CHC Payer Updates (December 2025)

December 2025

December Payer Processing Issues

Summary

When Optum discovers issues or interruptions to transaction processing, the details* will appear below.

If you're looking for a specific payer or specific transaction type, please use Ctrl + F on Windows or ⌘ + F on Mac to find that term within the page.

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

VIEW ALL PAYER LISTS →

Update: Payer Processing Issue for MetroPlus Health Plan

Update: All impacted claims have been processed. Please watch for corresponding reports.

Original notice sent Dec. 22, 2025:

We would like to give you awareness of a payer processing issue that could potentially impact your business.

Due to a payer processing issue, some Professional & Institutional claims transmitted to MetroPlus Health Plan since Dec. 4, 2025 are delayed.

Payer Name: MetroPlus Health Plan
Payer ID: 13265
CPID: 2296 Prof
CPID: 8872 Inst

Optum is working with the payer to resolve this processing issue. We will notify you once this issue has been resolved. 

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

If you have any questions, please contact Customer Support and refer to Global Issue INC-000003829.

12/31/2025

New Electronic Remittance Connections Available

Optum has new electronic remittance connections available:

Payer Name: Associated Administrators, LLC.
Institutional CPID: 1010
Professional CPID: 7834
Payer-assigned Payer ID: 13788
Line of Business (LOB) Code: H4C
Payer Enrollment Required: Yes
Payer Location: National

Action Required:

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

12/31/2025

New Electronic Remittance Connections Available

Optum has new electronic remittance connections available:

Payer Name: Associated Administrators, LLC.
Institutional CPID: 1010
Professional CPID: 7834
Payer-assigned Payer ID: 13788
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.

12/31/2025

New Electronic Eligibility and Claim Status Connection Available

Effective December 30th, 2025 Optum is pleased to announce the availability of Real-time Eligibility Inquiry and Response 270/271 and Claim Status 276/277 for the below payer:

Payer Name: AmeriHealth Caritas Next, A Product of AmeriHealth Caritas Louisiana

Industry Payer ID: 75066

IMN Real Time ID: 75066

Exchange Real Time ID: ACNLA

CPID(s): 9006, 3464

Optum IEDi Real Time ID: 75066

Payer Enrollment Required: No

Connection Type: X12

Search Options:

Eligibility Subscriber

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

Claim Status Inquiry subscriber

  • Member id, first name, last name, date of birth
  • Optional additional elements: Payer claim number; Total submitted charges

12/31/2025

New Electronic Eligibility and Claim Status Connection Available

Effective December 30th, 2025 Optum is pleased to announce the availability of Real-time Eligibility Inquiry and Response 270/271 and Claim Status 276/277 for the below payer:

Payer Name: AmeriHealth Caritas VIP Care – Michigan HIDE SNP

Industry Payer ID: 90689

IMN Real Time ID: 90689

Exchange Real Time ID: AVHMI

CPID(s): 9023, 3701

Optum IEDi Real Time ID: 90689

Payer Enrollment Required: No

Connection Type: X12

Search Options:

Eligibility Subscriber

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

Claim Status Inquiry subscriber

  • Member id, first name, last name, date of birth
  • Optional additional elements: Payer claim number; Total submitted charges

12/31/2025

New Electronic Eligibility and Claim Status Connection Available

Effective December 30th, 2025 Optum is pleased to announce the availability of Real-time Eligibility Inquiry and Response 270/271 and Claim Status 276/277 for the below payer:

Payer Name: AmeriHealth Caritas District of Columbia Healthy DC Plan

Industry Payer ID: A5420

IMN Real Time ID: A5420

Exchange Real Time ID: ACHDC

CPID(s): N/A

Optum IEDi Real Time ID: A5420

Payer Enrollment Required: No

Connection Type: X12

Search Options:

Eligibility Subscriber

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

Claim Status Inquiry subscriber

  • Member id, first name, last name, date of birth
  • Optional additional elements: Payer claim number; Total submitted charges

12/31/2025

999 Payer Batch Rejections for CPID 3786 Capital District Physician Health Plan

Professional claims transmitted to the payer listed below from Optum on Dec. 30, 2025 were not processed by the payer due to a 999 Batch Rejection.

  • CPID 3786 Capital District Physicians Health Plan

A resolution has been implemented and the claims were retransmitted to the payer on Dec. 31, 2025.

Action Required: None.

If you have any questions, please contact Customer Support and refer to Case Number 09818094.

12/31/2025

New Electronic Eligibility and Claim Status Connection Available

Effective December 30th, 2025 Optum is pleased to announce the availability of Real-time Eligibility Inquiry and Response 270/271 and Claim Status 276/277 for the below payer:

Payer Name: AmeriHealth Caritas VIP Care Louisiana HIDE SNP

Industry Payer ID: 73575

IMN Real Time ID: 73575

Exchange Real Time ID: ACVLA

CPID(s): 9022, 3499

Optum IEDi Real Time ID: 73575

Payer Enrollment Required: No

Connection Type: X12

Search Options:

Eligibility Subscriber

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

Claim Status Inquiry subscriber

  • Member id, first name, last name, date of birth
  • Optional additional elements: Payer claim number; Total submitted charges

12/31/2025

New Electronic Eligibility and Claim Status Connection Available

Effective December 30th, 2025 Optum is pleased to announce the availability of Real-time Eligibility Inquiry and Response 270/271 and Claim Status Inquiry and Response 276/277 for the below payer:

Payer Name: NYCE

Industry Payer ID: 26992

IMN Real Time ID: 26992

Exchange Real Time ID: NYCEU

CPID(s): 3783, 9055

Optum IEDi Real Time ID: 26992

Payer Enrollment Required: No

Connection Type: X12

 

Search Options:

Eligibility Subscriber

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

Eligibility Dependent

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

Claim Status Inquiry Subscriber

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

 Claim Status Inquiry Dependent

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

12/31/2025

Real Time Eligibility 270/271 and Claim Status 276/277

Effective December 30th, 2025 Optum is pleased to announce the availability of Real-time Eligibility Inquiry and Response 270/271 and Claim Status 276/277 for the below payer:

Payer Name: AmeriHealth Caritas VIP Care – North Carolina HIDE SNP

Industry Payer ID: 31481

IMN Real Time ID: 31481

Exchange Real Time ID: ACVNC

CPID(s): 9024, 3702

Optum IEDi Real Time ID: 31481

Payer Enrollment Required: No

Connection Type: X12

Search Options:

Eligibility Subscriber

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

Claim Status Inquiry subscriber

  • Member id, first name, last name, date of birth
  • Optional additional elements: Payer claim number; Total submitted charges

12/31/2025

Report Generation Delay for CPID 5502 Texas Medicare

A payer intermediary is experiencing issues affecting Institutional report generation for some claims submitted on Dec. 23, 2025.

Payer impacted: 

  • CPID 5502 Texas Medicare

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09817714.

12/31/2025

Report Generation Delay for Multiple CPIDs

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted since Dec. 22, 2025.

Payers impacted: 

  • CPID 7476 Medicare DME MAC Jurisdiction B
  • CPID 7477 Medicare DME MAC Jurisdiction C
  • CPID 7478 Medicare DME MAC Jurisdiction D

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09817690.

12/31/2025

Aetna Better Health of Kansas Medical Attachment Connections No Longer Available

Effective 01/01/2026, the payer listed below will no longer be available at Optum for medical attachment processing.

Payer Name: Aetna Better Health of Kansas
Medical Attachment CPIDs: 8111, 1084
Payer-assigned Payer ID: 128KS
Reason: Payer no longer in business.

Action Required: None

12/30/2025

AllCare PACE Electronic Claims Connection No Longer Available

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

Payer Name: AllCare PACE
Claims CPIDs: 9291, 7009
Payer-assigned Payer ID: ACPCE
Reason: Payer no longer in business.  

Payer will accept claims with dates of service of 12/31/2024 or prior via mail or fax. 

Action Required: None. 

12/30/2025

AllCare PACE Electronic Claims Connection No Longer Available

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

Payer Name: AllCare PACE
Claim CPIDs: 9291, 7009
Payer-assigned Payer ID: ACPCE
Reason: Payer no longer in business. 

Payer will accept claims with dates of service of 12/31/2024 or prior via mail or fax. 

Action Required: None

12/30/2025

999 Payer Batch Rejections for CPID 3786 Capital District Physician Health Plan

Professional claims transmitted to the payer listed below from Optum on Dec. 29, 2025 were not processed by the payer due to a 999 Batch Rejection.

  • CPID 3786 Capital District Physicians Health Plan

A resolution has been implemented and the claims were retransmitted to the payer on Dec. 30, 2025.

Action Required: None.

If you have any questions, please contact Customer Support and refer to Case Number 09817046.

12/30/2025

Multicare Connected Care Electronic Remittance Connection No Longer Available

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

Payer Name: Multicare Connected Care
Remittance CPIDs: 6098, 9276
Remittance LOB: K93
Payer-assigned Payer ID: RP036
Reason: Payer no longer offers an electronic connection to which Optum can connect

Action Required: None.

12/30/2025

Multicare Connected Care Electronic Remittance Connection No Longer Available

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

Payer Name: Multicare Connected Care
Remittance CPIDs: 6098, 9276
Payer-assigned Payer ID: RP036
Reason: Payer no longer offers an electronic connection to which Optum can connect

Action Required: None.

12/30/2025

Report Generation Delay for CPID 7738 CountyCare Health Plan

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted since Dec. 15, 2025.

Payer impacted: 

  • CPID 7738 CountyCare Health Plan

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09816609.

12/30/2025

New Electronic Claims and Remittance Connections Available

Effective January 1, 2026, Optum has new electronic claims and remittance connections available:    

Payer Name: NYCE
Institutional CPID: 9055
Professional CPID: 3783
Payer-assigned Payer ID: 26992
Line of Business (LOB) Code: H8A
Payer Claim Enrollment Required: No
Payer Remittance Enrollment Required: Yes
Secondary Claims Accepted: Yes
Payer Location: New York 

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. 

12/30/2025

New Electronic Claims and Remittance Connections Available

Effective January 1, 2026, Optum has new electronic claims and remittance connections available:  

Payer Name: NYCE
Institutional CPID: 9055
Professional CPID: 3783
Payer-assigned Payer ID: 26992
Payer Claim Enrollment Required: No
Payer Remittance Enrollment Required: Yes
Secondary Claims Accepted: Yes
Payer Location: New York
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. 

12/30/2025

Electronic Claims Connection Suspended

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

Payer Name:  Emanate Health IPA
CPIDs:  4036, 8764
Payer ID:  MPM62
Reason: Payer unavailable electronically. 

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

12/29/2025

New Assurance Attach Assist Medical Attachment Connections Available

Effective January 1, 2026, Optum will have new electronic medical attachment connections available for the following payers:

Payer Name: AmeriHealth Caritas Next, A Product of AmeriHealth Caritas Louisiana

Professional CPID: 3464

Institutional CPID: 9006

Payer-assigned Payer ID: 75066

Accepted Attachment Type: Solicited and Unsolicited

Payer Enrollment Required: No

Payer Location: Louisiana

Payer Name: AmeriHealth Caritas VIP Care - Michigan HIDE SNP

Professional CPID: 3701

Institutional CPID: 9023

Payer-assigned Payer ID: 90689

Accepted Attachment Type: Solicited and Unsolicited

Payer Enrollment Required: No

Payer Location: Michigan

Payer Name: AmeriHealth Caritas VIP Care - North Carolina HIDE SNP

Professional CPID: 3702

Institutional CPID: 9024

Payer-assigned Payer ID: 31481

Accepted Attachment Type: Solicited and Unsolicited

Payer Enrollment Required: No

Payer Location: North Carolina

Payer Name: AmeriHealth Caritas VIP Care – Louisiana HIDE SNP

Professional CPID: 3499

Institutional CPID: 9022

Payer-assigned Payer ID: 73575

Accepted Attachment Type: Solicited and Unsolicited

Payer Enrollment Required: No

Payer Location: Louisiana

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.

12/29/2025

New Electronic Medical Attachment Connections Available

Effective January 1, 2026, Optum will have new electronic medical attachment connections available for the following payers:

Payer Name: AmeriHealth Caritas Next, A Product of AmeriHealth Caritas Louisiana

Professional CPID: 3464

Institutional CPID: 9006

Payer-assigned Payer ID: 75066

Accepted Attachment Type: Solicited and Unsolicited

Payer Enrollment Required: No

Payer Location: Louisiana

Payer Name: AmeriHealth Caritas VIP Care - Michigan HIDE SNP

Professional CPID: 3701

Institutional CPID: 9023

Payer-assigned Payer ID: 90689

Accepted Attachment Type: Solicited and Unsolicited

Payer Enrollment Required: No

Payer Location: Michigan

Payer Name: AmeriHealth Caritas VIP Care - North Carolina HIDE SNP

Professional CPID: 3702

Institutional CPID: 9024

Payer-assigned Payer ID: 31481

Accepted Attachment Type: Solicited and Unsolicited

Payer Enrollment Required: No

Payer Location: North Carolina

Payer Name: AmeriHealth Caritas VIP Care – Louisiana HIDE SNP

Professional CPID: 3499

Institutional CPID: 9022

Payer-assigned Payer ID: 73575

Accepted Attachment Type: Solicited and Unsolicited

Payer Enrollment Required: No

Payer Location: Louisiana

Action Required:

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

Please update your system and procedures to take advantage of the new connection. For assistance with Medical Attachments, please contact your Practice Management System Vendor.

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

12/29/2025

S&S Healthcare Real Time Eligibility 270/271 Connection No Longer Available

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

Payer Name: S & S Healthcare Strategies
Optum IEDI Real Time ID: 10875
Reason: Payer no longer offers an electronic connection

Action Required: None

12/29/2025

New Electronic Eligibility Connection Available

Optum is pleased to announce the availability of Real-time Eligibility Inquiry and Response 270/271 for the below payer, effective Dec 22, 2025:

Payer Name: Point C
Industry Payer ID: IHS29
IMN Real Time ID: IHS29
Exchange Real Time ID: IHSPC
CPID(s): 9040, 3746
Optum IEDi Real Time ID: IHS29
Payer Enrollment Required: No
Connection Type: X12 

Search Options:

Eligibility Subscriber

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

Eligibility Dependent

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

Action Required by customer:

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

12/29/2025

New Electronic Remittance Connections Available

Optum has new electronic remittance connections available:  

Payer Name: VGM Homelink
Professional CPID: 6767
Payer-assigned Payer ID: 50701
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. 

12/29/2025

New Electronic Remittance Connections Available

Optum has new electronic remittance connections available:  

Payer Name: VGM Homelink
Professional CPID: 6767
Payer-assigned Payer ID: 50701
Line of Business (LOB) Code: H23
Payer Enrollment Required: Yes
Payer Location: National 

Action Required: 

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

12/29/2025

Electronic Routing Change for CPIDs 3293 and 5635 Carelon Health

Effective December 24, 2025, Optum will be changing electronic remittance routing for the following payer:   

Payer Name: Carelon Health
Professional CPID: 3293
Institutional CPID: 5635
Payer-assigned Payer ID: CARMO
Line of Business Code (LOB): J50
Payer Remittance Enrollment Required: Yes 

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:  

  • 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. 

12/29/2025

Electronic Routing Change for CPIDs 3293 and 5635 Carelon Health

Effective December 24, 2025, Optum will be changing electronic remittance routing for the following payer: 

Payer Name: Carelon Health
Professional CPID: 3293
Institutional CPID: 5635
Payer-assigned Payer ID: CARMO
Payer Remittance Enrollment Required: Yes
Remittance Fee: N/A 

Enrollment Requirements: 

Remittance:

  • Payer enrollment for electronic remittance is required. 
  • Providers currently receiving electronic remittance through Optum 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. 

12/29/2025

New Electronic Claim Status Connection Available

Optum is pleased to announce the availability of Real-time Claim Status Inquiry and Response 276/277 for the below payer, effective December 23, 2025:

Payer Name: Fidelis Care
Industry Payer ID: 11315
IMN Real Time ID: 11315
Exchange Real Time ID: FDCRNY
CPID(s): 6536, 3792
IEDI Real Time ID: 10459
Payer Enrollment Required: No
Connection Type: X12

Search Options:

Claim Status Inquiry subscriber

  • Member id, First name, Last name, Date of Birth

Optional additional elements:

  • Payer claim number, Total submitted charges

Action Required by customer:

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.

12/24/2025

Error Message for Payer ID 11328, HealthCare Partners IPA

Due to a potential trading partner processing issue, Professional and Institutional claims for the payer listed below may have received the following error message:

  • MEMBER ID NOT FOUND

The trading partner is diligently reviewing this issue for a resolution.

Payer affected:

  • Payer ID 11328, HealthCare Partners IPA

Action Required: None at this time. Please be aware of this issue. Further notification will be sent as it is received from the trading partner.

12/24/2025

Report Generation Delay for CPID 5568 Global Healthcare Alliance

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

Payer impacted: 

  • CPID 5568 Global Healthcare Alliance

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09813759.

12/24/2025

Payer Fee Change for CPID 7037 PhysMetrics

Please be aware of the following payer claim fee changes:

Payer Name: PhysMetrics

CPID(s): 7037

Payer ID: 48008

Current Fee: $0.00

New Fee: $0.10

Effective Date: 12/24/2025

Action Required: Please be aware the payers above have modified their claim fee.

12/24/2025

New Electronic Remittance (ERA) Connections Available on RPA

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

Payer ID – Payer name

HALOS – Halos Systems

SKMA9 – MassHealth

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.

12/24/2025

New Electronic Claims Connections Available on RPA

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

52682 – Benefit Health Plan

MSO11 – San Diego County Medical Services (CMS)

R4569 – Horizon Pace

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

22149 – Kern Health Care Network (Kern County)

52682 – Benefit Health Plan

R4569 – Horizon Pace

12/24/2025

New Real Time Connections Available on RPA

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

10964 – Group Hospitalization and Medical Services

11011 – EPSI, Inc

11041 – Group Health Northwest

11164 – Everest Reinsurance Company

11171 – Medica2

13284 – Erie Family Life Insurance

31348 – Crum & Forster

47362 – Auxilio Salud Plus Inc.

66063 – Vital - Plan de Salud Menonita Reform

COMMF – Community First Health Plan

PDSAM – Auxilio Plan de Socio

SAGE1 – Sage

VHP01 – Valley Health Plan

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

71412 – Mutual of Omaha

91051 – Kaiser Foundation Health Plan of WA

AETLC – Aetna Long Term Care

CALOP – CalOptima

LIFE1 – Optum Medical Network

SKIN0 – Indiana Medicaid

SKMI0 – Michigan Medicaid

12/24/2025

New Electronic Claims and Remittance Connections Available

Effective January 1, 2026, Optum will have new electronic claims and remittance connections available for the following payers:

Payer Name: AmeriHealth Caritas VIP Care - Michigan HIDE SNP

Institutional CPID: 9023

Professional CPID: 3701

Payer-assigned Payer ID: 90689

Payer Claim Enrollment Required: No

Payer Remittance Enrollment Required: Yes

Secondary Claims Accepted: Yes

Payer Location: Michigan

Claims Fee: N/A

Remittance Fee: N/A

 

Payer Name: AmeriHealth Caritas VIP Care – North Carolina HIDE SNP

Institutional CPID: 9024

Professional CPID: 3702

Payer-assigned Payer ID: 31481

Payer Claim Enrollment Required: No

Payer Remittance Enrollment Required: Yes

Secondary Claims Accepted: Yes

Payer Location: North Carolina

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.

12/23/2025

New Electronic Claims and Remittance Connections Available

Effective January 1, 2026, Optum will have new electronic claims and remittance connections available for the following payers:

Payer Name: AmeriHealth Caritas VIP Care - Michigan HIDE SNP
Institutional CPID: 9023
Professional CPID: 3701
Payer-assigned Payer ID: 90689
Payer Claim Enrollment Required: No
Payer Remittance Enrollment Required: Yes
Secondary Claims Accepted: Yes
Payer Location: Michigan
Claims Fee: N/A
Remittance Fee: N/A

Payer Name: AmeriHealth Caritas VIP Care – North Carolina HIDE SNP
Institutional CPID: 9024
Professional CPID: 3702
Payer-assigned Payer ID: 31481
Payer Claim Enrollment Required: No
Payer Remittance Enrollment Required: Yes
Secondary Claims Accepted: Yes
Payer Location: North Carolina
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.

12/23/2025

New Electronic Claims and Remittance Connections Available

Effective January 1, 2026, Optum will have new electronic claims and remittance connections available for the following payers:

Payer Name: AmeriHealth Caritas VIP Care - Michigan HIDE SNP
Institutional CPID: 9023
Professional CPID: 3701
Payer-assigned Payer ID: 90689
Line of Business (LOB) Code: E34
Payer Claim Enrollment Required: No
Payer Remittance Enrollment Required: Yes
Secondary Claims Accepted: Yes
Payer Location: Michigan

Payer Name: AmeriHealth Caritas VIP Care – North Carolina HIDE SNP
Institutional CPID: 9024
Professional CPID: 3702
Payer-assigned Payer ID: 31481
Line of Business (LOB) Code: E35
Payer Claim Enrollment Required: No
Payer Remittance Enrollment Required: Yes
Secondary Claims Accepted: Yes
Payer Location: North Carolina

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.

12/23/2025

New Electronic Claims and Remittance Connections Available

Effective January 1, 2026, Optum will have new electronic claims and remittance connections available for the following payers:

Payer Name: CareSource Nevada Marketplace
Institutional CPID: 9051
Professional CPID: 3767
Payer-assigned Payer ID: NVCS1
Payer Claim Enrollment Required: No
Payer Remittance Enrollment Required: Yes
Secondary Claims Accepted: Yes
Payer Location: Nevada
Claims Fee: $0.10
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. 

12/23/2025

New Electronic Claim Status Connection Available

Optum is pleased to announce the availability of Real-time Claim Status Inquiry and Response 276/277 for the below payer, effective December 19, 2025:

Payer Name: Pennsylvania Medicaid
Industry Payer ID: SKPA0
IMN Real Time ID: SKPA0
Exchange Real Time ID: PACAID
CPID(s): 1491, 5509
IEDI Real Time ID: PAMCD
Payer Enrollment Required: No
Connection Type: X12

Search Options:

Claim Status Inquiry subscriber

  • Member id, First name, Last name, Date of Birth

Optional additional elements:

  • Payer claim number, Total submitted charges

Action Required by customer:

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.

12/23/2025

New Electronic Claims and Remittance Connections Available
Optum will have new electronic claims and remittance connections available for the following payers, effective Jan. 1, 2026:

Payer Name: CareSource Nevada Medicaid
Institutional CPID: 9054
Professional CPID: 3788
Payer-assigned Payer ID: NVMCDCS1
Line of Business (LOB) Code: H5S
Payer Claim Enrollment Required: No
Payer Remittance Enrollment Required: Yes
Secondary Claims Accepted: Yes
Payer Location: Nevada

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.

12/23/2025

New Electronic Claims and Remittance Connections Available
Optum will have new electronic claims and remittance connections available for the following payers, effective Jan. 1, 2026:

Payer Name: CareSource Nevada Medicaid
Institutional CPID: 9054
Professional CPID: 3788
Payer-assigned Payer ID: NVMCDCS1
Payer Claim Enrollment Required: No
Payer Remittance Enrollment Required: Yes
Secondary Claims Accepted: Yes
Payer Location: Nevada
Claims Fee: $0.10

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.

12/23/2025

New Electronic Claims and Remittance Connections Available
Optum will have new electronic claims and remittance connections available for the following payer, effective Jan. 1, 2026:

Payer Name: CareSource Nevada Marketplace
Institutional CPID: 9051
Professional CPID: 3767
Payer-assigned Payer ID: NVCS1
Line of Business (LOB) Code: H5S
Payer Claim Enrollment Required: No
Payer Remittance Enrollment Required: Yes
Secondary Claims Accepted: Yes
Payer Location: Nevada

Action Required:

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

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

12/23/2025

Electronic Claims Connection Suspended - PACE of Southwest Michigan (45114)
Effective immediately, the payer listed below has been suspended at Optum for claim processing and removed from the payer list.

Payer Name: PACE of Southwest Michigan
Payer ID: 45114
Reason: Payer unavailable electronically.

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

12/23/2025

New Electronic Remittance Connections Available
Optum has new electronic remittance connections available:  

Payer Name: Christus Health Medicare Advantage
Payer ID: 10629
Payer Enrollment Required: Yes
Payer Location: Texas and New Mexico 

Payer Name: Christus Health Plan Health Insurance Exchange
Payer ID: 52106
Payer Enrollment Required: Yes
Payer Location: Texas 

Payer Name: UCLA Medical Group
Payer ID: USMBP
Payer Enrollment Required: Yes
Payer Location: California 

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. 

12/23/2025

Update: Report Generation Delay for CPID 7009 AllCare PACE

Update: The payer intermediary has been unable to generate and deliver the reports for some claims submitted from Oct. 30, 2025 through Nov. 21, 2025.

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

Original notice sent Nov. 12, 2025:

A payer intermediary is experiencing issues affecting Institutional report generation for some claims submitted since Oct. 30, 2025.

Payer impacted: 

  • CPID 7009 AllCare PACE

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09771277.

12/23/2025

Electronic Claims Connection Suspended

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

Payer Name: PACE of Southwest Michigan
CPID(s): 1150, 1586
Payer ID: 45114

Reason: Payer unavailable electronically.

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

12/23/2025

Medicare HETS - Upcoming HETS2026-1 System Release

CMS announces publication of the Release Summary. 

The HETS2025-3 release will introduce potential changes to the HETS 271 response. CMS urges all HETS submitters to use this HETS2025-3 Release Summary and the upcoming HETS2026-1 Companion Guide to prepare for this future release.

HETS2026-1 Release Summary (version 1-0): https://www.cms.gov/files/document/hets2026-1-hets-270-271-release-summary.pdf

The HETS2026-1 release is scheduled for March 2026. Submitters will be notified when additional information is available regarding this release.

Action Required: Review updated details on the potential changes that are linked above and distribute as appropriate within your facility.

12/23/2025

Electronic Routing Change for CPIDs 9001 and 3450 WeShare Legacy

Effective December 22, 2025, Optum will be changing electronic claims routing for the following payer:

Payer Name: WeShare Legacy
Professional CPID: 3450
Edit Master: PE_T007
Institutional CPID: 9001
Edit Master: HE9T007
Payer-assigned Payer ID: UHSM1
Payer Claim Enrollment Required: No
Secondary Claims Accepted: Yes

Enrollment Requirements:

Claims:

  • Payer enrollment for electronic claims is not required.

Report Changes:

You may see some differences in the payer reports you receive.

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

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

12/23/2025

New Electronic Remittance Connections Available
Optum has new electronic remittance connections available:  

Payer Name: UCLA Medical Group
Institutional CPID: 8680
Professional CPID:7266
Payer-assigned Payer ID: USMBP
Payer Enrollment Required: Yes
Remittance Fee: N/A
Payer Location: California 

Action Required: 

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

12/23/2025

New Electronic Remittance Connections Available
Optum has new electronic remittance connections available:  

Payer Name: UCLA Medical Group
Institutional CPID: 8680
Professional CPID: 7266
Payer-assigned Payer ID: USMBP
Line of Business (LOB) Code: J5F
Payer Enrollment Required: Yes
Payer Location: California 

Action Required: 

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

12/23/2025

New Electronic Remittance Connections Available
Optum has new electronic remittance connections available:  

Payer Name: Christus Health Medicare Advantage
Institutional CPID: 8579
Professional CPID: 7805
Payer-assigned Payer ID: 10629
Payer Enrollment Required: Yes
Remittance Fee: N/A
Payer Location: Texas and New Mexico 

Payer Name: Christus Health Plan Health Insurance Exchange
Institutional CPID: 9657
Professional CPID: 7716
Payer-assigned Payer ID: 52106
Payer Enrollment Required: Yes
Remittance Fee: N/A
Payer Location: Texas 

Action Required: 

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

12/23/2025

New Electronic Remittance Connections Available
Optum has new electronic remittance connections available:  

Payer Name: Christus Health Medicare Advantage
Institutional CPID: 8579
Professional CPID: 7805
Payer-assigned Payer ID: 10629
Line of Business (LOB) Code: H35
Payer Enrollment Required: Yes
Payer Location: Texas and New Mexico 

Payer Name: Christus Health Plan Health Insurance Exchange
Institutional CPID: 9657
Professional CPID: 7716
Payer-assigned Payer ID: 52106
Line of Business (LOB) Code: H4P
Payer Enrollment Required: Yes
Payer Location: Texas 

Action Required: 

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

12/23/2025

Update: Report Generation Delay for CPID 6195 Superior Vision Services
Update: The payer intermediary has been unable to generate and deliver the reports for some claims submitted Nov. 12, 2025-Nov. 24, 2025.

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

Original notice sent Nov. 26, 2025:
A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted since Nov. 12, 2025.

Payer impacted: 

  • CPID 6195 Superior Vision Services

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09790283.

12/23/2025

Electronic Routing Change for CPIDs 9001 and 3450 WeShare Legacy

Optum is changing electronic claims routing for the following payer, effective Dec. 22, 2025:

Payer Name: WeShare Legacy
Professional CPID: 3450
Institutional CPID: 9001
Payer-assigned Payer ID: UHSM1
Payer Claim Enrollment Required: No
Secondary Claims Accepted: Yes

Enrollment Requirements
Claims:

  • Payer enrollment for electronic claims is not required.

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

Action Required: Please 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.

12/22/2025

Tricare East/West (99727 and 99726) Real Time Eligibility Error

We want to make you aware of a current issue affecting real-time 270 eligibility transactions submitted through Optum for Tricare East and Tricare West.

Some transactions may return the message: "System Not Responding, please resubmit."

This response is due to a temporary system issue on the payer’s side. Your transaction was received correctly, and there is no issue with your submission or your connection to Optum.

Payer Name: Tricare East and Tricare West
IMN Payer ID: 99727 and 99726
Clearance EDI Payer ID: TRICRE/TRICA
Transaction: Real Time Eligibility

What You Should Know:

  • The issue is isolated to real-time eligibility transactions.
  • It is being actively investigated and prioritized by the payer.
  • There is no estimated time for resolution (ETA) at this moment.

What You Can Do:

  • Please wait a few minutes and resubmit the transaction.
  • If needed, consider using alternate eligibility verification methods (such as batch or portal) until the issue is resolved.
  • No action is needed on your part to correct or troubleshoot the issue.

We understand the importance of timely eligibility responses and are working closely with the payer to support resolution. We will share updates as they become available.

If you have any questions, please contact Customer Support and refer to Global Incident Number INC-000003438.

Thank you for your continued partnership and patience.

12/22/2025

Report Generation Delay for CPID 7146 Camp Lejeune Family Member Program

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

Payer impacted: 

  • 7146 Camp Lejeune Family Member Program

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09811943.

12/22/2025

Update: Report Generation Delay for CPID 5512 Wisconsin Medicare

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

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

Original notice sent Dec. 22, 2025:

A payer intermediary is experiencing issues affecting Institutional report generation for some claims submitted since Dec. 15, 2025.

Payer impacted:

  • CPID 5512 Wisconsin Medicare

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09811608.

12/22/2025

Update: Report Generation Delay for CPID 7567 Sentara Health Plans

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

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

Original notice sent Dec. 4, 2025:

A payer intermediary is experiencing issues affecting Institutional report generation for some claims submitted on Nov. 21, 2025.

Payer impacted: 

  • CPID 7567 Sentara Health Plans

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09795609.

12/22/2025

Report Generation Delay for CPID 7475 Medicare DME MAC Jurisdiction A

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted since Dec. 15, 2025.

Payer impacted:

  • CPID 7475 Medicare DME MAC Jurisdiction A

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09811499.

12/22/2025

Report Generation Delay for CPID 5512 Wisconsin Medicare

A payer intermediary is experiencing issues affecting Institutional report generation for some claims submitted since Dec. 15, 2025.

Payer impacted:

  • CPID 5512 Wisconsin Medicare

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09811608.

12/22/2025

Payer Processing Issue for MetroPlus Health Plan

Due to a payer processing issue, some Professional & Institutional claims transmitted to MetroPlus Health Plan since Dec. 4, 2025 are delayed.

Payer name: MetroPlus Health Plan
Payer id: 13265
CPID 2296 Prof
CPID 8872 Inst

Optum is working with the payer to resolve this processing issue. We will notify you once this issue has been resolved. 

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

If you have any questions, please contact Customer Support and refer to Global Issue INC-000003829.

12/22/2025

New Electronic Claims Connections Available - 11MED Funding

Optum has new electronic claims connections available:

Payer Name: 11MED Funding
Payer ID: 83729
Payer Enrollment Required: No
Secondary Claims Accepted: Yes
Payer Location: Colorado
Claims Fee: N/A

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. 

12/19/2025

New Electronic Remittance Connections Available

Optum has new electronic remittance connections available:  

Payer Name: Franciscan Senior Health & Wellness
Payer ID: FSHW1
Payer Enrollment Required: Yes 

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. 

12/19/2025

Clear Spring Health Real Time Eligibility and Claim Status No Longer Available

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

Payer Name: Clear Spring Health
Industry Payer ID: 85468
IMN Real Time ID: 85468
Exchange Real Time ID: CCAIL
CPID(s): 5043 8889
Optum IEDi Real Time ID: 85468
Connection Type: X12

Reason: Payer no longer offers an electronic connection.

Action Required: None

12/19/2025

New Electronic Remittance Connections Available

Optum has new electronic remittance connections available:  

Payer Name: Franciscan Senior Health & Wellness
Institutional CPID: 9029
Professional CPID: 3710
Payer-assigned Payer ID: FSHW1
Payer Enrollment Required: Yes 

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. 

12/19/2025

New Electronic Remittance Connections Available

Optum has new electronic remittance connections available:  

Payer Name: Franciscan Senior Health & Wellness
Institutional CPID: 9029
Professional CPID: 3710
Payer-assigned Payer ID: FSHW1
Line of Business (LOB) Code: E36
Payer Enrollment Required: Yes 

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. 

12/19/2025

Report Generation Delay for CPID 9458 CareSource Ohio Medicaid

Deloitte is experiencing issues affecting Professional report generation for some claims submitted on Dec. 17, 2025.

Payer impacted:

  • CPID 9458 CareSource Ohio Medicaid

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09810021.

12/19/2025

Update: Report Generation Delay for CPIDs 2296 and 8972 MetroPlus Health Plan

Update: The payer issues are affecting all files since Dec. 4, 2025.

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

Original notice sent Dec. 9, 2025:

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

Payer impacted:

  • CPID 2296 MetroPlus Health Plan
  • CPID 8972 MetroPlus Health Plan

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09799515.

12/19/2025

Update: Report Generation Delay for Multiple CPIDs

Update: This issue is also affecting the below payer 

  • CPID 3766 MDwise Medicare Advantage
  • CPID 7935 MDwise Medicare Advantage

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

Original notice sent Dec. 11, 2025:

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

Payers impacted:

  • CPID 1086 MDwise Healthy Indiana Plan
  • CPID 8113 MDwise Healthy Indiana Plan
  • CPID 1085 MDwise Hoosier Healthwise
  • CPID 8112 MDwise Hoosier Healthwise

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09802697.

12/19/2025

New Electronic Remittance Connections Available

Optum has new electronic remittance connections available:

Payer Name: Redlands Yucaipa Medical Group
Institutional CPID: 7536
Professional CPID: 5892
Payer-assigned Payer ID: 18247
Line of Business (LOB) Code: K43
Payer Enrollment Required: Yes
Payer Location: California

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. 

12/19/2025

New Electronic Remittance Connections Available

Optum has new electronic remittance connections available:

Payer Name: Redlands Yucaipa Medical Group
Institutional CPID: 7536
Professional CPID: 5892
Payer-assigned Payer ID: 18247
Payer Enrollment Required: Yes
Remittance Fee: N/A
Payer Location: California

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. 

12/19/2025

Electronic Claims Connection Suspended - Orange County Medical Clinic (DB497)

The payer listed below has been suspended at Optum for claim processing and removed from the payer list, effective immediately:

Payer Name: Orange County Medical Clinic
Payer ID: DB497
Reason: Payer unavailable electronically.

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

12/19/2025

999 Payer Batch Rejections for CPID 1844 Wellcare Health Plans

Professional claims transmitted to the payer listed below from Optum Dec. 18, 2025 were not processed by the payer due to a 999 Batch Rejection.

  • CPID 1844 Wellcare Health Plans

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

Action Required: None.

If you have any questions, please contact Customer Support and refer to Case Number 09809932.

12/19/2025

New Electronic Claims Connections Available

Optum has new electronic claims connections available:

Payer Name: 11MED Funding
Institutional CPID: 9052
Professional CPID: 3782
Payer-assigned Payer ID: 83729
Payer Enrollment Required: No
Secondary Claims Accepted: Yes
Payer Location: Colorado
Claims Fee: N/A

Action Required: 

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

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

12/18/2025

New Electronic Claims Connections Available

Effective January 1, 2026, Optum will have new electronic claims connections available:

Payer Name: AmeriHealth Caritas Next, A Product of AmeriHealth Caritas Louisiana
Institutional CPID: 9006
Professional CPID: 3464
Payer-assigned Payer ID: 75066
Payer Claim Enrollment Required: No
Secondary Claims Accepted: Yes
Payer Location: Louisiana
Claims Fee: N/A

Payer Name: AmeriHealth Caritas VIP Care - Louisiana HIDE SNP
Institutional CPID: 9022
Professional CPID: 3499
Payer-assigned Payer ID: 73575
Payer Claim Enrollment Required: No
Secondary Claims Accepted: Yes
Payer Location: Louisiana
Claims Fee: N/A

Note:  Electronic Remittance will be made available for these payers at a future date. Please monitor upcoming communications for further details.

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.

12/18/2025

Electronic Claims Connection Suspended

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

Payer Name: Orange County Medical Clinic
CPIDs: 9486, 7083
Payer ID: DB497
Reason: Payer unavailable electronically.

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

12/18/2025

Electronic Routing Change for CPIDs 3803 and 9500 Kern Health Systems

Effective December 18, 2025, Optum will be changing electronic remittance routing for the following payer: 

Payer Name: Kern Health Systems
Professional CPID: 3803
Institutional CPID: 9500
Payer-assigned Payer ID: 77039
Line of Business Code (LOB): U4J
Payer Remittance Enrollment Required: Yes 

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:  

  • 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. 

12/18/2025

Invalid Error Message for Payer ID 94163, Eyefinity VSP

Due to an internal processing issue, Professional and Institutional claims for the payer listed below may have received the following error message:

  • NPV134 Subscriber city must be alpha characters and may contain space, hyphen, or period

This issue began on November 20, 2025 and the error was resolved on December 11, 2025. Claims were reprocessed on December 17, 2025.

Payers affected: Eyefinity VSP, Payer ID 94163

12/18/2025

Report Generation Delay for CPID 9020 Blue Cross Community Health Plans

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

Payer impacted: 

  • CPID 9020 Blue Cross Community Health Plans

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09808810.

12/18/2025

Report Generation Delay for CPID 3480 ArchCare

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted Dec. 10, 2025.

Payer impacted: 

  • CPID 3480 ArchCare

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09808773.

12/18/2025

New Electronic Eligibility Connection Available

Optum is pleased to announce the availability of Real-time Eligibility Inquiry and Response 270/271 for the below payer, effective Dec. 17, 2025:

Payer Name: SBLI USA Life Insurance Company, Inc.
Industry Payer ID: 11162
IMN Real Time ID: 11162
Exchange Real Time ID: SBULI
Optum IEDI Real Time ID: 11162
Payer Enrollment Required: No
Connection Type: X12

Search Options
Eligibility Subscriber

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

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

12/18/2025

Resolved: Delay in Electronic Remittance Advice (ERA) for CPIDs 1487 and 5594 North Dakota Medicaid

Resolved: This issue has been resolved. All impacted ERAs have been processed.

Original notice sent Nov. 19, 2025:
There has been a delay in Professional and Institutional Electronic Remittance Advice (ERA) for the following payer for check dates since Nov. 14, 2025:

  • CPID 1487 North Dakota Medicaid
  • CPID 5594 North Dakota Medicaid 

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09780106.

12/18/2025

Report Generation Delay for CPID 1458 Oklahoma Medicare

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

Payer impacted:

  • CPID 1458 Oklahoma Medicare

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09808673.

12/18/2025

Electronic Routing Change for CPIDs 3803 and 9500 Kern Health Systems

Optum is changing electronic remittance routing for the following payer, effective Dec. 18, 2025: 

Payer Name: Kern Health Systems
Professional CPID: 3803
Institutional CPID: 9500
Payer-assigned Payer ID: 77039
Payer Remittance Enrollment Required: Yes
Remittance Fee: N/A 

Enrollment Requirements
Remittance:

  • Payer enrollment for electronic remittance is required. 
  • Providers currently receiving electronic remittance through Optum 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. 

12/18/2025

New Electronic Remittance Connections Available

Optum has new electronic remittance connections available:  

Payer Name: Halos Systems
Institutional CPID: 9030
Professional CPID:3715
Payer-assigned Payer ID: HALOS
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.

12/17/2025

New Electronic Remittance Connections Available

Optum has new electronic remittance connections available:  

Payer Name: Halos Systems
Institutional CPID: 9030
Professional CPID: 3715
Payer-assigned Payer ID: HALOS
Line of Business (LOB) Code: H45
Payer Enrollment Required: Yes
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. 

12/17/2025

Amerigroup Payers Consolidation

Effective immediately, claims currently exchanged with the following payer must use a different payer ID:

Payer Name: Americaid Community Care (Houston)

Payer ID: 27515

Claim Type: Professional and Institutional

 

Payer Name: Americaid Community Care (New Jersey)

Payer ID: 27516

Claim Type: Professional and Institutional

 

Payer Name: Americaid Community Care (Maryland)

Payer ID: 27517

Claim Type: Professional and Institutional

 

Payer Name: Amerigroup

Payer ID: 27519

Claim Type: Professional

 

Payer Name: Amerigroup of Illinois

Payer ID: 28804

Claim Type: Professional and Institutional

 

Payer Name: Amerigroup / Americaid - Houston

Payer ID: 28805

Claim Type: Professional

 

Payer Name: Amerigroup New Jersey

Payer ID: 28806

Claim Type: Professional

 

Payer Name: Amerigroup of Maryland and District of Columbia

Payer ID: 28807

Claim Type: Professional

 

Payer Name: Amerigroup of Florida

Payer ID: 28809

Claim Type: Professional

Payer IDs 27515, 27516, 27517, 27519, 28804, 28805, 28806, 28807, 28809 will be terminated effective January 16, 2026.

Providers must begin using the following ID for electronic claims:

Payer ID: 26375

Enrollment Requirements:

Claims:

  • Payer enrollment for electronic claims is not required.

Action Required:

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

12/17/2025

Electronic Routing Change for CPIDs 1874 and 8560 Community Care Managed Health Care Plans of Oklahoma

Effective December 17, 2025, Optum will be changing electronic remittance routing for the following payer: 

Payer Name: Community Care Managed Health Care Plans of Oklahoma
Professional CPID: 1874
Institutional CPID: 8560
Payer-assigned Payer ID: 73143
Line of Business Code (LOB): J36
Payer Remittance Enrollment Required: Yes 

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:  

  • 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. 

12/17/2025

Electronic Routing Change for CPIDs 1874 and 8560 Community Care Managed Health Care Plans of Oklahoma

Effective December 17, 2025, Optum will be changing electronic remittance routing for the following payer: 

Payer Name: Community Care Managed Health Care Plans of Oklahoma
Professional CPID: 1874
Institutional CPID: 8560
Payer-assigned Payer ID: 73143
Payer Remittance Enrollment Required: Yes
Remittance Fee: N/A 

Enrollment Requirements: 

Remittance:

  • Payer enrollment for electronic remittance is required. 
  • Providers currently receiving electronic remittance through Optum 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. 

12/17/2025

New Electronic Claims Connections Available

Optum has new electronic claims connections available:

Payer Name: Avmed (Encounters)
Professional CPID: 3787
Payer-assigned Payer ID: 59275
Payer Enrollment Required: No
Secondary Claims Accepted: Yes
Payer Location: Florida
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.

12/17/2025

New Electronic Claims Connections Available

Optum has new electronic claims connections available:

Payer Name: Avmed (Encounters)
Professional CPID: 3787
Professional Edit Master: PE_B800
Payer-assigned Payer ID: 59275
Payer Enrollment Required: No
Secondary Claims Accepted: Yes
Payer Location: Florida

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.

12/17/2025

New Electronic Eligibility Connection Available

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

Payer Name: S. USA Life Insurance Company, Inc.
Industry Payer ID: 11163
IMN Real Time ID: 11163
Exchange Real Time ID: SULIC
Optum IEDI Real Time ID: 11163
Payer Enrollment Required: No
Connection Type: X12

Search Options
Eligibility Subscriber

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

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

12/17/2025

Report Generation Delay for CPID 5502 Texas Medicare

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

Payer impacted:

  • CPID 5502 Texas Medicare

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09807281.

12/17/2025

Report Generation Delay for CPID 3650 JH Mutual of Omaha CO, NM, OK, TX

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

Payer impacted:

  • CPID 3650 JH Mutual of Omaha CO, NM, OK, TX

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09807273.

12/17/2025

999 Payer Batch Rejections for CPID 3786 Capital District Physicians Health Plan

Professional claims transmitted to the payer listed below from Optum Dec. 9, 2025 were not processed by the payer due to a 999 Batch Rejection.

  • CPID 3786 Capital District Physicians Health Plan

A resolution has been implemented and the claims were retransmitted to the payer Dec. 16, 2025.

Action Required: None.

If you have any questions, please contact Customer Support and refer to Case Number 09806595.

12/16/2025

Update: Report Generation Delay for CPID 1448 Florida Medicare

Update: The payer intermediary has been unable to generate and deliver the reports for some claims submitted Nov. 20, 2025-Nov. 26, 2025.

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

Original notice sent Dec. 1, 2025:
A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted since Nov. 20, 2025.

Payer impacted:

  • CPID 1448 Florida Medicare

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09791909.

12/16/2025

Report Generation Delay for CPIDs 2972 and 6781 Bienvivir Senior Health Services

The payer listed below is experiencing issues affecting Institutional and Professional report generation for some claims submitted on Dec. 8, 2025.

Payer impacted: 

  • CPID 2972 Bienvivir Senior Health Services
  • CPID 6781 Bienvivir Senior Health Services

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09803073.

12/16/2025

Payer Change for CPID 9434 River City Medical Group Senior

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

Payer Name: River City Medical Group Senior
Professional CPID: 9434
Professional Edit Master: PE_O007
Payer-assigned Payer ID: AMM23 

Claims must begin using the following:

Payer Name: Vivant Health
Professional CPID: 6296
Professional Edit Master: PE_T007
Institutional CPID: 5654
Institutional Edit Master: HE9T007
Payer-assigned Payer ID: RCMG1
Line of Business Code (LOB): U7V 

CPID 9434 River City Medical Group Senior will be terminated effective December 16, 2025.  

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 6296, 5654 Vivant Health do not need to complete a new enrollment form.  
  • Providers not receiving electronic remittance through Optum for CPIDs 6296, 5654 Vivant Health 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. 

12/16/2025

Update: Report Generation Delay for CPID 7893 Superior Select Health

Update: The payer intermediary has been unable to generate and deliver the reports for some claims submitted Nov. 20, 2025.

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

Original notice sent Dec. 1, 2025:
A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted since Nov. 20, 2025.

Payer impacted: 

  • CPID 7893 Superior Select Health

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09791940.

12/16/2025

Report Generation Delay for CPIDs 1581 and 1149 Children's Community Health Plan

The payer listed below is experiencing issues affecting Institutional and Professional report generation for some claims submitted Dec. 5, 2025.

Payer impacted: 

  • CPID 1581 Children's Community Health Plan
  • CPID 1149 Children's Community Health Plan

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09803070.

12/16/2025

Report Generation Delay for CPIDs 1969 and 4248 Community Care Behavioral Health Organization (BHO)

The payer listed below is experiencing issues affecting Institutional and Professional report generation for some claims submitted Dec. 5, 2025.

Payer impacted: 

  • CPID 1969 Community Care Behavioral Health Organization (BHO)
  • CPID 4248 Community Care Behavioral Health Organization (BHO)

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09803060.

12/16/2025

Payer Change for CPID 9434 River City Medical Group Senior

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

Payer Name: River City Medical Group Senior
Professional CPID: 9434
Remittance Available: No
Payer-assigned Payer ID: AMM23

Claims must begin using the following:
Payer Name: Vivant Health
Professional CPID: 6296
Institutional CPID: 5654
Remittance Available: Yes
Payer-assigned Payer ID: RCMG1
Claim Fee: N/A 

CPID 9434 River City Medical Group Senior will be terminated effective Dec. 16, 2025.  

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 6296, 5654 Vivant Health do not need to complete a new enrollment form.  
  • Providers not receiving electronic remittance through Optum for CPIDs 6296, 5654 Vivant Health 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.

12/16/2025

Report Generation Delay for CPID 5568 Global Healthcare Alliance

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

Payer impacted: 

  • CPID 5568 Global Healthcare Alliance

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09806162.

12/16/2025

Immanuel Pathways PACE Rejections

Due to a processing issue, claims submitted to Immanuel Pathways PACE payers listed below Dec. 10-15, 2025 may have received an invalid error message. 

Payers impacted:
Pace Central Iowa, CPIDs 1171, 2527
Pace Nebraska, CPIDs 1172, 2530
Pace Southwest Iowa, CPIDs 1170, 2519 

Error message:

  • THE PAYER ID IS NOT VALID. PLEASE CORRECT AND RESUBMIT THE FAILED TRANSACTIONS. 

This issue has been corrected, and claims have been resubmitted. Watch for updated accept/reject reports. 

Action Required: None.  

12/16/2025

New Electronic Eligibility Connection Available

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

Payer Name: Health Net National
Industry Payer ID: HNNC
IMN Real Time ID: XHNNC
Exchange Real Time ID: HLTHNT
Optum IEDI Real Time ID: 00213
Payer Enrollment Required: No
Connection Type: X12

Search Options:
Eligibility Subscriber

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

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

12/15/2025

Update: Report Generation Delay for CPID 2287 Michigan Medicare Plus Blue (MAP)

Update: The payer intermediary has been unable to generate and deliver the reports for some claims submitted Nov. 24, 2025.

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

Original notice sent Dec. 8, 2025:
A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted Nov. 24, 2025.

Payer impacted:

  • CPID 2287 Michigan Medicare Plus Blue (MAP)

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09798244.

12/15/2025

New Electronic Claims Connections Available - American Correctional Healthcare
Optum has new electronic claims connections available:

Payer Name: American Correctional Healthcare
Payer ID: 26326
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.

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

12/15/2025

Resolved: Payer Processing Issue for CPIDs 5594 and 1487 North Dakota Medicaid

Resolved: This issue has been resolved.

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

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

Original notice sent: Nov. 18, 2025:
Due to a payer processing issue, Professional and Institutional claims transmitted to the payer listed below Nov. 14, 2025 through present were not processed by the payer.

Payer impacted:

  • CPID 5594 North Dakota Medicaid
  • CPID 1487 North Dakota Medicaid

Optum is working with the payer to resolve this processing issue. We will notify you once this issue has been resolved.                          

Action Required: None. Please be aware of the processing issue above.

If you have any questions, please contact Customer Support and refer to Case Number 09780106.

12/15/2025

Electronic Claims Connection Suspended

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

Payer Name: AllCare PACE
CPID(s): 7009 9291
Payer ID: ACPCE
Reason: Payer unavailable electronically.

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

12/15/25

New Electronic Eligibility Connection Available

Optum is pleased to announce the availability of Real-time Eligibility Inquiry and Response 270/271 for the below payer, effective December 09, 2025:

Payer Name: Monitor Life Insurance Company of New York
Industry Payer ID: 01759
IMN Real Time ID: 16098
Exchange Real Time ID: MLINY
Optum IEDI Real Time ID: 14378
Payer Enrollment Required: No
Connection Type: X12

Eligibility Subscriber

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

Action Required by customer:

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

12/12/2025

New Electronic Eligibility Connection Available

Optum is pleased to announce the availability of Real-time Eligibility Inquiry and Response 270/271 for the below payer, effective December 05, 2025:

Payer Name: State Mutual (Lincoln Novation)
Industry Payer ID: 10982
IMN Real Time ID: 10982
Exchange Real Time ID: STMLN
Optum IEDI Real Time ID: 10982
Payer Enrollment Required: No
Connection Type: X12

Eligibility Subscriber

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

Action Required by customer:

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

12/12/2025

New Electronic Eligibility Connection Available

Optum is pleased to announce the availability of Real-time Eligibility Inquiry and Response 270/271 for the below payer, effective December 03, 2025:

Payer Name: PAN AMERICAN LIFE PUERTO RICO
Industry Payer ID: PAMPR
IMN Real Time ID: PAMPR
Exchange Real Time ID: PAMPR
Optum IEDI Real Time ID: PAMPR
Payer Enrollment Required: No
Connection Type: X12

Eligibility Subscriber

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

Action Required by customer:

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

12/12/2025

New Electronic Claims Connections Available

Optum has new electronic claims connections available:

Payer Name: PhysMetrics
Professional CPID: 8857
Edit Master: PE_T007
Payer-assigned Payer ID: 48008
Payer Enrollment Required: No
Secondary Claims Accepted: Yes
Payer Location: California

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.

12/12/2025

New Electronic Claims Connections Available

Optum has new electronic claims connections available:

Payer Name: PhysMetrics
Professional CPID: 8857
Payer-assigned Payer ID: 48008
Payer Enrollment Required: No
Secondary Claims Accepted: Yes
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.

12/12/2025

New Electronic Eligibility Connection Available

Optum is pleased to announce the availability of Real-time Eligibility Inquiry and Response 270/271 for the below payer, effective Dec. 5, 2025:

Payer Name: Public Employee Benefit Authority
Industry Payer ID: 11043
IMN Real Time ID: 11043
Exchange Real Time ID: PEBAT
Optum IEDI Real Time ID: 11043
Payer Enrollment Required: No
Connection Type: X12

Eligibility Subscriber

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

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

12/12/2025

Resolved: Report Delay

This issue has been resolved. All impacted billing reports (BD) have been processed.

Original notify sent Dec. 9, 2025
The delivery of the Optum reports listed below for November transactions were delayed due to a processing issue. Additional updates will be forwarded as more information becomes available.

  • Monthly Billing Report (BD)

We apologize for any inconvenience.

Action Required: None. Please be aware of the report delivery delay above.

12/12/2025

New Electronic Claims Connections Available

Optum has new electronic claims connections available:

Payer Name: American Correctional Healthcare
Institutional CPID: 9042
Professional CPID: 3750
Payer-assigned Payer ID: 26326
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. 

12/12/2025

Report Generation Delay for CPIDs 6701 and 5682 Partners Health Management

The payer listed below is experiencing issues affecting Professional and Institutional report generation for some claims submitted on Nov. 25, 2025.

Payer impacted:

  • CPID 6701 Partners Health Management
  • CPID 5682 Partners Health Management

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09803197.

12/11/2025

Tricare East (99727) Real Time Eligibility Error

We want to make you aware of a current issue affecting real-time 270 eligibility transactions submitted through Optum for Tricare East.

Some transactions may return the message: "System Not Responding, please resubmit."

This response is due to a temporary system issue on the payer’s side. Your transaction was received correctly, and there is no issue with your submission or your connection to Optum.

Payer Name: Tricare East
Payer ID: 99727
Transaction: Real Time Eligibility

What You Should Know:

  • The issue is isolated to real-time eligibility transactions.
  • It is being actively investigated and prioritized by the payer.
  • There is no estimated time for resolution (ETA) at this moment.

What You Can Do:

  • Please wait a few minutes and resubmit the transaction.
  • If needed, consider using alternate eligibility verification methods (such as batch or portal) until the issue is resolved.
  • No action is needed on your part to correct or troubleshoot the issue.

We understand the importance of timely eligibility responses and are working closely with the payer to support resolution. We will share updates as they become available.

If you have any questions, please contact Customer Support and refer to Global Incident Number INC-000003438.

Thank you for your continued partnership and patience.

12/11/2025

New Electronic Remittance Connections Available

Optum has new electronic remittance connections available:

Payer Name: Beaver Medical Group
Payer ID: 45967
Payer Enrollment Required: Yes
Remittance Payer Type: Nonpar
Payer Location: California

Payer Name: Pinnacle Medical Group
Payer ID: 95271
Payer Enrollment Required: Yes
Payer Location: California
Payer type: Nonpar

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.

12/11/2025

Report Generation Delay for CPID 6284 Trillium Health Resources

The payer listed below is experiencing issues affecting Professional report generation for some claims submitted Nov. 12, 2025 and Nov. 18, 2025.

Payer impacted: 

  • CPID 6284 Trillium Health Resources

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09803220.

12/11/2025

Report Generation Delay for CPIDs 7543 and 2803 UPMC Health Plan

The payer listed below is experiencing issues affecting Institutional and Professional report generation for some claims submitted Dec. 5, 2025.

Payer impacted: 

  • CPID 7543 UPMC Health Plan
  • CPID 2803 UPMC Health Plan

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09802832.

12/11/2025

Elips Life Insurance Company Real Time Eligibility 270/271

Effective December 10th, 2025 Optum is pleased to announce the availability of Real-time Eligibility Inquiry and Response 270/271 for the below payer:

Payer Name: Elips Life Insurance Company
Industry Payer ID: 14330
IMN Real Time ID: 14330
Exchange Real Time ID: ELPSE
CPID(s): N/A
Optum IEDi Real Time ID: 14330
Payer Enrollment Required: No
Connection Type: X12

Search Options:

Subscriber

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

12/11/2025

Payer Processing Issue for CPIDs 6705 and 9679 Prime Community Care of Central Valley

Due to a payer intermediary processing issue, Institutional and Professional claims transmitted to the payer listed below between Oct. 13, 2025 and Dec. 10, 2025 were not processed by the payer intermediary.

Payer impacted:

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

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

This delay affected claims released to Optum between 5 p.m. CT on Oct. 10, 2025 and 5 p.m. CT on Dec. 10, 2025.

Action Required: Be aware of the processing issue above.

If you have any questions, please contact Customer Support and refer to Case Number 09801039.

12/11/2025

Report Generation Delay for CPIDs 2708 and 7595 StandardHealth with Health Choice (HCS)

A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted on Dec. 2, 2025.

Payer impacted:

  • CPID 2708 StandardHealth with Health Choice (HCS)
  • CPID 7595 StandardHealth with Health Choice (HCS) 

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09802631.

12/11/2025

New Electronic Remittance Connections Available

Optum has new electronic remittance connections available:

Payer Name: Beaver Medical Group
Institutional CPID: 1967
Professional CPID: 6275
Payer-assigned Payer ID: 45967
Line of Business (LOB) Code: K40
Payer Enrollment Required: Yes
Payer Location: California

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.

12/11/2025

New Electronic Remittance Connections Available

Optum has new electronic remittance connections available:

Payer Name: Pinnacle Medical Group
Institutional CPID: 3945
Professional CPID:1106
Payer-assigned Payer ID: 95271
Payer Enrollment Required: Yes
Remittance Fee: N/A
Payer Location: California

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.

12/11/2025

Update: Report Generation Delay for CPID 7171 Neighborhood Health Plan of Rhode Island

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

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

Original notice sent Dec. 2, 2025:

A payer is experiencing issues affecting Professional report generation for some claims submitted on Nov. 21, 2025.

Payer impacted:

  • CPID 7171 Neighborhood Health Plan of Rhode Island

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 on Nov. 21, 2025.

If you have any questions, please contact Customer Support and refer to Case Number 09792856.

12/11/2025

Report Generation Delay for Multiple CPIDs

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

Payers impacted:

  • CPID 1086 MDwise Healthy Indiana Plan
  • CPID 8113 MDwise Healthy Indiana Plan
  • CPID 1085 MDwise Hoosier Healthwise
  • CPID 8112 MDwise Hoosier Healthwise

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09802697.

12/11/2025

Payer Processing Issue for multiple CPIDs

Due to a payer intermediary processing issue, some Professional claims transmitted to the payers listed below Dec. 10, 2025 were not processed by the payers.

Payers impacted: 

8714

Allstate Insurance Company

8454

AllyAlign Health

9712

American Health Plans

9731

American Health Plans

9142

American Health Plans

7854

American Health Plans

9117

American Health Plans

8879

American Health Plans

7782

American Health Plans

7794

Associated Hispanic Physicians IPA

7272

Axminster Medical Group 

1407

Blue Cross and Blue Shield of Georgia

3498

Blue Cross and Blue Shield of Illinois

2857

Blue Cross Blue Shield of South Carolina

4881

Cambia Health Solutions

2404

Cambia Health Solutions

2412

Cambia Health Solutions

2788

Cambia Health Solutions

7426

Cambia Health Solutions

7451

Cambia Health Solutions

1209

Cambia Health Solutions

4246

Capital Health Plan

2164

Carelon Health

1194

CareSource

7143

CareSource

3826

CareSource

7263

CareSource

6259

CareSource

3488

CareSource

3293

Carlon Health 

1764

Centene

9433

Centene

3706

Centene

9118

Centene

9430

Centene

7763

Columbine Health Plan

6778

Common Ground Healthcare Cooperative

8834

Commonwealth Care Alliance

7760

Community Care Health Plan of Louisiana, Inc.

6865

Community Care Plan

6795

Contra Costa Health Services

3856

Core Administrative Services

1232

Denver Health

8135

Doctors HealthCare Plans Inc

4279

El Paso First Health Plans

1741

Elevance Health

1415

Elevance Health

1420

Elevance Health

1412

Elevance Health

2421

Elevance Health

7446

Elevance Health

1408

Elevance Health

7496

Elevance Health

7422

Elevance Health

4437

Elevance Health

2418

Elevance Health

1413

Elevance Health

1401

Elevance Health

1169

Elevance Health

1167

Elevance Health

9162

Elevance Health

4743

Elevance Health

6127

Elevance Health

8123

Elevance Health

4448

Elevance Health

8867

Elevance Health

9133

Elevance Health

8124

Elevance Health

8473

Elevance Health

1775

Elevance Health

5483

Employee Benefit Management Services

1834

EPIC Insurance Midwest

9215

Everpoint

7738

Evolent Health

5238

Evolent Health

8812

Evolent Health

8708

Evolent Health

8816

Evolent Health

9414

Evry Health

3792

Fidelis Care New York

7435

FirstCare Health Plans

1414

Florida Blue Cross Blue Shield

3417

Florida Blue Cross Blue Shield

9128

Florida Blue Medicare

2298

Gateway Health Plan

1405

Health Care Service Corporation (HCSC)

7403

Health Care Service Corporation (HCSC)

1403

Health Care Service Corporation (HCSC)

1406

Health Care Service Corporation (HCSC)

1243

Health Care Service Corporation (HCSC)

5865

Health Care Service Corporation (HCSC)

5243

Healthcare Management Administrators, Inc

1723

HealthCare Partners, IPA

6220

Heritage Provider Network

2830

Humana

8814

Integrated Homecare Services

5479

IU Health Plans

7715

Johns Hopkins Healthcare

5432

Johns Hopkins Healthcare

6273

Lifepath Hospice

2810

Lucent Health

8860

Medica Health Plan Solutions 

7859

Medica Health Plan Solutions 

6799

Medica Health Plans

4423

Medical Mutual of Ohio

4714

Medigold

9102

Meridian Health Plan

1421

Michigan Blue Cross Blue Shield

2426

Michigan Blue Cross Blue Shield

2287

Michigan Blue Cross Blue Shield

1402

Minnesota Blue Cross Blue Shield

7892

Minnesota Blue Cross Blue Shield

8723

Minnesota Blue Cross Blue Shield

2411

Noridian

7489

Noridian

8864

North Dakota Blue Cross Blue Shield

7829

Passport Health Plan

8128

Pool Administrators Inc (PAI)

5838

Preferred Administrators

4252

Presbyterian Healthcare Services

2807

Professional Benefit Admin IL

7281

PruittHealth Premier

5428

Qualchoice

7264

Quartz Health Solutions, Inc.

6423

RevClaims

1776

RIS Rx

4464

SCAN Health Plan

7499

Sentara Healthcare

9438

Shared Health

7225

Sharp Community Medical Group

5835

Trilogy Health Network

6849

United Group Programs

7493

Vermont Blue Cross Blue Shield

4258

Visiting Nurse Service of New York

3757

Water Street

1844

Wellcare

3248

Wellcare

1404

Wellmark

6733

Wellmark

2490

Wellmark

9441

Wellspace NEXUS LLC

2720

Zelis Healthcare

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

This delay affected claims released to Optum Dec. 10, 2025, 2:00 p.m.-6:00 p.m. CT.

Action Required: Be aware of the processing issue above.

12/11/2025

New Electronic Remittance Connections Available

Optum has new electronic remittance connections available:

Payer Name: Beaver Medical Group
Institutional CPID: 1967
Professional CPID: 6275
Payer-assigned Payer ID: 45967
Payer Enrollment Required: Yes
Remittance Fee: N/A
Payer Location: California

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.

12/11/2025

Electronic Routing and Payer ID Change Prime Community Care of Central Valley

Optum will be changing electronic claims routing and Payer ID for the following payer, effective Dec. 12, 2025:

Payer Name: Prime Community Care of Central Valley
Old Payer ID: MVCV1
New Payer ID: MVCV0
Payer Claim Enrollment Required: No
Secondary Claims Accepted: Yes
Payer Type: Nonpar

Optum will be terminating electronic claims routing and Payer ID for the following payer, effective Jan. 2, 2026:

Payer Name: Prime Community Care of Central Valley
Payer ID: MVCV1 

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

  • Make any necessary system changes. 
  • No Payer Alias name changes are required. Payer name is not changing.

12/10/2025

Report Generation Delay for CPID 5554 Maryland Medicare

A payer intermediary is experiencing issues affecting Institutional report generation for some claims submitted since Dec. 5, 2025.

Payer impacted:

  • CPID 5554 Maryland Medicare

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09800893.

12/10/2025

Report Generation Delay for CPID 2456 Delaware Medicare

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted since Dec. 4, 2025.

Payer impacted:

  • CPID 2456 Delaware Medicare

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09800892.

12/10/2025

Report Generation Delay for CPID 1440 Texas Medicare

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted since Dec. 4, 2025.

Payer impacted:

  • CPID 1440 Texas Medicare

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09800897.

12/10/2025

Update: Report Generation Delay for CPID 5599 Capital Blue Cross of Pennsylvania Facility Contracted Providers

Update: It has been determined that the payer had a processing issue. A resolution has been implemented and the claims were retransmitted to the payer Dec. 10, 2025.

This delay affected claims released to Optum Dec. 1, 2025, 3:00 p.m.-Dec. 2, 2025, 3:00 p.m. CT.

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

Original notice sent Dec. 8, 2025:
A payer is experiencing issues affecting Institutional report generation for some claims submitted Dec. 2, 2025.

Payer impacted:

  • CPID 5599 Capital Blue Cross of Pennsylvania Facility Contracted Providers

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09798200.

12/10/2025

Update: Report Generation Delay for CPIDs 1997 and 7451 Regence Blue Shield of Washington

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

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

Original notice sent Nov. 24, 2025:

A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted on Nov. 10, 2025.

Payer impacted: 

  • CPID 1997 Regence Blue Shield of Washington
  • CPID 7451 Regence Blue Shield of Washington

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09787853.

12/10/2025

Payer Processing Issue for CPIDs 4405 and 5548 Arizona Medicaid

Due to a payer processing issue, Professional and Institutional claims transmitted to the payer listed below between Sept. 19, 2025 and Sept. 23, 2025 were not processed by the payer.

Payer impacted:

  • CPID 4405 Arizona Medicaid
  • CPID 5548 Arizona Medicaid

A resolution has been implemented and the claims were retransmitted to the payer on Oct. 2, 2025.

This delay affected claims released to Optum between 3 p.m. CT on Sept. 18, 2025 and 3 p.m. CT on Sept. 23, 2025.

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

If you have any questions, please contact Customer Support and refer to Case Number 09715241.

12/10/2025

Electronic Routing and Payer ID Change for CPIDs 9679 and 6705 Prime Community Care of Central Valley

Optum will be changing electronic claims routing and Payer ID for the following payer, effective Dec. 10, 2025: 

Payer Name: Prime Community Care of Central Valley
Professional CPID: 6705
Institutional CPID: 9679
Old Payer-assigned Payer ID: MVCV1
New Payer-assigned Payer ID: MVCV0
Payer Claim Enrollment Required: No
Secondary Claims Accepted: Yes 

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

Enrollment Requirements

Claims:

  • Payer enrollment for electronic claims is not required. 

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

  • Make any necessary system changes. 

12/10/2025

Electronic Routing Change for CPID 5159 Prism Univera

Optum will be reactivating and rerouting electronic claims routing for the following payer, effective Dec. 10, 2025:

Payer Name: Prism Univera
Professional CPID: 5159
Payer-assigned Payer ID: 37315
Payer Claim Enrollment Required: No
Secondary Claims Accepted: No
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 receive.

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

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

12/9/2025

Electronic Routing Change for CPID 5159 Prism Univera

Optum will be reactivating and rerouting electronic claims routing for the following payer, effective Dec. 10, 2025:

Payer Name: Prism Univera
Professional CPID: 5159
Current Edit Master: PE_E049
New Edit Master: PE_T007
Payer-assigned Payer ID: 37315
Payer Claim Enrollment Required: No
Secondary Claims Accepted: No

Enrollment Requirements
Claims:

  • Payer enrollment for electronic claims is not required.

Report Changes
You may see some differences in the payer reports you receive.

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

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

12/9/2025

Electronic Routing and Payer ID Change for CPIDs 9679 and 6705 Prime Community Care of Central Valley

Optum will be changing electronic claims routing and Payer ID for the following payer, effective Dec. 10, 2025: 

Payer Name: Prime Community Care of Central Valley
Professional CPID: 6705
Institutional CPID: 9679
Old Payer-assigned Payer ID: MVCV1
New Payer-assigned Payer ID: MVCV0
Payer Claim Enrollment Required: No
Secondary Claims Accepted: Yes 

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

Enrollment Requirements
Claims:

  • Payer enrollment for electronic claims is not required. 

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

  • Make any necessary system changes. 

12/9/2025

Electronic Routing and Payer ID Change for CPIDs 9679 and 6705 Prime Community Care of Central Valley

Optum will be changing electronic claims routing and Payer ID for the following payer, effective Dec. 10, 2025:

Payer Name: Prime Community Care of Central Valley
Professional CPID: 6705
Professional Edit Master: PE_T007
Institutional CPID: 9679
Institutional Edit Master: HE9T007
Old Payer-assigned Payer ID: MVCV1
New Payer-assigned Payer ID: MVCV0
Payer Claim Enrollment Required: No
Secondary Claims Accepted: Yes 

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

Enrollment Requirements
Claims:

  • Payer enrollment for electronic claims is not required. 

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

  • Make any necessary system changes. 
  • No Payer Alias changes are required. Payer name and CPIDs are not changing. 

12/9/2025

Edit Master for CPIDs 8948 and 4269 Anchor Benefit Consulting

Effective December 9, 2025. Optum will be changing Edit Masters for the following payer:

Payer Name: Anchor Benefit Consulting
Professional CPID: 4269
Current Edit Master: PE_C054
New Edit Master: PE_T007
Institutional CPID: 8948
Current Edit Master: HE9C054  
New Edit Master: HE9T007
Payer-assigned Payer ID: 53085 

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.

12/9/2025

Update: Report Generation Delay for CPID 4946 Texas Medicare

Update: The payer intermediary has been unable to generate and deliver the reports for some claims submitted on Nov. 18, 2025 and Nov. 19, 2025.

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

Original notice sent Dec. 1, 2025:

A payer intermediary is experiencing issues affecting Institutional report generation for some claims submitted since Nov. 18, 2025.

Payer impacted:

  • CPID 4946 Texas Medicare

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09791933.

12/9/2025

999 Payer Batch Rejections for CPID 1844 Wellcare Health Plans

Professional claims transmitted to the payer listed below from Optum on Dec. 5, 2025 were not processed by the payer due to a 999 Batch Rejection.

  • CPID 1844 Wellcare Health Plans

A resolution has been implemented and the claims were retransmitted to the payer on Dec. 9, 2025.

Action Required: None.

If you have any questions, please contact Customer Support and refer to Case Number 09797075.

12/9/2025

Report Generation Delay for CPID 5526 Horizon Blue Cross Blue Shield of New Jersey

A payer intermediary is experiencing issues affecting Institutional report generation for some claims submitted on Nov. 26, 2025 and Nov. 27, 2025.

Payer impacted:

  • CPID 5526 Horizon Blue Cross Blue Shield of New Jersey

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09799770.

12/9/2025

999 Payer Batch Rejections for CPID 1844 Wellcare Health Plans

Professional claims transmitted to the payer listed below from Optum on Dec. 8, 2025 were not processed by the payer due to a 999 Batch Rejection. 

  • CPID 1844 Wellcare Health Plans

A resolution has been implemented and the claims were retransmitted to the payer on Dec. 9, 2025.

Action Required: None.

If you have any questions, please contact Customer Support and refer to Case Number 09799887.

12/9/2025

Electronic Routing Change for CPIDs 7029 and 9413 CorrectCare Integrated Health (Non-LA Jails)

Effective December 10, 2025, Optum will be reactivating and changing electronic claims routing for the following payer:

Payer Name: CorrectCare Integrated Health (Non-LA Jails)
Professional CPID: 9413
Institutional CPID: 7029
Payer-assigned Payer ID: CCIHJ
Payer Claim Enrollment Required: No
Secondary Claims Accepted: No
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 receive.

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

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

12/9/2025

Report Generation Delay for CPIDs 2296 and 8972 MetroPlus Health Plan

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

Payer impacted:

  • CPID 2296 MetroPlus Health Plan
  • CPID 8972 MetroPlus Health Plan

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09799515.

12/9/2025

New Payer Edit for CPID 5823

The payer listed below has informed Optum of a new edit requirement effective immediately. In order to meet the new requirement, we will add the following edit Dec. 15, 2025:

  • PREF02A138: MISSING SL CLIA NUMBER - When this HCPCS/CPT-4 Code is present, the Service Line CLIA Number is required. Exceptions: 1. When the associated Service Line Referring CLIA Number is present, this requirement does not apply. 2. When the Claim Level CLIA Number is present, this requirement does not apply. 3. When the HCPCS/CPT-4 Code is 88304-88305 or 88312-88314 with an associated Modifier TC, this requirement does not apply. 4. When the CPID is 2418 and HCPCS/CPT-4 Code is 86328, this requirement does not apply. 5. When the CPID is 3429 and the Active Subscriber Filing Indicator Code is other than 2 or 8. this requirement does not apply. 6. When the CPID is 1486, 2400, or 6801 and the associated Modifier is 26, this requirement does not apply. 7. When an associated Modifier QW is present, this requirement does not apply. Notes: 1. If this requirement does not apply to your billing situation, you can override the edit in the Edit/Error Severity application or within the Error Text. 2. Edit is based on Chapter 16 of the CMS Claims Processing Manual. 3. Edit is based on Change Requests 9502, 10446, 11135, and 11640. LINK: https://www.cms.gov/files/document/r4542cp.pdf LOOP 2400 REF02

Edit applies to:

  • CPID 5823 AETNA BETTER HEALTH - PA

Action Required: Please be aware of updated edit requirements.

12/9/2025

Report Generation Delay for CPID 6671 HealthSun

A payer intermediary is experiencing issues affecting Institutional report generation for some claims submitted Nov. 26, 2025.

Payer impacted: 

  • CPID 6671 HealthSun

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09799667.

12/9/2025

Error Message for CPID 7450 Blue Cross Blue Shield of Montana

Due to an intermediary processing issue, Professional claims for the payer listed below may have received the following error message(s) on the Payer Batch Totals Report (SB), Payer Batch Totals Data File (SD), Payer Claim Data Report (SR), Payer Claim Data Report (SE), Payer Report Data File (SF):

  • Reject Code: A3:21
  • Message: DUPLICATE FILE ID-CANNOT USE TWICE IN 12 MONTHS
  • Reject Code: MSG-1SG
  • Message: DUPLICATE FILE ID-CANNOT USE TWICE IN 12 MONTHS

Payer impacted:

  • CPID 7450 Blue Cross Blue Shield of Montana

This issue affected claims sent to the payer Dec. 4, 2025.

Affected claims were retransmitted to the payer Dec. 9, 2025.

Action Required: Please be aware of the error message.

If you have any questions, please contact Customer Support and refer to Case Number 09799523.

12/9/2025

Electronic Routing Change for CPIDs 7029 and 9413 CorrectCare Integrated Health (Non-LA Jails)

Optum will be reactivating and changing electronic claims routing for the following payer, effective Dec. 10, 2025:

Payer Name: CorrectCare Integrated Health (Non-LA Jails)
Professional CPID: 9413
Current Edit Master: PE_0007
New Edit Master: PE_T007
Institutional CPID: 7029
Current Edit Master: HE9O007
New Edit Master: HE9T007
Payer-assigned Payer ID: CCIHJ
Payer Claim Enrollment Required: No
Payer Remittance Enrollment Required: Yes
Secondary Claims Accepted: No

Enrollment Requirements
Claims:

  • Payer enrollment for electronic claims is not required.

Report Changes
You may see some differences in the payer reports you receive.

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

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

12/9/2025

Report Generation Delay for CPID 2846 Hill Physicians Medical Group

A payer is experiencing issues affecting Professional report generation for some claims submitted on Nov. 24, 2025 and Nov. 25, 2025.

Payer impacted:

  • CPID 2846 Hill Physicians Medical Group

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09799456.

12/9/2025

Aliera Health Care Real Time Eligibility 270/271 No Longer Available

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

Payer Name: Aliera Health Care
Optum IEDi Real Time ID: ALH01
Connection Type: X12

Reason: Payer no longer offers an electronic connection

Action Required: None

12/9/2025

Report Generation Delay for CPIDs 2589 and 3793 Alliant Health Plan

A payer is experiencing issues affecting Institutional and Professional report generation for some claims submitted Nov. 30, 2025.

Payer impacted:

  • CPID 2589 Alliant Health Plans
  • CPID 3793 Alliant Health Plans

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09799397.

12/9/2025

New Payer Edit for CPID 5568

The payer listed below has informed Optum of a new edit requirement effective immediately. In order to meet the new requirement, we will add the following edit Dec. 9, 2025: 

  • ISBR0135FI: INVALID PAYER RESP SEQ NUM CODE - For an electronic claim, the Payer Indicator must be A. Exceptions: 1. When the CPID is other than 1935 and the Billing Provider State is MN, this requirement does not apply. 2. When the CPID is 2557 and the Other Payer Paid Amount is zero, this requirement does not apply. LOOP 2000B SBR01

Edit applies to: 

  • CPID 5568 GLOBAL HEALTHCARE ALLIANCE

Action Required: Please be aware of updated edit requirements.

12/9/2025

UPDATE: Electronic Claims Connection Suspended - Facey Medical Foundation

Update: This payer has been reactivated.  

Due to a processing issue, claims for Facey Medical Foundation may have received the following error message: 

PAYER NAME MATCHING REQUIRED. X12 INFO- 2010BB-NM1.PAYER NAME MATCHING REQUIRED 

This issue began on November 1, 2025. The issue has been resolved, and providers may resubmit claims. 

Original notification sent November 20, 2025:

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

Payer Name: Facey Medical Foundation
Payer ID: 95432
Reason: Payer unavailable electronically 

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

12/8/2025

Report Generation Delay for CPID 1457 New Mexico Medicare

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

Payer impacted:

  • CPID 1457 New Mexico Medicare

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09798578.

12/8/2025

Report Generation Delay for CPID 1460 Louisiana Medicare

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

Payer impacted:

  • CPID 1460 Louisiana Medicare

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09798585.

12/8/2025

Report Generation Delay for CPID 8920 Healthcare Management Administrators

A payer intermediary is experiencing issues affecting Institutional report generation for some claims submitted on Nov. 24, 2025.

Payer impacted: 

  • CPID 8920 Healthcare Management Administrators

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09798275.

12/8/2025

Report Generation Delay for CPIDs 9002 and 3452 Edenbridge PACE of West Baltimore

A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted since Nov. 22, 2025.

Payer impacted: 

  • CPID 9002 Edenbridge PACE of West Baltimore
  • CPID 3452 Edenbridge PACE of West Baltimore

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09798189.

12/8/2025

Report Generation Delay for CPID 5599 Capital Blue Cross of Pennsylvania Facility Contracted Providers

A payer is experiencing issues affecting Institutional report generation for some claims submitted on Dec. 2, 2025.

Payer impacted:

  • CPID 5599 Capital Blue Cross of Pennsylvania Facility Contracted Providers

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09798200.

12/8/2025

Electronic Routing Change for CPIDs 7116 and 7672 Group Benefit Services

Effective December 8, 2025, Optum will be changing electronic claims routing for the following payer:

Payer Name: Group Benefit Services
Professional CPID: 7116
Edit Master: PE_T007
Institutional CPID: 7672
Edit Master: HE9T007
Payer-assigned Payer ID: 80241
Payer Claim Enrollment Required: No
Secondary Claims Accepted: Yes

Enrollment Requirements:

Claims:

  • Payer enrollment for electronic claims is not required.

Report Changes:

You may see some differences in the payer reports you receive.

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

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

12/8/2025

Electronic Routing Change for Group Benefit Services (80241)

Optum is changing electronic claims routing for the following payer, effective Dec. 8, 2025:

Payer Name: Group Benefit Services
Payer ID: 80241
Payer Claim Enrollment Required: No
Secondary Claims Accepted: Yes
Claims Fee: N/A

Enrollment Requirements
Claims:

  • Payer enrollment for electronic claims is not required.

Report Changes
You may see some differences in the payer reports you receive.

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

  • Make any necessary system changes.

12/8/2025

Electronic Routing Change for American Postal Workers Union (44444)

Optum has reactivated and changed electronic claims routing for the following payer, effective immediately: 

Payer Name: American Postal Workers Union
Payer ID: 44444
Payer Claim Enrollment Required: No
Secondary Claims Accepted: Yes
Claims Fee: $0.10 

Enrollment Requirements
Claims:

  • Payer enrollment for electronic claims is not required. 

Report Changes
You may see some differences in the payer reports you receive.  

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

  • Make any necessary system changes.

12/8/2025

Report Generation Delay for CPID 8714 Allstate

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

Payer impacted: 

  • CPID 8714 Allstate

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09798382.

12/8/2025

Report Generation Delay for CPID 2287 Michigan Medicare Plus Blue (MAP)

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted Nov. 24, 2025.

Payer impacted: 

  • CPID 2287 Michigan Medicare Plus Blue (MAP)

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09798244.

12/8/2025

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

The payer intermediary is experiencing issues affecting Professional report generation for some claims submitted Dec. 1, 2025.

Payer impacted: 

  • CPID 9435 OhioRISE - Aetna Better Health of Ohio

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09798212.

12/8/2025

Electronic Routing Change for CPIDs 7116 and 7672 Group Benefit Services

Effective Dec. 8, 2025, Optum is changing electronic claims routing for the following payer:

Payer Name: Group Benefit Services
Professional CPID: 7116
Institutional CPID: 7672
Payer-assigned Payer ID: 80241
Payer Claim Enrollment Required: No
Secondary Claims Accepted: Yes
Claims Fee: N/A

Enrollment Requirements
Claims:

  • Payer enrollment for electronic claims is not required.

Report Changes
You may see some differences in the payer reports you receive.

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

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

12/8/2025

Update: Report Generation Delay for CPIDs 9010 and 3480 ArchCare

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

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

Original notice sent Nov. 11, 2025:

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

Payer impacted: 

  • CPID 9010 ArchCare
  • CPID 3480 ArchCare

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09768755.

12/8/2025

Error Message for CPIDs 8176, 2038 Saint Johns Health Clinic

Due to a processing issue, claims for the payer listed below may have received the following error message: 

PAYER NAME MATCHING REQUIRED. X12 INFO- 2010BB-NM1.PAYER NAME MATCHING REQUIRED 

This issue began on November 1, 2025. The issue has been resolved, and providers may resubmit claims. 

Payer Name: Saint Johns Health Clinic
CPIDs: 8176, 2038
Payer ID: SJHC1 

12/8/2025

Update: Electronic Claims Connection Suspended

Update: 

This payer has been reactivated.  

Due to a processing issue, claims for Facey Medical Foundation may have received the following error message: 

PAYER NAME MATCHING REQUIRED. X12 INFO- 2010BB-NM1.PAYER NAME MATCHING REQUIRED 

This issue began on November 1, 2025. The issue has been resolved, and providers may resubmit claims. 

Original notification sent November 20, 2025:

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

Payer Name: Facey Medical Foundation
CPID: 4896
Payer ID: 95432
Reason: Payer unavailable electronically 

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

12/8/2025

New Electronic Eligibility Connection Available

Optum is pleased to announce the availability of Real-time Eligibility Inquiry and Response 270/271 for the below payer, effective Dec. 4, 2025:

Payer Name: CSI Life Insurance Company
Industry Payer ID: 34186
IMN Real Time ID: 34186
Exchange Real Time ID: CSILF
CPID(s): 4626, 6145
Optum IEDi Real Time ID: 11160
Payer Enrollment Required: No
Connection Type: X12 

Search Options:

Eligibility Subscriber

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

Eligibility Dependent

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

Action Required by customer:

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

12/5/2025

New Electronic Eligibility Connection Available

Optum is pleased to announce the availability of Real-time Eligibility Inquiry and Response 270/271 for the below payer, effective Dec 4,, 2025:

Payer Name: Spectrum Health
Industry Payer ID: 10936
IMN Real Time ID: 10936
Exchange Real Time ID: SPTMH
CPID(s): N/A
Optum IEDi Real Time ID: 10936
Payer Enrollment Required: No
Connection Type: X12 

Search Options:

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

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.

12/5/2025

Update: Electronic Routing Change and Payer ID Change for CPIDs 3412 and 9570 St. Joseph Heritage Healthcare

Update: Optum will not reroute or change the Payer ID for St. Joseph Heritage Healthcare, and no system updates are required.  

Original notification sent Dec. 3, 2025:
Effective Dec. 10, 2025, Optum will be changing electronic claims routing and Payer ID for the following payer:

Payer Name: St. Joseph Heritage Healthcare
Professional CPID: 3412
Current Edit Master: PE_O007
New Edit Master: PE_T007
Institutional CPID: 9570
Current Edit Master: HE9O007
New Edit Master: HE9T007
Previous Payer ID: STJOE
New Payer ID: IP106
Payer Claim Enrollment Required: No
Secondary Claims Accepted: Yes

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

Enrollment Requirements
Claims:

  • Payer enrollment for electronic claims is not required.

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

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

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

12/5/2025

Update: Electronic Routing Change and Payer ID Change for CPIDs 3412 and 9570 St. Joseph Heritage Healthcare

Update: Optum will not reroute or change the Payer ID for St. Joseph Heritage Healthcare, and no system updates are required.

Original notification sent Dec. 3, 2025:  
Effective December 10, 2025, Optum will be changing electronic claims routing and Payer ID for the following payer:

Payer Name: St. Joseph Heritage Healthcare
Professional CPID: 3412
Institutional CPID: 9570
Previous Payer ID: STJOE
New Payer ID: IP106
Payer Claim Enrollment Required: No
Secondary Claims Accepted: Yes
Claims Fee: $0.10

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

Enrollment Requirements
Claims:

  • Payer enrollment for electronic claims is not required.

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

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

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

12/5/2025

New Electronic Claim Status Connection Available

Optum is pleased to announce the availability of Real-time Claim Status Inquiry and Response 276/277 for the below payer, effective December 01, 2025:

Payer Name: OSCAR HEALTH
Industry Payer ID: OSCAR
IMN Real Time ID: OSCAR
Exchange Real Time ID: OSCAR
CPID(s): 9638, 7468
Payer Enrollment Required: No
Connection Type: X12

Search Options:

Claim Status Inquiry Dependent

  • Member ID, dep first name, dep last name, dep date of birth, subscriber last name

Optional additional elements:

  • Payer claim number, Total submitted charges

Action Required by customer:

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

12/5/2025

Allegiance Benefit Management New Claim Status Connection

Effective November 21, 2025 Optum is pleased to announce the availability of Real Time Claim Status Inquiry and Response (276/277) transactions for the below payer:

Payer Name: Allegiance Benefit Plan Management
IMN Payer ID: 81040
Exchange CPID: ALLBE CPID (2295 & 1651)
IEDI Payer ID: 81040

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

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

12/4/2025

Electronic Reactivation and Routing Change for CPIDs 9486 and 7083 Orange County Medical Clinic

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

Payer Name: Orange County Medical Clinic
Professional CPID: 9486
Institutional CPID: 7083
Payer-assigned Payer ID: DB497
Payer Claim Enrollment Required: No
Secondary Claims Accepted: No
Claims Fee: N/A

Enrollment Requirements:

Claims:

  • Payer enrollment for electronic claims is not required.

Report Changes:

You may see some differences in the payer reports you receive.

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

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

12/4/2025

Electronic Reactivation and Routing Change for CPIDs 9486 and 7083 Orange County Medical Clinic

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

Payer Name: Orange County Medical Clinic
Professional CPID: 9486
Edit Master: PE_T007
Institutional CPID: 7083
Edit Master: HE9T007
Payer-assigned Payer ID: DB497
Payer Claim Enrollment Required: No
Secondary Claims Accepted: No

Enrollment Requirements:

Claims:

  • Payer enrollment for electronic claims is not required.

Report Changes:

You may see some differences in the payer reports you receive.

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

  • 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.

12/4/2025

999 Payer Batch Rejections for CPID 1844 Wellcare Health Plans

Professional claims transmitted to the payer listed below from Optum on Dec. 3, 2025 were not processed by the payer due to a 999 Batch Rejection.

  • CPID 1844 Wellcare Health Plans

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

Action Required: None.

If you have any questions, please contact Customer Support and refer to Case Number 09796029.

12/4/2025

Report Generation Delay for CPID 7567 Sentara Health Plans

A payer intermediary is experiencing issues affecting Institutional report generation for some claims submitted on Nov. 21, 2025.

Payer impacted: 

  • CPID 7567 Sentara Health Plans

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09795609.

12/4/2025

New Assurance Attach Assist Medical Attachment Connections Available
Optum has new electronic medical attachment connections available: 

Payer Name: Healthy Blue North Carolina
Professional CPID: 9133
Institutional CPID: 5086
Payer-assigned Payer ID: 00602
Accepted Attachment Type: Solicited and Unsolicited
Payer Enrollment Required: No
Payer Location: North Carolina 

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. 

12/4/2025

New Electronic Medical Attachment Connections Available
Optum has new electronic medical attachment connections available: 

Payer Name: Healthy Blue North Carolina
Professional CPID: 9133
Institutional CPID: 5086
Payer-assigned Payer ID: 00602
Accepted Attachment Type: Solicited and Unsolicited
Payer Enrollment Required: No
Payer Location: North Carolina 

Action Required:

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

Please update your system and procedures to take advantage of the new connection. For assistance with Medical Attachments, please contact your Practice Management System Vendor. 

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

12/4/2025

Report Generation Delay for CPID 7939 Virginia Health Network Inc.

The payer intermediary is experiencing issues affecting Institutional report generation for some claims submitted on Nov. 21, 2025.

Payer impacted:

  • CPID 7939 Virginia Health Network Inc

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09795465.

12/4/2025

Update: Payer Change for CPID 4492 Massachusetts Medicaid Format 5

Update: New Effective Date for 4492 Massachusetts Medicaid Format 5.

Effective February 11, 2026, claims and remittance currently exchanged with the following payer must use a different CPID:

Payer Name: Massachusetts Medicaid Format 5
Professional CPID: 4492
Payer-assigned Payer ID: DMA7384

Claims and remittance must begin using the following on January 14, 2026:

Payer Name: MassHealth
Professional CPID: 4491
Payer-assigned Payer ID: DMA7384
Claim Fee: N/A

CPID 4492 Massachusetts Medicaid Format 5 will be terminated effective January 14, 2026.

Enrollment Requirements:

Claims:

  • Payer enrollment for electronic claims is required.
    • Providers currently sending electronic claims through Optum for CPID 4492 Massachusetts Medicaid Format 5 do not need to complete a new enrollment form.
    • New providers must complete a new enrollment form for CPID 4491 MassHealth.

Remittance:

  • Payer enrollment for electronic remittance is required.
    • Providers currently receiving electronic remittance through Optum for CPID 4492 Massachusetts Medicaid Format 5 do not need to complete a new enrollment form.
    • Providers not receiving remittance through Optum for CPID 4492 must complete a new enrollment form for CPID 4491 MassHealth.
    • New providers must complete a new enrollment form for CPID 4491 MassHealth.

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.

12/4/2025

New Electronic Eligibility Connection Available

Optum is pleased to announce the availability of Real-time Eligibility Inquiry and Response 270/271 for the below payer, effective November 21, 2025.

Payer Name: Sage
Industry Payer ID: SAGE1
IMN Real Time ID: SAGE1
Exchange Real Time ID: SAGE
CPID(s): 7924, 2746
Optum IEDi Real Time ID: SAGE1
Payer Enrollment Required: No
Connection Type: X12

Search Options:

Subscriber

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

Dependent

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

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.

12/4/2025

Report Generation Delay for CPID 5582 Blue Cross of Idaho Boise

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

Payer impacted:

  • CPID 5582 Blue Cross of Idaho Boise

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09794842.

12/3/2025

Report Generation Delay for CPID 1464 NC Medicare

The payer intermediary is experiencing issues affecting Professional report generation for some claims submitted Nov. 19, 2025 and Nov. 20, 2025.

Payer impacted:

  • CPID 1464 NC Medicare

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09794620.

12/3/2025

Report Generation Delay for Multiple CPIDs
A payer intermediary is experiencing issues affecting Professional and Institutional report generation for some claims submitted since Nov. 14, 2025.

Payers impacted: 

  • CPID 1029 Physician Health Associates/Midland Mgmt
  • CPID 3770 Physician Health Associates/Midland Mgmt
  • CPID 1851 Lake County Physicians Association
  • CPID 3017 Gonzaba Medical Group
  • CPID 8266 Gonzaba Medical Group
  • CPID 3026 Essential Health Partners
  • CPID 8275 Essential Health Partners
  • CPID 3088 Lake County Physicians Association
  • CPID 6137 West Suburban Health Providers
  • CPID 7245 Oak West Physician Association
  • CPID 8664 Oak West Physician Association

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09794594.

12/3/2025

New Electronic Claims Connections Available

Optum has new electronic claims connections available:  

Payer Name: March Vision Care
Institutional CPID: 9047
Payer-assigned Payer ID: 52461
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. 

12/3/2025

Electronic Routing Change and Payer ID Change for CPIDs 3412 and 9570 St. Joseph Heritage Healthcare

Effective December 10, 2025, Optum will be changing electronic claims routing and Payer ID for the following payer: 

Payer Name: St. Joseph Heritage Healthcare 

Professional CPID: 3412 

Current Edit Master: PE_O007 

New Edit Master: PE_T007 

Institutional CPID: 9570 

Current Edit Master: HE9O007 

New Edit Master: HE9T007 

Previous Payer ID: STJOE 

New Payer ID: IP106 

Payer Claim Enrollment Required: No 

Secondary Claims Accepted: Yes 

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

Enrollment Requirements: 

Claims:

  • Payer enrollment for electronic claims is not required. 

Report Changes:

You may see some differences in the payer reports you receive. 

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

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

12/3/2025

Electronic Routing Change and Payer ID Change for CPIDs 3412 and 9570 St. Joseph Heritage Healthcare

Effective December 10, 2025, Optum will be changing electronic claims routing and Payer ID for the following payer: 

Payer Name: St. Joseph Heritage Healthcare 

Professional CPID: 3412 

Institutional CPID: 9570 

Previous Payer ID: STJOE 

New Payer ID: IP106 

Payer Claim Enrollment Required: No 

Secondary Claims Accepted: Yes 

Claims Fee: $0.10 

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

Enrollment Requirements: 

Claims:

  • Payer enrollment for electronic claims is not required. 

Report Changes:

You may see some differences in the payer reports you receive. 

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

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

12/3/2025

New Electronic Claims Connections Available

Optum has new electronic claims connections available:

Payer Name: Health Services Management
Professional CPID: 1712
Payer-assigned Payer ID: 41150
Payer Enrollment Required: No
Secondary Claims Accepted: No
Payer Location: National

Action Required: 

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

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

12/3/2025

New Electronic Claims Connections Available

Optum has new electronic claims connections available:

Payer Name: Health Services Management
Professional CPID: 1712
Payer-assigned Payer ID: 41150
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.

12/3/2025

Update: Report Generation Delay for CPID 2426 Michigan Blue Care Network

Update: The payer intermediary has been unable to generate and deliver the reports for some claims submitted Nov. 3, 2025.

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

Original notice sent Nov. 17, 2025:
A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted Nov. 3, 2025.

Payer impacted: 

  • CPID 2426 Michigan Blue Care Network

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09777827.

12/3/2025

Report Generation Delay for CPID 7241 TransactRX Part D

A payer is experiencing issues affecting Professional report generation for some claims submitted Nov. 25, 2025.

Payer impacted:

  • CPID 7241 TransactRX Part D

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09794027.

12/3/2025

New Payer ID for NYCE

Effective January 1, 2026, claims submitted to NYCE with a date of service starting in 2026 will need to utilize a different payer ID:

Payer Name: NYCE

Payer ID: 26992

Optum will be the front end for all EDI transactions (837P, 837I, 837D, 270/271 and 835/ERA).

As a result, all clearinghouse service organizations that submit transactions to 26992 must send their transactions directly to Optum and or a clearinghouse that has an established connection with Optum.

This change will take effect on Thursday, January 1, 2026.

Enrollment Requirements:

Claims/Real Time:

Payer enrollment for electronic claims and real time transactions are not required.

ERAs:

Payer enrollment for ERAs is required under payer ID 39026 (UMR)

Action Required:

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

12/2/2025

Electronic Routing Change for Angle Health (39856)

Optum is changing electronic remittance routing for the following payer, effective immediately:

Payer Name: Angle Health
Payer ID: 39856
Payer Remittance Enrollment Required: Yes
Remittance Fee: N/A 

Enrollment Requirements
Remittance:

  • Payer enrollment for electronic remittance is required. 
  • Providers currently receiving electronic remittance through Optum 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 IEDI.

12/2/2025

Prudent Medical Group Electronic Claims Connection No Longer Available

Effective Dec. 2, 2025, the payer listed below is no longer available at Optum for claims processing.

Payer Name: Prudent Medical Group
Payer ID: MPM25
Reason: Payer no longer offers an electronic connection to which Optum can connect. 

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

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

12/2/2025

RESOLVED - National Medicare CMS (CMSEL) Eligibility And Benefits Error

This issue is now resolved. 

Root Cause: A database migration table issue that was resolved 

Original Notification:

We are aware of an issue causing users to get an error when searching E&B for National Medicare CMS patients. Error states user is not enrolled for this transaction but have an approved enrollment on file in transaction enrollment.

Error: YOUR REQUEST WAS INVALID. THE PROVIDER NPI IS NOT APPROVED FOR NATIONAL MEDICARE/CMS 270/271 TRANSACTIONS.

We continue to monitor this issue with the payer. If you have any questions, please contact Customer Support and refer to Global Incident Number INC-000003400

Action Required:  Please be aware of the ongoing issue.

12/2/2025

Update: Payer Processing Issue for CPIDs 5594 and 1487 North Dakota Medicaid

Update: Optum continues to work with the payer to resolve this processing issue. We will notify you once this issue has been resolved.

Action Required: None. Please be aware of the processing issue above.

Original notice sent: Nov. 18, 2025:

Due to a payer processing issue, Professional and Institutional claims transmitted to the payer listed below on Nov. 14, 2025 through present were not processed by the payer.

Payer impacted:

  • CPID 5594 North Dakota Medicaid
  • CPID 1487 North Dakota Medicaid

Optum is working with the payer to resolve this processing issue. We will notify you once this issue has been resolved.                                                                                                                                                                     Action Required: None. Please be aware of the processing issue above.

If you have any questions, please contact Customer Support and refer to Case Number 09780106.

12/2/2025

Update: Delay in Electronic Remittance Advice (ERA) for CPIDs 1487 and 5594 North Dakota Medicaid

Update: Optum continues working diligently with the payer to resolve the issue and ensure ERA are received.

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

Original notice sent: Nov. 19, 2025:

There has been a delay in Professional and Institutional Electronic Remittance Advice (ERA) for the following payer for check dates since Nov. 14, 2025:

  • CPID 1487 North Dakota Medicaid
  • CPID 5594 North Dakota Medicaid 

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09780106.

12/2/2025

Payer ID Consolidation - First Choice VIP Care

Effective Jan. 1, 2026 claims with DOS on or after Jan. 1, 2026 must be sent to Payer ID 32456.

  • Payer ID 32456 CPIDs (6087, 9248)

All claims with a DOS on or prior to Dec. 31, 2025 will continue to be sent to Payer ID 77009.

  • Payer ID 77009 CPIDs (8631, 7193)

There will be a one year run out period and all claims on or after Jan. 1, 2027 must be submitted to Payer ID 32456.

12/2/2025

Prudent Medical Group Electronic Claims Connection No Longer Available

Effective Dec. 2, 2025, the payer listed below is no longer available at Optum for claims processing.

Payer Name: Prudent Medical Group
Claims CPIDs: 7259, 8696
Payer-assigned Payer ID: MPM25
Reason: Payer no longer offers an electronic connection to which Optum can connect. 

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

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

12/2/2025

Prudent Medical Group Electronic Claims Connection No Longer Available

Effective Dec. 2, 2025, the payer listed below is no longer available at Optum for claims processing:

Payer Name: Prudent Medical Group
Claim CPIDs: 7259, 8696
Payer-assigned Payer ID: MPM25

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

Action Required: None.

12/2/2025

Report Generation Delay for CPID 7171 Neighborhood Health Plan of Rhode Island

A payer is experiencing issues affecting Professional report generation for some claims submitted Nov. 21, 2025.

Payer impacted:

  • CPID 7171 Neighborhood Health Plan of Rhode Island

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 Nov. 21, 2025.

If you have any questions, please contact Customer Support and refer to Case Number 09792856.

12/2/2025

Report Generation Delay for CPID 2451 Mississippi Medicare

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted since Nov. 20, 2025.

Payer impacted:

  • CPID 2451 Mississippi Medicare

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09792852.

12/2/2025

999 Payer Batch Rejections for CPID 1844 Wellcare Health Plans

Professional claims transmitted to the payer listed below from Optum Dec. 1, 2025 were not processed by the payer due to a 999 Batch Rejection. 

  • CPID 1844 Wellcare Health Plans

A resolution has been implemented and the claims were retransmitted to the payer Dec. 2, 2025.

Action Required: None.

If you have any questions, please contact Customer Support and refer to Case Number 09792688.

12/2/2025

Payer Change for CPID 4492 Massachusetts Medicaid Format 5

Effective Jan. 14, 2026, claims and remittance currently exchanged with the following payer must use a different CPID:

Payer Name: Massachusetts Medicaid Format 5
Professional CPID: 4492
Payer-assigned Payer ID: DMA7384

Claims and remittance must begin using the following Jan. 14, 2026:
Payer Name: MassHealth
Professional CPID: 4491
Payer-assigned Payer ID: DMA7384
Claim Fee: N/A

CPID 4492 Massachusetts Medicaid Format 5 will be terminated effective Jan. 14, 2026.

Enrollment Requirements
Claims:

  • Payer enrollment for electronic claims is required.
    • Providers currently sending electronic claims through Optum for CPID 4492 Massachusetts Medicaid Format 5 do not need to complete a new enrollment form.
    • New providers must complete a new enrollment form for CPID 4491 MassHealth.

Remittance:

  • Payer enrollment for electronic remittance is required.
    • Providers currently receiving electronic remittance through Optum for CPID 4492 Massachusetts Medicaid Format 5 do not need to complete a new enrollment form.
    • Providers not receiving remittance through Optum for CPID 4492 must complete a new enrollment form for CPID 4491 MassHealth.
    • New providers must complete a new enrollment form for CPID 4491 MassHealth.

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.

12/2/2025

New Payer Edit for CPID 1937 Global Care

The payer listed below has informed Optum of a new edit requirement effective immediately. In order to meet the new requirement, we will add the following edit Dec. 8, 2025.

  • IHI-01A108: MISSING PATIENT RSN FOR VISIT - When the following conditions are present, the Patient Reason for Visit is required. 1. Type of Bill 13x, 78x, or 85x; and 2. Revenue Code 45x, 516, 526, or 762; and 3. Type of Admission 1, 2, 3, or 5. LOOP 2300 HI01-2

Edit applies to:  

  • CPID 1937 GLOBAL CARE

Action Required: Please be aware of updated edit requirements. 

12/1/2025

Electronic Routing Change for CPIDs 2290 and 2935 Mutual Health Services

Optum is changing electronic claims and remittance routing for the following payer, effective Dec. 1, 2025:

Payer Name: Mutual Health Services
Professional CPID: 2290
Institutional CPID: 2935
Payer-assigned Payer ID: 34192
Payer Claim Enrollment Required: No
Payer Remittance Enrollment Required: Yes
Secondary Claims Accepted: Yes
Claims Fee: $0.10

Enrollment Requirements
Claims:

  • Payer enrollment for electronic claims is not required.

Remittance:

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

Report Changes
You may see some differences in the payer reports you receive.

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

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

12/1/2025

Electronic Routing Change for CPIDs 4423 and 3506 Medical Mutual of Ohio

Optum is changing electronic claims and remittance routing for the following payer, effective Dec. 1, 2025:

Payer Name: Medical Mutual of Ohio
Professional CPID: 4423
Current Edit Master: PE_T007
New Edit Master: PE_B800
Institutional CPID: 3506
Current Edit Master: HE9T007
New Edit Master: HE9B801
Payer-assigned Payer ID: 29076
Line of Business Code (LOB): H17
Payer Claim Enrollment Required: No
Payer Remittance Enrollment Required: Yes
Secondary Claims Accepted: Yes

Enrollment Requirements
Claims:

  • Payer enrollment for electronic claims is not required.

Remittance:

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

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

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

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

12/1/2025

Electronic Routing Change for CPIDs 2290 and 2935 Mutual Health

Optum will be changing electronic claims and remittance routing for the following payer, effective Dec. 1, 2025:

Payer Name: Mutual Health Services
Professional CPID: 2290
Current Edit Master: PE_T007
New Edit Master: PE_C051
Institutional CPID: 2935
Current Edit Master: HE9T007
New Edit Master: HE9C051
Payer-assigned Payer ID: 34192
Line of Business Code (LOB): H78
Payer Claim Enrollment Required: No
Payer Remittance Enrollment Required: Yes
Secondary Claims Accepted: Yes

Enrollment Requirements
Claims:

  • Payer enrollment for electronic claims is not required.

Remittance:

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

Report Changes
You may see some differences in the payer reports you receive.

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

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

12/1/2025

Electronic Routing Change for CPIDs 4423 and 3506 Medical Mutual of Ohio

Optum is changing electronic claims and remittance routing for the following payer, effective Dec. 1, 2025:

Payer Name: Medical Mutual of Ohio
Professional CPID: 4423
Institutional CPID: 3506
Payer-assigned Payer ID: 29076
Payer Claim Enrollment Required: No
Payer Remittance Enrollment Required: Yes
Secondary Claims Accepted: Yes
Claims Fee: $0.10

Enrollment Requirements
Claims:

  • Payer enrollment for electronic claims is not required.

Remittance:

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

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

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

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

12/1/2025

Report Generation Delay for CPID 7893 Superior Select Health

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted since Nov. 20, 2025.

Payer impacted:

  • CPID 7893 Superior Select Health

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09791940.

12/1/2025

Report Generation Delay for CPID 4946 Texas Medicare

A payer intermediary is experiencing issues affecting Institutional report generation for some claims submitted since Nov. 18, 2025.

Payer impacted:

  • CPID 4946 Texas Medicare

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09791933.

12/1/2025

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

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted since Nov. 18, 2025.

Payer impacted:

  • CPID 2824 The Health Plan of West Virginia

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09791925.

12/1/2025

Report Generation Delay for CPID 1558 Oklahoma Medicare

A payer intermediary is experiencing issues affecting Institutional report generation for some claims submitted Nov. 18, 2025.

Payer impacted:

  • CPID 1558 Oklahoma Medicare

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09791921.

12/1/2025

Report Generation Delay for CPID 1448 Florida Medicare

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted since Nov. 20, 2025.

Payer impacted:

  • CPID 1448 Florida Medicare

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09791909.

12/1/2025

Report Generation Delay for CPIDs 1474 and 3501 Indiana Medicaid

A payer intermediary is experiencing issues affecting Professional and Institutional report generation for some claims submitted since Nov. 25, 2025.

Payer impacted: 

  • CPID 1474 Indiana Medicaid
  • CPID 3501 Indiana Medicaid

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09791837.

12/1/2025

Report Generation Delay for CPID 1780 Managed Care Advisors - Sedgwick

A payer is experiencing issues affecting Professional report generation for some claims submitted since Nov. 21, 2025.

Payer impacted: 

  • CPID 1780 Managed Care Advisors - Sedgwick

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09791791.

12/2/2025

Update: Report Generation Delay for CPID 7264 Quartz ASO

Update: The payer intermediary has been unable to generate and deliver the reports for some claims submitted from Nov. 4, 2025-Nov. 6, 2025.

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

Original notice sent Nov. 17, 2025:
A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted since Nov. 4, 2025.

Payer impacted:

  • CPID 7264 Quartz ASO

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09777986.

12/1/2025

Payer Processing Issue for CPID 7074 UnitedHealthcare Ohio Medicaid

Due to a payer intermediary processing issue, some Institutional claims transmitted to the payer listed below Nov. 18, 2025 were not processed by the payer intermediary.

Payer impacted:

  • CPID 7074 UnitedHealthcare Ohio Medicaid

A resolution has been implemented and the claims were retransmitted to the payer intermediary Dec. 1, 2025.

This delay affected claims released to Optum Nov. 18, 2025, 10:00 a.m.-5:00 p.m. CT.

Action Required: Be aware of the processing issue above.

If you have any questions, please contact Customer Support and refer to Case Number 09791686.

12/1/2025

999 Payer Batch Rejections for CPID 1844 Wellcare Health Plans

Professional claims transmitted to the payer listed below from Optum Nov. 26, 2025 were not processed by the payer due to a 999 Batch Rejection.

  • CPID 1844 Wellcare Health Plans

A resolution has been implemented and the claims were retransmitted to the payer Dec. 1, 2025.

Action Required: None.

If you have questions, please contact Customer Support and refer to Case Number 09791663.

12/1/2025

Electronic Routing Change for CPIDs 9184 and 6032 Angle Health

Optum is changing electronic remittance routing for the following payer, effective immediately:

Payer Name: Angle Health
Professional CPID: 9184
Institutional CPID: 6032
Payer-assigned Payer ID: 39856
Line of Business Code (LOB): N26
Payer Remittance Enrollment Required: Yes 

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: 

  • 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. 

12/1/2025

Electronic Routing Change for CPIDs 9184 and 6032 Angle Health

Optum is changing electronic remittance routing for the following payer, effective immediately:

Payer Name: Angle Health
Professional CPID: 9184
Institutional CPID: 6032
Payer-assigned Payer ID: 39856
Payer Remittance Enrollment Required: Yes
Remittance Fee: N/A 

Enrollment Requirements
Remittance:

  • Payer enrollment for electronic remittance is required. 
  • Providers currently receiving electronic remittance through Optum 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. 

12/1/2025

Older Payer Updates

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

GET OLDER UPDATES
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