CHC Payer Updates (June 2025)

June 2025

June Payer Processing Issues

Summary

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

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

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

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Real Time Eligibility 270/271, Claim Status Inquiry 276/277 Payer ID Change

Real Time Eligibility 270/271, Claim Status 276/277 Payer ID change for the following:

Tricare West - New Payer ID: 99726
Tricare East - New Payer ID: 99727
(Note TRICRE, TRICAR. IDs are not changing).

Effective immediately, begin using the new Payer ids Tricare West 99726, Tricare East 99727.

Legacy payer IDs 68299/TREST, 00080/TRICE,SCWI0,61125,57106, will be removed from the payer list and terminated effective June 25th.

6/4/2025

New Electronic Claims Connections Available

Optum has new electronic claims connections available:

Payer Name: Healthy Mississippi
Institutional CPID: 9012
Professional CPID: 3482
Payer-assigned Payer ID: 99914
Payer Enrollment Required: No
Secondary Claims Accepted: No
Payer Location: Mississippi
Claims Fee: N/A

Action Required: 

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

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

6/4/2025

Report Generation Delay for CPID 4248 Community Care BHO

The payer listed below is experiencing issues affecting Professional report generation for some claims submitted May 29, 2025.

Payer impacted: 

  • CPID 4248 Community Care BHO

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09527320.

6/4/2025

Report Generation Delay for CPID 3425 New York Independent Health

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

Payer impacted:

  • CPID 3425 New York Independent Health

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09519225.

6/4/2025

Report Generation Delay for CPIDs 2423 and 5558 Blue Cross Blue Shield of Alabama

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

Payer impacted:

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

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09525222.

6/3/2025

New Electronic Claims Connections Available

Optum has new electronic claims connections available:

Payer Name: Imperial Insurance Companies Exchange Nevada
Institutional CPID: 9009
Professional CPID: 3479
Payer-assigned Payer ID: IEXNV
Payer Enrollment Required: No
Secondary Claims Accepted: No
Payer Location: Nevada
Claims Fee: $0.10

Action Required: 

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

6/3/2025

Report Generation Delay for Multiple CPIDs

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

Payers impacted:

  • CPID   5405   1199SEIU Family of Funds
  • CPID   3262   Affiliated Physicians IPA
  • CPID   2468   Alabama Medicare
  • CPID   1455   Alaska Medicare
  • CPID   5121   Allegeant, LLC
  • CPID   6254   AmFirst Insurance
  • CPID   3270   American Chiropractic Network IPA of NY (ACNIPA)
  • CPID   1456   Arizona Medicare
  • CPID   2161   Arkansas Medicare
  • CPID   7113   Aspirion MVA
  • CPID   8840   Aspirus Medicare Advantage
  • CPID   3802   AvMed
  • CPID   4241   Bakersfield Family Medical Center
  • CPID   7722   Bankers Reserve/Wellcare
  • CPID   2416   Blue Cross Blue Shield of Arkansas
  • CPID   2415   Blue Cross Blue Shield of Mississippi
  • CPID   6792   CHOC - Childrens Hospital of Orange County Health - Rady
  • CPID   3894   CareCore National
  • CPID   2835   CareCore National Aetna Radiology
  • CPID   1727   CareCore National Oxford Radiology
  • CPID   4870   CareCore National Wellcare Radiology (NY counties only)
  • CPID   7250   Carelon Anthem Home Health
  • CPID   2795   Cigna HealthSpring Tennessee/Alabama
  • CPID   3404   Coachella Medical Group
  • CPID   2162   Colorado Medicare
  • CPID   7722   Combined Insurance Company of America
  • CPID   7722   Companion Life Insurance Company
  • CPID   2223   Connecticut Medicare
  • CPID   6814   Consumers Choice of South Carolina/HealthSCOPE Benefits
  • CPID   2831   Correctional Medical Services
  • CPID   1861   Covet Health
  • CPID   6289   Crescent Health Solutions
  • CPID   2163   Delaware Medicare
  • CPID   2425   District of Columbia CareFirst Blue Cross Blue Shield
  • CPID   2165   District of Columbia Metropolitan Area (DCMA) Medicare
  • CPID   2763   EOB TPA
  • CPID   6769   Electrical Workers Insurance Fund Local 5800
  • CPID   5817   EyeMed Vision Care
  • CPID   6453   First Choice Health Network
  • CPID   8821   FirstCarolinaCare - New
  • CPID   7822   Florida Hospital VBR
  • CPID   2216   Florida Medicare
  • CPID   7722   Forethought Life Insurance Company
  • CPID   2299   FrontPath Health Coalition
  • CPID   8472   Gateway Health Plan Medicaid Pennsylvania
  • CPID   2298   Gateway Health Plan Medicare Assured Pennsylvania
  • CPID   9274   Geisinger Health Plan - Reclamation Claims
  • CPID   1466   Georgia Medicare
  • CPID   5814   GlobalHealth OKC
  • CPID   9229   GlobalHealth Texas
  • CPID   1418   Gloria Gates
  • CPID   1877   Group Health Cooperative of South Central Wisconsin Encounters
  • CPID   2865   H.E.R.E.I.U. Welfare Pension Plan
  • CPID   2717   HFN Inc.
  • CPID   1454   HPI Vanderbilt
  • CPID   3778   HPS Paradigm
  • CPID   2467   Hawaii / Guam Medicare
  • CPID   2494   Health Alliance Medical Plans of Illinois
  • CPID   2822   Health Partners Plans of Pennsylvania
  • CPID   8431   HealthPlan Services
  • CPID   3290   High Desert Medical Group
  • CPID   2189   Horace Mann Life Insurance Company
  • CPID   1236   IU Health Plans
  • CPID   2465   Idaho Medicare
  • CPID   2224   Illinois Medicare
  • CPID   5404   Insight Benefit Administrators
  • CPID   1427   Insurance Design Administrators
  • CPID   3860   Integra Group - CHA
  • CPID   2790   Integra Group - Home
  • CPID   6163   Integrated Medical Solutions
  • CPID   6805   Intercommunity Health Network
  • CPID   5485   Intergroup Services Corporation
  • CPID   1469   Iowa Medicaid
  • CPID   2462   Kentucky Medicare
  • CPID   2821   Key Benefit Administrators
  • CPID   2884   Know the Costs
  • CPID   8153   Lasso Healthcare
  • CPID   7722   Liberty Bankers Life Insurance Company
  • CPID   3844   Life Trac
  • CPID   2171   Louisiana Medicare
  • CPID   1701   MBACLM
  • CPID   8295   MDsave
  • CPID   2766   MDwise Medicare Advantage
  • CPID   1700   MPMBA
  • CPID   1748   MVP Health Care
  • CPID   1419   Magellan Healthcare
  • CPID   6827   Maine Community Health Options
  • CPID   2225   Maine Medicare
  • CPID   2419   Maryland CareFirst Blue Cross Blue Shield
  • CPID   2201   Maryland Medicare
  • CPID   2464   Maryland Medicare (Montgomery,Prince George)
  • CPID   2229   Massachusetts Medicare
  • CPID   6739   McLaren Advantage SNP
  • CPID   6732   McLaren Health Plan Medicaid
  • CPID   3261   McLaren Medicare Supplement
  • CPID   7480   Med-Pay
  • CPID   8819   MedStar Family Choice, Inc (DC)
  • CPID   4775   MedStar Family Choice, Inc (MD)
  • CPID   4229   Medicare DME MAC Jurisdiction A
  • CPID   2209   Medicare DME MAC Jurisdiction A
  • CPID   2211   Medicare DME MAC Jurisdiction B
  • CPID   4230   Medicare DME MAC Jurisdiction B
  • CPID   2213   Medicare DME MAC Jurisdiction C
  • CPID   2215   Medicare DME MAC Jurisdiction D
  • CPID   2754   MercyCare Janesville MVP
  • CPID   5248   Miami Behavioral Health
  • CPID   2230   Minnesota Medicare
  • CPID   2203   Mississippi Medicare
  • CPID   7400   Montana Medicare
  • CPID   2167   Municipal Health Benefit Fund
  • CPID   2420   Mutual of Omaha
  • CPID   2737   My Patient Prepaid
  • CPID   6842   Nascentia Health Options
  • CPID   8780   Nascentia Health Plus
  • CPID   2733   National Telecommunications Cooperative Association
  • CPID   9419   NeueHealth
  • CPID   1446   Nevada Medicare
  • CPID   2237   New Hampshire Medicare
  • CPID   2205   New Jersey Medicare
  • CPID   2204   New Mexico Medicare
  • CPID   2244   New York Medicare Empire
  • CPID   2260   New York Medicare GHI
  • CPID   2261   New York Medicare Upstate
  • CPID   5863   New York State Dept of Health Uncompensated Care Program
  • CPID   1464   North Carolina Medicare
  • CPID   2453   North Dakota Medicare
  • CPID   1436   Northern California Medicare
  • CPID   6707   OLOLRMC Uninsured Patient Services Program
  • CPID   1447   Ohio Medicare
  • CPID   2206   Oklahoma Medicare
  • CPID   2765   Optum Rx
  • CPID   1459   Oregon Medicare
  • CPID   6862   Peak Pace Solutions
  • CPID   2207   Pennsylvania Medicare
  • CPID   8455   Peoples Health Network
  • CPID   1737   PodAmerica
  • CPID   1742   Point C
  • CPID   2292   Premier Health Systems, Inc
  • CPID   6133   ProviDRs Care Network
  • CPID   2785   Puerto Rico Medicare
  • CPID   2220   Puerto Rico Medicare
  • CPID   3272   RMSCO Inc.
  • CPID   1443   Railroad Medicare
  • CPID   2268   Rhode Island Medicare
  • CPID   7470   Rocky Mountain HMO
  • CPID   3426   SECUR Health Plan
  • CPID   2491   SISCO
  • CPID   2700   Saint Mary's Health Plan (Encounters)
  • CPID   6192   San Diego County Physician Emergency Services
  • CPID   6736   San Francisco Health Plan
  • CPID   2116   Sanford Health Plan
  • CPID   1134   Sante Community Physicians Medical Group
  • CPID   2281   Sante Health System
  • CPID   4100   Scott & White Health Plan
  • CPID   7722   Shenandoah Life Insurance Company (AIA)
  • CPID   9271   Simpra Advantage Inc.
  • CPID   2452   South Carolina Medicare
  • CPID   5173   South Dakota Chiropractic (Sanford Health Plan)
  • CPID   2454   South Dakota Medicare
  • CPID   1444   Southern California Medicare
  • CPID   7722   Standard Life And Casualty Insurance Company
  • CPID   2708   StandardHealth with Health Choice (HCS)
  • CPID   4713   Sutter Gould Medical Foundation
  • CPID   2872   TRICARE East Region
  • CPID   8827   TakeCare Insurance Company
  • CPID   1453   Tennessee Medicare
  • CPID   8471   Texas Independence Health Plan Inc.
  • CPID   2208   Texas Medicare
  • CPID   2712   The Alliance
  • CPID   3245   The City of Odessa
  • CPID   2824   The Health Plan of West Virginia, Inc
  • CPID   7722   Thrivent
  • CPID   4737   Touchstone Health PSO
  • CPID   2892   Transamerica Life Insurance Co
  • CPID   2238   Trusteed Plans Service
  • CPID   8763   U.S. Networks and Administrative Services
  • CPID   6266   UltraBenefits
  • CPID   9780   Unified Health Plan TPA
  • CPID   8817   Unite Here Health Las Vegas
  • CPID   3741   Upper Peninsula Health Plan
  • CPID   2458   Utah Medicare
  • CPID   6186   VHN
  • CPID   4753   Verdegard Administrators
  • CPID   2755   Verdegard Employee Plan
  • CPID   2278   Vermont Medicare
  • CPID   9121   Village Practice Management Company
  • CPID   4487   Virgin Islands Medicare
  • CPID   2221   Virgin Islands Medicare
  • CPID   1442   Virginia Medicare
  • CPID   2461   Virginia Medicare (Alexandria,Arlington,Fairfax)
  • CPID   1702   Vitori Health
  • CPID   1462   Washington Medicare
  • CPID   1450   West Virginia Medicare
  • CPID   7722   Western Catholic Union
  • CPID   9761   Western Pennsylvania Electrical Employees Insurance Trust Fund
  • CPID   8402   Weyco
  • CPID   2288   Wisconsin Medicare
  • CPID   2466   Wyoming Medicare
  • CPID   8246   Zing Health
  • CPID   2852   Zurich American Insurance Company
  • CPID   7722   illumifin Corporation

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09519221.

Payer Processing Issue for multiple CPIDs

Due to a payer intermediary processing issue, some Institutional claims transmitted to the payers listed below June 2, 2025 were not processed by the payers.

Payers impacted:

  • CPID 1522 District of Columbia Medicare
  • CPID 1526 Arkansas Medicare
  • CPID 1547 Colorado Medicare
  • CPID 1558 Oklahoma Medicare
  • CPID 2528 New Hampshire Medicare
  • CPID 3518 Florida Medicare
  • CPID 3519 New York Medicare Empire
  • CPID 3521 Minnesota Medicare
  • CPID 3533 Connecticut Medicare
  • CPID 3547 Maine Medicare
  • CPID 3579 Louisiana Medicare
  • CPID 3650 JH Mutual of Omaha CO, NM, OK, TX
  • CPID 5502 Texas Medicare

A resolution has been implemented and the claims were retransmitted to the payer intermediary June 3, 2025.

This delay affected claims released to Optum June 2, 2025, 12:00 p.m.-2:00 p.m. CT.

Action Required: Be aware of the processing issue above.

If you have any questions, please contact Customer Support and refer to Case Number 09524915.

6/3/2025

Payer Processing Issue for CPID 5547 Blue Cross Blue Shield of Arizona

Due to a payer processing issue, Institutional claims transmitted to the payer listed below May 30, 2025 were not processed by the payer.

Payer impacted:

  • CPID 5547 Blue Cross Blue Shield of Arizona

A resolution has been implemented and the claims were retransmitted to the payer June 3, 2025.

This delay affected claims released to Optum May 29, 202, 3:00 p.m.-May 30, 2025, 3:00 p.m. CT.

Action Required: Be aware of the processing issue above.

If you have any questions, please contact Customer Support and refer to Case Number 09524957.

6/3/2025

Report Generation Delay for CPIDs 5909 and 4743 Carelon Behavioral Health

A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted since May 19, 2025.

Payer impacted: 

  • CPID 5909 Carelon Behavioral Health
  • CPID 4743 Carelon Behavioral Health

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09524643.

6/3/2025

Report Generation Delay for CPID 5575 New Jersey Charity Care Inpatient

A payer is experiencing issues affecting Institutional report generation for some claims submitted on May 28, 2025.

Payer impacted:

  • CPID 5575 New Jersey Charity Care Inpatient

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09523006.

6/3/2025

Report Generation Delay for CPIDs 2513 and 1167 Blue Cross Medicare Advantage PPO/HMO

A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted since May 19, 2025.

Payer impacted: 

  • CPID 2513 Blue Cross Medicare Advantage PPO/HMO
  • CPID 1167 Blue Cross Medicare Advantage PPO/HMO

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09521117.

6/3/2025

UPDATE: Electronic Routing Change for claims and Reactivating and Routing Change for remittance for CPIDs 2121 and 5953 Healthy Blue South Carolina

Update:
Providers must be registered at the payer's Provider Enrollment Portal - My Provider Enrollment Portal (MyPep), prior to submitting the Remittance agreement. Providers that do not complete the registration process will not be setup to receive electronic remittance.

Original sent on April 16, 2025:
Effective April 16, 2025, Optum has changed electronic claims routing and reactivating and changing remittance routing for the following payer:

Payer Name: Healthy Blue South Carolina
Professional CPID: 2121
Institutional CPID: 5953
Payer-assigned Payer ID: 00403
Secondary Claims Accepted: Yes
Claims Fee: N/A
Remittance Fee: N/A

Enrollment Requirements:
Claims:

  • Payer enrollment for electronic claims is not required.

Remittance:

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

6/2/2025

UPDATE: Electronic Routing Change for claims and Reactivating and Routing Change for remittance for CPIDs 2121 and 5953 Healthy Blue South Carolina

Update:
Providers must be registered at the payers Provider Enrollment Portal - My Provider Enrollment Portal (MyPep), prior to submitting the Remittance agreement. Providers that do not complete the registration process will not be setup to receive electronic remittance.

Original sent April 16, 2025
Effective April 16, 2025, Optum changed electronic claims routing and reactivating and changing remittance routing for the following payer:

Payer Name: Healthy Blue South Carolina
Professional CPID: 2121
Institutional CPID: 5953
Payer-assigned Payer ID: 00403
Secondary Claims Accepted: Yes
Claims Fee: N/A
Remittance Fee: N/A

Enrollment Requirements:
Claims:

  • Payer enrollment for electronic claims is not required.

Remittance:

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

6/2/2025

Report Generation Delay for CPID 5503 New Jersey Medicare

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

Payer impacted:

  • CPID 5503 New Jersey Medicare

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09523040.

6/2/2025

Older Payer Updates

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

GET OLDER UPDATES
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