February 2026

February 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 →

Delay in Electronic Remittance Advice (ERA) for CPIDs 3506, 4423 Medical Mutual of Ohio

Due to a payer intermediary processing issue, there has been a delay in Professional and Institutional Electronic Remittance Advice (ERA) for the following payers for check dates of Sept. 9, 2025-present:

CPID 3506 Medical Mutual of Ohio
CPID 4423 Medical Mutual of Ohio

Additional updates will be forwarded as more information becomes available.

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

If you have any questions, feel free to contact your Customer Support Team and refer to Case Number INC-000004086.

2/11/2026

Payer Processing Issue for CPID 4479 Alabama Medicaid

Due to a payer processing issue, some Professional claims transmitted to the payer listed below Feb. 6, 2026 were not processed by the payer.

Payer impacted:

CPID 4479 Alabama Medicaid

A resolution has been implemented and the claims were retransmitted to the payer Feb. 11, 2026.

This delay affected claims released to Optum Feb. 5, 2026, 3:00 p.m.-Feb. 6, 2026, 3:00 p.m. CT.

Action Required: Be aware of the processing issue above.

If you have any questions, please contact Customer Support and refer to Case Number 09887149.

2/11/2026

New Electronic Remittance Connections Available

Optum has new electronic remittance connections available:

Payer Name: Christian Care Ministries
Institutional CPID: 8638
Professional CPID: 7154
Payer-assigned Payer ID: 59355
Payer Enrollment Required: Yes
Remittance Fee: N/A
Payer Location: National

Payer Name: WelbeHealth
Institutional CPID: 7076
Professional CPID: 9477
Payer-assigned Payer ID: WBHCA
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.

2/11/2026

New Electronic Remittance Connections Available

Optum has new electronic remittance connections available:

Payer Name: Christian Care Ministries
Institutional CPID: 8638
Professional CPID: 7154
Payer-assigned Payer ID: 59355
Line of Business (LOB) Code: E48
Payer Enrollment Required: Yes
Payer Location: National

Payer Name: WelbeHealth
Institutional CPID: 7076
Professional CPID: 9477
Payer-assigned Payer ID: WBHCA
Line of Business (LOB) Code: E49
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.

2/11/2026

Report Generation Delay for CPID 7736 Direct Care Administrators

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted on Jan. 28, 2026.

Payer impacted:

CPID 7736 Direct Care Administrators

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09886981.

2/11/2026

New Electronic Remittance Connections Available

Optum has new electronic remittance connections available:

Payer Name: Van Lang IPA
Institutional CPID: 7016
Professional CPID: 9298
Payer-assigned Payer ID: 77036
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.

2/11/2026

New Electronic Remittance Connections Available

Optum has new electronic remittance connections available:

Payer Name: Van Lang IPA
Institutional CPID: 7016
Professional CPID: 9298
Payer-assigned Payer ID: 77036
Line of Business (LOB) Code: N53
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.

2/11/2026

Reminder: Payer Change for CPID 4492 Massachusetts Medicaid Format 5

Reminder: Effective Feb. 11, 2026, providers must begin using CPID 4491 MassHealth for electronic claims and remittance. CPID 4492 Massachusetts Medicaid Format 5 will be terminated.

Reminder CSA sent 2/2/26:

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 February 11, 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 February 11, 2026.

Enrollment Requirements:

Claims:

Payer enrollment for electronic claims is required.
- Providers currently submitting electronic claims through Optum to CPID 4492 Massachusetts Medicaid Format 5 do not need to complete a new enrollment form.
- Providers who have not submitted claims to CPID 4492 since November 9, 2025, must complete a new enrollment form for CPID 4491 MassHealth.
- 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.
  - Optum has migrated providers who have received remittance since November 9, 2025, by updating their clearinghouse routes to the applicable CPID 4491 MassHealth.
- Providers who have not received remittance since November 9, 2025, were not migrated and 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.

2/10/2026

Payer Consolidation - Immanuel Pathways

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

Payer Name: Pace Nebraska
Payer ID: 35416
Claim Type: Professional, Institutional

Payer Name: Pace Southwest Iowa
Payer ID: 53534
Claim Type: Professional, Institutional

Payer IDs 35416 and 53534 will be terminated effective March 10, 2026.

Providers must begin using the following ID for electronic claims:
Payer Name: Immanuel Pathways
Payer ID: IMP01

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.

2/10/2026

New Electronic Remittance Connections Available - Gold Kidney Health Plan (A6865)

Optum has new electronic remittance connections available:

Payer Name: Gold Kidney Health Plan
Payer ID: A6865
Payer Enrollment Required: Yes
Payer Location: Arizona

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.

2/10/2026

Update: Assurance Reimbursement Management Performance Issue

Update: Optum is continuing to work to resolve this issue. We will notify you as soon as additional information becomes available.

Original notify sent Jan. 27, 2026:
Assurance Reimbursement Management is experiencing an issue with intermittent performance.

This may result in:

Error: An error occurred while retrieving worklist data
Slowness or Delay in viewing or validating claims

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

We apologize for any inconvenience.

Action Required: None.

2/10/2026

Update: Invalid Error Message for CPIDs 5547/4426 Arizona Blue Cross Blue Shield

Update: This issue is still under review with the payer. Additional notifications will be sent as updates become available.

Original notify sent on: March 27, 2025

Due to a payer processing issue, Professional and Institutional claims for the payer listed below may have received the following invalid error message on the Payer Claim Data Report (SR), Payer Claim Data Report (SE), Payer Report Data File (SF):

Reject Code: 601
Message: CLM: MISPLACED SEGMENT DTP (DATE - REPRICER RECEIVED DATE) AT 2-1350 WITHIN LOOP CLM (2300)(CLAIM INFORMATION) AT 2-1300, THIS SEGMENT, LOOP/GROUP MAY NOT BE IN THE CORRECT POSITION FOR LOOP/GROUP

This issue began November 2024 and is still ongoing. The payer is working to resolve the invalid error message in their system. Currently, the payer does not have an ETA on correcting the error, however any affected claims can be resubmitted.

Payers affected:

5547 Arizona Blue Cross Blue Shield
4426 Arizona Blue Cross Blue Shield

Action Required: Please be aware of the invalid error message.

2/10/2026

Electronic Routing Change for Mercalis (56155)

Effective Feb. 9, 2026, Optum is changing electronic remittance routing for the following payer:

Payer Name: Mercalis
Payer ID: 56155
Payer Remittance Enrollment Required: Yes
Par Status: Non-Par

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:

No Payer Alias changes are required. Payer name and payer ID are not changing.
When a payer requires enrollment, forms must be submitted and approved from IEDI.

2/10/2026

New Electronic Remittance Connections Available

Optum has new electronic remittance connections available:

Payer Name: Gold Kidney Health Plan
Institutional CPID: 8048
Professional CPID: 9766
Payer-assigned Payer ID: A6865
Line of Business (LOB) Code: E47
Payer Enrollment Required: Yes
Payer Location: Arizona

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.

2/10/2026

New Electronic Remittance Connections Available

Optum has new electronic remittance connections available:

Payer Name: Gold Kidney Health Plan
Institutional CPID: 8048
Professional CPID: 9766
Payer-assigned Payer ID: A6865
Payer Enrollment Required: Yes
Remittance Fee: N/A
Payer Location: Arizona

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.

2/10/2026

Update: Report Generation Delay for CPIDs 4549 and 1232 Denver Health Medical Plan Inc. - Medicare Choice

Update: The payer intermediary has been unable to generate and deliver the reports for some claims submitted on Jan. 22, 2026 and Jan. 23, 2026.

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

Original notice sent Feb. 2, 2026:

A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted since Jan. 19, 2026.

Payer impacted:

CPID 4549 Denver Health Medical Plan Inc. - Medicare Choice
CPID 1232 Denver Health Medical Plan Inc. - Medicare Choice

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 09876517.

2/10/2026

New Electronic Remittance Connections Available

Optum has new electronic remittance connections available:

Payer Name: AdventHealth Transplant Institute
Payer ID: RP090
Payer Enrollment Required: Yes
Payer Location: Florida

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.

2/10/2026

New Payer Name

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

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

Action Required: None.

2/10/2026

Report Generation Delay for CPIDs 5927 and 4791 AultCare

The payer listed below is experiencing issues affecting Institutional and Professional report generation for some claims submitted Jan. 30, 2026.

Payer impacted:

CPID 5927 AultCare
CPID 4791 AultCare

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 09885418.

2/10/2026

New Electronic Remittance Connections Available

Optum has new electronic remittance connections available:

Payer Name: Valor Health Plan
Payer ID: 43259
Payer Enrollment Required: Yes
Payer Location: Ohio

Payer Name: Children's Specialists of San Diego
Payer ID: CSSD2
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.

2/10/2026

Report Generation Delay for CPID 9057 Sentara PACE

A payer intermediary is experiencing issues affecting Institutional report generation for some claims submitted Jan. 29, 2026.

Payer impacted:

CPID 9057 Sentara PACE

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 09885220.

2/10/2026

Report Generation Delay for CPID 1405 Blue Cross Blue Shield of Illinois

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted Jan. 27, 2026.

Payer impacted:

CPID 1405 Blue Cross Blue Shield of Illinois

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 09885172.

2/10/2026

New Electronic Claims and Remittance Connections Available

Optum has new electronic claims and remittance connections available:

Payer Name: Hinge Health
Institutional CPID: 9074
Professional CPID: 3841
Payer-assigned Payer ID: HINGE
Line of Business (LOB) Code: H9C
Payer Claim Enrollment Required: No
Payer Remittance Enrollment Required: Yes
Secondary Claims Accepted: Yes
Payer Location: National

Action Required:

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

2/10/2026

New Electronic Claims and Remittance Connections Available

Optum has new electronic claims and remittance connections available:

Payer Name: Hinge Health
Institutional CPID: 9074
Professional CPID: 3841
Payer-assigned Payer ID: HINGE
Payer Claim Enrollment Required: No
Payer Remittance Enrollment Required: Yes
Secondary Claims Accepted: Yes
Payer Location: National
Claims Fee: N/A
Remittance Fee: N/A

Action Required:

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

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

2/10/2026

New Electronic Remittance Connections Available

Optum has new electronic remittance connections available:

Payer Name: AdventHealth Transplant Institute
Institutional CPID: 8026
Professional CPID: 9743
Payer-assigned Payer ID: RP090
Payer Enrollment Required: Yes
Remittance Fee: N/A
Payer Location: Florida

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.

2/9/2026

New Electronic Remittance Connections Available

Optum has new electronic remittance connections available:

Payer Name: AdventHealth Transplant Institute
Institutional CPID: 8026
Professional CPID: 9743
Payer-assigned Payer ID: RP090
Line of Business (LOB) Code: H7T
Payer Enrollment Required: Yes
Payer Location: Florida

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.

2/9/2026

Edit Master for CPIDs 8944 and 5247 Fringe Benefit Coordinators (Medical and Accident)

Effective February 10, 2026, Optum will be changing Edit Masters for the following payer:

Payer Name: Fringe Benefit Coordinators (Medical and Accident)
Professional CPID: 5247
Current Edit Master: PE_C054
New Edit Master: PE_T007
Institutional CPID: 8944
Current Edit Master: HE9C054
New Edit Master: HE9T007
Payer-assigned Payer ID: 59204

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.

2/9/2026

Electronic Routing Change for CPIDs 7821 and 9532 Mercalis

Effective Feb. 9, 2026, Optum is changing electronic remittance routing for the following payer:

Payer Name: Mercalis
Professional CPID: 7821
Institutional CPID: 9532
Payer-assigned Payer ID: 56155
Line of Business Code (LOB): J9M
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:

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.

2/9/2026

Electronic Routing Change for CPIDs 7821 and 9532 Mercalis

Effective Feb. 9, 2026, Optum is changing electronic remittance routing for the following payer:

Payer Name: Mercalis
Professional CPID: 7821
Institutional CPID: 9532
Payer-assigned Payer ID: 56155
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.

2/9/2026

New Electronic Claims Connections Available on RPA

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

29123 – Chorus Community Health Plan

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

29123 – Chorus Community Health Plan

2/9/2026

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

95393 – High Desert Medical Group
CLFM1 – Camp Lejeune Family Member Program
DSCYF – Department of Services for Children
SKLA2 – Louisiana Medicaid Ambulance
SKLA4 – Louisiana Medicaid Rehab

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.

2/9/2026

Delay in Electronic Remittance Advice (ERA) for multiple CPIDs

There has been a delay in Professional and Institutional Electronic Remittance Advice (ERA) for the following payers for check dates since Jan. 30, 2026:

CPID 6147 PacificSource Medicare
CPID 4627 PacificSource Medicare
CPID 6575 PacificSource Health
CPID 5441 PacificSource Health
CPID 4972 PacificSource Community Health Solutions
CPID 4794 PacificSource Community Health Solutions

Optum is working diligently with the payers 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 09883238.

2/9/2026

New Real Time Connections Available on Revenue Performance Advisor

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

10936 – Spectrum Health
10982 – State Mutual (Lincoln Novation)
14330 – Elips Life Insurance Company
16098 – Monitor Life Insurance Company of New York
26992 – NYCE
34186 – CSI Life Insurance
86304 – Insurers Administrative Corporation
PAMPR – Pan American Life Puerto Rico

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

26992 – NYCE
81040 – Allegiance Benefit Plan Management
86304 – Insurers Administrative Corporation

2/9/2026

Electronic Claims Connection Suspended - Leon Medical Center Health Plan

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

Payer Name: Leon Medical Center Health Plan
Payer ID: 37316
Reason: Payer unavailable electronically.

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

2/6/2026

New Electronic Claims Connections Available - JP Farley Corporation

Optum has new electronic claims connections available:

Payer Name: JP Farley Corporation
Payer ID: 34136
Payer Enrollment Required: No
Secondary Claims Accepted: Yes
Payer Location: Alabama, Alaska, Georgia, Ohio, Tennessee

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.

2/6/2026

Electronic Claims Connection Suspended

Effective Feb. 3, 2026, Optum will be reactivating and changing electronic claims routing for the following payer:

Payer Name: AvMed
Payer ID: 59274
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.

Original notice sent Jan. 16, 2026:

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

Payer Name: AvMed
Payer ID: 59274
Reason: Payer unavailable electronically.

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

2/6/2026

Electronic Claims Connection Suspended

Update: This payer has been reactivated. Providers may begin submitting claims after Feb. 6, 2026, 6:00 p.m. CT. Please note that this connection supports Encounter transactions only.

This connection is now a Non-Par payer.

Original notice sent Jan. 26, 2026:

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

Payer Name: Avmed (Encounters)

CPID(s): 3787, 9053
Payer ID: 59275
Reason: Payer unavailable electronically.

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

2/6/2026

Electronic Routing Change for CPIDs 3198 and 1652 Preferred Benefit Administrators (Longwood, Florida)

Effective February 10, 2026, Optum will be changing electronic claims routing for the following payer:

Payer Name: Preferred Benefit Administrators (Longwood, Florida)
Professional CPID: 3198
Current Edit Master: PE_C054
New Edit Master: PE_T007
Institutional CPID: 1652
Current Edit Master: HE9C054
New Edit Master: HE9T007
Payer-assigned Payer ID: 53476
Payer Claim Enrollment Required: No
Secondary Claims Accepted: Yes

Enrollment Requirements:

Claims:

Payer enrollment for electronic claims is not required.

Report Changes:

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

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

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

2/6/2026

Electronic Routing Change for CPIDs 3198 and 1652 Preferred Benefit Administrators (Longwood, Florida)

Effective February 10, 2026, Optum will be changing electronic claims routing for the following payer:

Payer Name: Preferred Benefit Administrators (Longwood, Florida)
Professional CPID: 3198
Institutional CPID: 1652
Payer-assigned Payer ID: 53476
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.

2/6/2026

New Electronic Remittance Connections Available

Optum has new electronic remittance connections available:

Payer Name: Ascension Living HOPE PACE
Institutional CPID: 8035
Professional CPID: 2859
Payer-assigned Payer ID: R3470
Payer Enrollment Required: Yes
Remittance Fee: N/A
Payer Location: Kansas

Payer Name: Coastal Communities Physician Network
Institutional CPID: 6625
Professional CPID: 6726
Payer-assigned Payer ID: 51579
Payer Enrollment Required: Yes
Remittance Fee: N/A
Payer Location: California

Payer Name: Presbyterian Salud
Institutional CPID: 1691
Professional CPID: 4252
Payer-assigned Payer ID: PRESA
Payer Enrollment Required: Yes
Remittance Fee: N/A
Payer Location: New Mexico

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.

2/6/2026

New Electronic Remittance Connections Available

Optum has new electronic remittance connections available:

Payer Name: Ascension Living HOPE PACE
Institutional CPID: 8035
Professional CPID: 2859
Payer-assigned Payer ID: R3470
Line of Business (LOB) Code: E45
Payer Enrollment Required: Yes

Payer Location: Kansas

Payer Name: Coastal Communities Physician Network
Institutional CPID: 6625
Professional CPID: 6726
Payer-assigned Payer ID: 51579
Line of Business (LOB) Code: E46
Payer Enrollment Required: Yes
Payer Location: California

Payer Name: Presbyterian Salud
Institutional CPID: 1691
Professional CPID: 4252
Payer-assigned Payer ID: PRESA
Line of Business (LOB) Code: E44
Payer Enrollment Required: Yes
Payer Location: New Mexico

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.

2/6/2026

Report Generation Delay for CPIDs 4972 and 4794 PacificSource Community Health Solutions

A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted since Jan. 30, 2026.

Payer impacted:

CPID 4794 PacificSource Community Health Solutions
CPID 4972 PacificSource Community Health Solutions

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 09883238.

2/6/2026

Report Generation Delay for CPID 2714 Blue Cross Blue Shield of Hawaii

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted Jan. 29, 2026 and Feb. 3, 2026.

Payer impacted:

CPID 2714 Blue Cross Blue Shield of Hawaii

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 09824865.

2/6/2026

New Electronic Remittance Connections Available

Optum has new electronic remittance connections available:

Payer Name: Next Generation MyCare Anthem Blue Cross Blue Shield
Payer ID: 22147
Payer Enrollment Required: Yes
Payer Location: Ohio

Payer Name: Next Generation MyCare Buckeye Community Health Plan
Payer ID: 21583
Payer Enrollment Required: Yes
Payer Location: Ohio

Payer Name: Next Generation MyCare CareSource
Payer ID: 21599
Payer Enrollment Required: Yes
Payer Location: Ohio

Payer Name: Next Generation MyCare Molina Healthcare of Ohio Inc.
Payer ID: 21586
Payer Enrollment Required: Yes
Payer Location: Ohio

Action Required:

Add the payers to your system to begin using the new payer connection.
Providers currently receiving electronic remittance through Optum for Ohio Medicaid do not need to complete a new enrollment form.
Enrollment forms must be submitted and approved to begin receiving electronic remittance through Optum.

2/6/2026

New Electronic Remittance Connections Available - S. USA Life Insurance Company

Optum has new electronic remittance connections available:

Payer Name: S. USA Life Insurance Company, Inc.
Payer ID: 95721
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.

2/6/2026

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: Leon Medical Center Health Plan
CPID(s): 2282, 2924
Payer ID: 37316
Reason: Payer unavailable electronically.

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

2/6/2026

Report Generation Delay for CPIDs 4792 and 5928 Ohio Bureau of Children with Medical Handicaps

A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted since Jan. 26, 2026.

Payer impacted:

CPID 4792 Ohio Bureau of Children with Medical Handicaps
CPID 5928 Ohio Bureau of Children with Medical Handicaps

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 09877081.

2/6/22026

Report Generation Delay for multiple CPIDs

A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted since Jan. 30, 2026.

Payers impacted:

CPID 6147 PacificSource Medicare
CPID 4627 PacificSource Medicare
CPID 6575 PacificSource Health
CPID 5441 PacificSource 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 09883238.

2/6/2026

Update: Electronic Claims Connection Suspended

Update: This payer has been reactivated. Providers may begin submitting claims after Feb. 6, 2026, 6:00 p.m. CT. Please note that this connection supports Encounter transactions only.

Original notice sent Jan. 26, 2026:
Effective immediately, the payer listed below has been suspended at Optum for claim processing and removed from the payer list.

Payer Name: Avmed (Encounters)
CPID(s): 3787, 9053
Payer ID: 59275
Reason: Payer unavailable electronically.

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

2/6/2026

CareFirst Administrators/NCAS Electronic Remittance Connection No Longer Available

The payer listed below is no longer available at Optum for remittance processing, effective immediately.

Payer Name: CareFirst Administrators/NCAS
Remittance CPIDs: 2914, 1730
Remittance LOB: H29
Payer-assigned Payer ID: 75190
Reason: Payer no longer offers an electronic connection to which Optum can connect.

Action Required: None.

2/6/2026

CareFirst Administrators/NCAS Electronic Remittance Connection No Longer Available

The payer listed below is no longer available at Optum for remittance processing, effective immediately.

Payer Name: CareFirst Administrators/NCAS
Remittance CPIDs: 2914, 1730
Payer-assigned Payer ID: 75190
Reason: Payer no longer offers an electronic connection to which Optum can connect.

Action Required: None.

2/6/2026

New Electronic Remittance Connections Available

Optum has new electronic remittance connections available:

Payer Name: Children's Specialists of San Diego
Professional CPID: 1197
Payer-assigned Payer ID: CSSD2
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.

2/6/2026

New Electronic Remittance Connections Available

Optum has new electronic remittance connections available:

Payer Name: Children's Specialists of San Diego
Professional CPID: 1197
Payer-assigned Payer ID: CSSD2
Line of Business (LOB) Code: J2B
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.

2/6/2026

New Payer Edit for CPID 4295

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 Feb. 11, 2026:

PSBR0135FI: INVALID PAYER RESP SEQ NUM CODE- For an electronic claim, the Payer Indicator must be A. Exceptions: 1. When the CPID is other than 2712 and the Billing Provider State is MN, this requirement does not apply. 2. When the CPID is 2802 and the Other Payer Prior Paid Amount is zero, this requirement does not apply. LOOP 2000B SBR01

Edit applies to:

CPID 4295 Hillsborough County

Action Required: Please be aware of updated edit requirements.

2/5/2026

Update: Report Generation Delay for CPIDs 2824 and 7551 The Health Plan of West Virginia

Update: The payer intermediary has been unable to generate and deliver the reports for some claims submitted Jan. 23, 2026-Jan. 28, 2026.

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

Original notify sent Feb. 2, 2026:
A payer intermediary is experiencing issues affecting Professional and Institutional report generation for some claims submitted since Jan. 23, 2026.

Payer impacted:

CPID 2824 The Health Plan of West Virginia
CPID 7551 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 09876388.

2/5/2026

Update 999 Error for Multiple Payer IDs

Update: Optum continues to work diligently to resolve the issue.

Original Notify sent January 29, 2026:

Due to a potential internal processing issue, professional claims for the payers listed below may have received the following error message:

Claim rejected on 999 report, contact payer for additional information.

This issue began on January 22, 2026. Additional updates will be forwarded as more information becomes available.

Potential Payers Affected:

09824 Molina Healthcare of New Mexico

16146 Molina Healthcare of New York

20149 Molina Healthcare of Ohio

20554 Molina Healthcare of Texas

20934 Molina Healthcare of Illinois

33373 Molina Healthcare of California Encounters

38333 Molina Healthcare of California

38334 Molina Healthcare of Michigan

38336 Molina Healthcare of Washington

46299 Molina Healthcare of South Carolina

51062 Molina Healthcare of Florida

61325 Passport Health Plan by Molina Healthcare

61799 Molina Healthcare of Idaho

77010 Molina Healthcare of Mississippi

A6106 Molina Healthcare of Nevada

ABRI1 Molina Healthcare of Wisconsin

MCC01 Molina Complete Care of Arizona

MCC02 Molina Complete Care of Virginia

MLNIA Molina Healthcare of Iowa

MLNNE Molina Healthcare of Nebraska

MLNNV Molina Healthcare of Nevada

NM505 Molina Health Care Of New Mexico

SWHMA Senior Whole Health, LLC DBA Molina Healthcare

SWHNY Senior Whole Health New York

SX109 Molina Healthcare of Utah

Action Required: Please be aware of the given error message and note that Optum is working to determine root cause and resolution.

2/5/2026

Processing Issue for CPIDs 1573 and 3802 AvMed

Due to a processing issue, Institutional and Professional claims submitted to Optum on Feb. 3, 2026 were not processed by Optum.

Payer impacted:

CPID 1573 AvMed
CPID 3802 AvMed

A resolution has been implemented, and the claims were processed and transmitted to the payer on Feb. 4, 2026.

Action Required: Be aware of the processing issue above.

If you have any questions, please contact Customer Support and refer to Case Number 09880437.

2/5/2026

New Electronic Remittance Connections Available

Optum has new electronic remittance connections available:

Payer Name: Valor Health Plan
Institutional CPID: 2000
Professional CPID: 8132
Payer-assigned Payer ID: 43259
Line of Business (LOB) Code: J4H
Payer Enrollment Required: Yes
Payer Location: Ohio

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.

2/5/2026

New Electronic Remittance Connections Available

Optum has new electronic remittance connections available:

Payer Name: Valor Health Plan
Institutional CPID: 2000
Professional CPID: 8132
Payer-assigned Payer ID: 43259
Payer Enrollment Required: Yes
Remittance Fee: N/A
Payer Location: Ohio

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.

2/5/2026

New Payer Name

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

Previous Payer Name: AmeriHealth Caritas Next A Product of AmeriHealth Caritas VIP Next, Inc.
New Payer Name: AmeriHealth Caritas Next A Product of AmeriHealth Caritas VIP Next, Inc. (Delaware)
Professional CPID: 9426
Professional Edit Master: PE_T007
Institutional CPID: 7043
Institutional Edit Master: HE9T007
Remit Line of Business (LOB) Code: U1I

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

Action Required: None

2/5/2026

Processing Issue for CPIDs 1573 and 3802 AvMed

Due to a processing issue, Institutional and Professional claims submitted to Optum on Feb. 3, 2026 were not processed by Optum.

Payer impacted:

CPID 1573 AvMed
CPID 3802 AvMed

A resolution has been implemented, and the claims were processed and transmitted to the payer on Feb. 4, 2026.

Action Required: Be aware of the processing issue above.

If you have any questions, please contact Customer Support and refer to Case Number 09880437.

2/5/2026

New Payer Name

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

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

2/5/2026

Report Generation Delay for CPID 3706 Cenpatico

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted Jan. 22, 2026.

Payer impacted:

CPID 3706 Cenpatico

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 09881566.

2/5/2026

Electronic Routing Change for Scripps Health Plans

Effective February 10, 2026, Optum will be changing electronic claims routing for the following payers:

Payer Name: Scripps Coastal Medical Group
Professional CPID: 7102
Institutional CPID: 6624
Payer-assigned Payer ID: SHPS1
Payer Claim Enrollment Required: No
Secondary Claims Accepted: Yes
Claims Fee: N/A

Payer Name: Scripps Health Plan MSO
Professional CPID: 1199
Institutional CPID: 2653
Current Payer-assigned Payer ID: SHPM1
New Payer-assigned Payer ID: 33099
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.

2/4/2026

Electronic Routing Change for Scripps Health Plans

Effective February 10, 2026, Optum will be changing electronic claims routing for the following payers:

Payer Name: Scripps Coastal Medical Group
Professional CPID: 7102
Edit Master: PE_T007
Institutional CPID: 6624
Edit Master: HE9T007
Payer-assigned Payer ID: SHPS1
Payer Claim Enrollment Required: No
Secondary Claims Accepted: Yes

Payer Name: Scripps Health Plan MSO
Professional CPID: 1199
Current Edit Master: PE_O007
New Edit Master: PE_T007
Institutional CPID: 2653
Current Edit Master: HE9O007
New Edit Master: HE9T007
Current Payer-assigned Payer ID: SHPM1
New Payer-assigned Payer ID: 33099
Payer Claim Enrollment Required: No
Secondary Claims Accepted: Yes

Enrollment Requirements:

Claims:

Payer enrollment for electronic claims is not required.

Report Changes:

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

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

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

2/4/2026

New Payer Name

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

Previous Payer Name: Blue Cross of Michigan Complete
New Payer Name: Blue Cross Complete of Michigan
Payer ID: 32002

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

2/4/2026

New Electronic Remittance Connections Available

Optum has new electronic remittance connections available:

Payer Name: High Desert Medical Group
Payer ID: 95393
Payer Enrollment Required: Yes
Payer Location: California

Payer Name: Associates for Healthcare
Payer ID: 36326
Payer Enrollment Required: Yes
Payer Location: Wisconsin

Action Required:

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

2/4/2026

Payer Consolidation - St. Joseph Heritage Healthcare

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

Payer Name: HDPC - Premier Healthcare
Payer ID: 90023
Claim Type: Professional

Payer Name: St. Joseph Heritage Healthcare
Payer ID: IP106, JOEHD
Claim Type: Professional

Payer IDs 90023, IP106, JOEHD will be terminated effective March 5, 2026.

Providers must begin using the following ID for electronic claims:

Payer Name: St. Joseph Heritage Healthcare
Payer ID: STJOE

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.

2/4/2026

IMN PAR Status Change for Real Time Payers

The PAR Status is changing for the following payers, effective Feb. 1, 2026:

Payer Name: Absolute Total Care
IMN ID: 68069
New Par Status: Non Par
Transaction: Eligibility

Payer Name: ACS Benefit Services
IMN ID: 72467
New Par Status: Non Par
Transaction: Eligibility

Payer Name: Ameriben Solutions
IMN ID: 75137
New Par Status: Non Par
Transaction: Eligibility

Payer Name: Americo Financial Life & Annuity
IMN ID: AMRCO
New Par Status: Non Par
Transaction: Eligibility

Payer Name: Asuris Northwest Regence
IMN ID: 93221
New Par Status: Non Par
Transaction: Eligibility

Payer Name: Blue Cross Blue Shield of Texas Medicaid
IMN ID: 66001
New Par Status: Non Par
Transaction: Eligibility, Claim Status

Payer Name: Blue Cross Blue Shield of Vermont
IMN ID: SB915
New Par Status: Non Par
Transaction: Eligibility, Claim Status

Payer Name: Blue Cross Community Health Plans
IMN ID: MCDIL
New Par Status: Non Par
Transaction: Eligibility, Claim Status

Payer Name: Blue Cross Medicare Advantage
IMN ID: 66006
New Par Status: Non Par
Transaction: Eligibility, Claim Status

Payer Name: Bridgespan Regence
IMN ID: BRIDG
New Par Status: Non Par
Transaction: Eligibility, Claim Status

Payer Name: Caprock Health Plans
IMN ID: CAPHP
New Par Status: Non Par
Transaction: Eligibility

Payer Name: CareFirst Administrators/NCAS
IMN ID: 75190
New Par Status: Non Par
Transaction: Eligibility

Payer Name: Community Health Plan of Washington (CHPWA)
IMN ID: SB613
New Par Status: Non Par
Transaction: Eligibility, Claim Status

Payer Name: ConnectiCare
IMN ID: 06105
New Par Status: Non Par
Transaction: Eligibility, Claim Status

Payer Name: Dean Health Plan by Medica
IMN ID: 39113
New Par Status: Non Par
Transaction: Eligibility, Claim Status

Payer Name: Delta Care USA (CDCAP)
IMN ID: CDCAP
New Par Status: Non Par
Transaction: Eligibility

Payer Name: Delta Dental of North Carolina
IMN ID: 56101
New Par Status: Non Par
Transaction: Eligibility

Payer Name: Denver Health Medical Plan
IMN ID: 84135
New Par Status: Non Par
Transaction: Eligibility

Payer Name: Employee Benefit Management Services (EBMS)
IMN ID: SX182
New Par Status: Non Par
Transaction: Eligibility, Claim Status

Payer Name: Fidelis Care
IMN ID: 11315
New Par Status: Non Par
Transaction: Claim Status

Payer Name: FirstCarolinaCare
IMN ID: FCC01
New Par Status: Gateway
Transaction: Eligibility

Payer Name: Harvard Pilgrim Health Care
IMN ID: 04271
New Par Status: Gateway
Transaction: Eligibility

Payer Name: Health First Insurance
IMN ID: HFRST
New Par Status: Non Par
Transaction: Eligibility

Payer Name: Health Net National
IMN ID: XHNNC
New Par Status: Non Par
Transaction: Eligibility

Payer Name: Health Partners Plans of Pennsylvania
IMN ID: 80142
New Par Status: Non Par
Transaction: Eligibility, Claim Status

Payer Name: Healthease
IMN ID: WCHEA
New Par Status: Non Par
Transaction: Claim Status

Payer Name: HealthEase Kids
IMN ID: WCHEK
New Par Status: Non Par
Transaction: Claim Status

Payer Name: HealthSpring
IMN ID: ELDER
New Par Status: Non Par
Transaction: Eligibility

Payer Name: Horizon New Jersey Health
IMN ID: 22326
New Par Status: Non Par
Transaction: Eligibility, Claim Status

Payer Name: Humana Dental
IMN ID: 73288
New Par Status: Non Par
Transaction: Eligibility

Payer Name: Illinois Medicaid
IMN ID: SKIL0
New Par Status: Non Par
Transaction: Claim Status

Payer Name: Johns Hopkins Healthcare / Priority Partners
IMN ID: 52189
New Par Status: Non Par
Transaction: Eligibility

Payer Name: Kaiser Foundation Health Plan of Colorado
IMN ID: 91617
New Par Status: Non Par
Transaction: Eligibility, Claim Status

Payer Name: Kaiser Foundation Health Plan of Georgia
IMN ID: 21313
New Par Status: Non Par
Transaction: Eligibility

Payer Name: Kaiser Foundation Health Plan of Northern California Region
IMN ID: 94135
New Par Status: Non Par
Transaction: Eligibility

Payer Name: Kaiser Foundation Health Plan of the Mid-Atlantic States
IMN ID: 52095
New Par Status: Non Par
Transaction: Eligibility

Payer Name: Kaiser Foundation Health Plan of the Northwest
IMN ID: 93079
New Par Status: Non Par
Transaction: Eligibility

Payer Name: Kaiser Permanente Hawaii
IMN ID: 94123
New Par Status: Non Par
Transaction: Eligibility

Payer Name: Lifewise Health Plan of Oregon
IMN ID: 93093
New Par Status: Non Par
Transaction: Eligibility

Payer Name: Magellan Healthcare
IMN ID: 01260
New Par Status: Non Par
Transaction: Eligibility

Payer Name: Mass General Brigham Health Plan
IMN ID: 04293
New Par Status: Non Par
Transaction: Eligibility

Payer Name: Medico Insurance Company
IMN ID: 23160
New Par Status: Non Par
Transaction: Eligibility, Claim Status

Payer Name: Molina Complete Care of Arizona
IMN ID: MLNAZ
New Par Status: Non Par
Transaction: Eligibility, Claim Status

Payer Name: Molina Complete Care of Virginia
IMN ID: 26176
New Par Status: Non Par
Transaction: Eligibility, Claim Status

Payer Name: Molina Healthcare of California
IMN ID: 38333
New Par Status: Non Par
Transaction: Eligibility, Claim Status

Payer Name: Molina Healthcare of Florida
IMN ID: 51062
New Par Status: Non Par
Transaction: Eligibility, Claim Status

Payer Name: Molina Healthcare of Idaho
IMN ID: 61799
New Par Status: Non Par
Transaction: Eligibility, Claim Status

Payer Name: Molina Healthcare of Illinois
IMN ID: 20934
New Par Status: Non Par
Transaction: Eligibility, Claim Status

Payer Name: Molina Healthcare of Michigan
IMN ID: 38334
New Par Status: Non Par
Transaction: Eligibility, Claim Status

Payer Name: Molina Healthcare of Mississippi
IMN ID: 77010
New Par Status: Non Par
Transaction: Eligibility

Payer Name: Molina Healthcare of Nevada
IMN ID: MLNNV
New Par Status: Non Par
Transaction: Eligibility, Claim Status

Payer Name: Molina Healthcare of New Mexico
IMN ID: 09824
New Par Status: Non Par
Transaction: Eligibility, Claim Status

Payer Name: Molina Healthcare of Ohio
IMN ID: MLNOH
New Par Status: Non Par
Transaction: Claim Status

Payer Name: Molina Healthcare of Texas
IMN ID: 20554
New Par Status: Non Par
Transaction: Eligibility, Claim Status

Payer Name: Molina Healthcare of Utah
IMN ID: SX109
New Par Status: Non Par
Transaction: Eligibility, Claim Status

Payer Name: Molina Healthcare of Washington
IMN ID: 38336
New Par Status: Non Par
Transaction: Eligibility, Claim Status

Payer Name: Molina Healthcare of Wisconsin
IMN ID: ABRI1
New Par Status: Non Par
Transaction: Eligibility, Claim Status

Payer Name: Ohana Health Plan
IMN ID: WCOHP
New Par Status: Non Par
Transaction: Claim Status

Payer Name: Passport Health Plan by Molina Healthcare
IMN ID: MLNKY
New Par Status: Non Par
Transaction: Eligibility, Claim Status

Payer Name: Physicians Health Plan of Mid Michigan
IMN ID: 37330
New Par Status: Non Par
Transaction: Eligibility, Claim Status

Payer Name: Premera Blue Cross Blue Shield of Washington and Alaska
IMN ID: SB930
New Par Status: Non Par
Transaction: Eligibility

Payer Name: Regence Blue Shield of Idaho
IMN ID: IDBCS
New Par Status: Non Par
Transaction: Eligibility

Payer Name: Reserve National Insurance Company
IMN ID: 73066
New Par Status: Non Par
Transaction: Eligibility

Payer Name: Security Health Plan
IMN ID: 39045
New Par Status: Non Par
Transaction: Eligibility

Payer Name: StayWell
IMN ID: WCSWA
New Par Status: Non Par
Transaction: Claim Status

Payer Name: StayWell Kids
IMN ID: WCSWK
New Par Status: Non Par
Transaction: Claim Status

Payer Name: VNS Health
IMN ID: 77073
New Par Status: Non Par
Transaction: Eligibility, Claim Status

Payer Name: WEBTPA
IMN ID: 75261
New Par Status: Non Par
Transaction: Eligibility, Claim Status

Action Required: Please be aware of the PAR Status changes.

2/4/2026

Payer Consolidation - HealthSmart Benefit Solutions

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

Payer Name: Healthsmart Benefit Solutions Oklahoma City
Payer ID: 37256
Claim Type: Professional and Institutional

Payer Name: HealthSmart OKC
Payer ID: 73140
Claim Type: Professional and Institutional

Payer Name: HealthSmart
Payer ID: 37212, 37272, 87815
Claim Type: Professional and Institutional

Payer IDs 37212, 37256, 37272, 73140, 87815 will be terminated effective March 5, 2026.

Providers must begin using the following ID for electronic claims:
Payer Name: HealthSmart Benefit Solutions
Payer ID: 37283

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.

2/4/2026

Report Generation Delay for CPID 8714 Allstate

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted Jan. 22, 2026.

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 09879802.

2/4/2026

Report Generation Delay for CPID 6671 HealthSun

A payer intermediary is experiencing issues affecting Institutional report generation for some claims submitted Jan. 22, 2026.

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 09879757.

2/4/2026

Eligibility and Claim Status No Longer Available on RPA for Payer ID 85468

Effective immediately, Real Time Eligibility 270/271 or Claim Status Inquiry 276/277 for the payer listed below will no longer be available on the Revenue Performance Advisor (RPA) system.

Payer Name: Clear Spring Health
Payer ID: 85468
Reason: Payer no longer offers an electronic connection.

Action Required: None

2/4/2026

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 January 29, 2026:

Payer Name: Community Health Group
Industry Payer ID: 66170
IMN Real Time ID: 66170
Exchange Real Time ID: COMHGR
CPID(s): 7668 (I), 7110 (P)
IEDI Real Time ID: 11087
Payer Enrollment Required: No
Connection Type: X12

Search Options:

Claim Status Inquiry subscriber

Member id, First name, Last name, Date of Birth
Payer claim number

Optional additional elements:

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.

2/3/2026

Update: Electronic Claims Connection Suspended and Routing Change for CPIDs 1573 and 3802 AvMed

Update:

Effective Feb. 3, 2026, Optum will be reactivating and changing electronic claims routing for the following payer:

Payer Name: AvMed
Professional CPID: 3802
Current Edit Master: PE_N000
New Edit Master: PE_B800
Institutional CPID: 1573
Current Edit Master: HE9N000
New Edit Master: HE9B801
Payer-assigned Payer ID: 59274
Payer Claim Enrollment Required: No
Secondary Claims Accepted: Yes

Enrollment Requirements:

Claims:

Payer enrollment for electronic claims is not required.

Report Changes:

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

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

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

Original notice sent Jan. 16, 2026:

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

Payer Name: AvMed
CPIDs: 1573, 3802
Payer ID: 59274
Reason: Payer unavailable electronically.

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

2/3/2026

Update: Electronic Claims Connection Suspended and Routing Change for CPIDs 1573 and 3802 AvMed

Update:

Effective Feb. 3, 2026, Optum will be reactivating and changing electronic claims routing for the following payer:

Payer Name: AvMed
Professional CPID: 3802
Institutional CPID: 1573
Payer-assigned Payer ID: 59274
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.
When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.

Original notice sent Jan. 16, 2026:

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

Payer Name: AvMed
CPIDs: 1573, 3802
Payer ID: 59274
Reason: Payer unavailable electronically.

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

2/3/2026

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

Previous Payer Name: Blue Cross of Michigan Complete
New Payer Name: Blue Cross Complete of Michigan
Professional CPID: 7409
Professional Edit Master: PE_T007
Institutional CPID: 5096
Institutional Edit Master: HE9T007
Remit Line of Business (LOB) Code: X69

Action Required: None

2/3/2026

Report Generation Delay for CPIDs 1532 and 4480 Select Health

A payer is experiencing issues affecting Professional and Institutional report generation for some claims submitted Jan. 25, 2026.

Payer impacted:

CPID 1532 Select Health
CPID 4480 Select Health

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09878976.

2/3/2026

New Payer Name

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

Previous Payer Name: Blue Cross of Michigan Complete
New Payer Name: Blue Cross Complete of Michigan
Professional CPID: 7409
Institutional CPID: 5096

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

2/3/2026

New Electronic Remittance Connections Available

Optum has new electronic remittance connections available:

Payer Name: Next Generation MyCare Anthem Blue Cross Blue Shield Institutional CPID: 9061
Professional CPID: 3813
Payer-assigned Payer ID: 0022147
Payer Enrollment Required: Yes
Remittance Fee: N/A
Payer Location: Ohio

Payer Name: Next Generation MyCare Buckeye Community Health Plan
Institutional CPID: 9062
Professional CPID: 3817
Payer-assigned Payer ID: 0021583
Payer Enrollment Required: Yes
Remittance Fee: N/A
Payer Location: Ohio

Payer Name: Next Generation MyCare CareSource
Institutional CPID: 9063
Professional CPID: 3819
Payer-assigned Payer ID: 0021599
Payer Enrollment Required: Yes
Remittance Fee: N/A
Payer Location: Ohio

Payer Name: Next Generation MyCare Molina Healthcare of Ohio Inc.
Institutional CPID: 9064
Professional CPID: 3821
Payer-assigned Payer ID: 0021586
Payer Enrollment Required: Yes
Remittance Fee: N/A
Payer Location: Ohio

Action Required:

Add the payers to your system to begin using the new payer connection.
Providers currently receiving electronic remittance through Optum for Ohio Medicaid do not need to complete a new enrollment form.
Enrollment forms must be submitted and approved to begin receiving electronic remittance through Optum.

2/3/2026

New Electronic Remittance Connections Available

Optum has new electronic remittance connections available:

Payer Name: Next Generation MyCare Anthem Blue Cross Blue Shield
Institutional CPID: 9061
Professional CPID: 3813
Payer-assigned Payer ID: 0022147
Line of Business (LOB) Code: J5N
Payer Enrollment Required: Yes
Payer Location: Ohio

Payer Name: Next Generation MyCare Buckeye Community Health Plan
Institutional CPID: 9062
Professional CPID: 3817
Payer-assigned Payer ID: 0021583
Line of Business (LOB) Code: J7C
Payer Enrollment Required: Yes
Payer Location: Ohio

Payer Name: Next Generation MyCare CareSource
Institutional CPID: 9063
Professional CPID: 3819
Payer-assigned Payer ID: 0021599
Line of Business (LOB) Code: J95
Payer Enrollment Required: Yes
Payer Location: Ohio

Payer Name: Next Generation MyCare Molina Healthcare of Ohio Inc.
Institutional CPID: 9064
Professional CPID: 3821
Payer-assigned Payer ID: 0021586
Line of Business (LOB) Code: J94
Payer Enrollment Required: Yes
Payer Location: Ohio

Action Required:

Add the payers to your system to begin using the new payer connection.
Providers currently receiving electronic remittance through Optum for Ohio Medicaid do not need to complete a new enrollment form.
Enrollment forms must be submitted and approved to begin receiving electronic remittance through Optum.

2/3/2026

Report Generation Delay for CPID 5547 Blue Cross Blue Shield of Arizona

A payer is experiencing issues affecting Institutional report generation for some claims submitted on Jan. 28, 2026.

Payer impacted:

CPID 5547 Blue Cross Blue Shield of Arizona

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 09878187.

2/3/2026

Upcoming Payer Edit Change for CPIDs 8293, 3044 Physicians Health Plan of Michigan

Optum has been informed that Physicians Health Plan of Michigan, Payer ID 83276 coverage has ended effective Dec. 31, 2025. Physicians Health Plan of Michigan is operating on a standard runout period for claims with 2025 dates of service. Optum will be implementing the following edits for date of service effective Febr. 3, 2026.

PDTP03C450: INVALID STATEMENT FROM DATE - This payer is not accepting claims with a Service Line From Date on or after 01/01/2026. LOOP 2400 DTP03
IDTP038270: INVALID STATEMENT FROM DATE - This Payer is not accepting claims with Statement From Date on or after 01/01/2026. LOOP 2300 DTP03

The date of service edits will be applied for:

Payer Name: Physicians Health Plan of Michigan
Claim CPIDs: 8293, 3044
Payer-assigned Payer ID: 83276

Providers must be aware that claims with date of service on or after Jan. 1, 2026, will be rejected.

For additional information, providers can go to payer’s website - www.phpmichigan.com.

Action Required: Providers should be aware of the date of service edit implementation.

2/2/2026

New Electronic Claims Connections Available

Optum has new electronic claims connections available:

Payer Name: JP Farley Corporation
Institutional CPID: 2578
Professional CPID: 3771
Payer-assigned Payer ID: 34136
Payer Enrollment Required: No
Secondary Claims Accepted: Yes
Payer Location: Alabama, Alaska, Georgia, Ohio, Tennessee
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.

2/2/2026

New Electronic Remittance Connections Available

Optum has new electronic remittance connections available:

Payer Name: High Desert Medical Group
Institutional CPID: 9670
Professional CPID: 3290
Payer-assigned Payer ID: 95393
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.

2/2/2026

New Electronic Remittance Connections Available

Optum has new electronic remittance connections available:

Payer Name: Associates for Healthcare
Institutional CPID: 4592
Professional CPID: 6482
Payer-assigned Payer ID: 36326
Line of Business (LOB) Code: E42
Payer Enrollment Required: Yes
Payer Location: Wisconsin

Action Required:

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

2/2/2026

New Electronic Remittance Connections Available

Optum has new electronic remittance connections available:

Payer Name: Associates for Healthcare
Institutional CPID: 4592
Professional CPID: 6482
Payer-assigned Payer ID: 36326
Payer Enrollment Required: Yes
Remittance Fee: N/A
Payer Location: Wisconsin

Action Required:

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

2/2/2026

New Electronic Remittance Connections Available

Optum has new electronic remittance connections available:

Payer Name: High Desert Medical Group
Institutional CPID: 9670
Professional CPID: 3290
Payer-assigned Payer ID: 95393
Line of Business (LOB) Code: E41
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.

2/2/2026

Upcoming Payer Edit Change for CPIDs 8293, 3044 Physicians Health Plan of Michigan

Optum has been informed that Physicians Health Plan of Michigan, Payer ID 83276 coverage has ended effective Dec. 31, 2025. Physicians Health Plan of Michigan is operating on a standard runout period for claims with 2025 dates of service. Optum will be implementing the following edits for date of service effective Febr. 3, 2026.

PDTP03C450: INVALID STATEMENT FROM DATE - This payer is not accepting claims with a Service Line From Date on or after 01/01/2026. LOOP 2400 DTP03
IDTP038270: INVALID STATEMENT FROM DATE - This Payer is not accepting claims with Statement From Date on or after 01/01/2026. LOOP 2300 DTP03

The date of service edits will be applied for:

Payer Name: Physicians Health Plan of Michigan
Claim CPIDs: 8293, 3044
Payer-assigned Payer ID: 83276

Providers must be aware that claims with date of service on or after Jan. 1, 2026, will be rejected.

For additional information, providers can go to payer’s website - www.phpmichigan.com.

Action Required: Providers should be aware of the date of service edit implementation.

2/2/2026

New Electronic Claims Connection Available

Optum has a new electronic claims connection available:

Payer Name: Wellcare by Meridian Illinois 
Institutional CPID: 9066
Professional CPID: 3830
Payer-assigned Payer ID: 68069
Payer Enrollment Required: No 
Secondary Claims Accepted: Yes

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.

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

2/2/2026

New Electronic Claims Connection Available

Optum has a new electronic claims connection available:

Action Required:

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

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

2/2/2026

Report Generation Delay for CPID 1405 Blue Cross Blue Shield of Illinois

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted on Jan. 20, 2026.

Payer impacted:

CPID 1405 Blue Cross Blue Shield of Illinois

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 09876720.

2/2/2026

Update: Report Generation Delay for CPIDs 7420 and 5579 Blue Cross Blue Shield of Rhode Island

Update: The payer intermediary has been unable to generate and deliver the reports for some claims submitted on Jan. 13, 2026.

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

Original notice sent Jan. 20, 2026:

A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted on Jan. 13, 2026.

Payer impacted:

CPID 7420 Blue Cross Blue Shield of Rhode Island
CPID 5579 Blue Cross Blue Shield of Rhode Island

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 09835171.

2/2/2026

Resolved: Invalid Error Message for NGS Medicare

Resolved: The payer confirmed the fix was put in place February 1, 2026.

Action Required: Please resubmit any impacted claims.

Previous Notify sent January 29, 2026:

Update: The intermediary has advised their initial fix completed January 18, 2026 requires additional correction. The intermediary estimates the issue will be resolved February 1, 2026.

Action Required: Please be aware that some claims submitted after January 18, 2026 may receive this error. We will notify you as soon as the intermediary confirms the issue is resolved.

Original Notify sent January 22, 2026:

Due to an intermediary processing issue, Professional claims for the payers listed below may have received the following invalid payer error message:

NGSEDIT SUBMITTED THERAPY PROCEDURE CODE IS MISSING REQUIRED MODIFIER GP, GO OR GN

This issue began on January 2, 2026 and was resolved by the intermediary on January 18, 2026. Providers will need to resubmit impacted claims.

CPIDs affected:

CPID 1452 Connecticut Medicare
CPID 2472 Maine Medicare
CPID 2469 Massachusetts Medicare
CPID 1435 Minnesota Medicare
CPID 2470 New Hampshire
CPID 2244, 4442 New York Medicare Empire
CPID 2260, 7401 New York Medicare GHI
CPID 1463 New York Medicare Upstate
CPID 7419 Rhode Island Medicare
CPID 2471 Vermont Medicare
CPID 1434 Wisconsin Medicare

Action Required: Please resubmit any impacted claims.

2/2/2026

New Electronic Remittance Connections Available

Optum has new electronic remittance connections available:

Payer Name: S USA Life Insurance
Professional CPID: 3800
Payer-assigned Payer ID: 95721
Line of Business (LOB) Code: E38
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.

2/2/2026

PAR Status Change for Eligibility Payers

Effective Feb. 1, 2026, the PAR Status changed for the following Eligibility payer(s):

Payer Name: Ameritas Life Insurance Company
Industry ID: 00425
Exchange CPIDs: 9402
Exchange RT ID: AMRTAS
Old Par Status: Transitional
New Par Status: Par

Payer Name: First Ameritas of New York
Industry ID: 00426
Exchange RT ID: AMTSNY
Old Par Status: Transitional
New Par Status: Par

Payer Name: Kaiser Permanente Hawaii
Industry ID: 94123
Exchange CPIDs: 5925, 6772
Exchange RT ID: HIKAIS
Old Par Status: Gateway
New Par Status: Non Par

Payer Name: Reliance Standard Life
Industry ID: 00427
Exchange RT ID: RELSTD
Old Par Status: Transitional
New Par Status: Par

Payer Name: Standard Insurance
Industry ID: 00429
Exchange RT ID: STDINS
Old Par Status: Transitional
New Par Status: Par

Payer Name: Standard Insurance of New York
Industry ID: 00430
Exchange RT ID: STDINY

Action Required: Please be aware of the upcoming changes.

2/2/2026

Resolved: Assurance Reimbursement Management Edit Issue

Resolved: This issue was resolved with the updated edit package deployed Jan. 30, 2026.

Action Required: Any claims affected by invalid edits require revalidation. Turnkey clients must run and install the latest EPD package. Once installation is complete, all affected claims should be revalidated. For questions, please contact Support.

Original Notify Sent Jan. 30, 2026:
Assurance Reimbursement Management is experiencing an issue with intermittent performance.

This may result in:

Invalid Edit

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

We apologize for any inconvenience.

Action Required: None.

2/2/2026

New Electronic Remittance Connections Available

Optum has new electronic remittance connections available:

Payer Name: S USA Life Insurance
Professional CPID: 3800
Payer-assigned Payer ID: 95721
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.

2/2/2026

Resolved: Invalid Error Message for NGS Medicare

Resolved: The payer confirmed the fix was put in place Feb. 1, 2026.

Action Required: Please resubmit any impacted claims.

Previous Notify sent January 29, 2026:
Update: The intermediary has advised their initial fix completed Jan. 18, 2026 requires additional correction. The intermediary estimates the issue will be resolved Feb. 1, 2026.

Action Required: Please be aware that some claims submitted after Jan. 18, 2026 may receive this error. We will notify you as soon as the intermediary confirms the issue is resolved.

Original Notify sent January 22, 2026:
Due to an intermediary processing issue, Professional claims for the payers listed below may have received the following invalid payer error message:

NGSEDIT SUBMITTED THERAPY PROCEDURE CODE IS MISSING REQUIRED MODIFIER GP, GO OR GN

This issue began Jan. 2, 2026 and was resolved by the intermediary Jan. 18, 2026. Providers will need to resubmit impacted claims.

Payer IDs affected:

CCTMCR Connecticut Medicare
MEMCR Maine Medicare
MAMCR Massachusetts Medicare
MNMCR Minnesota Medicare
NHMCR New Hampshire
NYMCR, SMNY0 New York Medicare Empire
GHMCR, SMNY2 New York Medicare GHI
NN1MCR New York Medicare Upstate
RIMCR Rhode Island Medicare
VTMCR Vermont Medicare
WIMCR Wisconsin Medicare

Action Required: Please resubmit any impacted claims.

2/2/2026

Report Generation Delay for CPIDs 4549 and 1232 Denver Health Medical Plan Inc. - Medicare Choice

A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted since Jan. 19, 2026.

Payer impacted:

CPID 4549 Denver Health Medical Plan Inc. - Medicare Choice
CPID 1232 Denver Health Medical Plan Inc. - Medicare Choice

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 09876517.

2/2/2026

Reminder: Payer Change for CPID 4492 Massachusetts Medicaid Format 5

Reminder:

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 February 11, 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 February 11, 2026.

Enrollment Requirements:

Claims:

Payer enrollment for electronic claims is required.
- Providers currently submitting electronic claims through Optum to CPID 4492 Massachusetts Medicaid Format 5 do not need to complete a new enrollment form.
- Providers who have not submitted claims to CPID 4492 since November 9, 2025, must complete a new enrollment form for CPID 4491 MassHealth.
- 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.
  - Optum has migrated providers who have received remittance since November 9, 2025, by updating their clearinghouse routes to the applicable CPID 4491 MassHealth.
- Providers who have not received remittance since November 9, 2025, were not migrated and 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.

2/2/2026

Report Generation Delay for CPIDs 8980 and 7279 PACE Southeast Michigan

A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted Jan. 19, 2026.

Payer impacted:

CPID 8980 PACE Southeast Michigan
CPID 7279 PACE Southeast Michigan

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09876452.

2/2/2026

Update: Report Generation Delay for CPID 1209 Regence Group Administrators

Update: The payer intermediary has been unable to generate and deliver the reports for some claims submitted on Dec. 31, 2025 and Jan. 1, 2026.

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

Original notice sent Jan. 13, 2026:

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted on Dec. 31, 2025 and Jan. 1, 2026.

Payer impacted:

CPID 1209 Regence Group Administrators

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09828528.

2/2/2026

Transmit Delay for CPID 2527 Immanuel Pathways

Due to a system issue, a delay occurred in some of the transmissions to the following payer on Jan. 29, 2026 and Jan. 30, 2026.

Payer impacted:

CPID 2527 Immanuel Pathways

A resolution has been implemented and the affected claims were transmitted to the payer on Feb. 2, 2026.

This delay affected claims released to Optum between 1 a.m. CT on Jan. 28, 2026 and 1 a.m. CT on Jan. 30, 2026.

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 09847944.

2/2/2026

Report Generation Delay for CPIDs 2824 and 7551 The Health Plan of West Virginia

A payer intermediary is experiencing issues affecting Professional and Institutional report generation for some claims submitted since Jan. 23, 2026.

Payer impacted:

CPID 2824 The Health Plan of West Virginia
CPID 7551 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 09876388.

2/2/2026

Older Payer Updates

Click the link below to access payer updates prior to February 1st, 2026.

GET OLDER UPDATES

CHC Payer Updates (February 2026)

February 2026

February Payer Processing Issues

Software

Full Suite

Practice Management

Electronic Health Records

Electronic Prescribing

Patient Engagement

Medical Scheduling

Telehealth

Mobile Apps

Software for Billing Cos.

Software for Hospice

Resources

Help Center ↗

Learn Academy ↗

Our Support Team

Specialties We Help

Customer Stories

Certifications & Awards

EPCS Mandates

FAQs

White Papers

Blog Articles

About

Why RXNT?

Plans & Pricing

Our Leadership

Company News

Conferences & Events

Press & Media

Contact Us

Careers

Our Brand ↗

Client Login ↗