1744	91136	South Bay Hotel, Employees Restaurant Employees Funds
6591	91136	South Bay Hotel, Employees Restaurant Employees Funds
3991	12T63	Spohn Health
1744	91136	Spokane Firefighters Benefit Trust
6591	91136	Spokane Firefighters Benefit Trust
1271	43619	Teamsters Medicare Trust for Retired Employees (TMT)
6508	43619	Teamsters Medicare Trust for Retired Employees (TMT)
1729	76048	Texas Childrens Health Plan (CHIP)
6583	76048	Texas Childrens Health Plan (CHIP)
1911	75228	Texas Childrens Health Plan (STAR Medicaid)
2483	75228	Texas Childrens Health Plan (STAR Medicaid)
1470	SKTX0	Texas Medicaid
5500	SKTX0	Texas Medicaid
1109	MP340	Three Rivers Preferred
8593	THIPA	Torrance Hospital IPA
3249	37284	Transchoice Key Benefit Administrators
4677	37284	Transchoice Key Benefit Administrators
8261	96436	UCS Insight Benefit Administrators
8060	11149	University Medical Center
9777	11149	University Medical Center
4779	SX155	University of Utah Health Plan
5920	SX155	University of Utah Health Plan
6444	50383	US Imaging Network
1131	48123	Valir Pace
2515	48123	Valir Pace
4967	BCBSVT	Vermont Blue Cross Blue Shield
7493	BCBSVT	Vermont Blue Cross Blue Shield
7889	42636	VillageMD of Georgia
1744	91136	Washington State Council of County and City Employees Health and Welfare Trust
6591	91136	Washington State Council of County and City Employees Health and Welfare Trust
5873	MPM09	Watts Healthcare
1744	91136	Welfare & Pension Administration Service, Inc.
6591	91136	Welfare & Pension Administration Service, Inc.
1744	91136	Welfare Pension Admin Services (WPAS)
6591	91136	Welfare Pension Admin Services (WPAS)
5803	87843	Wellfleet Group LLC
9441	NEXUS	Wellspace NEXUS LLC
5824	91064	Wenatchee Valley Medical Center
3979	31048	Western Southern Life Group
5415	31048	Western Southern Life Group
1126	WHLTH	Willow Health
2506	WHLTH	Willow Health

REF 828461 12/3/2024

---

New Electronic Claims Connections Available

This message is intended for Assurance Reimbursement Management customers.

Optum has new electronic claims connections available: 

Payer Name: Meridian PACE Solutions 

Institutional CPID: 8077 

Professional CPID: 2867 

Payer-assigned Payer ID: MPSAB 

Payer Enrollment Required: No 

Secondary Claims Accepted: No 

Payer Location: National 

Claims Fee: N/A 

Action Required: 

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

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

REF 829351 12/3/2024

---

Report Generation Delay for CPIDs 4936 and 3476 Masters, Mates and Pilots

A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted on Nov. 22, 2024.

Payer impacted: 

• CPID 4936 Masters, Mates and Pilots
• CPID 3476 Masters, Mates and Pilots

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

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

REF 829153 12/3/2024

---

New Electronic Remittance Connection Available – Re-enrollment required

Effective immediately, Optum has new electronic Remittance connection available: 

Payer Name: Chinese Community Health Plan

Professional CPID: 3473

Institutional CPID: 5683

Industry Payer ID: 94302

Remittance Enrollment Requirements:

• Payer enrollment for electronic remittance is required:

Action Required: 

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

• Make any necessary system changes.
• When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.

REF 829200 12/3/2024

---

New Electronic Claims Connections Available

Optum has new electronic claims connections available:

Payer Name:  Meridian PACE Solutions

Institutional CPID: 8077

Professional CPID: 2867

Payer-assigned Payer ID: MPSAB

Payer Enrollment Required: No

Secondary Claims Accepted: No

Payer Location: National

Claims Fee: $0.10

Action Required:

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

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

REF 829350 12/3/2024

---

Update: Report Generation Delay for CPIDs 3061 and 8454 Align Senior Care of Michigan

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

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

Original message sent Nov. 18, 2024:

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

Payer impacted:

• CPID 3061 Align Senior Care of Michigan
• CPID 8454 Align Senior Care 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.

REF 829151 12/3/2024

---

Payer ID Update for UMR - Onalaska

This message is intended for Revenue Performance Advisor customers.

Effective immediately, UMR - Onalaska (ID 79480) claims have been deactivated on the Revenue Performance Advisor system.

Providers should now be sending their claims to:

Payer Name: United Medical Resources

Payer ID: 39026

Action Required: Please update the above payer within your medical billing software or contact your software vendor for assistance, as needed.

REF 829300 12/3/2024

---

Payer Transmit Delay for CPIDs 4427 and 5586 Montana Medicaid

Due to a payer system issue, a delay occurred in some of the transmissions to the following payer since Dec. 2, 2024. 

Payer impacted: 

• CPID 4427 Montana Medicaid 
• CPID 5586 Montana Medicaid 

Optum is working with the payer to resolve this issue. We will notify you as soon as additional information becomes available. This delay affected claims released to Optum since 2 p.m. CT on Nov. 29, 2024. 

Action Required: Be aware of the transmit delay above.

REF 829100 12/3/2024

---

Report Generation Delay for multiple CPIDs

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

WPS is experiencing issues affecting Professional and Institutional report generation for some claims submitted on Nov. 25, 2024.

Payers impacted:

• CPID 3975 Indiana Medicare
• CPID 2120 Missouri Medicare Eastern
• CPID 2127 Nebraska Medicare

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

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

REF 828402 12/2/2024

---

Report Generation Delay for CPIDs 4557 and 2875 First Health Network (Coventry Health Care National Network)

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

A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted on Nov. 21, 2024, and Nov. 22, 2024.

Payer impacted:

• CPID 4557 First Health Network (Coventry Health Care National Network)
• CPID 2875 First Health Network (Coventry Health Care National Network)

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

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

REF 828450 12/2/2024

---

Institutional Claims Suspended - Peak Pace Solutions

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

Effective immediately, the payer listed below has been temporarily suspended at Optum for institutional claims processing.

Payer Name: Peak Pace Solutions

Payer ID: 27034

Action Required: 

Please refrain from submitting institutional claims until further notice.

REF 828706 12/2/2024

---

Pace Greater New Orleans (NORLN) and Team Choice PNS Electronic Claim Connections No Longer Available

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

Payer Name: Pace Greater New Orleans (NORLN)
Claim CPIDs: 5590, 1267
Reason: Payer no longer contracted.

Payer Name: Team Choice PNS
Claim CPIDs: 5021, 8869
Reason: Payer no longer contracted.

Action Required: None.

REF 828750  12/2/2024

---

New Electronic Remittance Connections Available

Optum has new electronic remittance connections available: 

Payer Name: Auxiant
Institutional CPID: 8059
Payer-assigned Payer ID: AUX01
Payer Enrollment Required: Yes
Remittance Fee: N/A
Payer Location: Iowa, Wisconsin 

CPID 1121 Auxiant, was previously setup as remittance only payer that was used for both professional and institutional remit. 

Action Required: 

• Add the payers to your system to begin using the new payer connection.
• Enrollment forms must be submitted and approved to begin receiving electronic remittance through Optum.

REF 828600 12/2/2024

---

Update: Report Generation Delay for CPID 3044 University of Michigan Health Medicare

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

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

Original notify sent Nov. 22, 2024:

A payer is experiencing issues affecting Institutional report generation for some claims submitted on Nov. 4, 2024.

Payer impacted: 

• CPID 3044 University of Michigan Health Medicare

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

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

REF 828404 12/2/2024

---

New Payer Edit: Keenan Associates

Effective Dec. 9, 2024, at 5  p.m. CT,  professional and institutional claims for the payer listed below must be submitted with a 9 alpha character Member ID in the 2010BA Loop, NM109*IL segment.  Claims submitted with more than a 9 alpha character member ID will reject with the following message:

• Edit INM10911DZ - INVALID SUBSCRIBER MEMBER ID - The Active Subscriber Member ID must not begin with 3 alpha characters.
• Edit PNM10903DZ - INVALID SUBSCRIBER MEMBER ID - The Active Subscriber Member ID must not begin with 3 alpha characters.

Payers affected: 

• CPID 7617 Keenan Associates, Payer ID 95279
• CPID 6838 Keenan Associates, Payer ID 95279

NOTE: Providers should start submitting the correct Member ID effective immediately.  Claims will start rejecting on Dec. 9, 2024.

Action Required: Please be aware of this new requirement.

REF 828501 12/2/2024

---

Report Generation Delay for multiple CPIDs

The payers listed below are experiencing issues affecting Professional and Institutional report generation for some claims submitted on Nov. 21, 2024, and Nov. 22, 2024.

Payers impacted:

• CPID 7045 AmeriHealth Caritas Ohio
• CPID 9428 AmeriHealth Caritas Ohio
• CPID 7068 Buckeye Ohio Medicaid
• CPID 9457 Buckeye Ohio Medicaid
• CPID 9704 Buckeye Ohio Medicaid Vision
• CPID 7073 Humana Ohio Medicaid
• CPID 9463 Humana Ohio Medicaid
• CPID 9455 Molina Ohio Medicaid Vision
• CPID 2481 Ohio Medicaid
• CPID 3509 Ohio Medicaid
• CPID 9435 OhioRISE - Aetna Better Health of Ohio
• CPID 7052 OhioRISE - Aetna Better Health of Ohio
• CPID 9465 UnitedHealthcare Ohio Medicaid
• CPID 7074 UnitedHealthcare Ohio Medicaid
• CPID 9706 UnitedHealthcare Ohio Medicaid Vision

The payers have been unable to generate and deliver the reports for some claims submitted on Nov. 21, 2024, and Nov. 22, 2024.

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

REF 828403 12/2/2024

---

Payer Change for CPID 3040 Carelon Aetna Home Health

Effective January 1, 2025, Aetna will begin managing the Carelon Medicare Advantage network for Aetna members receiving services in Connecticut, Pennsylvania, and West Virginia. Providers will need to submit claims for these states to a different CPID starting with Dates of Service on or after January 1, 2025.

Claims and Remittance containing Dates of Service on or prior to December 31, 2024, must continue to use the following:

Payer Name: Carelon Aetna Home Health

Institutional CPID: 3040

Remittance Available: Yes

Payer-assigned Payer ID: 34010

NOTE: For the states of Connecticut, Pennsylvania and West Virginia, Carelon will continue to accept payer ID 34010 claims with DOS through December 31, 2024, however all 2024 claims need to be submitted to Carelon prior to June 30, 2025.

Claims and Remittance containing Dates of Service on or after January 1, 2025, must begin using the following:

Payer Name: Aetna

Institutional CPID: 4500

Remittance Available: Yes

Payer-assigned Payer ID: 60054

Claim Fee: No

NOTE: This only affects members receiving services in the states of Connecticut, Pennsylvania and West Virginia, all other states will continue to submit to CPID 3040 Carelon Aetna Home Health, payer ID 34010.

Enrollment Requirements:

Claims:

• Payer enrollment for electronic claims is not required. 

Remittance:

• Payer enrollment for electronic remittance is required.
  • Providers currently receiving electronic remittance through Optum for CPID 4500 Aetna do not need to complete a new enrollment form.
  • Providers not receiving electronic remittance through Optum for CPID 4500 Aetna must complete a new enrollment form.
  • New providers must complete a new enrollment form. 

For additional information, please refer to the payer website.

Action Required:

• Please be aware of the changes above and make any necessary changes in your system.
• To access the new enrollment forms, please visit Enrollment Central.

REF 828500 12/2/2024

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New Electronic Remittance Connections Available

Optum has new electronic remittance connections available:

Payer Name: Auxiant
Institutional CPID: 8059
Payer-assigned Payer ID: AUX01
Line of Business (LOB) Code: JN7
Payer Enrollment Required: Yes
Remittance Fee: N/A
Payer Location: Iowa, Wisconsin

CPID 1121 Auxiant, was previously setup as remittance only payer that was used for both professional and institutional remit.

Action Required:

• Add the payers to your system to begin using the new payer connection.
• Enrollment forms must be submitted and approved to begin receiving electronic remittance through Optum.

REF 828601  12/2/2024

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Report Generation Delay for CPID 3211 Wellcare Health Plans (Encounters)

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted since Nov. 19, 2024.

Payer impacted: 

• CPID 3211 Wellcare Health Plans (Encounters)

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

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

REF 828201 12/2/2024

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Update: Report Generation Delay for CPIDs 8921 and 5865 Indian Health Services

The payer intermediary has been unable to generate and deliver the reports for some claims submitted from Oct. 25, 2024 through Nov. 19, 2024.

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

Original message sent Nov. 13, 2024:

A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted since Oct. 25, 2024.

Payer impacted:

• CPID 8921 Indian Health Services
• CPID 5865 Indian Health Services

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

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

REF 828200 12/2/2024