New Electronic Claims Connections Available - HAP Caresource Michigan Marketplace 

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

Optum has new electronic claims connections available:  

Payer Name: HAP Caresource Michigan Marketplace 

Institutional CPID: 8095

Professional CPID: 2891

Payer-assigned Payer ID: MICS1 

Payer Enrollment Required: No 

Secondary Claims Accepted: Yes 

Payer Location: Michigan

Claims Fee: N/A

Action Required:  

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

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

REF 15836582 1/15/2025

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New Electronic Claims Connections Available - PACE Your Life 

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

Optum has new electronic claims connections available:

Payer Name: PACE Your Life
Institutional CPID: 8099
Professional CPID: 3204
Payer-assigned Payer ID: 98472
Payer Enrollment Required: No
Secondary Claims Accepted: No
Payer Location: Delaware
Claims Fee: N/A

Action Required:

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

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

REF 15835466 1/15/2025

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Payer processing issue for multiple CPIDs

Due to a payer intermediary processing issue, some professional claims transmitted to the payers listed below on Jan. 13, 2025 were not processed by the payers.

Payers impacted:

CPID        Payer Name

9409        Align Senior Care of California

9267        Align Senior Care of Florida

2113        Allcare Health Plan

1764        Ambetter From Absolute Total Care

1765        Ambetter From Louisiana Healthcare Connections

9278        Ambetter from Nebraska Total Care

9431        Ambetter from WellCare of Kentucky

9432        Ambetter from WellCare of New Jersey

9775        Ambetter of Alabama

9433        Ambetter of Oklahoma

9429        American Health Advantage of Idaho & Utah

9117        American Health Advantage of Texas

1741        Amerigroup

1412        Anthem Blue Cross and Blue Shield - Indiana

1413        Anthem Blue Cross and Blue Shield (Virginia)

2418        Anthem Blue Cross and Blue Shield of Ohio

4437        Anthem Blue Cross Blue Shield New York

6220        Arizona Priority Care Plus

4477        Asuris Northwest Medadvantage Regence

7272        Axminster Medical Group

3845        Banner Health Network

7798        Bay Bridge Administrators LLC

1415        Blue Cross Blue Shield of Colorado

1407        Blue Cross Blue Shield of Georgia

7496        Blue Cross Blue Shield of Nevada

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

1243        Blue Cross Community Centennial

1167        Blue Cross Medicare Advantage PPO/HMO

4110        Bollinger Inc

6165        Bridgeview

4246        Capital Health Plan

2810        Capitol Administrators

8146        Care N Care Insurance Co.

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

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

4743        Carelon Behavioral Health

2164        Carelon Behavioral Health Maryland

6127        Carelon Behavioral Health, MBHP

3293        Carelon Health

2830        CarePlus Health Plans

1194        CareSource of Georgia

7143        CareSource of Indiana

3826        CareSource of Ohio

7263        CareSource of West Virginia

9226        CareSource PASSE of Arkansas

6777        Centers Plan for Healthy Living

9765        Central Valley Medical Providers

8123        Clear Health Alliance

7416        Colorado Anthem Blue Cross Blue Shield HMO

6778        Common Ground Healthcare Cooperative

8834        Commonwealth Care Alliance DOS after 3/31/2023

8477        Community Care Plan

2160        Community Care Plan (Commercial)

6865        Community Care Plan (Medicaid)

8147        Community Care Plan (Palm Beach Health District)

1420        Connecticut Anthem Blue Cross Blue Shield

2427        Connecticut BlueCare Family Plan

6795        Contra Costa Health Plan

6241        Correctional Health Partners

7738        CountyCare Health Plan

9747        Delaware First Health

2433        Denver Health and Hospital Authority

8135        Doctors HealthCare Plans

1119        Easy Choice Health Plan of California

7787        El Paso First Health Plans - Health Care Options (HCO)

5483        Employee Benefit Management Services (EBMS)

1834        Employee Plans

8137        Empower Healthcare Solutions

1795        Envolve Benefit Options

5238        Evolent Specialty Cardiology

7121        Evolent Specialty Oncology

3792        Fidelis Care

2875        First Health Network (Coventry Health Care National Network)

7435        FirstCare Health Plans

1414        Florida Blue Cross Blue Shield

3417        Florida Blue Cross Blue Shield Health Options HMO

9417        Florida Complete Care

2150        Florida Health Care Plans

5440        Fox Valley Medicine

8189        Gemcare IPA

2720        GlobalCare

5853        GMS Insurance

9766        Gold Kidney Health Plan

1772        HAP CareSource

1797        HAP CareSource Michigan Dual Medicare/Medicaid

5243        Healthcare Management Administrators

1723        HealthCare Partners IPA

4448        HealthLink PPO

8750        Healthy Blue Dual Advantage Louisiana

7760        Healthy Blue Louisiana

8867        Healthy Blue Missouri

9133        Healthy Blue North Carolina

7715        Hopkins Health Advantage

6259        Humana - CareSource of Kentucky

7426        Idaho Regence Blue Shield

1405        Illinois Blue Cross Blue Shield

3757        IMAGINE360 ADMINISTRATORS (GPA)

5865        Indian Health Services

4445        Insurance Management Services TX

4116        IntegraNet Health

1404        Iowa Wellmark Blue Cross Blue Shield

6733        Iowa Wellmark Blue Cross Blue Shield Crossover

5479        IU Health Plan Medicare Advantage

5432        Johns Hopkins Healthcare / Priority Partners

2421        Kentucky Anthem Blue Cross Blue Shield

9412        Leon Health Plans

7446        Maine Anthem Blue Cross Blue Shield

8812        Maryland Physicians Care

8860        Medica Government Programs

7859        Medica Health Plan Solutions

6799        Medica Individual and Family (IFB)

2287        Medicare Plus Blue of MI(MAP)

9102        Meridian Medicare Medicaid Plan

9118        MeridianComplete Michigan

2426        Michigan Blue Care Network

1421        Michigan Blue Cross Blue Shield

1402        Minnesota Blue Cross Blue Shield

1410        Minnesota Blue Cross Blue Shield CC Systems

7892        Minnesota Blue Cross Blue Shield Health Care Programs

1429        Minnesota Blue Cross Blue Shield HMO

1408        Missouri Anthem Blue Cross Blue Shield

8723        MN BCBS Health Care Programs Non Emergent Transportation

7450        Montana Blue Cross Blue Shield

7496        Nevada Anthem Blue Cross Blue Shield

7422        New Hampshire Anthem Blue Cross Blue Shield

7403        New Mexico Blue Cross Blue Shield

8864        NextBlue of North Dakota

1213        NHC Advantage

2411        North Dakota Blue Cross Blue Shield

1403        Oklahoma Blue Cross Blue Shield

2404        Oregon Regence Blue Cross Blue Shield

7829        Passport Advantage

4252        Presbyterian Salud

8182        PruittHealth Premier NC/SC

5428        QualChoice of Arkansas

7264        Quartz ASO

1209        Regence Group Administrators

4464        SCAN Health Plan

2254        Scott & White Health Plan

9438        Shared Health Mississippi

7225        Sharp Community Medical Group

8124        Simply Healthcare Plans, Inc.

8708        SOMOS Anthem

8816        SOMOS Emblem

1740        Sonder Health Plans

2490        South Dakota Blue Cross Blue Shield

6195        Superior Vision Services

1406        Texas Blue Cross Blue Shield

1729        Texas Childrens Health Plan (CHIP)

2483        Texas Childrens Health Plan (STAR Medicaid)

4278        The Boon Group

8763        U.S. Networks and Administrative Services

8473        Unicare

2412        Utah Regence Blue Cross Blue Shield

2788        Utah Regence Blue Cross Blue Shield Federal Employee Program

7493        Vermont Blue Cross Blue Shield

4258        VNS Health

7451        Washington Regence Blue Shield

9430        Wellcare by Allwell of Oklahoma

1844        Wellcare Health Plans

3211        Wellcare Health Plans (Encounters)

1775        Wellpoint

1401        Wisconsin Anthem Blue Cross Blue Shield

7489        Wyoming Blue Cross Blue Shield

6731        ZELIS

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

This delay affected claims released to Optum between 2 p.m. and 6 p.m. CT on Jan. 13, 2025.

Action Required: Be aware of the processing issue above.

REF 15835150 1/15/2025

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New Electronic Remittance Connections Available

This message is intended for Assurance EDI customers.

Optum has new electronic remittance connections available:

Payer Name: Kalos Health

Institutional CPID: 9665

Professional CPID: 7720

Payer-assigned Payer ID: 40137

Payer Enrollment Required: Yes

Remittance Fee: N/A

Payer Location: New York

Action Required: 

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

REF 15836581 1/15/2025

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Leisure World Managed Care Electronic Claims Connection No Longer Available

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

Payer Name: Leisure World Managed Care
Claim CPID: 1153
Payer-assigned Payer ID: LWMC1
Reason: Payer no longer contracted.

Action Required: Claims must be submitted to Optum on paper.

REF 15836425  1/15/2025

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New Electronic Claims Connections Available

Optum has new electronic claims connections available: 

Payer Name: Carolina SeniorCare
Institutional CPID: 8096
Professional CPID: 2896
Payer-assigned Payer ID: 71499
Payer Enrollment Required: No
Secondary Claims Accepted: No
Payer Location: North Carolina
Claims Fee: N/A

Action Required: 

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

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

REF 15835473 1/15/2025

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Leisure World Managed Care Electronic Claims Connection No Longer Available

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

Payer Name: Leisure World Managed Care
Claim CPID: 1153
Payer-assigned Payer ID: LWMC1
Reason: Payer no longer contracted.

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

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

REF 15836426  1/15/2025

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Report generation delay for CPID 1209  Regence Group Administrators

A payer intermediary is experiencing issues affecting professional report generation for some claims submitted since Jan. 3, 2025.

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.

REF 15835143 1/15/2024

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New Electronic Claims Connections Available

Optum has new electronic claims connections available: 

Payer Name: Starlife Holdings

Institutional CPID: 8094

Professional CPID: 2889

Payer-assigned Payer ID: STARH

Payer Enrollment Required: No

Secondary Claims Accepted: No

Payer Location: California 

Claims Fee: $0.10

Action required: 

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

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

REF 15835465 1/15/2025

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Payer Processing Issue for multiple CPIDs

Due to a payer processing issue, Professional and Institutional claims transmitted to the payers listed below on Jan. 13, 2025, were not processed by the payers.

Payers impacted:

• 1473 California Medi-cal
• 1648 California Medi-cal SNF/Hospice
• 2436 California Medi-cal
• 3510 California Medi-cal
• 5023 California Medi-cal CA009
• 5024 California Medi-cal CAA7P
• 5025 California Medi-cal CAEP1
• 5987 California Medi-cal
• 8613 California Medi-cal (Restricted)
• 8871 California Medi-cal CA009
• 8872 California Medi-cal CA2E5
• 8873 California Medi-cal CAA7P 

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

This delay affected claims released to Optum between 3 p.m. ET on Jan. 12, 2025, and 3 p.m. ET on Jan. 13, 2025.

Action Required: Be aware of the processing issue above.

REF 15835558 1/15/2025

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New Payer Availability 837D claims Payer ID 83028

Jan. 15, 2025 - Important Announcement from Optum - Intelligent EDI - Claims for PID 83028

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

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

MBA Benefit Administrators (Payer ID 83028)

Transactions: 837 Dental

Effective Date: Jan. 15, 2025

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

REF 15823711 1/14/2025

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Report Generation Delay for CPID 1592 Johns Hopkins Healthcare / Priority Partners

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

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

Payer impacted:

• CPID 1592 Johns Hopkins Healthcare / Priority Partners

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

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

REF 15826913 1/14/2025

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Report Generation Delay for CPID 2414 New Jersey Horizon Blue Cross Blue Shield

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

The payer listed below experienced an issue affecting Professional report generation for some claims submitted on Nov. 11, 2024.

Payer impacted:

• CPID 2414 New Jersey Horizon Blue Cross Blue Shield

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

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

REF 15824319 1/14/2025

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Multiple Payers Electronic Claims Connections No Longer Available

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

Payer Name: Cofinity - Group Resources
Claim CPIDs: 3035 & 8286
Payer-assigned Payer ID: 42049
Reason: Payer no longer contracted.

Payer Name: Employee Benefit Concepts Michigan
Claim CPIDs: 7561 & 3705
Payer-assigned Payer ID: 38241
Reason: Payer no longer contracted.

Action Required: Claims must be submitted to Optum on paper.

REF 15822392  1/14/2025

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Multiple Payers Electronic Claims Connections No Longer Available

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

Payer Name: Cofinity - Group Resources
Claim CPIDs: 3035 & 8286
Payer-assigned Payer ID: 42049
Reason: Payer no longer contracted.

Payer Name: Employee Benefit Concepts Michigan
Claim CPIDs: 7561 & 3705
Payer-assigned Payer ID: 38241
Reason: Payer no longer contracted.

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

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

REF 15822393  1/14/2025

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Electronic Routing Change for CPIDs 7620 and 6834, VillageCareMax - Assurance Reimbursement Management

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

Payer Name: VillageCareMax

Professional CPID: 6834

Institutional CPID: 7620

Payer-assigned Payer ID: 26545

LOB Code: H2H

Enrollment Requirements: 

Remittance:

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

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

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

REF 15821414 1/14/2025

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Electronic Routing Change for CPIDs 7620 and 6834, VillageCareMax - Assurance EDI

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

Payer Name: VillageCareMax

Professional CPID: 6834

Institutional CPID: 7620

Payer-assigned Payer ID: 26545 

Enrollment Requirements: 

Remittance:

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

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

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

REF 15821413 1/14/2025

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Report Generation Delay for CPID 8113 MDwise Healthy Indiana Plan

The payer listed below experienced an issue affecting Professional report generation for some claims submitted on Nov. 22, 2024 and Nov. 28, 2024.

Payer impacted:

• CPID 8113 MDwise Healthy Indiana Plan

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

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

REF 15824320 1/14/2025

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Electronic Remittance Advice (ERA) Delay for California Medi-Cal

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

 Due to a payer processing issue, there has been a delay in Professional and Institutional Electronic Remittance Advice (ERA) for the following payer for check date of January 6, 2025:

• SKCA3 California Medi-Cal
• SKCA0 California Medi-Cal

Additional updates will be forwarded as more information becomes available. 

Action Required:

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

REF 15825626 1/14/2025

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Electronic Routing Reactivation and Change for CPIDs 3046 and 8295 MDsave

Effective January 15, 2025, Optum will be reactivating and changing electronic remittance routing for the following payer:

Payer Name: MDsave
Professional CPID: 8295
Institutional CPID: 3046
Payer-assigned Payer ID: MDSV

Enrollment Requirements: 

Remittance:

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

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

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

REF 15822367 1/14/2025

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Report Generation Delay for CPIDs 1913 and 2287 Medicare Plus Blue of MI(MAP)

A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted on Jan. 1, 2025, and Jan. 3, 2025.

Payer impacted:

• CPID 1913 Medicare Plus Blue of MI(MAP)
• CPID 2287 Medicare Plus Blue of MI(MAP)

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

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

REF 15825308 1/14/2025

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Electronic Routing Change for CPIDs 5279 and 7000 Santa Clara County IPA HMO

Effective Jan. 14, 2025, Optum is changing electronic claims routing for the following payer:

Payer Name: Santa Clara County IPA HMO
Professional CPID: 5279
Current Edit Master: PE_O007
New Edit Master: PE_T007
Institutional CPID: 7000
Current Edit Master: HE9O007
New Edit Master: HE9T007
Payer-assigned Payer ID: 10378

Enrollment Requirements:
Claims:

• Payer enrollment for electronic claims is not required.

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

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

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

REF 15823710  1/14/2025

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Electronic Routing Change for CPIDs 5279 and 7000 Santa Clara County IPA HMO

Effective Jan. 14, 2025, Optum is changing electronic claims routing for the following payer:

Payer Name: Santa Clara County IPA HMO
Professional CPID: 5279
Institutional CPID: 7000
Payer-assigned Payer ID: 10378
Claims Fee: $0.10

Enrollment Requirements:
Claims:

• Payer enrollment for electronic claims is not required.

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

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

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

REF 15823709  1/14/2025

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Update: Report Generation Delay for CPID 2455 Arkansas Medicare

The payer has been unable to generate and deliver the reports for some claims submitted between Dec. 13, 2024 and Dec. 16, 2024.

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

Original message sent Jan. 6, 2025:

A payer is experiencing issues affecting Professional report generation for some claims submitted since Dec. 13, 2024.

Payer impacted:

• CPID 2455 Arkansas Medicare

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

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

REF 15821758 1/14/2025

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Update: Report generation delay for CPID 1449 Colorado Medicare

Update: The payer has been unable to generate and deliver the reports for some claims submitted on Dec. 18, 2024 and Dec. 19, 2024.

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

Original notify sent Jan. 6, 2025:

A payer is experiencing issues affecting Professional report generation for some claims submitted since Dec. 18, 2024.

Payer impacted: 

• CPID 1449 Colorado Medicare

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

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

REF 15821759 1/14/2025

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New Payer Edit for CPID 8714

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

• PDTP03A118: MISSING ACCIDENT DATE: The Accident Date is required. LOOP 2300 DTP03

Edit applies to:

• CPID 8714 ALLSTATE – EXCEPT NEW JERSEY

Action Required: Please be aware of updated edit requirements.

REF 15812864 1/13/2025

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HealthSCOPE Benefits Electronic Claims Connection No Longer Available - Assurance Reimbursement Management

This message is intended for Assurance Reimbursement Management customers.

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

Payer Name: HealthSCOPE Benefits
Claim CPIDs: 4643, 6162
Payer-assigned Payer ID: 52429
Reason: Payer no longer offers an electronic connection.

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

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

REF 15810509 1/13/2025

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HealthSCOPE Benefits Electronic Claims Connection No Longer Available - Assurance EDI

This message is intended for Assurance EDI customers.

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

Payer Name: HealthSCOPE Benefits
Claim CPIDs: 4643, 6162
Payer-assigned Payer ID: 52429
Reason: Payer no longer offers an electronic connection.

Action Required: Claims must be submitted to Optum on paper

REF 15810508 1/13/2025

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New Electronic Claims Connections Available

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

Optum has new electronic claims connections available:

Payer Name: Alternative Insurance Resources
Institutional CPID: 5061
Professional CPID: 9106
Payer-assigned Payer ID: IHS06
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.

REF 15814714 1/13/2025

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New Electronic Claims Connections Available

Optum has new electronic claims connections available: 

Payer Name:  NueHealth

Institutional CPID: 8083

Professional CPID: 2880

Payer-assigned Payer ID: RP138

Payer Enrollment Required: No

Secondary Claims Accepted: No

Payer Location: National

Claims Fee: N/A

Action Required: 

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

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

REF 15814187 1/13/2025

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Electronic Routing Change for CPIDs 6674 and 6778 Common Ground Healthcare Cooperative - Assurance Reimbursement Management

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

Payer Name: Common Ground Healthcare Cooperative 

Professional CPID: 6778 

Current Edit Master: PE_T007 

New Edit Master: PE_B800 

Institutional CPID: 6674

Current Edit Master: HE9T007 

New Edit Master: HE9B801 

Payer-assigned Payer ID: 77170

Enrollment Requirements:  

Claims: Payer enrollment for electronic claims is not required. 

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

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

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

REF 15810593 1/13/2025

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Electronic Routing Change for CPIDs 6674 and 6778 Common Ground Healthcare Cooperative - Assurance EDI

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

Payer Name: Common Ground Healthcare Cooperative 

Professional CPID: 6778 

Institutional CPID: 6674 

Payer-assigned Payer ID: 77170 

Enrollment Requirements:   

Claims: Payer enrollment for electronic claims is not required. 

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

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

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

REF 15807642 1/13/2025

---

New Electronic Claims Connections Available

Optum has new electronic claims connections available:  

Payer Name: Innermark TPA 

Institutional CPID: 8093 

Professional CPID: 2888 

Payer-assigned Payer ID: 98481 

Payer Enrollment Required: No 

Secondary Claims Accepted: Yes 

Payer Location: National 

Claims Fee: N/A 

Plans accepted with this connection: 

Bluegrass Care Navigators
Lutheran Senior Life 

Action Required:  

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

When a payer requires enrollment, forms must be submitted and approved to begin submitting transactions. 

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

REF 15808118 1/13/2025

---

New Electronic Claims Connections Available

Optum has new electronic claims connections available: 

Payer Name:  UFCW Local 1000

Institutional CPID: 8090

Professional CPID: 2886

Payer-assigned Payer ID: 99843

Payer Enrollment Required: No

Secondary Claims Accepted: No

Payer Location: National 

Claims Fee: N/A 

Plans accepted with this connection:

• UFCW Local 1000 and Kroger Dallas Health and Welfare Plan 

Action Required: 

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

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

REF 15811408 1/13/2025

---

Payer Processing Issue for multiple CPIDs

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

Payers impacted:

1214 AgeRight Advantage Health Plan

2842 Alexian PACE

9409 Align Senior Care of California

8454 Align Senior Care of Michigan

4101 AllCare Advantage

2113 Allcare Health Plan

9278 Ambetter from Nebraska Total Care

9431 Ambetter from WellCare of Kentucky

9775 Ambetter of Alabama

9433 Ambetter of Oklahoma

9142 American Health Advantage of Mississippi

1741 Amerigroup

1412 Anthem Blue Cross and Blue Shield - Indiana

1413 Anthem Blue Cross and Blue Shield (Virginia)

2418 Anthem Blue Cross and Blue Shield of Ohio

4437 Anthem Blue Cross Blue Shield New York

6220 Arizona Priority Care Plus

7794 Associated Hispanic Physicians IPA

4881 Asuris Northwest Regence

7272 Axminster Medical Group

3845 Banner Health Network

1415 Blue Cross Blue Shield of Colorado

1407 Blue Cross Blue Shield of Georgia

7496 Blue Cross Blue Shield of Nevada

1243 Blue Cross Community Centennial

1167 Blue Cross Medicare Advantage PPO/HMO

9162 Blue Medicare Advantage

6779 Bridgespan Regence

4246 Capital Health Plan

2810 Capitol Administrators

8146 Care N Care Insurance Co.

4743 Carelon Behavioral Health

2164 Carelon Behavioral Health Maryland

6127 Carelon Behavioral Health, MBHP

3293 Carelon Health

2830 CarePlus Health Plans

9722 CareSource North Carolina

1194 CareSource of Georgia

7143 CareSource of Indiana

3826 CareSource of Ohio

9297 Cenpatico Behavioral Health - Nebraska

6777 Centers Plan for Healthy Living

9765 Central Valley Medical Providers

7275 Citrus Valley Physicians Group

8123 Clear Health Alliance

7416 Colorado Anthem Blue Cross Blue Shield HMO

7763 Columbine Health Plan

8834 Commonwealth Care Alliance DOS after 3/31/2023

6865 Community Care Plan (Medicaid)

8147 Community Care Plan (Palm Beach Health District)

1420 Connecticut Anthem Blue Cross Blue Shield

6795 Contra Costa Health Plan

7738 CountyCare Health Plan

2433 Denver Health and Hospital Authority

1232 Denver Health Medical Plan, Inc. - Medicare Choice

8135 Doctors HealthCare Plans

1733 Doctors Professional Services Consultants (DPSC)

1119 Easy Choice Health Plan of California

7294 Eberle Vivian

4279 El Paso Health-STAR

5483 Employee Benefit Management Services (EBMS)

8137 Empower Healthcare Solutions

1795 Envolve Benefit Options

3792 Fidelis Care

2875 First Health Network (Coventry Health Care National Network)

7435 FirstCare Health Plans

1414 Florida Blue Cross Blue Shield

3417 Florida Blue Cross Blue Shield Health Options HMO

9128 Florida Blue Medicare

2150 Florida Health Care Plans

5440 Fox Valley Medicine

2720 GlobalCare

1772 HAP CareSource

1797 HAP CareSource Michigan Dual Medicare/Medicaid

5243 Healthcare Management Administrators

1723 HealthCare Partners IPA

4448 HealthLink PPO

4740 Healthways WholeHealth Networks

7760 Healthy Blue Louisiana

8867 Healthy Blue Missouri

9133 Healthy Blue North Carolina

7715 Hopkins Health Advantage

6259 Humana - CareSource of Kentucky

7426 Idaho Regence Blue Shield

1405 Illinois Blue Cross Blue Shield

3757 IMAGINE360 ADMINISTRATORS (GPA)

4445 Insurance Management Services TX

4116 IntegraNet Health

1404 Iowa Wellmark Blue Cross Blue Shield

6733 Iowa Wellmark Blue Cross Blue Shield Crossover

5479 IU Health Plan Medicare Advantage

5432 Johns Hopkins Healthcare / Priority Partners

2421 Kentucky Anthem Blue Cross Blue Shield

9412 Leon Health Plans

6273 Lifepath Hospice

7446 Maine Anthem Blue Cross Blue Shield

8812 Maryland Physicians Care

8860 Medica Government Programs

7859 Medica Health Plan Solutions

6799 Medica Individual and Family (IFB)

2287 Medicare Plus Blue of MI(MAP)

3475 Memorial Hermann Health Solutions

9102 Meridian Medicare Medicaid Plan

9118 MeridianComplete Michigan

2426 Michigan Blue Care Network

1421 Michigan Blue Cross Blue Shield

1402 Minnesota Blue Cross Blue Shield

1410 Minnesota Blue Cross Blue Shield CC Systems

7892 Minnesota Blue Cross Blue Shield Health Care Programs

1429 Minnesota Blue Cross Blue Shield HMO

1408 Missouri Anthem Blue Cross Blue Shield

7450 Montana Blue Cross Blue Shield

7422 New Hampshire Anthem Blue Cross Blue Shield

7403 New Mexico Blue Cross Blue Shield

8864 NextBlue of North Dakota

1213 NHC Advantage

2411 North Dakota Blue Cross Blue Shield

1403 Oklahoma Blue Cross Blue Shield

2404 Oregon Regence Blue Cross Blue Shield

7829 Passport Advantage

5838 Preferred Administrators

4252 Presbyterian Salud

2807 Professional Benefit Administrators (Oakbrook, Illinois)

4253 Prominence Administrative Services

5428 QualChoice of Arkansas

7264 Quartz ASO

1209 Regence Group Administrators

4270 Resurrection Physicians Provider Group

4464 SCAN Health Plan

2254 Scott & White Health Plan

7225 Sharp Community Medical Group

8124 Simply Healthcare Plans, Inc.

8816 SOMOS Emblem

2490 South Dakota Blue Cross Blue Shield

6195 Superior Vision Services

1406 Texas Blue Cross Blue Shield

1729 Texas Childrens Health Plan (CHIP)

2483 Texas Childrens Health Plan (STAR Medicaid)

4278 The Boon Group

8763 U.S. Networks and Administrative Services

8473 Unicare

2412 Utah Regence Blue Cross Blue Shield

2788 Utah Regence Blue Cross Blue Shield Federal Employee Program

7493 Vermont Blue Cross Blue Shield

4258 VNS Health

7451 Washington Regence Blue Shield

1844 Wellcare Health Plans

3211 Wellcare Health Plans (Encounters)

1775 Wellpoint

1401 Wisconsin Anthem Blue Cross Blue Shield

7489 Wyoming Blue Cross Blue Shield

A resolution has been implemented and the claims were retransmitted to the payer intermediary on Jan. 13, 2025.

This delay affected claims released to Optum between 7 p.m. and 11 p.m. ET on Jan. 10, 2025.

REF 15805639 1/13/2025

---

Action Required: Be aware of the processing issue above.

Delay in Electronic Remittance Advice (ERA) for California Medi-Cal

Due to a payer processing issue, there has been a delay in Professional and Institutional Electronic Remittance Advice (ERA) for the following payers for check date of January 6, 2025:

• CPID 1473 California Medi-Cal
• CPID 1648 California Medi-Cal
• CPID 3510 California Medi-Cal
• CPID 5023 California Medi-Cal
• CPID 5024 California Medi-Cal
• CPID 5025 California Medi-Cal
• CPID 5026 California Medi-Cal
• CPID 5987 California Medi-Cal
• CPID 8613 California Medi-Cal

Additional updates will be forwarded as more information becomes available.  

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

If you have any questions, feel free to contact your Customer Support Team and refer to case 09312305.

REF 15806982  1/13/2025

---

District of Columbia Real Time Rejections 270/271

District of Columbia Medicaid has been receiving 270 transactions with missing fields in Loop 2100C REF segment. These transactions are being rejected by the payer. Please note that District of Columbia Medicaid has the following requirement:

When data is populated in the 2100C Loop (Subscriber Additional ID), and REF*01=SY, REF*02 must = Nine Digits, Minimum 9, Maximum 9.  It must be a valid 9-digit ID.  The payer will reject any transactions that do not meet these requirements. Please update your system to send the correct required elements else do not send the REF Segment. The REF segment in 2100C is an optional field and not required in the 270 but when sent, must adhere to this payer’s requirements.

REF 15804222 1/13/2025

---

Remittance Processing Suspended for CPIDs 1928, 2772 Medical Associates Health Plans

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

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

Payer Name: Medical Associates Health Plans
CPIDs: 1928, 2772
Payer ID: MAHC1
Reason: Payer unavailable electronically

Action Required: None

REF 15794258 1/10/2025

---

Payer Processing Issue for multiple CPIDs

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

Due to a payer intermediary processing issue, some Professional claims transmitted to the payers listed below on Jan. 9, 2025, were not processed by the payers.

Payers impacted:

9267 Align Senior Care of Florida
8454 Align Senior Care of Michigan
2113 Allcare Health Plan
1764 Ambetter From Absolute Total Care
9278 Ambetter from Nebraska Total Care
9431 Ambetter from WellCare of Kentucky
9432 Ambetter from WellCare of New Jersey
9775 Ambetter of Alabama
9433 Ambetter of Oklahoma
2138 American Family Insurance
9712 American Health Advantage of Florida
9142 American Health Advantage of Mississippi
9117 American Health Advantage of Texas
4468 Americas Choice Healthplan
1741 Amerigroup
1412 Anthem Blue Cross and Blue Shield - Indiana
1413 Anthem Blue Cross and Blue Shield (Virginia)
2418 Anthem Blue Cross and Blue Shield of Ohio
4437 Anthem Blue Cross Blue Shield New York
8749 Anthem MaineHealth
6220 Arizona Priority Care Plus
2859 Ascension Living Hope PACE
4477 Asuris Northwest Medadvantage Regence
4881 Asuris Northwest Regence
7272 Axminster Medical Group
3845 Banner Health Network
1415 Blue Cross Blue Shield of Colorado
1407 Blue Cross Blue Shield of Georgia
7496 Blue Cross Blue Shield of Nevada
1243 Blue Cross Community Centennial
1167 Blue Cross Medicare Advantage PPO/HMO
9162 Blue Medicare Advantage
6165 Bridgeview
4246 Capital Health Plan
2810 Capitol Administrators
8146 Care N Care Insurance Co.
9759 Care1st Health Plan of Arizona Medicaid DOS before 12/01/2022
4743 Carelon Behavioral Health
2164 Carelon Behavioral Health Maryland
6127 Carelon Behavioral Health, MBHP
3293 Carelon Health
2830 CarePlus Health Plans
1194 CareSource of Georgia
7143 CareSource of Indiana
3826 CareSource of Ohio
7263 CareSource of West Virginia
6777 Centers Plan for Healthy Living
9765 Central Valley Medical Providers
8123 Clear Health Alliance
7416 Colorado Anthem Blue Cross Blue Shield HMO
8834 Commonwealth Care Alliance DOS after 3/31/2023
2160 Community Care Plan (Commercial)
6865 Community Care Plan (Medicaid)
8147 Community Care Plan (Palm Beach Health District)
1420 Connecticut Anthem Blue Cross Blue Shield
2427 Connecticut BlueCare Family Plan
3419 Connecticut Federal Employee Health Benefits
3420 Connecticut Medicare Blue (Risk)
6795 Contra Costa Health Plan
6241 Correctional Health Partners
7738 CountyCare Health Plan
9747 Delaware First Health
2433 Denver Health and Hospital Authority
1232 Denver Health Medical Plan, Inc. - Medicare Choice
8135 Doctors HealthCare Plans
1119 Easy Choice Health Plan of California
5483 Employee Benefit Management Services (EBMS)
1834 Employee Plans
1795 Envolve Benefit Options
5238 Evolent Specialty Cardiology
3792 Fidelis Care
2875 First Health Network (Coventry Health Care National Network)
7435 FirstCare Health Plans
1414 Florida Blue Cross Blue Shield
3417 Florida Blue Cross Blue Shield Health Options HMO
9128 Florida Blue Medicare
2150 Florida Health Care Plans
8189 Gemcare IPA
2720 GlobalCare
9766 Gold Kidney Health Plan
1772 HAP CareSource
1797 HAP CareSource Michigan Dual Medicare/Medicaid
5243 Healthcare Management Administrators
1723 HealthCare Partners IPA
4448 HealthLink PPO
4740 Healthways WholeHealth Networks
7760 Healthy Blue Louisiana
8867 Healthy Blue Missouri
9133 Healthy Blue North Carolina
7715 Hopkins Health Advantage
6259 Humana - CareSource of Kentucky
7426 Idaho Regence Blue Shield
1405 Illinois Blue Cross Blue Shield
3757 IMAGINE360 ADMINISTRATORS (GPA)
5865 Indian Health Services
4445 Insurance Management Services TX
4116 IntegraNet Health
1107 Integrated Health Partners (IHP)
9713 Iowa Health Advantage
1404 Iowa Wellmark Blue Cross Blue Shield
6733 Iowa Wellmark Blue Cross Blue Shield Crossover
5479 IU Health Plan Medicare Advantage
5432 Johns Hopkins Healthcare / Priority Partners
7782 Kansas Health Advantage
2421 Kentucky Anthem Blue Cross Blue Shield
9412 Leon Health Plans
7446 Maine Anthem Blue Cross Blue Shield
8812 Maryland Physicians Care
8860 Medica Government Programs
7859 Medica Health Plan Solutions
6799 Medica Individual and Family (IFB)
2287 Medicare Plus Blue of MI(MAP)
3475 Memorial Hermann Health Solutions
9102 Meridian Medicare Medicaid Plan
9118 MeridianComplete Michigan
2426 Michigan Blue Care Network
1421 Michigan Blue Cross Blue Shield
1402 Minnesota Blue Cross Blue Shield
1410 Minnesota Blue Cross Blue Shield CC Systems
7892 Minnesota Blue Cross Blue Shield Health Care Programs
1429 Minnesota Blue Cross Blue Shield HMO
1408 Missouri Anthem Blue Cross Blue Shield
8723 MN BCBS Health Care Programs Non Emergent Transportation
7450 Montana Blue Cross Blue Shield
7422 New Hampshire Anthem Blue Cross Blue Shield
7403 New Mexico Blue Cross Blue Shield
8864 NextBlue of North Dakota
2411 North Dakota Blue Cross Blue Shield
1403 Oklahoma Blue Cross Blue Shield
2404 Oregon Regence Blue Cross Blue Shield
7829 Passport Advantage
4252 Presbyterian Salud
8468 Procare Advantage of TX
2807 Professional Benefit Administrators (Oakbrook, Illinois)
4253 Prominence Administrative Services
7281 PruittHealth Premier Medicare Advantage
5428 QualChoice of Arkansas
7264 Quartz ASO
1209 Regence Group Administrators
1776 RIS Rx
4464 SCAN Health Plan
2254 Scott & White Health Plan
8124 Simply Healthcare Plans, Inc.
8708 SOMOS Anthem
8816 SOMOS Emblem
1740 Sonder Health Plans
2490 South Dakota Blue Cross Blue Shield
1406 Texas Blue Cross Blue Shield
1729 Texas Childrens Health Plan (CHIP)
2483 Texas Childrens Health Plan (STAR Medicaid)
4278 The Boon Group
8763 U.S. Networks and Administrative Services
8473 Unicare
2412 Utah Regence Blue Cross Blue Shield
2788 Utah Regence Blue Cross Blue Shield Federal Employee Program
7493 Vermont Blue Cross Blue Shield
4258 VNS Health
7451 Washington Regence Blue Shield
9430 Wellcare by Allwell of Oklahoma
1844 Wellcare Health Plans
3211 Wellcare Health Plans (Encounters)
1775 Wellpoint
2448 Wellpoint Encounters
1401 Wisconsin Anthem Blue Cross Blue Shield
7489 Wyoming Blue Cross Blue Shield

A resolution has been implemented and the claims were retransmitted to the payer intermediary on Jan. 10, 2025.

This delay affected claims released to Optum between 3 p.m. and 7 p.m. ET on Jan. 9, 2025.

Action Required: Be aware of the processing issue above.

REF 15798278 1/10/2025

---

ERA and Reports Delay for VA Fee Basis Programs & CHAMPVA - HAC

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

Due to Payer scheduled maintenance, there will been a delay in Professional and Institutional Electronic Remittance Advice (ERA) and 277CAs for the below mentioned payers. The delay is expected to last two weeks from Dec. 31, 2024, to Jan. 14, 2025.

12115 - Veterans Administration Fee Basis Programs

84146 - CHAMPVA - HAC

Action Required:

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

REF 15799179  1/10/2025

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New Electronic Remittance Connections Available on RPA

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

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

88058 – Med Pay

ACN90 – Altais Care Network

RP129 – Wellstar Health Plan

RP130 – NLIA (Ningen Dock)

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

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

REF 15794112  1/10/2025

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New Electronic Claim Connections Available on Revenue Performance Advisor (RPA)

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

00C63 – BlueCross BlueShield of South Carolina Medicare Advantage
36423 – Zurich American Insurance Company
77306 – Sutter Connect - SIP,SMG,SWMG
82347 – DH Cook
87347 – US Family Health Plan - NW Region
88057 – Zelis
99727 – TRICARE East Region
ABH02 – Access Behavioral Health
ALLCA – AllCare Family Medical Group
AUX01 – Auxiant
EHI01 – Empire Healthcare IPA
EXC01 – Physicians Medical Group of San Jose
HMLIC – Horace Mann
IP082 – Key Medical Group
JVHMQ – JVHL - Physicians Health Plan (Medicare Advantage) **enrollment required
JVHMT – JVHL - HAP CareSource - FFS **enrollment required
LCO01 – Longevity Health Plan of Colorado
MAI60 – Millette Administrators
MMFUC – UC Irvine Health
MPM38 – AHP Provider Network
MPSAB – Meridian PACE Solutions
OSUAE – OSU Aetna Better Health
PRC01 – Utah Navajo Health System Inc
R3459 – Ascension Living St Vincent PACE
R3470 – Ascension Living Hope PACE
R3471 – Alexian PACE

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

00C63 – BlueCross BlueShield of South Carolina Medicare Advantage
36423 – Zurich American Insurance Company
82347 – DH Cook
87347 – US Family Health Plan - NW Region
88057 – Zelis
99727 – TRICARE East Region
ABH02 – Access Behavioral Health
ALLCA – AllCare Family Medical Group
AUDIO – Audionet - National Elevator
AUX01 – Auxiant
EHI01 – Empire Healthcare IPA
HMLIC – Horace Mann
JVHMQ – JVHL - Physicians Health Plan (Medicare Advantage) **enrollment required
JVHMT – JVHL - HAP CareSource - FFS **enrollment required
LCO01 – Longevity Health Plan of Colorado
MAI60 – Millette Administrators
MMFUC – UC Irvine Health
MPM38 – AHP Provider Network
MPSAB – Meridian PACE Solutions
OSUAE – OSU Aetna Better Health
PRC01 – Utah Navajo Health System Inc
R3459 – Ascension Living St Vincent PACE
R3470 – Ascension Living Hope PACE
R3471 – Alexian PACE
UC002 – Brand New Day Encounters

REF 15794114 1/10/2025

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New Payer Name

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

Previous Payer Name: Professional Health Care Network (PHCN)
New Payer Name: tango
Professional CPID: 9217
Institutional CPID: 6062

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

REF 15789498  1/10/2025

---

New Payer Name

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

Previous Payer Name: Professional Health Care Network (PHCN)
New Payer Name: tango
Professional CPID: 9217
Institutional CPID: 6062
Edit Masters:  PE_T007 and HE9T007
Remit Line of Business (LOB) Code: H5E

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

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

REF 15789499  1/10/2025

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Update: Report Generation Delay for CPID 4252 Presbyterian Salud

Update: The payer intermediary has been unable to generate and deliver the reports for some claims submitted on Dec. 17, 2024, and Dec. 18, 2024.

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

Original notification sent Jan. 2, 2025:

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted since Dec. 16, 2024.

Payer impacted:

• CPID 4252 Presbyterian Salud

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

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

REF 15792997 1/10/2025

---

New Electronic Claims Connections Available

Optum has new electronic claims connections available:

Payer Name: Elderhaus

Institutional CPID: 8092

Professional CPID: 2887

Payer-assigned Payer ID: 64192

Payer Enrollment Required: No

Secondary Claims Accepted: No

Payer Location: North Carolina

Claims Fee: N/A

Action Required:

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

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

REF 15793723 1/10/2025

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Payer Change for TRICARE East Region

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

UPDATE: 99727 is now live for claims and ERA on RPA. Please ensure that any needed enrollments have been done.

Original message posted Dec. 30, 2024:

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

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

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

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

Payer Name: TRICARE East Region DOS before 1/1/25

RPA Payer ID: 68299

Payer-assigned Payer ID: TREST

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

Payer Name: TRICARE East Region

RPA Payer ID: 99727

Payer-assigned Payer ID: 99727

NOTES:

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

Enrollment Requirements for TRICARE East Region ID 99727:

Claims:

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

Remittance:

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

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

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

REF 15788903 1/9/2025

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Payer Processing Issue for multiple CPIDs

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

Due to a payer intermediary processing issue, some Professional claims transmitted to the payers listed below on Jan. 8, 2025, were not processed by the payers.

Payers impacted:
8454 Align Senior Care of Michigan
2113 Allcare Health Plan
8714 Allstate - Except New Jersey
1764 Ambetter From Absolute Total Care
1765 Ambetter From Louisiana Healthcare Connections
9278 Ambetter from Nebraska Total Care
9431 Ambetter from WellCare of Kentucky
9432 Ambetter from WellCare of New Jersey
9775 Ambetter of Alabama
9433 Ambetter of Oklahoma
9429 American Health Advantage of Idaho & Utah
9142 American Health Advantage of Mississippi
1741 Amerigroup
1412 Anthem Blue Cross and Blue Shield - Indiana
1413 Anthem Blue Cross and Blue Shield (Virginia)
2418 Anthem Blue Cross and Blue Shield of Ohio
4437 Anthem Blue Cross Blue Shield New York
8749 Anthem MaineHealth
6220 Arizona Priority Care Plus
4881 Asuris Northwest Regence
7272 Axminster Medical Group
3845 Banner Health Network
7798 Bay Bridge Administrators LLC
1415 Blue Cross Blue Shield of Colorado
1407 Blue Cross Blue Shield of Georgia
7496 Blue Cross Blue Shield of Nevada
1243 Blue Cross Community Centennial
1167 Blue Cross Medicare Advantage PPO/HMO
9162 Blue Medicare Advantage
4246 Capital Health Plan
2810 Capitol Administrators
8146 Care N Care Insurance Co.
9759 Care1st Health Plan of Arizona Medicaid DOS before 12/01/2022
4743 Carelon Behavioral Health
2164 Carelon Behavioral Health Maryland
6127 Carelon Behavioral Health, MBHP
3293 Carelon Health
2830 CarePlus Health Plans
1194 CareSource of Georgia
7143 CareSource of Indiana
3826 CareSource of Ohio
6777 Centers Plan for Healthy Living
9765 Central Valley Medical Providers
6700 Centurion Managed Care
7275 Citrus Valley Physicians Group
8123 Clear Health Alliance
7763 Columbine Health Plan
8834 Commonwealth Care Alliance DOS after 3/31/2023
8477 Community Care Plan
2160 Community Care Plan (Commercial)
6865 Community Care Plan (Medicaid)
8147 Community Care Plan (Palm Beach Health District)
1420 Connecticut Anthem Blue Cross Blue Shield
2427 Connecticut BlueCare Family Plan
3419 Connecticut Federal Employee Health Benefits
6795 Contra Costa Health Plan
7738 CountyCare Health Plan
9747 Delaware First Health
2433 Denver Health and Hospital Authority
8135 Doctors HealthCare Plans
1119 Easy Choice Health Plan of California
5483 Employee Benefit Management Services (EBMS)
1834 Employee Plans
1795 Envolve Benefit Options
9215 Everpointe
5238 Evolent Specialty Cardiology
3792 Fidelis Care
2875 First Health Network (Coventry Health Care National Network)
7435 FirstCare Health Plans
1414 Florida Blue Cross Blue Shield
3417 Florida Blue Cross Blue Shield Health Options HMO
9417 Florida Complete Care
2150 Florida Health Care Plans
8189 Gemcare IPA
2720 GlobalCare
1772 HAP CareSource
1797 HAP CareSource Michigan Dual Medicare/Medicaid
5243 Healthcare Management Administrators
1723 HealthCare Partners IPA
4448 HealthLink PPO
7760 Healthy Blue Louisiana
8867 Healthy Blue Missouri
9133 Healthy Blue North Carolina
7715 Hopkins Health Advantage
6259 Humana - CareSource of Kentucky
7426 Idaho Regence Blue Shield
1405 Illinois Blue Cross Blue Shield
3757 IMAGINE360 ADMINISTRATORS (GPA)
5865 Indian Health Services
4445 Insurance Management Services TX
4116 IntegraNet Health
1107 Integrated Health Partners (IHP)
4876 International Medical Group
1404 Iowa Wellmark Blue Cross Blue Shield
6733 Iowa Wellmark Blue Cross Blue Shield Crossover
5479 IU Health Plan Medicare Advantage
5432 Johns Hopkins Healthcare / Priority Partners
2421 Kentucky Anthem Blue Cross Blue Shield
9412 Leon Health Plans
6273 Lifepath Hospice
7446 Maine Anthem Blue Cross Blue Shield
8812 Maryland Physicians Care
3476 Masters, Mates and Pilots
8860 Medica Government Programs
7859 Medica Health Plan Solutions
6799 Medica Individual and Family (IFB)
2287 Medicare Plus Blue of MI(MAP)
3475 Memorial Hermann Health Solutions
9102 Meridian Medicare Medicaid Plan
9118 MeridianComplete Michigan
2426 Michigan Blue Care Network
1421 Michigan Blue Cross Blue Shield
1402 Minnesota Blue Cross Blue Shield
1410 Minnesota Blue Cross Blue Shield CC Systems
7892 Minnesota Blue Cross Blue Shield Health Care Programs
1429 Minnesota Blue Cross Blue Shield HMO
1408 Missouri Anthem Blue Cross Blue Shield
8723 MN BCBS Health Care Programs Non Emergent Transportation
7450 Montana Blue Cross Blue Shield
7422 New Hampshire Anthem Blue Cross Blue Shield
7403 New Mexico Blue Cross Blue Shield
8864 NextBlue of North Dakota
2411 North Dakota Blue Cross Blue Shield
2881 Northwell Direct
1403 Oklahoma Blue Cross Blue Shield
2404 Oregon Regence Blue Cross Blue Shield
7829 Passport Advantage
4252 Presbyterian Salud
8468 Procare Advantage of TX
7281 PruittHealth Premier Medicare Advantage
5428 QualChoice of Arkansas
7264 Quartz ASO
1209 Regence Group Administrators
3257 ResourceOne Administrators
1776 RIS Rx
4464 SCAN Health Plan
2254 Scott & White Health Plan
7225 Sharp Community Medical Group
8124 Simply Healthcare Plans, Inc.
8708 SOMOS Anthem
8816 SOMOS Emblem
1740 Sonder Health Plans
2490 South Dakota Blue Cross Blue Shield
6195 Superior Vision Services
1203 TCC Basic Plus
1406 Texas Blue Cross Blue Shield
1729 Texas Childrens Health Plan (CHIP)
2483 Texas Childrens Health Plan (STAR Medicaid)
4278 The Boon Group
8763 U.S. Networks and Administrative Services
8473 Unicare
2412 Utah Regence Blue Cross Blue Shield
2788 Utah Regence Blue Cross Blue Shield Federal Employee Program
7493 Vermont Blue Cross Blue Shield
4258 VNS Health
7451 Washington Regence Blue Shield
1844 Wellcare Health Plans
3211 Wellcare Health Plans (Encounters)
1775 Wellpoint
2448 Wellpoint Encounters
1401 Wisconsin Anthem Blue Cross Blue Shield
7489 Wyoming Blue Cross Blue Shield
6731 ZELIS

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

This delay affected claims released to Optum between 3 p.m. and 7 p.m. ET on Jan. 8, 2025.

Action Required: Be aware of the processing issue above.

REF 15782458 1/9/2025

---

Report Generation Delay for multiple CPIDs

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

A payer intermediary is experiencing issues affecting Professional and Institutional report generation for some claims submitted since Jan. 3, 2025.

Payers impacted:

• CPID 2216 Florida Medicare
• CPID 3650 JH Mutual of Omaha CO, NM, OK, TX
• CPID 1460 Louisiana Medicare
• CPID 3579 Louisiana Medicare
• CPID 7402 Maryland Medicare 
• CPID 2451 Mississippi Medicare
• CPID 5556 Mississippi Medicare
• CPID 1457 New Mexico Medicare
• CPID 5566 New Mexico Medicare
• CPID 1558 Oklahoma Medicare
• CPID 1440 Texas Medicare
• 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.

REF 15784936 1/9/2025

---

Optum Notice: Electronic Routing Change for CPIDs 7030 and 9414 Evry Health - Assurance Reimbursement Management

Effective Immediately, Optum will be reactivating and changing electronic remittance routing for the following payer:

Payer Name: Evry Health

Professional CPID: 9414

Institutional CPID: 7030

Remittance LOB Code: K1Z

Payer-assigned Payer ID: EH001

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.

REF 15783368 1/9/2025

---

Optum Notice: Electronic Routing Change for CPIDs 7030 and 9414 Evry Health - Assurance EDI

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

Payer Name: Evry Health

Professional CPID: 9414

Institutional CPID: 7030

Payer-assigned Payer ID: EH001

Enrollment Requirements:

Remittance:

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

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

• Make any necessary system changes.

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

REF 15783366 1/9/2025

---

Electronic Routing Change for CPIDs 7794 and 8554, Associated Hispanic Physicians IPA

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

Payer Name: Associated Hispanic Physicians IPA

Professional CPID: 7794

Institutional CPID: 8554

Old Payer-assigned Payer ID: MPM44

New Payer-assigned Payer ID: AHPSC

Enrollment Requirements:

Claims:

• Payer enrollment for electronic claims is not required.

Report Changes:

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

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

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

REF 15783510 1/9/2025

---

Electronic Routing Change for CPIDs 7794 and 8554, Associated Hispanic Physicians IPA

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

Payer Name: Associated Hispanic Physicians IPA
Professional CPID: 7794
Current Edit Master: PE_O007
New Edit Master: PE_B800
Institutional CPID: 8554
Current Edit Master: HE9O007
New Edit Master: HE9B801
Old Payer-assigned Payer ID: MPM44
New Payer-assigned Payer ID: AHPSC

Enrollment Requirements:
Claims:

• Payer enrollment for electronic claims is not required.

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

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

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

REF 15783511  1/9/2025

---

Report Generation Delay for CPID 2481 Ohio Medicaid

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

Payer impacted:

• CPID 2481 Ohio Medicaid

The payer has been unable to generate and deliver the reports for some claims submitted Jan. 1, 2025.

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

REF 15782708  1/9/2025

---

New Eligibility and Claims Status Connection Available for Luminare Health KC

Effective Jan., 9 2025 Optum is pleased to announce the availability of Real-time Eligibility Inquiry and Response 270/271 for the below payer:

Payer Name: Luminare Health KC

Industry Payer ID: 48117

IMN Real Time ID: 48117

Exchange Real Time ID: 48117

CPID(s): 4568,5492

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

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
• Member ID, Dependent Date of Birth

For Claim Status 276/277

Search Options:

Subscriber

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

Dependent

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

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

REF 15782359 1/9/2025

---

Electronic Claims Connection Suspended

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

Payer Name: Healthy Blue Nebraska

CPIDs: 5502 and 8870

Payer ID: 00544

Payer Name: Healthy Blue South Carolina

CPIDs: 5953 and 2121

Payer ID: 00403

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

REF 15772674 1/9/2025

---

Payer Change for CPIDs 4545, 1231 - Imagine Health - Assurance Reimbursement Management

This message is intended for Assurance Reimbursement Management customers.

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

Payer Name: Imagine Health
Professional CPID: 1231
Professional Edit Master: PE_T007
Institutional CPID: 4545
Institutional Edit Master: HE9T007
Payer-assigned Payer ID: 43123

Claims must begin using the following:

Payer Name: Imagine360 Administrators
Professional CPID: 3757
Professional Edit Master: PE_B800
Institutional CPID: 2936
Institutional Edit Master: HE9B801
Payer-assigned Payer ID: 48143
Line of Business Code (LOB): J23

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 3757 and 2936 Imagine360 Administrators do not need to complete a new enrollment form.
  • Providers not receiving electronic remittance through Optum for CPIDs 3757, 2936 Imagine360 Administrators must complete a new enrollment form.
  • New providers must complete a new enrollment form.

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

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

REF 15769970 1/8/2025

---

Payer Change for CPIDs 4545, 1231 - Imagine Health - Assurance EDI

This message is intended for Assurance EDI customers.

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

Payer Name: Imagine Health
Professional CPID: 1231
Institutional CPID: 4545
Payer-assigned Payer ID: 43123

Claims must begin using the following:

Payer Name: Imagine360 Administrators
Professional CPID: 3757
Institutional CPID: 2936
Remittance Available: Yes
Payer-assigned Payer ID: 48143
Claim 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 for CPIDs 3757, 2936 Imagine360 Administrators do not need to complete a new enrollment form. 
  • Providers not receiving electronic remittance through Optum for CPIDs 3757, 2936 Imagine360 Administrators must complete a new enrollment form.
  • New providers must complete a new enrollment form.

Action Required: 

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

REF 15769969 1/8/2025

---

Payer Processing Issue for multiple CPIDs

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

Due to a payer intermediary processing issue, some Professional claims transmitted to the payers listed below on Jan. 7, 2025, were not processed by the payers.

Payers impacted:
9267 Align Senior Care of Florida
8454 Align Senior Care of Michigan
4101 AllCare Advantage
2113 Allcare Health Plan
8714 Allstate - Except New Jersey
1764 Ambetter From Absolute Total Care
9278 Ambetter from Nebraska Total Care
9431 Ambetter from WellCare of Kentucky
9775 Ambetter of Alabama
9433 Ambetter of Oklahoma
2138 American Family Insurance
9142 American Health Advantage of Mississippi
7854 American Health Advantage of Oklahoma
9117 American Health Advantage of Texas
4468 Americas Choice Healthplan
1741 Amerigroup
1412 Anthem Blue Cross and Blue Shield - Indiana
1413 Anthem Blue Cross and Blue Shield (Virginia)
2418 Anthem Blue Cross and Blue Shield of Ohio
4437 Anthem Blue Cross Blue Shield New York
6220 Arizona Priority Care Plus
4881 Asuris Northwest Regence
7272 Axminster Medical Group
3845 Banner Health Network
1415 Blue Cross Blue Shield of Colorado
1407 Blue Cross Blue Shield of Georgia
7496 Blue Cross Blue Shield of Nevada
1243 Blue Cross Community Centennial
1167 Blue Cross Medicare Advantage PPO/HMO
9162 Blue Medicare Advantage
2857 BlueCross BlueShield of South Carolina Medicare Advantage
4110 Bollinger Inc
6779 Bridgespan Regence
2810 Capitol Administrators
8146 Care N Care Insurance Co.
2289 Care1st Health Plan of Arizona Medicaid DOS after 11/30/2022
9759 Care1st Health Plan of Arizona Medicaid DOS before 12/01/2022
4743 Carelon Behavioral Health
2164 Carelon Behavioral Health Maryland
6127 Carelon Behavioral Health, MBHP
3293 Carelon Health
2830 CarePlus Health Plans
1194 CareSource of Georgia
7143 CareSource of Indiana
3826 CareSource of Ohio
6777 Centers Plan for Healthy Living
9765 Central Valley Medical Providers
7275 Citrus Valley Physicians Group
8123 Clear Health Alliance
8834 Commonwealth Care Alliance DOS after 3/31/2023
8147 Community Care Plan (Palm Beach Health District)
1420 Connecticut Anthem Blue Cross Blue Shield
2427 Connecticut BlueCare Family Plan
3419 Connecticut Federal Employee Health Benefits
3420 Connecticut Medicare Blue (Risk)
6795 Contra Costa Health Plan
7738 CountyCare Health Plan
9747 Delaware First Health
2433 Denver Health and Hospital Authority
1232 Denver Health Medical Plan, Inc. - Medicare Choice
8135 Doctors HealthCare Plans
1733 Doctors Professional Services Consultants (DPSC)
3477 Early Intervention Central Billing
1119 Easy Choice Health Plan of California
4289 El Paso Health-CHIP
4279 El Paso Health-STAR
5483 Employee Benefit Management Services (EBMS)
1834 Employee Plans
8137 Empower Healthcare Solutions
1795 Envolve Benefit Options
7761 Esurance Insurance Company
5238 Evolent Specialty Cardiology
3792 Fidelis Care
2875 First Health Network (Coventry Health Care National Network)
7435 FirstCare Health Plans
1414 Florida Blue Cross Blue Shield
3417 Florida Blue Cross Blue Shield Health Options HMO
9128 Florida Blue Medicare
9417 Florida Complete Care
2150 Florida Health Care Plans
5440 Fox Valley Medicine
6851 Friday Health Plans
8189 Gemcare IPA
8879 Georgia Health Advantage
2720 GlobalCare
9766 Gold Kidney Health Plan
1772 HAP CareSource
1797 HAP CareSource Michigan Dual Medicare/Medicaid
5243 Healthcare Management Administrators
1723 HealthCare Partners IPA
4448 HealthLink PPO
8750 Healthy Blue Dual Advantage Louisiana
7760 Healthy Blue Louisiana
8867 Healthy Blue Missouri
8870 Healthy Blue Nebraska
9133 Healthy Blue North Carolina
6272 Hispanic Physicians IPA (Encounters Only)
7715 Hopkins Health Advantage
6259 Humana - CareSource of Kentucky
7426 Idaho Regence Blue Shield
1405 Illinois Blue Cross Blue Shield
2234 Illinois Health Partners
3757 IMAGINE360 ADMINISTRATORS (GPA)
5865 Indian Health Services
4445 Insurance Management Services TX
4116 IntegraNet Health
1107 Integrated Health Partners (IHP)
8814 Integrated Homecare Services
1404 Iowa Wellmark Blue Cross Blue Shield
6733 Iowa Wellmark Blue Cross Blue Shield Crossover
5479 IU Health Plan Medicare Advantage
5432 Johns Hopkins Healthcare / Priority Partners
7782 Kansas Health Advantage
2421 Kentucky Anthem Blue Cross Blue Shield
9412 Leon Health Plans
6273 Lifepath Hospice
1205 Lifeworks Advantage (ISNP Plan)
2863 Longevity Health Plan of Colorado
7446 Maine Anthem Blue Cross Blue Shield
8812 Maryland Physicians Care
8860 Medica Government Programs
7859 Medica Health Plan Solutions
6799 Medica Individual and Family (IFB)
2287 Medicare Plus Blue of MI(MAP)
9102 Meridian Medicare Medicaid Plan
9118 MeridianComplete Michigan
2426 Michigan Blue Care Network
1421 Michigan Blue Cross Blue Shield
1402 Minnesota Blue Cross Blue Shield
1410 Minnesota Blue Cross Blue Shield CC Systems
7892 Minnesota Blue Cross Blue Shield Health Care Programs
1429 Minnesota Blue Cross Blue Shield HMO
5871 Mission Community IPA Medical Group
1408 Missouri Anthem Blue Cross Blue Shield
7450 Montana Blue Cross Blue Shield
7422 New Hampshire Anthem Blue Cross Blue Shield
7403 New Mexico Blue Cross Blue Shield
8864 NextBlue of North Dakota
2411 North Dakota Blue Cross Blue Shield
1403 Oklahoma Blue Cross Blue Shield
2404 Oregon Regence Blue Cross Blue Shield
7829 Passport Advantage
9123 Perennial Advantage
8128 Pool Administrators, Inc.
5838 Preferred Administrators
7168 Premier Healthcare Exchange (PHX)
4252 Presbyterian Salud
8468 Procare Advantage of TX
4253 Prominence Administrative Services
7281 PruittHealth Premier Medicare Advantage
5428 QualChoice of Arkansas
8828 Qualexa Healthcare
7264 Quartz ASO
1209 Regence Group Administrators
3257 ResourceOne Administrators
1776 RIS Rx
6246 Riverside Medical Clinic
4464 SCAN Health Plan
2254 Scott & White Health Plan
9438 Shared Health Mississippi
7225 Sharp Community Medical Group
8124 Simply Healthcare Plans, Inc.
8816 SOMOS Emblem
1740 Sonder Health Plans
2490 South Dakota Blue Cross Blue Shield
1406 Texas Blue Cross Blue Shield
1729 Texas Childrens Health Plan (CHIP)
2483 Texas Childrens Health Plan (STAR Medicaid)
4278 The Boon Group
8763 U.S. Networks and Administrative Services
7810 UMass Medical School Health and Criminal Justice Program
8473 Unicare
6849 United Group Programs
2412 Utah Regence Blue Cross Blue Shield
2788 Utah Regence Blue Cross Blue Shield Federal Employee Program
7493 Vermont Blue Cross Blue Shield
4258 VNS Health
7451 Washington Regence Blue Shield
9293 Wellcare by Allwell from Nebraska Total Care
9430 Wellcare by Allwell of Oklahoma
1844 Wellcare Health Plans
3211 Wellcare Health Plans (Encounters)
1775 Wellpoint
9441 Wellspace NEXUS LLC
1401 Wisconsin Anthem Blue Cross Blue Shield
7489 Wyoming Blue Cross Blue Shield
6731 ZELIS

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

This delay affected claims released to Optum between 11 a.m. and  3 p.m. ET on Jan. 7, 2025.

Action Required: Be aware of the processing issue above.

REF 15771661 1/8/2025

---

Electronic Routing Change for CPID 5676 Alliance Behavioral Health

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

Payer Name: Alliance Behavioral Health
Institutional CPID: 5676
Payer-assigned Payer ID: 23071

Enrollment Requirements:
Claims:

• Payer enrollment for electronic claims is required.
  • Providers who previously sent electronic claims through Optum must complete a new enrollment form.
  • New providers must complete a new enrollment form.

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

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

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

REF 15778310  1/8/2025

---

Electronic Routing Change for CPID 5676 Alliance Behavioral Health

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

Payer Name: Alliance Behavioral Healthcare
Institutional CPID: 5676
Current Edit Master: HE9O007
New Edit Master: HE9T007
Payer-assigned Payer ID: 23071

Enrollment Requirements:
Claims:

• Payer enrollment for electronic claims is required.
  • Providers who previously sent electronic claims through Optum must complete a new enrollment form.
  • New providers must complete a new enrollment form.

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

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

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

REF 15778311  1/8/2025

---

Update: VA payer delay of 277CA and 835 responses

The Department of Veterans Affairs (VA) payer is migrating to an updated system and due to this migration has paused all processing. 

The latest update from the payer is as follows: The VA payer has stated that they have resumed processing of claims for 12115 and 12116. Optum has started to receive 277CA, 835s and 999s for those two payer IDs as of today, Jan. 8, 2025. The VA has also pushed 835s for claims that completed processing at the VA for payer IDs 84146, 84147, and 80214, but they continue to hold the new claim files that Optum delivered to them starting 12/31. They continue to work on data migration and validation of new system which now only impacts 84146, 84147, and 80214.

No new ETA has been provided, but updates will be published as they are made available.

Original message sent Dec. 31, 2024 (REF 15699577): The VA payer has stated that there will be a delay in the delivery of 277CAs and 835 electronic remittance advice transactions. This delay is expected to be a minimum of two weeks and into the New Year. The cause of the delay is due to a scheduled migration of a critical system from a legacy process to a cloud-based process.

REF 15774052 1/8/2025

---

Report Generation Delay for CPIDs 9615 and 7292 CorrectCare Integrated Health- Louisiana

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

Payer impacted:

• CPID 9615 CorrectCare Integrated Health- Louisiana
• CPID 7292 CorrectCare Integrated Health- Louisiana

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

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

REF 15771673 1/8/2025

---

Enrollment Form Change for CPIDs 4967, 7493 / Payer IDs BCBSVT / Payer Name-Vermont Blue Cross Blue Shield

The following payers have changed their Remittance enrollment form:

• CPID 4967 / Payer ID BCBSVT - Vermont Blue Cross Blue Shield
• CPID 7493 / Payer ID BCBSVT - Vermont Blue Cross Blue Shield

Providers already approved to submit and receive transactions through Change Healthcare do not need to complete a new enrollment form.

To access the new enrollment form, please visit Enrollment Central.

Action Required: None for existing providers.  New providers should begin using the new enrollment form immediately.

REF 15769749 1/8/2025

---

Enrollment Form Change for CPIDs 1481,5517/Payer ID SKOR0/Payer Name Oregon Medicaid

The following payers have changed their Remittance enrollment form:

• CPID 1481 / Payer ID SKOR0 Oregon Medicaid
• CPID 5517 / Payer ID SKOR0 Oregon Medicaid

Providers already approved to submit and receive transactions through Optum do not need to complete a new enrollment form.

To access the new enrollment form, please visit Enrollment Central.

Action Required: None for existing providers. New providers should begin using the new enrollment form immediately.

REF 15769963  1/8/2025

---

New Electronic Claims Connections Available

Optum has new electronic claims connections available: 

Payer Name:  Carelon Health of Pennsylvania

Institutional CPID: 8089

Professional CPID: 2885

Payer-assigned Payer ID: BHOPA

Payer Enrollment Required: No

Secondary Claims Accepted: No

Payer Location: Pennsylvania

Claims Fee: N/A

Action Required: 

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

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

REF 15762360 1/8/2025

---

Updated Electronic Eligibility Connection Available

Effective immediately, Optum is pleased to announce an update of Real-time Eligibility Inquiry and Response 270/271 for the below payer:

Payer Name: Group Administrators LTD

Industry Payer ID: 36338

IMN Real Time ID: 36338

Exchange Real Time ID: N/A

CPID(s): 8501/1770

Payer Enrollment Required: No

Connection Type: X12

Eligibility Inquiries are currently only accepted for members of the following Group IDs:

CCL

CHE24

DFF

DMOS

EIQC

EJEI

EXMP

GSTC

HSS

HUNT

HYVE

NSH

NWI

OPL

REC

RSNF

SYNC

TBG

TDC

Search Options:

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

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

Action Required by customer:

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

REF 15764140 1/8/2025

---

New Electronic Claims Connections Available

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

Optum has new electronic claims connections available:

Payer Name: Wellspace NEXUS LLC
Institutional CPID: 8088
Payer-assigned Payer ID: NEXUS
Payer Enrollment Required: No
Secondary Claims Accepted: No
Payer Location: California
Claims Fee: N/A

Action Required:

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

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

REF 15762361 1/7/2025

---

UPDATE: Optum Notice: Electronic Routing Change for 9518 Pioneer Provider Network 

There is a Claim Fee associated for this routing change. 

Current Claim Fee: N/A

New Claim Fee: $0.10

Original sent on Jan. 7, 2025: 

Effective Jan. 7, 2025, Optum will be changing electronic claims routing for the following payer:

Payer Name: Pioneer Provider Network  

Institutional CPID: 9518

Payer-assigned Payer ID: PPNZZ

Enrollment Requirements: 

Claims:

• Payer enrollment for electronic claims Is not required.

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

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

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

REF 15746887 1/7/2025

---

Delay in NGS Electronic Remittance Advice (ERA)

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

Payers Affected:

• 12M35 - New York Medicare Empire
• SMCT0 - Connecticut Medicare
• 12M13 - Maine Medicare
• 12M74 - Rhode Island Medicare
• 12M08 - Illinois Medicare

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

REF 15762363  1/7/2025

---

Report Generation Delay for CPID 6987 Veterans Affairs Financial Services Center

A payer intermediary is experiencing issues affecting Institutional report generation for some claims submitted on Dec. 31, 2024.

Payer impacted: 

• CPID 6987 Veterans Affairs Financial Services Center

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

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

REF 15753208 1/7/2025

---

Payer ID Update for Selman & Company - Revenue Performance Advisor 

Effective immediately, Selman & Company (ID SLMTC) Eligibility and Claim Status Inquiry have been deactivated on the Revenue Performance Advisor system.

Providers should now be using:

Payer Name: Selman & Company

Payer ID: 52214

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

REF 15754595 1/7/2025

---

Associated Hispanic Physicians IPA Electronic Remittance Connection No Longer Available

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

Payer Name: Associated Hispanic Physicians IPA
Remittance LOB: H9Q
Payer-assigned Payer ID: MPM44 

Reason: Payer no longer contracted with Medpoint Management. Electronic remittance can be obtained directly from the payer’s portal https://provider.astranahealth.com/login?ipa=AHISP or through nmm.epayment.center.

Action Required: None.

REF 15754598  1/7/2025

---

Claim Processing Suspended for CPIDs 7224, 8640 National Association of Letter Carriers

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

Payer Name: National Association of Letter Carriers

CPIDs: 7224, 8640

Payer ID: 53011

Reason: Payer unavailable electronically

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

REF 15755324 1/7/2025

---

New Electronic Claims Connections Available

This message is intended for Assurance Reimbursement Management customers.

Optum has new electronic claims connections available: 

Payer Name: Champion Health Plans

Institutional CPID: 8085

Professional CPID: 2883

Payer-assigned Payer ID: CPS01

Payer Enrollment Required: No

Secondary Claims Accepted: No

Payer Location: California, Nevada

Claims Fee: N/A

Action Required: 

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

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

REF 15745595 1/7/2025

---

Associated Hispanic Physicians IPA Electronic Remittance Connection No Longer Available

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

Payer Name: Associated Hispanic Physicians IPA
Remittance CPIDs:  8554, 7794
Payer-assigned Payer ID:MPM44

Reason: Payer no longer contracted with Medpoint Management. Electronic remittance can be obtained directly from the payer’s portal https://provider.astranahealth.com/login?ipa=AHISP or through nmm.epayment.center.

Action Required: None.

REF 15754597  1/7/2025

---

New Electronic Claims Connections Available

This message is intended for Assurance EDI customers.

Optum has new electronic claims connections available: 

Payer Name: Champion Health Plans

Institutional CPID: 8085

Professional CPID: 2883

Payer-assigned Payer ID: CPS01

Payer Enrollment Required: No

Secondary Claims Accepted: No

Payer Location: California, Nevada

Claims Fee: $0.10

Action Required: 

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

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

REF 15745594 1/7/2025

---

Report Generation Delay for CPID 5976 Carelon Behavioral Health Maryland

A payer intermediary is experiencing issues affecting Institutional report generation for some claims submitted on Dec. 24, 2024.

Payer impacted: 

• CPID 5976 Carelon Behavioral Health Maryland

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

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

REF 15751408 1/7/2025

---

Electronic Routing Change for 9518 Pioneer Provider Network

This message intended for Assurance Reimbursement Management customers.

Effective January 7, 2025, Optum will be changing electronic claims routing for the following payer:

Payer Name: Pioneer Provider Network 

Institutional CPID: 9518

Current Edit Master: HE9O007

New Edit Master: HE9C051

Payer-assigned Payer ID: PPNZZ

Enrollment Requirements:

Claims:

• Payer enrollment for electronic claims Is not required.

Report Changes:

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

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

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

REF 15739443 1/7/2025

---

Electronic Routing Change for 9518 Pioneer Provider Network

This message intended for Assurance EDI customers.

Effective January 7, 2025, Optum will be changing electronic claims routing for the following payer:

Payer Name: Pioneer Provider Network 

Institutional CPID: 9518

Payer-assigned Payer ID: PPNZZ

Enrollment Requirements:

Claims:

• Payer enrollment for electronic claims Is not required.

Report Changes:

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

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

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

REF 15739442 1/7/2025

---

Update: Report Generation Delay for Multiple CPIDs

The payers have been unable to generate and deliver the reports.

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

Original message sent Dec. 17, 2024:

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

Payers impacted:

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

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

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

REF 15751516 1/7/2025

---

Payer Deactivation Notice - Peoples Health Network

Effective immediately, the payer listed below will no longer be available at Optum for claims processing. ERA/remittance will be terminated once run out is completed.

Payer Name: Peoples Health Network
Payer ID: 72126

Claims with dates of service Jan. 1, 2024 and forward should be sent to Payer ID 87726. 

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

REF 15749912  1/7/2025

---

Electronic claims connection no longer available for Combined Health Administrators

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

Payer Name: Combined Health Administrators

Claim CPIDs: 5004, 8807

Payer-assigned Payer ID: 88059

Reason: Payer no longer contracted. 

Action Required: Claims must be submitted to Optum on paper.

REF 15749319 1/7/2025

---

Payer Deactivation Notice - Rocky Mountain HMO

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

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

Payer Name: Rocky Mountain HMO

Payer ID: RMHMO, SX141, 84065

Claims should be sent to Payer ID 87726.

ERA/remittances will now come under UnitedHealthcare Community Plan, Payer ID 04567.

Action Required:

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

REF 15745299 1/7/2025

---

Report Generation Delay for CPID 1514 Oklahoma Blue Cross Blue Shield

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

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

Payer impacted:

• CPID 1514 Oklahoma Blue Cross Blue Shield

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

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

REF 15739358 1/6/2025

---

Payer Processing Issue for multiple CPIDs

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

Due to a payer intermediary processing issue, some Professional claims transmitted to the payers listed below on Jan. 3, 2025, were not processed by the payers.

Payers impacted:
1214 AgeRight Advantage Health Plan
4101 AllCare Advantage
2113 Allcare Health Plan
1764 Ambetter From Absolute Total Care
1765 Ambetter From Louisiana Healthcare Connections
9278 Ambetter from Nebraska Total Care
9433 Ambetter of Oklahoma
2138 American Family Insurance
7854 American Health Advantage of Oklahoma
1741 Amerigroup
1412 Anthem Blue Cross and Blue Shield - Indiana
2421 Anthem Blue Cross and Blue Shield - Kentucky
1413 Anthem Blue Cross and Blue Shield (Virginia)
2418 Anthem Blue Cross and Blue Shield of Ohio
4437 Anthem Blue Cross Blue Shield New York
8749 Anthem MaineHealth
6220 Arizona Priority Care Plus
4881 Asuris Northwest Regence
7272 Axminster Medical Group
3845 Banner Health Network
1415 Blue Cross Blue Shield of Colorado
1407 Blue Cross Blue Shield of Georgia
7496 Blue Cross Blue Shield of Nevada
1401 Blue Cross Blue Shield of Wisconsin
1243 Blue Cross Community Centennial
1167 Blue Cross Medicare Advantage PPO/HMO
9162 Blue Medicare Advantage
6779 Bridgespan Regence
6165 Bridgeview
4246 Capital Health Plan
2810 Capitol Administrators
8146 Care N Care Insurance Co.
2289 Care1st Health Plan of Arizona Medicaid DOS after 11/30/2022
9759 Care1st Health Plan of Arizona Medicaid DOS before 12/01/2022
4743 Carelon Behavioral Health
2164 Carelon Behavioral Health Maryland
3293 Carelon Health
2830 CarePlus Health Plans
1194 CareSource of Georgia
7143 CareSource of Indiana
3826 CareSource of Ohio
7263 CareSource of West Virginia
9226 CareSource PASSE of Arkansas
6777 Centers Plan for Healthy Living
9765 Central Valley Medical Providers
8123 Clear Health Alliance
7763 Columbine Health Plan
8834 Commonwealth Care Alliance DOS after 3/31/2023
2160 Community Care Plan (Commercial)
6865 Community Care Plan (Medicaid)
1420 Connecticut Anthem Blue Cross Blue Shield
3420 Connecticut Medicare Blue (Risk)
6795 Contra Costa Health Plan
7292 CorrectCare Integrated Health- Louisiana
7738 CountyCare Health Plan
9747 Delaware First Health
2433 Denver Health and Hospital Authority
1232 Denver Health Medical Plan, Inc. - Medicare Choice
8135 Doctors HealthCare Plans
1119 Easy Choice Health Plan of California
7787 El Paso First Health Plans - Health Care Options (HCO)
4289 El Paso Health-CHIP
4279 El Paso Health-STAR
5483 Employee Benefit Management Services (EBMS)
8137 Empower Healthcare Solutions
1795 Envolve Benefit Options
5238 Evolent Specialty Cardiology
3792 Fidelis Care
2875 First Health Network (Coventry Health Care National Network)
7435 FirstCare Health Plans
1414 Florida Blue Cross Blue Shield
3417 Florida Blue Cross Blue Shield Health Options HMO
9128 Florida Blue Medicare
9417 Florida Complete Care
2150 Florida Health Care Plans
5440 Fox Valley Medicine
8189 Gemcare IPA
2720 GlobalCare
9766 Gold Kidney Health Plan
1772 HAP CareSource
1797 HAP CareSource Michigan Dual Medicare/Medicaid
5243 Healthcare Management Administrators
1723 HealthCare Partners IPA
4448 HealthLink PPO
4740 Healthways WholeHealth Networks
7760 Healthy Blue Louisiana
8867 Healthy Blue Missouri
9133 Healthy Blue North Carolina
6272 Hispanic Physicians IPA (Encounters Only)
7715 Hopkins Health Advantage
6259 Humana - CareSource of Kentucky
7426 Idaho Regence Blue Shield
1405 Illinois Blue Cross Blue Shield
2234 Illinois Health Partners
3757 IMAGINE360 ADMINISTRATORS (GPA)
5865 Indian Health Services
4116 IntegraNet Health
1107 Integrated Health Partners (IHP)
9713 Iowa Health Advantage
1404 Iowa Wellmark Blue Cross Blue Shield
6733 Iowa Wellmark Blue Cross Blue Shield Crossover
5479 IU Health Plan Medicare Advantage
5432 Johns Hopkins Healthcare / Priority Partners
9412 Leon Health Plans
6273 Lifepath Hospice
2863 Longevity Health Plan of Colorado
7446 Maine Anthem Blue Cross Blue Shield
8812 Maryland Physicians Care
3476 Masters, Mates and Pilots
8860 Medica Government Programs
7859 Medica Health Plan Solutions
6799 Medica Individual and Family (IFB)
2287 Medicare Plus Blue of MI(MAP)
3475 Memorial Hermann Health Solutions
9102 Meridian Medicare Medicaid Plan
9118 MeridianComplete Michigan
2426 Michigan Blue Care Network
1421 Michigan Blue Cross Blue Shield
1402 Minnesota Blue Cross Blue Shield
7892 Minnesota Blue Cross Blue Shield Health Care Programs
1429 Minnesota Blue Cross Blue Shield HMO
5871 Mission Community IPA Medical Group
1408 Missouri Anthem Blue Cross Blue Shield
7450 Montana Blue Cross Blue Shield
7422 New Hampshire Anthem Blue Cross Blue Shield
7403 New Mexico Blue Cross Blue Shield
8864 NextBlue of North Dakota
1213 NHC Advantage
2411 North Dakota Blue Cross Blue Shield
1403 Oklahoma Blue Cross Blue Shield
2404 Oregon Regence Blue Cross Blue Shield
7829 Passport Advantage
8128 Pool Administrators, Inc.
4252 Presbyterian Salud
2807 Professional Benefit Administrators (Oakbrook, Illinois)
8182 PruittHealth Premier NC/SC
5428 QualChoice of Arkansas
7264 Quartz ASO
1209 Regence Group Administrators
6246 Riverside Medical Clinic
4464 SCAN Health Plan
2254 Scott & White Health Plan
9438 Shared Health Mississippi
7225 Sharp Community Medical Group
8124 Simply Healthcare Plans, Inc.
8708 SOMOS Anthem
8816 SOMOS Emblem
2490 South Dakota Blue Cross Blue Shield
8134 Summit Community Care
1406 Texas Blue Cross Blue Shield
1729 Texas Childrens Health Plan (CHIP)
2483 Texas Childrens Health Plan (STAR Medicaid)
4278 The Boon Group
8763 U.S. Networks and Administrative Services
8473 Unicare
2412 Utah Regence Blue Cross Blue Shield
2788 Utah Regence Blue Cross Blue Shield Federal Employee Program
7493 Vermont Blue Cross Blue Shield
4258 VNS Health
7451 Washington Regence Blue Shield
9293 Wellcare by Allwell from Nebraska Total Care
9430 Wellcare by Allwell of Oklahoma
1844 Wellcare Health Plans
3211 Wellcare Health Plans (Encounters)
1775 Wellpoint
9441 Wellspace NEXUS LLC
7489 Wyoming Blue Cross Blue Shield
6731 ZELIS

A resolution has been implemented and the claims were retransmitted to the payer intermediary on Jan. 6, 2025.

This delay affected claims released to Optum between 11 a.m. and 3 p.m. ET on Jan. 3, 2025.

Action Required: Be aware of the processing issue above.

REF 15739378 1/6/2025

---

Report Generation Delay for CPID 6987 Veterans Affairs Financial Services Center

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

A payer intermediary is experiencing issues affecting Institutional report generation for some claims submitted on Dec. 30, 2024.

Payer impacted:

• CPID 6987 Veterans Affairs Financial Services Center

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

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

REF 15743708 1/6/2025

---

Atypical Provider ID Issuance from iEDI

This message is intended for Assurance Reimbursement Management and Revenue Performance Advisor customers.

Due to a processing issue, some atypical provider’s claims have received the error below in error.

TO BE CONSIDERED FOR REIMBURSEMENT, SERVICES MUST BE SUBMITTED EITHER WITH A BILLING PROVIDER NPI OR WITH BOTH A BILLING PROVIDER MEDICAID ID AND A G2 INDICATOR.

Payer: Humana
Payer ID: 61101 (CPID: 2449)

Payer: Iowa Medicaid
Payer ID: SKIA0 (CPID: 1469)

This issue has been corrected and impacted claims can be resubmitted for processing.

Action Required: Resubmit any impacted claims

REF 15747353 1/6/2025

---

Electronic Routing Change for CPID 6195 Superior Vision Services - Assurance Reimbursement Management

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

Payer Name: Superior Vision Services

Professional CPID:  6195

Current Edit Master: PE_T007

New Edit Master:  PE_B800

Current Payer-assigned Payer ID: 41352

New Payer-assigned Payer ID: 13305

Enrollment Requirements: 

Claims:

• Payer enrollment for electronic claims is not required.

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

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

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

REF 15739445 1/6/2025

---

Electronic routing change for CPID 6195 Superior Vision Services - Assurance EDI

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

Payer Name: Superior Vision Services

Professional CPID: 6195

Current Payer-assigned Payer ID: 41352

New Payer-assigned Payer ID: 13305

Enrollment Requirements: 

Claims:

• Payer enrollment for electronic claims is not required.

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

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

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

REF 15739444 1/6/2024

---

Real Time update for Eligibility and Claim Status

Effective Jan. 1, 2025, Unicare became Wellpoint and effective immediately payer ID 80314 will no longer be active for 270/271 and 276/277 transactions. Unicare has advised that the payer ID to use moving forward is WLPNT.

Terminated payer details:
Payer ID: 80314
Payer Name: Unicare
Transaction: Eligibility Inquiry and Response 270/271 and Claim Status 276/277

New payer details:
Payer ID: WLPNT
Payer Name: Wellpoint
Transaction: Eligibility Inquiry and Response 270/271 and Claim Status 276/277

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

REF 15742505  1/6/2025

---

Report Generation Delay for CPID 1449 Colorado Medicare

A payer is experiencing issues affecting Professional report generation for some claims submitted since Dec. 18, 2024.

Payer impacted:

• CPID 1449 Colorado Medicare

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

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

REF 15738389 1/6/2025

---

Report Generation Delay for CPID 2455 Arkansas Medicare

A payer is experiencing issues affecting Professional report generation for some claims submitted since Dec. 13, 2024.

Payer impacted: 

• CPID 2455 Arkansas Medicare

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

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

REF 15738388 1/6/2025

---

Payer Processing Issue for CPID 6400 Aetna

Due to a payer processing issue, some Professional claims transmitted to the payer listed below on Jan. 3, 2025 were not processed by the payer.

Payer impacted:

• CPID 6400 Aetna

A resolution has been implemented and the claims were retransmitted to the payer on Jan. 6, 2025.

This delay affected claims released to Optum between 1:00 a.m. and 7:00 a.m. ET on Jan. 3, 2025.

Action Required: Be aware of the processing issue above.

REF 15738377 1/6/2025

---

Report Generation Delay for CPID 1402 Minnesota Blue Cross Blue Shield

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

Payer impacted: 

• CPID 1402 Minnesota Blue Cross Blue Shield

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

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

REF15739110 1/6/2025

---

Report Generation Delay for CPID 4246 Capital Health Plan

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted Dec. 25, 2024.

Payer impacted:

• CPID 4246 Capital Health Plan

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

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

REF 15739374  1/6/2025

---

Report Generation Delay for CPIDs 7892 and 1064 Minnesota Blue Cross Blue Shield Health Care Programs

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

Payer impacted:

• CPID 7892 Minnesota Blue Cross Blue Shield Health Care Programs
• CPID 1064 Minnesota Blue Cross Blue Shield Health Care Programs

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

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

REF 15739108 1/6/2025

---

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

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

Payer impacted: 

• CPID 7403 New Mexico Blue Cross Blue Shield

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

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

REF 15739109 1/6/2025

---

New Electronic Remittance (ERA) Connections Available on RPA

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

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

77052 – Coastal TPA
85729 – HealthComp
99727 – TRICARE East Region
JVHMQ – JVHL - Physicians Health Plan (Medicare Advantage)
JVHMT – JVHL - HAP CareSource – FFS

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

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

REF 15736634 1/3/2025

---

Report Generation Delay for CPID 4070 Integrated Homecare Services

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

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

Payer impacted:

• CPID 4070 Integrated Homecare Services

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

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

REF 15728592 1/3/2025

---

Report Generation Delay for CPID 1782 North American Medical Management

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

A payer experienced issues affecting Professional report generation for some claims submitted on Dec. 03, 2024.

Payer impacted:

• CPID 1782 North American Medical Management 

The payer is unable to generate and deliver the reports.

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

REF 15719552 1/3/2025

---

Report Generation Delay for CPID 7426 Idaho Regence Blue Shield

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

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted on Dec. 18, 2024, and Dec. 19, 2024.

Payer impacted:

• CPID 7426 Idaho Regence Blue Shield

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

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

REF 15728586 1/3/2025

---

New Electronic Real Time Connections Available on Revenue Performance Advisor

Eligibility transactions have recently been added for the following payers:

• 75190 – CareFirst Administrators/NCAS 
• XMEDX – CMS Medicare (RT) 

Claim Status Inquiry transactions have recently been added for the following payers:

• 22384 – Administrative Concepts
• 37330 – University of Michigan Health Plan
• SB590 – Florida Blue Cross Blue Shield

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

REF 15736633  1/3/2025

---

Report Generation Delay for CPIDs 3658 and 5862 CorrectCare Integrated Health

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

Payer impacted:

• CPID 3658 CorrectCare Integrated Health
• CPID 5862 CorrectCare Integrated 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.

REF 15728599 1/3/2025

---

Payer Transmit Delay for CPID 5979 Tricare East Region

Due to a payer system issue, a delay is occurring in the transmissions to the following payer since Dec. 31, 2024.

Payer impacted:

• CPID 5979 Tricare East Region

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

This delay affects claims released to Optum since 3 p.m. CT on Dec. 31, 2024.

Action Required: Be aware of the transmit delay above.

REF 15731612 1/3/2025

---

Report Generation Delay for CPID 2050 Gemcare IPA

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

Payer impacted: 

• CPID 2050 Gemcare IPA

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

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

REF 15728589 1/3/2025

---

Report Generation Delay for CPID 1844 Wellcare Health Plans

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

Payer impacted:

• CPID 1844 Wellcare 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.

REF 15728590 1/3/2025

---

New Payer Name

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

Previous Payer Name: One Call Equipment and Devices
New Payer Name: One Call Medical DME and Home Health
Professional CPID: 9238
Institutional CPID: 6079

Previous Payer Name:  One Call Medical
New Payer Name: One Call Medical Diagnostics
Professional CPID: 4254
Institutional CPID:  3696

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

REF 15724388  1/3/2025

---

Report generation delay for CPID 2830 CarePlus Health Plans

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

Payer impacted: 

• CPID 2830 CarePlus Health Plans

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

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

REF 15728588 1/3/2025

---

Report generation delay for CPID 1729 Texas Childrens Health Plan (CHIP)

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted on Dec. 18, 2024 and Dec. 19, 2024.

Payer impacted:

• CPID 1729 Texas Childrens Health Plan (CHIP)

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

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

REF 15728584 1/3/2025

---

Report generation delay for CPID 5432 Johns Hopkins Healthcare / Priority Partners

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted on Dec. 18, 2024.

Payer impacted:

• CPID 5432 Johns Hopkins Healthcare / Priority Partners

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

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

REF 15728583 1/3/2025

---

New Payer Name

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

Previous Payer Name: One Call Equipment and Devices
New Payer Name: One Call Medical DME and Home Health
Professional CPID: 9238
Institutional CPID: 6079
Edit Master:  PE_T007, HE9T007

Previous Payer Name:  One Call Medical
New Payer Name: One Call Medical Diagnostics
Professional CPID: 4254
Institutional CPID:  3696
Edit Master:  PE_T007, HE9T007
Remit Line of Business (LOB) Code: J6N

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

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

REF 15724389  1/3/2025

---

Report Generation Delay for CPIDs 2400 and 5975 Utah Medicaid

A payer intermediary is experiencing issues affecting Professional and Institutional report generation for some claims submitted on Dec. 24, 2024.

Payer impacted:

• CPID 2400 Utah Medicaid
• CPID 5975 Utah Medicaid

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

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

REF 15728086 1/3/2025

---

Report Generation Delay for CPID 2404 Oregon Regence Blue Cross Blue Shield

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted Dec. 18, 2024 and Dec. 20, 2024.

Payer impacted:

• CPID 2404 Oregon Regence Blue Cross Blue Shield

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

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

REF 15728585  1/3/2025

---

Payer Processing Issue for multiple CPIDs

Due to a payer intermediary processing issue, some Professional claims transmitted to the payers listed below on Dec. 31, 2024 were not processed by the payers.

Payers impacted: 

8454 Align Senior Care of Michigan
2113 Allcare Health Plan
8714 Allstate - Except New Jersey
1764 Ambetter From Absolute Total Care
9278 Ambetter from Nebraska Total Care
9433 Ambetter of Oklahoma
9270 American Benefit Corporation
2138 American Family Insurance
7854 American Health Advantage of Oklahoma
9218 American Health Advantage of Tennessee
9117 American Health Advantage of Texas
4468 Americas Choice Healthplan
1741 Amerigroup
1412 Anthem Blue Cross and Blue Shield - Indiana
2421 Anthem Blue Cross and Blue Shield - Kentucky
1413 Anthem Blue Cross and Blue Shield (Virginia)
2418 Anthem Blue Cross and Blue Shield of Ohio
4437 Anthem Blue Cross Blue Shield New York
8749 Anthem MaineHealth
6220 Arizona Priority Care Plus
4881 Asuris Northwest Regence
7272 Axminster Medical Group
3845 Banner Health Network
1415 Blue Cross Blue Shield of Colorado
1407 Blue Cross Blue Shield of Georgia
7496 Blue Cross Blue Shield of Nevada
1401 Blue Cross Blue Shield of Wisconsin
1243 Blue Cross Community Centennial
1167 Blue Cross Medicare Advantage PPO/HMO
9162 Blue Medicare Advantage
4110 Bollinger Inc
6165 Bridgeview
4246 Capital Health Plan
2810 Capitol Administrators
2289 Care1st Health Plan of Arizona Medicaid DOS after 11/30/2022
9759 Care1st Health Plan of Arizona Medicaid DOS before 12/01/2022
4743 Carelon Behavioral Health
2164 Carelon Behavioral Health Maryland
6127 Carelon Behavioral Health, MBHP
3293 Carelon Health
2830 CarePlus Health Plans
1194 CareSource of Georgia
7143 CareSource of Indiana
3826 CareSource of Ohio
7263 CareSource of West Virginia
9226 CareSource PASSE of Arkansas
6777 Centers Plan for Healthy Living
9765 Central Valley Medical Providers
7275 Citrus Valley Physicians Group
8123 Clear Health Alliance
7763 Columbine Health Plan
8834 Commonwealth Care Alliance DOS after 3/31/2023
2160 Community Care Plan (Commercial)
6865 Community Care Plan (Medicaid)
8147 Community Care Plan (Palm Beach Health District)
1420 Connecticut Anthem Blue Cross Blue Shield
3419 Connecticut Federal Employee Health Benefits
3420 Connecticut Medicare Blue (Risk)
6795 Contra Costa Health Plan
4460 Cook Group Health Plan
7738 CountyCare Health Plan
6145 CSI Network Services
9747 Delaware First Health
2433 Denver Health and Hospital Authority
1232 Denver Health Medical Plan, Inc. - Medicare Choice
8135 Doctors HealthCare Plans
1119 Easy Choice Health Plan of California
4279 El Paso Health-STAR
5483 Employee Benefit Management Services (EBMS)
1834 Employee Plans
1795 Envolve Benefit Options
9215 Everpointe
5238 Evolent Specialty Cardiology
7121 Evolent Specialty Oncology
3792 Fidelis Care
2875 First Health Network (Coventry Health Care National Network)
7435 FirstCare Health Plans
1414 Florida Blue Cross Blue Shield
3417 Florida Blue Cross Blue Shield Health Options HMO
9128 Florida Blue Medicare
9417 Florida Complete Care
2150 Florida Health Care Plans
5440 Fox Valley Medicine
8189 Gemcare IPA
8879 Georgia Health Advantage
2720 GlobalCare
9766 Gold Kidney Health Plan
1772 HAP CareSource
5243 Healthcare Management Administrators
1723 HealthCare Partners IPA
4448 HealthLink PPO
7760 Healthy Blue Louisiana
8867 Healthy Blue Missouri
9133 Healthy Blue North Carolina
7715 Hopkins Health Advantage
6259 Humana - CareSource of Kentucky
7426 Idaho Regence Blue Shield
1405 Illinois Blue Cross Blue Shield
2234 Illinois Health Partners
3757 IMAGINE360 ADMINISTRATORS (GPA)
5865 Indian Health Services
4445 Insurance Management Services TX
4116 IntegraNet Health
1107 Integrated Health Partners (IHP)
1404 Iowa Wellmark Blue Cross Blue Shield
6733 Iowa Wellmark Blue Cross Blue Shield Crossover
5479 IU Health Plan Medicare Advantage
5432 Johns Hopkins Healthcare / Priority Partners
9412 Leon Health Plans
6273 Lifepath Hospice
7446 Maine Anthem Blue Cross Blue Shield
8812 Maryland Physicians Care
8860 Medica Government Programs
7859 Medica Health Plan Solutions
6799 Medica Individual and Family (IFB)
2287 Medicare Plus Blue of MI(MAP)
3475 Memorial Hermann Health Solutions
9102 Meridian Medicare Medicaid Plan
9118 MeridianComplete Michigan
2426 Michigan Blue Care Network
1421 Michigan Blue Cross Blue Shield
1402 Minnesota Blue Cross Blue Shield
1410 Minnesota Blue Cross Blue Shield CC Systems
7892 Minnesota Blue Cross Blue Shield Health Care Programs
1429 Minnesota Blue Cross Blue Shield HMO
5871 Mission Community IPA Medical Group
1408 Missouri Anthem Blue Cross Blue Shield
7450 Montana Blue Cross Blue Shield
7422 New Hampshire Anthem Blue Cross Blue Shield
7403 New Mexico Blue Cross Blue Shield
8864 NextBlue of North Dakota
2411 North Dakota Blue Cross Blue Shield
9406 Ochsner Health Plan
1403 Oklahoma Blue Cross Blue Shield
8165 Oncology Physicians Network
2404 Oregon Regence Blue Cross Blue Shield
7829 Passport Advantage
9421 Perennial Advantage of Colorado
9199 Piedmont Community Health Plan
7168 Premier Healthcare Exchange (PHX)
4252 Presbyterian Salud
8468 Procare Advantage of TX
2807 Professional Benefit Administrators (Oakbrook, Illinois)
4253 Prominence Administrative Services
7281 PruittHealth Premier Medicare Advantage
5428 QualChoice of Arkansas
8828 Qualexa Healthcare
7264 Quartz ASO
1209 Regence Group Administrators
1776 RIS Rx
6246 Riverside Medical Clinic
8256 Saudi Health Mission
4464 SCAN Health Plan
2254 Scott & White Health Plan
9438 Shared Health Mississippi
7225 Sharp Community Medical Group
8124 Simply Healthcare Plans, Inc.
8816 SOMOS Emblem
1740 Sonder Health Plans
2490 South Dakota Blue Cross Blue Shield
1406 Texas Blue Cross Blue Shield
1729 Texas Childrens Health Plan (CHIP)
2483 Texas Childrens Health Plan (STAR Medicaid)
4278 The Boon Group
8763 U.S. Networks and Administrative Services
8473 Unicare
6849 United Group Programs
2412 Utah Regence Blue Cross Blue Shield
2788 Utah Regence Blue Cross Blue Shield Federal Employee Program
7493 Vermont Blue Cross Blue Shield
4258 VNS Health
7451 Washington Regence Blue Shield
9430 Wellcare by Allwell of Oklahoma
1844 Wellcare Health Plans
3211 Wellcare Health Plans (Encounters)
1775 Wellpoint
9441 Wellspace NEXUS LLC
7489 Wyoming Blue Cross Blue Shield
6731 ZELIS

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

This delay affected claims released to Optum between 10 a.m. and 2 p.m. CT on Dec. 31, 2024.

Action Required: Be aware of the processing issue above.

REF 15728580 1/3/2025

---

New Electronic Eligibility Connection Available

Effective January 1, 2025, Optum is pleased to announce the availability of Real-time Eligibility Inquiry and Response 270/271 transactions for the below payer:

Payer Name: Promise Health

Industry Payer ID: RP128

IMN Real Time ID: RP128

Exchange Real Time ID: PROMS

CPID(s): 2751, 7928

Payer Enrollment Required: No

Connection Type: X12

Search Options:

270/271 Search options (Subscriber)

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

270/271 Search Options (Dependent)

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

Action Required:

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. 

REF 15721312 1/3/2025

---

New Electronic Eligibility Connections Available

Effective January 1, 2025, Optum is pleased to announce the availability of Real-time Eligibility Inquiry and Response 270/271 transactions for the below payer:

Payer Name: Wellstar Health Plan

Industry Payer ID: RP129

IMN Real Time ID: RP129

Exchange Real Time ID: WELST

CPID(s): 2813, 7955

Payer Enrollment Required: No

Connection Type: X12

Search Options:

270/271 Search options (Subscriber)

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

270/271 Search Options (Dependent)

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

Action Required:

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. 

REF 15721313 1/3/2025

---

Electronic Connection No Longer Available - Aetna Better Health of California

Effective Jan. 2, 2025, the payer listed below will no longer be available at Optum for claim status and/or eligibility processing:

Payer Name: Aetna Better Health of California

Claim Status Payer ID: 128CA, ABHCA

Eligibility Payer ID: 128CA, ABHCA

Reason: Effective Jan 1, 2025, this plan terminated

REF 15723875 1/2/2025

---

Payer Processing issue for multiple CPIDs

Due to a payer intermediary processing issue, some professional claims transmitted to the payers listed below on Dec. 19, 2024 were not processed by the payers.

Payers impacted: 

CPID Payer Name 

• 8454 Align Senior Care of Michigan
• 4101 AllCare Advantage
• 2113 Allcare Health Plan
• 1764 Ambetter From Absolute Total Care
• 9278 Ambetter from Nebraska Total Care
• 9431 Ambetter from WellCare of Kentucky
• 9432 Ambetter from WellCare of New Jersey
• 9775 Ambetter of Alabama
• 9433 Ambetter of Oklahoma
• 9712 American Health Advantage of Florida
• 9429 American Health Advantage of Idaho & Utah
• 9142 American Health Advantage of Mississippi
• 7280 American Health Advantage of Missouri
• 7854 American Health Advantage of Oklahoma
• 9117 American Health Advantage of Texas
• 4468 Americas Choice Healthplan
• 1741 Amerigroup
• 1412 Anthem Blue Cross and Blue Shield - Indiana
• 2421 Anthem Blue Cross and Blue Shield - Kentucky
• 1413 Anthem Blue Cross and Blue Shield (Virginia)
• 2418 Anthem Blue Cross and Blue Shield of Ohio
• 4437 Anthem Blue Cross Blue Shield New York
• 6220 Arizona Priority Care Plus
• 4477 Asuris Northwest Medadvantage Regence
• 4881 Asuris Northwest Regence
• 7272 Axminster Medical Group
• 1415 Blue Cross Blue Shield of Colorado
• 1407 Blue Cross Blue Shield of Georgia
• 7496 Blue Cross Blue Shield of Nevada
• 1169 Blue Cross Blue Shield of Western New York Medicaid/CHP
• 1401 Blue Cross Blue Shield of Wisconsin
• 1243 Blue Cross Community Centennial
• 1167 Blue Cross Medicare Advantage PPO/HMO
• 9162 Blue Medicare Advantage
• 4246 Capital Health Plan
• 2810 Capitol Administrators
• 8146 Care N Care Insurance Co.
• 9759 Care1st Health Plan of Arizona Medicaid DOS before 12/01/2022
• 4743 Carelon Behavioral Health
• 6127 Carelon Behavioral Health, MBHP
• 3293 Carelon Health
• 2830 CarePlus Health Plans
• 9722 CareSource North Carolina
• 1194 CareSource of Georgia
• 7143 CareSource of Indiana
• 3826 CareSource of Ohio
• 7263 CareSource of West Virginia
• 6777 Centers Plan for Healthy Living
• 9765 Central Valley Medical Providers
• 7275 Citrus Valley Physicians Group
• 8123 Clear Health Alliance
• 7416 Colorado Anthem Blue Cross Blue Shield HMO
• 7763 Columbine Health Plan
• 8834 Commonwealth Care Alliance DOS after 3/31/2023
• 2160 Community Care Plan (Commercial)
• 6865 Community Care Plan (Medicaid)
• 8147 Community Care Plan (Palm Beach Health District)
• 1420 Connecticut Anthem Blue Cross Blue Shield
• 3419 Connecticut Federal Employee Health Benefits
• 3420 Connecticut Medicare Blue (Risk)
• 6795 Contra Costa Health Plan
• 7738 CountyCare Health Plan
• 9747 Delaware First Health
• 2433 Denver Health and Hospital Authority
• 1232 Denver Health Medical Plan, Inc. - Medicare Choice
• 8135 Doctors HealthCare Plans
• 1733 Doctors Professional Services Consultants (DPSC)
• 1119 Easy Choice Health Plan of California
• 4279 El Paso Health-STAR
• 5483 Employee Benefit Management Services (EBMS)
• 1834 Employee Plans
• 1795 Envolve Benefit Options
• 5238 Evolent Specialty Cardiology
• 7121 Evolent Specialty Oncology
• 3792 Fidelis Care
• 2875 First Health Network (Coventry Health Care National Network)
• 7435 FirstCare Health Plans
• 1414 Florida Blue Cross Blue Shield
• 3417 Florida Blue Cross Blue Shield Health Options HMO
• 9128 Florida Blue Medicare
• 2150 Florida Health Care Plans
• 8189 Gemcare IPA
• 2720 GlobalCare
• 9766 Gold Kidney Health Plan
• 1772 HAP CareSource
• 1797 HAP CareSource Michigan Dual Medicare/Medicaid
• 5243 Healthcare Management Administrators
• 1723 HealthCare Partners IPA
• 4448 HealthLink PPO
• 7760 Healthy Blue Louisiana
• 8867 Healthy Blue Missouri
• 9133 Healthy Blue North Carolina
• 7715 Hopkins Health Advantage
• 6259 Humana - CareSource of Kentucky
• 7426 Idaho Regence Blue Shield
• 1405 Illinois Blue Cross Blue Shield
• 3757 IMAGINE360 ADMINISTRATORS (GPA)
• 5865 Indian Health Services
• 4445 Insurance Management Services TX
• 4116 IntegraNet Health
• 1107 Integrated Health Partners (IHP)
• 8814 Integrated Homecare Services
• 9713 Iowa Health Advantage
• 1404 Iowa Wellmark Blue Cross Blue Shield
• 6733 Iowa Wellmark Blue Cross Blue Shield Crossover
• 5479 IU Health Plan Medicare Advantage
• 5432 Johns Hopkins Healthcare / Priority Partners
• 7782 Kansas Health Advantage
• 9412 Leon Health Plans
• 7446 Maine Anthem Blue Cross Blue Shield
• 8812 Maryland Physicians Care
• 8860 Medica Government Programs
• 7859 Medica Health Plan Solutions
• 6799 Medica Individual and Family (IFB)
• 2287 Medicare Plus Blue of MI(MAP)
• 3475 Memorial Hermann Health Solutions
• 9102 Meridian Medicare Medicaid Plan
• 9118 MeridianComplete Michigan
• 2426 Michigan Blue Care Network
• 1421 Michigan Blue Cross Blue Shield
• 1402 Minnesota Blue Cross Blue Shield
• 1410 Minnesota Blue Cross Blue Shield CC Systems
• 7892 Minnesota Blue Cross Blue Shield Health Care Programs
• 1429 Minnesota Blue Cross Blue Shield HMO
• 1408 Missouri Anthem Blue Cross Blue Shield
• 7450 Montana Blue Cross Blue Shield
• 7422 New Hampshire Anthem Blue Cross Blue Shield
• 7403 New Mexico Blue Cross Blue Shield
• 8864 NextBlue of North Dakota
• 2411 North Dakota Blue Cross Blue Shield
• 1403 Oklahoma Blue Cross Blue Shield
• 2404 Oregon Regence Blue Cross Blue Shield
• 7829 Passport Advantage
• 9199 Piedmont Community Health Plan
• 7168 Premier Healthcare Exchange (PHX)
• 4252 Presbyterian Salud
• 8468 Procare Advantage of TX
• 5428 QualChoice of Arkansas
• 7264 Quartz ASO
• 1209 Regence Group Administrators
• 8256 Saudi Health Mission
• 4464 SCAN Health Plan
• 2254 Scott & White Health Plan
• 9438 Shared Health Mississippi
• 8124 Simply Healthcare Plans, Inc.
• 8708 SOMOS Anthem
• 8816 SOMOS Emblem
• 1740 Sonder Health Plans
• 2490 South Dakota Blue Cross Blue Shield
• 1406 Texas Blue Cross Blue Shield
• 1729 Texas Childrens Health Plan (CHIP)
• 2483 Texas Childrens Health Plan (STAR Medicaid)
• 4278 The Boon Group
• 8763 U.S. Networks and Administrative Services
• 8473 Unicare
• 2412 Utah Regence Blue Cross Blue Shield
• 2788 Utah Regence Blue Cross Blue Shield Federal Employee Program
• 7493 Vermont Blue Cross Blue Shield
• 4258 VNS Health
• 7451 Washington Regence Blue Shield
• 1844 Wellcare Health Plans
• 3211 Wellcare Health Plans (Encounters)
• 1775 Wellpoint
• 7489 Wyoming Blue Cross Blue Shield
• 6731 ZELIS

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

This delay affected claims released to Optum between 2 p.m. and 6 p.m. CT on Dec. 19, 2024.

Action Required: Be aware of the processing issue above.

REF15725714 1/2/2025

---

Report Generation Delay for CPID 7907 Scott & White Health Plan

A payer intermediary is experiencing issues affecting institutional report generation for some claims submitted on Dec. 18, 2024.

Payer impacted: 

• CPID 7907 Scott & White Health Plan

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

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

REF 15724025 1/2/2025

---

Report Generation Delay for CPID 4101 AllCare Advantage

A payer intermediary is experiencing issues affecting professional report generation for some claims submitted from Dec. 16, 2024 through Dec. 18, 2024.

Payer impacted: 

• CPID 4101 AllCare Advantage

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

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

REF 15720902 1/2/2025

---

Payer Processing Issue for multiple CPIDs

Due to a payer intermediary processing issue, some Institutional claims transmitted to the payers listed below on Dec. 19, 2024 were not processed by the payers.

Payers impacted:

• 8549 Absolute Total Care
• 8526 Allwell from Absolute Total Care
• 7592 Allwell from Buckeye Health Plan
• 7591 Allwell from Home State Health
• 7588 Allwell from Louisiana Healthcare Connections
• 7582 Allwell from Managed Health Services
• 9587 Ambetter Illinicare Health
• 9588 Ambetter New Hampshire Healthy Families
• 6660 Ambetter from Buckeye Community Health Plan
• 8583 Ambetter from Health Net
• 8584 Ambetter from Homestate Health
• 6658 Ambetter from Magnolia Health
• 6656 Ambetter from Managed Health Services
• 6030 Ambetter from Meridian
• 6655 Ambetter from Peach State Health Plan
• 6654 Ambetter from Sunshine Health
• 6661 Ambetter from Superior HealthPlan
• 6652 Ambetter of Arkansas
• 2071 Ambetter of North Carolina Inc
• 4013 Ambetter of Tennessee
• 1045 Arizona Complete Health
• 1962 Buckeye Community Health
• 6027 Carolina Complete Health Care
• 7515 Health Net of CA, OR
• 4652 Home State Health
• 2026 Iowa Total Care
• 4639 Louisiana Health Connections
• 1611 Magnolia Health Plan
• 1562 Managed Health Services Indiana
• 3504 Managed Health Services Wisconsin
• 4560 Meridian Health Plan of Michigan
• 2508 Nebraska Total Care
• 5628 New Hampshire Healthy Families
• 7533 Oklahoma Complete Health Centene
• 6582 PA Health & Wellness
• 1921 Peach State Health Plan
• 5542 Silver Summit Health Plan
• 5613 Sunflower Health Plan
• 5947 Sunshine Health
• 3522 Superior Health Plan of Texas
• 9617 Trillium Community Health Plan
• 2029 Wellcare Complete a product of Wellcare By Allwell
• 1076 Western Sky Community Care

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

This delay affected claims released to Optum between 3:50 p.m. CT on Dec. 18, 2024 and 5 a.m. CT on Dec. 19, 2024.

Action Required: Be aware of the processing issue above.

REF 15724031 1/2/2024

---

Report Generation Delay for CPID 2234 Illinois Health Partners

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted on Dec. 18, 2024 and Dec. 19, 2024.

Payer impacted: 

• CPID 2234 Illinois Health Partners

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

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

REF 15724026 1/2/2025

---

Update: Report Generation Delay for CPID 5879 Erisa Administrative Services

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

Update: The payer intermediary has been unable to generate and deliver the reports for some claims submitted from Sept. 30, 2024, through Dec. 13, 2024.

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

Original notify sent Aug. 21, 2024:

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

Payer impacted:

• CPID 5879 Erisa Administrative Services

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

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

REF 15717476 1/2/2025

---

Claims Delay for Rhode Island Medicaid

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

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

Payer Name: Rhode Island Medicaid

Institutional ID: 12K74

Professional ID: SKRI0

Optum was working with the payer to resolve this issue. A resolution has been implemented and the claims were transmitted to the payer on Jan. 2, 2025.

Submitter Action:

Be aware of the transmit delay above.

REF 15723461 1/2/2025

---

Report Generation Delay for CPID 4252 Presbyterian Salud

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

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted since Dec. 16, 2024.

Payer impacted:

• CPID 4252 Presbyterian Salud

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

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

REF 15720900 1/2/2025

---

Electronic Routing Change for CPIDs 3824, 9513 - OptumHealth Care Solutions

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

Effective Jan. 3, 2025, Optum will be changing electronic remittance routing for the following payer:

Payer Name: OptumHealth Care Solutions
Professional CPID: 3824
Institutional CPID: 9513
Payer-assigned Payer ID: 41194

Enrollment Requirements:
Remittance:

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

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

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

REF 15718038 1/2/2025

---

Electronic Routing Change for CPIDs 6132 and 8698 Family Care Specialist IPA

Effective Jan. 2, 2025, Optum will be changing electronic claims routing for the following payer:

Payer Name: Family Care Specialist IPA
Professional CPID:  6132
Current Edit Master: PE_O007
New Edit Master:  PE_T007
Institutional CPID:  8698
Current Edit Master: HE9O007
New Edit Master:  HE9T007
Current Payer-assigned Payer ID: MPM40
New Payer-assigned Payer ID: FCS01

Enrollment Requirements:
Claims:

• Payer enrollment for electronic claims is not required.

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

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

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

REF 15723871  1/2/25

---

Electronic Routing Change for CPIDs 6132 and 8698 Family Care Specialist IPA

Effective Jan. 2, 2025, Optum will be changing electronic claims routing for the following payer:

Payer Name: Family Care Specialist IPA
Professional CPID: 6132
Institutional CPID: 8698
Current Payer-assigned Payer ID: MPM40
New Payer-assigned Payer ID: FCS01

Enrollment Requirements:
Claims:

• Payer enrollment for electronic claims is not required.

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

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

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

REF 15723870  1/2/25

---

Report Generation Delay for CPIDs 8900 and 2113 Allcare Health Plan

A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted from Dec. 16, 2024, through Dec. 18, 2024.

Payer impacted:

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

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

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

REF 15720901 1/2/2025

---

Report Generation Delay for CPID 2404 Oregon Regence Blue Cross Blue Shield

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted on Dec. 13, 2024.

Payer impacted:

• CPID 2404 Oregon Regence Blue Cross Blue Shield

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

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

REF 15717479 1/2/2025

---

Report Generation Delay for multiple CPIDs

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted Dec. 13, 2024.

Payers impacted:

• CPID 2412 Utah Regence Blue Cross Blue Shield
• CPID 2788 Utah Regence Blue Cross Blue Shield Federal Employee Program

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

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

REF 15717478  1/2/25

---

Report Generation Delay for CPID 2593 QualChoice of Arkansas

A payer intermediary is experiencing issues affecting institutional report generation for some claims submitted on Dec. 13, 2024.

Payer impacted: 

• CPID 2593 QualChoice of Arkansas

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

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

REF 15720821 1/2/2025

---

Update: Payer Transmit Delay for Rhode Island Medicaid - Multiple CPIDs

Update: A resolution has been implemented and the claims were transmitted to the payer on Jan. 2, 2025.

Action Required: Please be aware of the transmit delay.

Original Notify sent Dec. 18, 2024: Due to a payer system issue, a delay is occurring in the transmissions to the following payer since Dec. 14, 2024.

Payer impacted:

• CPID 7421 Rhode Island Medicaid
• CPID 3647 Rhode Island Medicaid
• CPID 2405 Rhode Island Medicaid

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

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

Action Required: Be aware of the transmit delay above.

REF15719430 1/2/2025

---

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

This message is intended for Assurance Reimbursement Management customers.

Update:
Optum would like to clarify the Payer Alias Names associated with the TRICARE East Region payer changes.

For claims containing Dates of Service on or prior to Dec. 31, 2024 must continue to use the following entry:

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

Claims containing Dates of Service on or after Jan. 1, 2025 must use the following entry:

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

NOTES:

• Beginning May 1, 2025, submit 2024 claims to CPIDs 2872 and 5979 TRICARE East Reg.

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

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

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

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

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

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

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

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

NOTES: 

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

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

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

Remittance:

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

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

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

REF 15698975 / 15719559 1/2/2025

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JP Farley Electronic Eligibility Connection No Longer Available

This message intended for Clearance Patient Access Suite customers.

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

Payer Name: JP Farley

Connection Type: Portal

Reason: Payer no longer offers an electronic connection

Action Required: None

REF 15715360 1/2/2025

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JP Farley Electronic Eligibility Connection No Longer Available

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

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

Payer Name: JP Farley

Real Time ID: JPFAR1

CPIDs: 2578, 3771

Industry Payer ID: 34136

Connection Type: Portal

Reason: Payer no longer offers an electronic connection

Action Required: None

REF 15715359 1/2/2025