CHC Payer Updates (May 2025)

May 2025

May Payer Processing Issues

Summary

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

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

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

VIEW ALL PAYER LISTS →

Electronic Remittance Advice (ERA) Delay for multiple CPIDs

Due to a file processing issue, there has been a delay in Professional and Institutional Electronic Remittance Advice (ERA) for the following payers for file date of May 7, 2025:

  • CPID 1164 Nebraska Total Care
  • CPID 1503 CHAMPVA HAC
  • CPID 3807 CHAMPVA HAC
  • CPID 3429 UnitedHealthcare
  • CPID 3550 UnitedHealthcare
  • CPID 4590 United Medical Resources
  • CPID 5402 United Medical Resources
  • CPID 8139 Surest

This issue has been resolved. All impacted ERA files have been received and processed. Providers may receive duplicate ERA

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

If you have any questions, feel free to contact your Customer Support Team and refer to Case Number 09502532. 

5/21/2025

Invalid Error Message for CPID 7867 UCare Plans

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

Reject Code:    A6^145^85

Message:           ^ENTITY'S SPECIALTY CODE, ENTITY'S SPECIALTY, TAXONOMY CODE.^BILLING PROVIDER BILLING PROVIDER TAXONOMY CODE MISSING. REQUIRED BY PAYER.

Payer impacted:

  • CPID 7867 UCare Plans

This issue began on May 13, 2025 and was resolved on May 16, 2025.

Claims were retransmitted to the payer on May 21, 2025.

Action Required: Please be aware of the invalid error message and possible valid duplicate rejections.

If you have any questions, please contact Customer Support and refer to Case Number 09510931.

5/21/2025

Electronic Claims Connection Suspended

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

Payer Name: Santa Clara County IPA HMO
CPIDs: 7000, 5279
Payer ID: 10378
Reason: Payer unavailable electronically.

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

5/21/2025

Report Generation Delay for CPID 7052 OhioRISE - Aetna Better Health of Ohio

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

Payer impacted:

  • CPID 7052 OhioRISE - Aetna Better Health of Ohio

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09510240.

5/21/2025

Update: Report Generation Delay for CPIDs 1876 and 8990 Group Health Cooperative of South Central Wisconsin

Update: The payer has been unable to generate and deliver the reports for some claims submitted on May 9, 2025 and May 10, 2025.

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

Original notify sent May 16, 2025:

A payer is experiencing issues affecting Professional and Institutional report generation for some claims submitted since May 9, 2025.

Payer impacted:

  • CPID 1876 Group Health Cooperative of South Central Wisconsin
  • CPID 8990 Group Health Cooperative of South Central Wisconsin

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 09504403.

5/21/2025

Electronic Claims Connection Suspended

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

Payer Name: Santa Clara County IPA PPO
CPIDs: 6222
Payer ID: SCACO
Reason: Payer unavailable electronically.

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

5/21/2025

Electronic Claims Connection Suspended

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

Payer Name: Optum Care Network - Inland Faculty Medical Group
CPIDs: 3416, 8957
Payer ID: MPM70
Reason: Payer unavailable electronically.

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

5/21/2025

Update: Report Generation Delay for CPID 5909 Carelon Behavioral Health

Update: The payer intermediary has been unable to generate and deliver the reports for some claims submitted from April 21, 2025 through May 14, 2025.

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

Original notify sent May 8, 2025:

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

Payer impacted: 

  • CPID 5909 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 09493607.

5/21/2025

Update: Report Generation Delay for CPIDs 4615 and 6127 Carelon Behavioral Health, MBHP

Update: The payer intermediary has been unable to generate and deliver the reports for some claims submitted from April 2, 2025 through May 13, 2025.

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

Original notify sent April 15, 2025:

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

Payer impacted: 

  • CPID 4615 Carelon Behavioral Health, MBHP
  • CPID 6127 Carelon Behavioral Health, MBHP

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 09462869.

5/21/2025

Report Generation Delay for CPID 9743 AdventHealth Transplant Institute

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

Payer impacted: 

  • CPID 9743 AdventHealth Transplant Institute

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09505979.

5/21/2025

​​Report Generation Delay for CPIDs 9178 and 9443 AIDS Healthcare Foundation

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted on May 9, 2025 and May 10, 2025.

Payers impacted:

  • CPID 9178 AIDS Healthcare Foundation - PHC
  • CPID 9443 AIDS Healthcare Foundation - RW

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 09508970.

5/20/2025

Report Generation Delay for CPID 6884 Positive Healthcare

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted between May 9, 2025 and May 12, 2025.

Payer impacted:

  • CPID 6884 Positive Healthcare 

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 09508922.

5/20/2025

Update: Report Generation Delay for CPID 4426 Arizona BCBS

Update: It has been determined that part of the report delay below was due to a payer claims processing issue. We have retransmitted the impacted claims to the payer May 20, 2025. Reports will be delivered once the claims have successfully processed at the payer.

Action Required: Please be aware of delays.

Original Notice Sent May 16, 2025:
A payer is experiencing issues affecting Professional report generation for some claims submitted since May 14, 2025.

Payer impacted:

  • CPID 4426 Arizona Blue Cross Blue Shield

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 09504459.

5/20/2025

Report Generation Delay for CPIDs 6760 Virgin Islands Medicaid

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted May 8, 2025-May 9, 2025.

Payer impacted:

  • CPID 6760 Virgin Islands Medicaid

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09507822.

5/20/2025

New Electronic Claims Connections Available

Optum has new electronic claims connections available:  

Payer Name: Edenbridge PACE of West Baltimore
Institutional CPID: 9002
Professional CPID: 3452
Payer-assigned Payer ID: R3491
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. 

5/20/2025

Delay in Electronic Remittance Advice (ERA) for Multiple CPIDS, PacificSource

Due to a processing issue, there has been a delay in Professional and Institutional Electronic Remittance Advice (ERA) for the following payers from May 9, 2025, to present.

  • CPID 5441 PacificSource
  • CPID 6575 PacificSource
  • CPID 6147 PacificSource
  • CPID 4627 PacificSource
  • CPID 4794 PacificSource
  • CPID 4972 PacificSource

Additional updates will be forwarded as more information becomes available. 

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

If you have any questions, feel free to contact your Customer Support Team and refer to Case Number INC-000002730.

5/20/2025

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 on May 9, 2025.

Payer impacted: 

  • CPID 8900 Allcare Health Plan
  • CPID 2113 Allcare 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.

If you have any questions, please contact Customer Support and refer to Case Number 09507739.

5/20/2025

New Electronic Eligibility Connection Available

Optum is pleased to announce the availability of Real-time Eligibility Inquiry and Response 270/271 for the below payer, effective May 12, 2025:

Payer Name: CALOPTIMA DIRECT
Industry Payer ID: CALOP
IMN Real Time ID: CALOP
Exchange Real Time ID: CALOP
CPID(s): 4221 /5914
Optum iEDI Real Time ID: CALOP
Payer Enrollment Required: No
Connection Type: X12

Search Options:
Eligibility Subscriber

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

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

5/19/2025

Report Generation Delay for CPID 7264 Quartz ASO

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted May 7, 2025 and May 9, 2025.

Payer impacted: 

  • CPID 7264 Quartz ASO

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09505912.

5/19/2025

Electronic Routing Change for CPID 8787 Delta Dental of New Jersey

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

Payer Name: Delta Dental of New Jersey
CPID: 8787
Payer-assigned Payer ID: 22189
Line of Business Code (LOB): U81
Payer Remittance Enrollment Required: Yes 

Enrollment Requirements: 

Remittance:

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

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

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

5/19/2025

New Electronic Remittance Connections Available

Optum has new electronic remittance connections available:  

Payer Name: Delta Dental of New Jersey
CPID: 8787
Payer-assigned Payer ID: 22189
Payer Enrollment Required: Yes
Remittance Fee: N/A
Payer Location: New Jersey 

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. 

5/19/2025

Electronic Routing Change for Multiple Payers

Effective May 20, 2025, Optum will be changing electronic claims routing for the following payers:

Payer Name: Cigna Healthcare for Seniors
Professional CPID: 5436
Institutional CPID: 2595
Payer-assigned Payer ID: 62308\
Payer Claim Enrollment Required: No
Secondary Claims Accepted: Yes
Claims Fee: N/A

Payer Name: Evernorth Behavioral Health, Inc
Professional CPID: 1841
Institutional CPID: 5943
Payer-assigned Payer ID: 62308
Payer Claim Enrollment Required: No
Secondary Claims Accepted: Yes
Claims Fee: N/A

Enrollment Requirements:
Claims:

  • Payer enrollment for electronic claims is not required.

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

5/19/2025

Update: Payer Processing Issue for CPIDs 2872 and 5979 TRICARE East Region

Update: Optum is continuing to work diligently to resolve the delivery of reports. Thank you for your patience and please watch for future updates regarding report processing.

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

Update sent May 2, 2025:
A resolution has been implemented and all claims were transmitted to the payer May 2, 2025. There is a delay in processing payer reports, Optum is working diligently to resolve the issue to ensure delivery of reports on or after May 9, 2025.

We apologize for any inconvenience. 

Action Required: None. Please be aware of delays in the report generation for claims.

Original notify sent April 28, 2025:
Due to a payer processing issue, some Professional and Institutional claims transmitted to the payer listed below since April 21, 2025 were not processed by the payer.

Payer(s) impacted: 

  • CPID 2872 TRICARE East Region
  • CPID 5979 TRICARE East Region

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

This delay affected claims released to Optum since April 21, 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 09479475.

5/16/2025

Report Generation Delay for CPIDs 1876 and 8990 Group Health Cooperative of South Central Wisconsin

A payer is experiencing issues affecting Professional and Institutional report generation for some claims submitted since May 9, 2025.

Payer impacted:

  • CPID 1876 Group Health Cooperative of South Central Wisconsin
  • CPID 8990 Group Health Cooperative of South Central Wisconsin

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 09504403.

5/16/2025

Report Generation Delay for CPIDs 1876 and 8990 Group Health Cooper

A payer is experiencing issues affecting Professional and Institutional report generation for some claims submitted since May 9, 2025.

Payer impacted:

  • CPID 1876 Group Health Cooperative of South Central Wisconsin
  • CPID 8990 Group Health Cooperative of South Central Wisconsin

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 09504403.

5/16/2025

Report Generation Delay for CPID 4426 Arizona Blue Cross Blue Shield

A payer is experiencing issues affecting Professional report generation for some claims submitted since May 14, 2025.

Payer impacted:

  • CPID 4426 Arizona Blue Cross Blue Shield

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 09504459.

Update: Report Generation Delay for CPIDs 4426 and 5547 Arizona Blue Cross Blue Shield

Update: The payer has been unable to generate and deliver the reports for some claims submitted April 29, 2025.

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

Original notify sent May 5, 2025:
A payer is experiencing issues affecting Professional and Institutional report generation for some claims submitted since April 29, 2025.

Payer impacted:

  • CPID 4426 Arizona Blue Cross Blue Shield
  • CPID 5547 Arizona Blue Cross Blue Shield

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 09488265.

5/16/2025

New Electronic Connection Available

Effective May 13, 2025 Optum is pleased to announce the availability of Real-time Eligibility Inquiry and Response 270/271, Claim Status Inquiry 276/277 for the below payer:

Payer Name: Tricare East
Industry Payer ID: 99727
IMN Real Time ID: 99727
Exchange Real Time ID: TRICRE
CPID(s): 2872, 5979
Optum IEDi Real Time ID: 00080
Payer Enrollment Required: No
Connection Type: X12 

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.

5/16/2025

New Electronic Eligibility Connection Available

Effective April, 28, 2025 Optum is pleased to announce the availability of Real-time Eligibility Inquiry and Response 270/271 for the below payer:

Payer Name: TRANSACTRX PART D

Industry Payer ID: PARTD

IMN Real Time ID: PARTD

Exchange Real Time ID: RXPTD

CPID(s): 7241

Optum iEDI Real Time ID: 11037

Payer Enrollment Required: No

Connection Type: X12

Search Options:

Eligibility Subscriber

  • Member ID (full Social Security Number), First Name, Last Name, Date of Birth, Gender Code

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 https://customercare.changehealthcare.com/public/home.html.

New electronic eligibility connection available

Effective April 08, 2025, Optum is pleased to announce the availability of Real-time Eligibility Inquiry and Response 270/271 transactions for the below payer:

Payer Name: HEALTHY BLUE DUAL ADVANTAGE LOUISIANA
Industry Payer ID:00551
IMN Real Time ID: 00551
Exchange Real Time ID: HBDALA
CPID(s): 4021 / 8750
Optum IEDi Real Time ID: 14504
Payer Enrollment Required: No
Connection Type: X12

Search Options: 

Eligibility Subscriber:

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

Action Required by customer:

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

5/16/2025

Payer Processing Issue for CPID 7241 TransactRX Part D

Due to a payer processing issue, Professional claims transmitted to the payer listed below on May 12, 2025 were not processed by the payer.

Payer impacted:

  • CPID 7241 TransactRX Part D

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

This delay affected claims released to Optum between 9 p.m. CST on May 9, 2025 and 9 p.m. CST on May 12, 2025.

Action Required: Be aware of the processing issue above.

If you have any questions, please contact Customer Support and refer to Case Number 09503336.

5/15/2025

Report Generation Delay for CPID 1448 Florida Medicare

A payer is experiencing issues affecting Professional report generation for some claims submitted since May 9, 2025.

Payer impacted:

  • CPID 1448 Florida 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.

If you have any questions, please contact Customer Support and refer to Case Number 09503168.

5/15/2025

Report Generation Delay for CPID 5598 Pennsylvania Medicare

A payer is experiencing issues affecting Institutional report generation for some claims submitted since May 9, 2025.

Payer impacted:

  • CPID 5598 Pennsylvania 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.

If you have any questions, please contact Customer Support and refer to Case Number 09502436.

5/15/2025

Update: Report Generation Delay for CPID 1116 Special Agents Mutual

Update: The payer intermediary has been unable to generate and deliver the reports for some claims submitted April 2, 2025-April 25, 2025.

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

Original notify sent April 17, 2025:
A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted since April 2, 2025.

Payer impacted:

  • CPID 1116 Special Agents Mutual Benefit Association (SAMBA) Teledoc only

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 09466268.

5/15/2025

VAHAC Excessive Subscriber Insured Not Found

The Veterans Affairs Health Administration Center payer ID -VAHAC has observed extremely high volume of real-time eligibility transactions that are being rejected for "SUBSCRIBER/INSURED/PATIENT NOT FOUND" over the last several months. This has caused a spike in excessive transaction cost for the Veterans Administration payer. On closer review it was determined that many of these should have been submitted to Veterans Affairs Fee Basis Program (VAFEE) or that the patient submitted in the eligibility request was not enrolled or do not meet the criteria as further defined below. The two Veterans Administration payers VAFEE and VAHAC are unique in membership and enrollment.

CHAMPVA is a health benefits program in which the department of Veterans Affairs (VAHAC) shares the cost of certain health care services and supplies with eligible beneficiaries. CHAMPVA provides coverage to the spouse or widow(er) and to the children of veterans who meet very specific criteria which is further defined on VA website: https://www.va.gov/COMMUNITYCARE/programs/dependents/champva/champva_eligibility.asp.

Please review the enrollment criteria above.

PLEASE NOTE: *CHAMPVA (VAHAC) does not provide coverage to the veteran.*

You should always check the member ID card to establish if the patient is enrolled with CHAMPVA/VAHAC. Insurance Cards for CHAMPVA will have the following at the top left corner of the member card, "Department of Veterans Affairs Health Administration Center." Please also note that in order to be eligible for CHAMPVA a member cannot be eligible for TRICARE.

Carefully review the eligibility responses you are receiving from the VA payers, and check  the member's ID cards to be sure you are submitting to the correct plan when "subscriber/member/patient not found" responses are encountered. If the patient is a veteran, submit eligibility inquiries to VA Fee Basis Program/VAFEE. If the patient is a spouse/widow(er) or dependent, AND has a CHAMPVA insurance card, submit eligibility inquiries to CHAMPVA/VAHAC.

Vivida Health Plan DOS less than 11/1/22 Electronic Claims and Remittance Connections No Longer Available

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

Payer Name: Vivida Health Plan DOS less than 11/1/22
Claim and Remittance CPIDs: 5028, 8876
Payer-assigned Payer ID: A0102
Reason: Claims with DOS GT 10/31/22 should be sent to Simply Healthcare Plans, Inc., Payer ID SMPLY CPID 8124, 1096. 

Action Required: None.

5/14/2025

Report Generation Delay for CPID 2472 Maine Medicare

A payer is experiencing issues affecting Professional report generation for some claims submitted since May 7, 2025.

Payer impacted:

  • CPID 2472 Maine 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.

If you have any questions, please contact Customer Support and refer to Case Number 09501527.

5/14/2025

Electronic Routing Change for CPIDs 3292 and 6621 Regal Medical Group

Effective May 14, 2025, Optum is changing electronic claims routing for the following payers:

Payer Name: Regal Medical Group
Professional CPID: 3292
Institutional CPID: 6621
Payer-assigned Payer ID: REGAL
Payer Claim Enrollment Required:
Secondary Claims Accepted: Yes
Claims Fee: $0.10

Enrollment Requirements:
Claims:

  • Payer enrollment for electronic claims is not required.

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

5/14/2025

Report Generation Delay for CPID 2470 New Hampshire Medicare

A payer is experiencing issues affecting Professional report generation for some claims submitted since May 6, 2025.

Payer impacted:

  • CPID 2470 New Hampshire 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.

If you have any questions, please contact Customer Support and refer to Case Number 09501553.

5/14/2025

Update: Payer Transmit Delay for multiple CPIDs

Update: A resolution has been implemented and the claims were transmitted to the payers on May 13, 2025.

This delay affected claims released to Optum between 9 p.m. CT on May 2, 2025 and 2 p.m. CT on May 13, 2025.

Action Required: Please be aware of the transmit delay.

Original Notify sent May 6, 2025:

Due to a payer system issue, a delay occurred in some of the transmissions to the following payers since May 5, 2025.

Payers impacted:

  • CPID 1422 New York Medicaid
  • CPID 1500 New York Medicaid
  • CPID 1501 New York Medicaid Inpatient
  • CPID 1502 New York Medicaid Outpatient
  • CPID 2429 New York Medicaid 
  • CPID 6540 New York Medicaid

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

This delay affected claims released to Optum since 9 p.m. CT on May 2, 2025. 

Action Required: Be aware of the transmit delay above.

If you have any questions, please contact Customer Support and refer to Case Number 09490284.

REF 17629909 5/13/2025

Ingalls Provider Group Electronic Claims and Remittance Connections No Longer Available

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

Payer Name: Ingalls Provider Group
Claim and Remittance CPIDs: 9640, 7471
Payer-assigned Payer ID: 85578
Reason: Payer no longer in business.

Action Required: None.

REF 17623621  5/13/2025

Ingalls Provider Group Electronic Claims and Remittance Connections No Longer Available

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

Payer Name: Ingalls Provider Group
Claims and Remittance CPIDs: 9640, 7471
Remittance LOB: J7T
Payer-assigned Payer ID: 85578
Reason: Payer no longer in business.

Payer will no longer accept paper claims.

Action Required: None.

REF 17623620  5/13/2025

Eligibility IMN Payer ID Change

Effective immediately, IMN payer ID change: IMN submitters using IMN payer ID CAPTL begin using IMN payer ID 95112 immediately. 

Payer Name: Capital Health Plan
IMN Real Time ID:  OLD: CAPTL, NEW: 95112
Reason: IMN payer ID CAPTL is a duplicate of IMN payer ID 95112.

Action Required by customer:

Please update your system to take advantage of this payer transaction.

REF 17623159 5/13/2025

New electronic eligibility connection available

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

Payer Name: South Dakota Medicaid
Industry Payer ID: SKSD0
IMN Real Time ID: SKSD0
Exchange Real Time ID: SDCAID
CPID(s): 4478 / 5591
Optum iEDI Real Time ID: SDMCD
Payer Enrollment Required: No
Connection Type: X12

Search Options:
Eligibility Subscriber

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

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

REF 17620640  5/13/2025

New electronic eligibility connection available

Optum is pleased to announce the availability of Real-time Eligibility Inquiry and Response 270/271 transactions for the below payer, effective April 29, 2025:

Payer Name: South Carolina Medicaid
Industry Payer ID: SCXIX
IMN Real Time ID: SKSC0
Exchange Real Time ID: SCCAID
CPID(s): 1484 / 5540
Optum iEDI Real Time ID: SCMCD
Payer Enrollment Required: No
Connection Type: X12

Search Options:
Eligibility Subscriber

  • Member ID, First Name, Last Name, Date of Birth
  • Member ID, Date of Birth
  • Member ID
  • SSN, 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 17620641  5/13/2025

New eligibility connection available

Optum is pleased to announce the availability of Real-time Eligibility Inquiry and Response 270/271 transactions for the below payer, effective April 29, 2025:

Payer Name: West Virginia Medicaid
Industry Payer ID: SKWV0
IMN Real Time ID: SKWV0
Exchange Real Time ID: WVCAID
CPID(s): 2477 / 5532
Optum iEDI Real Time ID: WVMCD
Payer Enrollment Required: No
Connection Type: X12

Search Options:
Eligibility Subscriber

  • Member ID, First Name, Last Name, Date of Birth
  • First Name, Last Name, Date of Birth
  • Member ID, Date of Birth
  • Member ID
  • SSN, 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 17620639  5/13/2025

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

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

Payer impacted:

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

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09498685.

REF 17619987  5/13/2025

Update: Report Generation Delay for CPID 2770 Fidelis Care New York Encounters

Update: The payer intermediary has been unable to generate and deliver the reports for some claims submitted from April 4, 2025 through April 22, 2025.

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

Original notify sent April 16, 2025:

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

Payer impacted: 

  • CPID 2770 Fidelis Care New York Encounters

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09464331.

REF 17619008 5/13/2025

Payer Change for CPIDs 4058, 8802 Boncura Health Solutions

Effective May 14, 2025, claims currently exchanged with the following payer must use different CPIDs.

Payer Name: Boncura Health Solutions
Professional CPID: 8802
Professional Edit Master: PE_O007
Institutional CPID: 4058
Institutional Edit Master: HE9O007\
Payer-assigned Payer ID: 66727
Line of Business Code (LOB): N/A

Claims sent on or after May 14, 2025, must begin using the following:

Payer Name: Illinois Health Partners
Professional CPID: 2234
Professional Edit Master: HE9B801
Institutional CPID: 5994
Institutional Edit Master: PE_B800
Payer-assigned Payer ID: DMG01
Line of Business Code (LOB): E11

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 2234, 5994 Illinois Health Partners do not need to complete a new enrollment form.
  • Providers not receiving electronic remittance through Optum for CPIDs 2234, 5994 Illinois Health Partners 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 17618859  5/13/2025

Payer Change for CPIDs 4058, 8802 Boncura Health Solutions

Effective May 14, 2025 claims currently exchanged with the following payer must use different CPIDs.

Payer Name: Boncura Health Solutions
Professional CPID: 8802
Institutional CPID: 4058
Remittance Available: No
Payer-assigned Payer ID: 66727

Claims sent on or after May 14, 2025, must begin using the following:

Payer Name: Illinois Health Partners
Professional CPID: 2234
Institutional CPID: 5994
Remittance Available: yes
Payer-assigned Payer ID: DMG01
Claim Fee: N/A

Enrollment Requirements:
Claims:

  • Payer enrollment for electronic claims is not required.

Remittance:

  • Payer enrollment for electronic remittance is required.
  • Providers currently receiving electronic remittance through Optum for CPIDs 2234, 5994 Illinois Health Partners do not need to complete a new enrollment form.
  • Providers not receiving electronic remittance through Optum for CPIDs 2234, 5994 Illinois Health Partners 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 17618858  5/13/2025

Report Generation Delay for CPID 2930 Health Choice Arizona

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

Payer impacted:

  • CPID 2930 Health Choice Arizona

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 09498568.

REF 17618508  5/13/2025

New Electronic Claims Connections Available

Optum has new electronic claims connections available:

Payer Name: Hollywood Presbyterian San Judas
Institutional CPID: 8989
Professional CPID: 3441
Payer-assigned Payer ID: MPM49
Payer Enrollment Required: No
Secondary Claims Accepted: Yes
Payer Location: California
Claims Fee: N/A

Action Required:

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

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

REF 17608760  5/12/2025

New Electronic Claims Connections Available

Optum has new electronic claims connections available:

Payer Name: Hollywood Presbyterian San Judas
Institutional CPID: 8989
Professional CPID: 3441
Payer-assigned Payer ID: MPM49
Payer Enrollment Required: No
Secondary Claims Accepted: Yes
Payer Location: California
Claims Fee: $0.10

Action Required:

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

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

REF 17608759  5/12/2025

Report Generation Delay for CPID 2164 Carelon Behavioral Health Maryland

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted on May 3, 2025.

Payer impacted: 

  • CPID 2164 Carelon Behavioral Health Maryland

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09497661.

REF 17607858 5/12/2025

Edit Master for Aetna Better Health - Multiple Payers

Effective this evening, Optum will be changing Edit Masters for the following payers:

Payer Name: Aetna Better Health of Florida
Professional CPID: 7265
Current Edit Master: PE_E049
New Edit Master: PE_T007
Institutional CPID: 8678
Current Edit Master: HE9E049
New Edit Master: HE9T007
Payer-assigned Payer ID: 128FL

Payer Name: Aetna Better Health of Illinois - MMAI Duals
Professional CPID: 6140
Current Edit Master: PE_E049
New Edit Master: PE_T007
Institutional CPID: 4623
Current Edit Master: HE9E049
New Edit Master: HE9T007
Payer-assigned Payer ID: 26337

Payer Name: Aetna Better Health of Kentucky
Professional CPID: 7410
Current Edit Master: PE_E049
New Edit Master: PE_T007
Institutional CPID: 9626
Current Edit Master: HE9E049
New Edit Master: HE9T007
Payer-assigned Payer ID: 128KY

Payer Name: Aetna Better Health of Michigan
Professional CPID: 7220
Current Edit Master: PE_E049
New Edit Master: PE_T007
Institutional CPID: 8637
Current Edit Master: HE9E049
New Edit Master: HE9T007
Payer-assigned Payer ID: 128MI

Payer Name: Aetna Better Health of New Jersey
Professional CPID: 7190
Current Edit Master: PE_E049
New Edit Master: PE_T007
Institutional CPID: 8629
Current Edit Master: HE9E049
New Edit Master: HE9T007
Payer-assigned Payer ID: 46320

Payer Name: Aetna Better Health of New York
Professional CPID: 6832
Current Edit Master: PE_E049
New Edit Master: PE_T007
Institutional CPID: 7612
Current Edit Master: HE9E049
New Edit Master: HE9T007
Payer-assigned Payer ID: 34734

Payer Name: Aetna Better Health of Pennsylvania
Professional CPID: 5823
Current Edit Master: PE_E049
New Edit Master: PE_T007
Institutional CPID: 3617
Current Edit Master: HE9E049
New Edit Master: HE9T007
Payer-assigned Payer ID: 23228

Payer Name: Aetna Better Health of Texas
Professional CPID: 2142
Current Edit Master: PE_E049
New Edit Master: PE_T007
Institutional CPID: 2933
Current Edit Master: HE9E049
New Edit Master: HE9T007
Payer-assigned Payer ID: 38692

Payer Name: Aetna Better Health of Virginia
Professional CPID: 7737
Current Edit Master: PE_E049
New Edit Master: PE_T007
Institutional CPID: 9686
Current Edit Master: HE9E049
New Edit Master: HE9T007
Payer-assigned Payer ID: 128VA

Payer Name: Aetna Better Health of West Virginia
Professional CPID: 1147
Current Edit Master: PE_E049
New Edit Master: PE_T007
Institutional CPID: 1577\
Current Edit Master: HE9E049
New Edit Master: HE9T007
Payer-assigned Payer ID: 128WV

Payer Name: Aetna Better Health of Louisiana
Professional CPID: 7183
Current Edit Master: PE_N000
New Edit Master: PE_T007
Institutional CPID: 8621
Current Edit Master: HE9N000
New Edit Master: HE9T007
Payer-assigned Payer ID: 128LA

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

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

REF 17607162  5/12/2025

Report Generation Delay for CPIDs 3577 and 1209 Regence Group Administrators

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

Payer impacted:

  • CPID 3577 Regence Group Administrators
  • CPID 1209 Regence Group Administrators

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09497586.

REF 17607009 5/12/2025

Report Generation Delay for CPIDs 8920 and 5243 Healthcare Management Administrators

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

Payer impacted:

  • CPID 8920 Healthcare Management Administrators
  • CPID 5243 Healthcare Management Administrators

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09497543.

REF 17607008  5/12/2025

Electronic Routing Change for CPIDs 7867 and 1038 UCare Plans

Effective May 12, 2025, Optum will be changing electronic claims routing for the following payers:

Payer Name: UCare Plans 

Professional CPID: 7867

Edit Master: PE_U009

Institutional CPID: 1038

Edit Master: HE9U009

Payer-assigned Payer ID: 55413

Payer Claim Enrollment Required: No

Secondary Claims Accepted: Yes

Enrollment Requirements: 

Claims:

  • Payer enrollment for electronic claims is not required.

Report Changes:

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

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

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

REF 17605112 5/12/2025

Electronic Routing Change for CPIDs 7867 and 1038 Ucare Plans

Effective May 12, 2025, Optum will be changing electronic claims routing for the following payers:

Payer Name: UCare Plans 

Professional CPID: 7867

Institutional CPID: 1038

Payer-assigned Payer ID: 55413

Payer Claim Enrollment Required: No

Secondary Claims Accepted: Yes

Claims Fee: $0.10

Enrollment Requirements: 

Claims:

  • Payer enrollment for electronic claims is not required.

Report Changes:

You may see some differences in the payer reports you 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 17605111 5/12/2025

Update: Report Generation Delay for CPID 1806 FiServ Health (Kansas & Tennessee)

Update: The payer has been unable to generate and deliver the reports for some claims submitted between April 2, 2025 and April 10, 2025.

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

Original notify sent April 10, 2025:

A payer is experiencing issues affecting Professional report generation for some claims submitted since April 2, 2025.

Payer impacted: 

  • CPID 1806 FiServ Health (Kansas & Tennessee)

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 09457835.

REF 17603258 5/12/2025

Update: Report Generation Delay for CPID 2824 The Health Plan of West Virginia, Inc

Update: The payer has been unable to generate and deliver the reports for some claims submitted April 22, 2025-April 29, 2025.

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

Original notify sent May 1, 2025:
A payer is experiencing issues affecting Professional and Institutional report generation for some claims submitted since April 20, 2025.

Payer impacted:

  • CPID 2824 The Health Plan of West Virginia, Inc
  • CPID 7551 The Health Plan of West Virginia, Inc

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 09484936.

REF 17603260  5/12/2025

Update: Report Generation Delay for CPID 2457 Pennsylvania Medicare

Update: The payer has been unable to generate and deliver the reports for some claims submitted March 27, 2025-March 28, 2025.

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

Original notify sent April 4, 2025:
A payer is experiencing issues affecting Professional report generation for some claims submitted since March 27, 2025.

Payer impacted:

  • CPID 2457 Pennsylvania 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.

If you have any questions, please contact Customer Support and refer to Case Number 09449464.

REF 17603259  5/12/2025

Report Generation Delay for CPIDs 1691 and 4252 Presbyterian Salud

A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted since April 29, 2025.

Payer impacted:

  • CPID 1691 Presbyterian Salud
  • 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.

If you have any questions, please contact Customer Support and refer to Case Number 09497094.

REF 17602309  5/12/2025

Advocate Health Centers Claims and Remittance Connections No Longer Available

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

Payer Name: Advocate Health Centers
Claim and Remittance CPIDs: 2517, 3704
Payer-assigned Payer ID: 36320
Reason: Per the payer, this Payer ID has been inactive since Jan. 1, 2021. Payer will no longer accept paper claims.

Action Required: None.

REF 17601909  5/12/2025

Advocate Health Centers Claims and Remittance Connections No Longer Available

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

Payer Name: Advocate Health Centers
Claim and Remittance CPIDs: 2517, 3704
Remittance LOB: J17
Payer-assigned Payer ID: 36320
Reason: Per the payer, this Payer ID has been inactive since Jan. 1, 2021. Payer will no longer accept paper claims.

Action Required: None.

REF 17601908  5/12/2025

Update: Report Generation Delay for CPIDs 3693 and 2150 Florida Health Care Plans

Update: The payer intermediary has been unable to generate and deliver the reports for some claims submitted April 11, 2025.

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

Original notify sent April 21, 2025:
A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted April 11, 2025.

Payer impacted:

  • CPID 3693 Florida Health Care Plans
  • CPID 2150 Florida Health Care Plans

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09470047.

REF 17601708  5/12/2025

Electronic Routing Change for Multiple Payers

Effective May 12, 2025, Optum will be changing electronic claims routing for the following payers:

 

Payer Name: CareFirst BlueCross BlueShield Community Health Plan Maryland

Professional CPID: 6749

Edit Master: PE_T007

Institutional CPID: 6647

Edit Master: HE9T007

Payer-assigned Payer ID: 45281

Payer Claim Enrollment Required: No

Secondary Claims Accepted: No

 

Payer Name: Geisinger Health Plan

Professional CPID: 5473

Edit Master: PE_T007

Institutional CPID: 2559

Edit Master: HE9T007

Payer-assigned Payer ID: 75273

Payer Claim Enrollment Required: No

Secondary Claims Accepted: Yes

 

Payer Name: Health Plan of San Joaquin

Professional CPID: 3469

Current Edit Master: PE_E049

New Edit Master: PE_T007

Institutional CPID: 4682

Current Edit Master: HE9E049

New Edit Master: HE9T007

Payer-assigned Payer ID: 68035

Payer Claim Enrollment Required: No

Secondary Claims Accepted: Yes

 

Payer Name: Kaiser Foundation Health Plan of Washington

Professional CPID: 8405

Current Edit Master: PE_N000

New Edit Master: PE_T007

Institutional CPID: 6511

Current Edit Master: HE9N000

New Edit Master: HE9T007

Payer-assigned Payer ID: 91051

Payer Claim Enrollment Required: No

Secondary Claims Accepted: Yes

Enrollment Requirements: 

Claims:

  • Payer enrollment for electronic claims is not required.

Report Changes:

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

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

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

REF 17601259 5/12/2025

Electronic Routing Change for Multiple Payers

Effective May 12, 2025, Optum will be changing electronic claims routing for the following payers:

 

Payer Name: CareFirst BlueCross BlueShield Community Health Plan Maryland

Professional CPID: 6749

Institutional CPID: 6647

Payer-assigned Payer ID: 45281

Payer Claim Enrollment Required: No

Secondary Claims Accepted: No

Claims Fee: N/A

 

Payer Name: Geisinger Health Plan

Professional CPID: 5473

Institutional CPID: 2559

Payer-assigned Payer ID: 75273

Payer Claim Enrollment Required: No

Secondary Claims Accepted: Yes

Claims Fee: $0.10

 

Payer Name: Health Plan of San Joaquin

Professional CPID: 3469

Institutional CPID: 4682

Payer-assigned Payer ID: 68035

Payer Claim Enrollment Required: No

Secondary Claims Accepted: Yes

Claims Fee: N/A

 

Payer Name: Kaiser Foundation Health Plan of Washington

Professional CPID: 8405

Institutional CPID: 6511

Payer-assigned Payer ID: 91051

Payer Claim Enrollment Required: No

Secondary Claims Accepted: Yes

Claims Fee: $0.10

Enrollment Requirements: 

Claims:

  • Payer enrollment for electronic claims is not required.

Report Changes:

You may see some differences in the payer reports you 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 17601258 5/12/2025

Report Generation Delay for CPID 6284 Trillium Health Resources

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

Payer impacted: 

  • CPID 6284 Trillium Health Resources

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 09496257.

REF 17596908 5/9/2025

Report Generation Delay for CPIDs 1532 and 4480 Select Health

A payer is experiencing issues affecting Professional and Institutional report generation for some claims submitted since April 17th, 2025.

Payer impacted: 

  • CPID 1532 Select Health
  • CPID 4480 Select Health

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09438185.

REF 17596909 5/9/2025

Update: Report Generation Delay for CPID 1532 Select Health

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

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

Previous Update sent April 15, 2025:

Update: A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted on March 18, 2025 and April 10, 2025.

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

Original notify sent March 26, 2025:

A payer is experiencing issues affecting Professional report generation for some claims submitted on March 18,2025.

Payer impacted: 

  • CPID 1532 Select Health

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09438185.

REF 17596910 5/9/2025

Delay in Electronic Remittance Advice (ERA) for CPIDS 4749, 5913 Tricare for Life

Due to a payer processing issue, there has been a delay in Professional and Institutional Electronic Remittance Advice (ERA) for the following payers for April 24, 2025 - May 6, 2025:

  • CPID 5913 Tricare for Life
  • CPID 4749 Tricare for Life

Additional updates will be forwarded as more information becomes available.  

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

If you have any questions, feel free to contact your Customer Support Team and refer to Case Number INC-000002668.

REF 17586838 5/9/2025

Report Generation Delay for CPID 7493 Vermont Blue Cross Blue Shield

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

Payer impacted:

  • CPID 7493 Vermont 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.

If you have any questions, please contact Customer Support and refer to Case Number 09494244.

REF 17576970  5/8/2025

Remittance (ERA) Delay for multiple CPIDs

Due to a payer processing issue, there has been a delay in Professional and Institutional Electronic Remittance Advice (ERA) for the following payers for receive dates of May 5, 2025 through present:

Payers impacted:

  • CPID 1422 New York Medicaid
  • CPID 1500 New York Medicaid
  • CPID 1501 New York Medicaid Inpatient
  • CPID 1502 New York Medicaid Outpatient
  • CPID 2429 New York Medicaid 
  • CPID 6540 New York Medicaid

Additional updates will be forwarded as more information becomes available.

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

If you have any questions, please contact Customer Support and refer to Case Number 09490284.

REF 17575510 5/8/2025

Payer Processing Issue for CPIDs 5579 and 7420 Rhode Island Blue Cross Blue Shield

Due to a payer processing issue, some Professional and Institutional claims transmitted to the payer listed below April 22, 2025, and April 29, 2025, were not processed by the payer.

Payer impacted:

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

A resolution has been implemented, and the claims were retransmitted to the payer May 18, 2025.

This delay affected claims released to Optum April 21, 2025, 2:00 p.m.-April 29, 2025, 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 09494268.

REF 17574522  5/8/2025

New electronic eligibility connection available

Optum is pleased to announce the availability of Real-time Eligibility Inquiry and Response 270/271 transactions for the below payer effective March 26, 2025:

Payer Name: ANTHEM MAINEHEALTH
Industry Payer ID: 00958
IMN Real Time ID: 00958
Exchange Real Time ID: ANTHME
CPID(s): 4020 / 8749
Optum IEDi Real Time ID: MEBLS
Payer Enrollment Required: No
Connection Type: X12

Eligibility Subscriber:

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

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

REF 17570109  5/8/2025

New electronic eligibility connection available

Optum is pleased to announce the availability of Real-time Eligibility Inquiry and Response 270/271 transactions for the below payer effective April 8, 2025:

Payer Name: National Telecommunications Coop Assoc (NTCA)
Industry Payer ID: 52103
IMN Real Time ID: 52103
Exchange Real Time ID: NTCA
CPID(s): 3987 / 2407
Optum IEDi Real Time ID: 10812
Payer Enrollment Required: No
Connection Type: X12

Search Options:
Eligibility Subscriber:

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

Eligibility Dependent:

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

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

REF 17570108  5/8/2025

Report Generation Delay for CPID 5909 Carelon Behavioral Health

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

Payer impacted:

  • CPID 5909 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 09493607.

REF 17569208  5/8/2025

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

Update: The payer intermediary has been unable to generate and deliver the reports for some claims submitted April 2, 2025-April 30, 2025.

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

Original notify sent April 15, 2025:
A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted since April 2, 2025.

Payer impacted:

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

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09462813.

REF 17568009  5/8/2025

Update: Report Generation Delay for CPID 7493 Vermont Blue Cross Blue Shield

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

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

Original notify sent April 21, 2025:
A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted April 10, 2025.

Payer impacted:

  • CPID 7493 Vermont 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.

If you have any questions, please contact Customer Support and refer to Case Number 09470030.

REF 17568012  5/8/2025

Update: Report Generation Delay for CPID 4258 VNS Health

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

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

Original notify sent April 21, 2025:
A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted April 10, 2025.

Payer impacted:

  • CPID 4258 VNS 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 09470014.

REF 17568010  5/8/2025

Update: Report Generation Delay for CPID 5428 QualChoice of Arkansas

Update: The payer intermediary has been unable to generate and deliver the reports for some claims submitted from March 31, 2025 through April 30, 2025.

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

Original notify sent April 10, 2025:

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted since March 31, 2025.

Payer impacted: 

  • CPID 5428 QualChoice of Arkansas

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 09457378.

REF 17568258 5/8/2025

Payer Processing Issue for CPID 1483 New Jersey Medicaid

Due to a payer processing issue, Professional claims transmitted to the payer listed below May 5, 2025 were not processed by the payer.

Payer impacted:

  • CPID 1483 New Jersey Medicaid

A resolution has been implemented and the claims were retransmitted to the payer May 7, 2025.

This delay affected claims released to Optum May 2, 2025, 3:00 p.m.-May 5, 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 09492974.

REF 17564909  5/7/2025

New Assurance Attach Medical Attachment Connections Available

Optum has new electronic medical attachment connections available:

Payer Name: Hometown Health
Professional CPID: 2839
Institutional CPID: 2960
Payer-assigned Payer ID: 88023
Accepted Attachment Type: Solicited and Unsolicited
Payer Enrollment Required: No
Payer Location: Nevada

Action Required:

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

REF 17558881  5/7/2025

New Electronic Medical Attachment Connections Available

Optum has new electronic medical attachment connections available:

Payer Name: Hometown Health
Professional CPID: 2839
Institutional CPID: 2960
Payer-assigned Payer ID: 88023
Accepted Attachment Type: Solicited and Unsolicited
Payer Enrollment Required: No
Payer Location: Nevada

Action Required:

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

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

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

REF 17559311  5/7/2025

Report Generation Delay for CPID 5502 Texas Medicare

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

Payer impacted: 

  • CPID 5502 Texas 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.

If you have any questions, please contact Customer Support and refer to Case Number 09491660.

REF 17551716 5/7/2025

Database Maintenance for May - CANCELLED

This message is intended for ConnectCenter, Enrollment Central, Revenue Performance Advisor, Assurance Reimbursement Management, Assurance EDI and Clearance EDI customers.

The quarterly database maintenance previously schedule to occur this weekend, May 9-May 10, 2025, has been cancelled.

The next quarterly database maintenance is scheduled to be done on Aug. 8-9, 2025.

REF 17539565

Update: Report Generation Delay for CPID 2481 Ohio Medicaid

Update: The payer has been unable to generate and deliver the reports for some claims submitted on April 7, 2025.

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

Original notify sent April 10, 2025:

A payer is experiencing issues affecting Professional report generation for some claims submitted on April 7, 2025.

Payer impacted: 

  • CPID 2481 Ohio Medicaid

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09457903.

REF 17545361 5/6/2025

Update: Report Generation Delay for CPID 9458 CareSource Ohio Medicaid

Update: The payer has been unable to generate and deliver the reports for some claims submitted on March 17, 2025.

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

Original notify sent March 20, 2025:

A payer is experiencing issues affecting Professional report generation for some claims submitted since March 17, 2025.

Payer impacted: 

  • CPID 9458 CareSource Ohio Medicaid

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09429693.

REF 17545360 5/6/2025

Update: Report Generation Delay for CPIDs 3509 and 2481 Ohio Medicaid

Update: The payer has been unable to generate and deliver the reports for some claims submitted March 13, 2025, March 21, 2025 and March 27, 2025.

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

Original notify sent March 19, 2025:
A payer is experiencing issues affecting Professional and Institutional report generation for some claims submitted since March 13, 2025.

Payer impacted:

  • CPID 3509 Ohio Medicaid
  • CPID 2481 Ohio Medicaid

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09427316.

REF 17545359  5/6/2025

New Payer Edit for CPID 3065

The payer listed below has informed Optum of a new edit requirement effective immediately. In order to meet the new requirement, we will add the following edit on May 12, 2025:

  • INM109085T: MISSING OPERATING PHYSICIAN NPI – When the Operating Physician Name is present, the Operating Physician NPI is required. Exception: When the Operating Physician ID is present, this requirement does not apply. LOOP 2310B NM109

Edit applies to:

  • CPID 3065 Keycare

Action Required: Please be aware of updated edit requirements.

REF 17543660 5/6/2025

New Electronic Claims Connections Available

Optum has new electronic claims connections available:

Payer Name: MERP Administration Services
Institutional CPID: 8541
Professional CPID: 3259
Payer-assigned Payer ID: MERP1
Payer Enrollment Required: No
Secondary Claims Accepted: Yes
Payer Location: Colorado, Illinois
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 17543708  5/6/2025

Significa Benefits Services Electronic Claims and Remittance Connections No Longer Available

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

Payer Name: Significa Benefits Services
Claims and Remittance CPIDs: 5469, 7532
Remittance LOB: H4O
RTE Payer ID: ERINGP
Payer-assigned Payer ID: 23250
Reason: Payer no longer in business. 

Action Required: None.

REF 17541309 5/6/2025

Significa Benefits Services Electronic Claims and Remittance Connections No Longer Available

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

Payer Name: Significa Benefits Services
Claim and Remittance CPIDs: 5469, 7532
Payer-assigned Payer ID: 23250
Reason: Payer no longer in business. 

Action Required: None.

REF 17541310 5/6/2025

Payer Transmit Delay for multiple CPIDs

Due to a payer system issue, a delay occurred in some of the transmissions to the following payers since May 5, 2025.

Payers impacted:

  • CPID 1422 New York Medicaid
  • CPID 1500 New York Medicaid
  • CPID 1501 New York Medicaid Inpatient
  • CPID 1502 New York Medicaid Outpatient
  • CPID 2429 New York Medicaid
  • CPID 6540 New York Medicaid

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

This delay affected claims released to Optum since May 2, 2025. 9:00 p.m. CT.

Action Required: Be aware of the transmit delay above.

If you have any questions, please contact Customer Support and refer to Case Number 09490284.

REF 17541258  5/6/2025

Report Generation Delay for CPIDs 8677 and 7264 Quartz

A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted April 25, 2025-April 26, 2025.

Payer impacted:

  • CPID 7264 Quartz
  • CPID 8677 Quartz

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09488707.

REF 17522210  5/5/2025

Report Generation Delay for CPID 1733 Doctors Professional Services Consultants (DPSC)

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

Payer impacted: 

  • CPID 1733 Doctors Professional Services Consultants (DPSC)

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 09488444.

REF 17522108 5/5/2025

Report Generation Delay for CPID 7489 Wyoming Blue Cross Blue Shield

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

Payer impacted: 

  • CPID 7489 Wyoming 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.

If you have any questions, please contact Customer Support and refer to Case Number 09488355.

REF 17519308 5/5/2025

Report Generation Delay for CPIDs 4426 and 5547 Arizona Blue Cross Blue Shield

A payer is experiencing issues affecting Professional and Institutional report generation for some claims submitted since April 29, 2025.

Payer impacted: 

  • CPID 4426 Arizona Blue Cross Blue Shield
  • CPID 5547 Arizona Blue Cross Blue Shield

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 09488265.

REF 17518458 5/5/2025

Update: Report Generation Delay for CPIDs 5909 and 4743 Carelon Behavioral Health

Update: The payer intermediary has been unable to generate and deliver the reports for some claims submitted from March 28, 2025 through April 16, 2025.

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

Original notify sent April 10, 2025:

A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted since March 28, 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 09457355.

REF 17518358 5/5/2025

Electronic Restoration and Routing Change for CPIDs 2532 and 3741 Upper Peninsula Health Plan

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

Payer Name: Upper Peninsula Health Plan
Professional CPID: 3741
Institutional CPID: 2532
Payer-assigned Payer ID: 38337
Payer Remittance Enrollment Required: Yes
Remittance Fee: N/A

Enrollment Requirements: 

Remittance:

  • Payer enrollment for electronic remittance is required. 
    • Providers who moved their enrollment to another clearinghouse or have not received remittance will need to re-enroll to receive remittance for this payer from Optum (Change Healthcare).
    • 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 17518109 5/5/2025

Electronic Restoration and Routing Change for CPIDs 2532 and 3741 Upper Peninsula Health Plan

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

Payer Name: Upper Peninsula Health Plan
Professional CPID: 3741
Institutional CPID: 2532
Payer-assigned Payer ID: 38337
Line of Business Code (LOB): J53
Payer Remittance Enrollment Required: Yes

Enrollment Requirements: 

Remittance:

  • Payer enrollment for electronic remittance is required. 
    • Providers who moved their enrollment to another clearinghouse or have not received remittance will need to re-enroll to receive remittance for this payer from Optum (Change Healthcare).
    • 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 17518108 5/5/2025

Update: Payer Processing Issue for CPIDs 2872 and 5979 TRICARE East Region

Update: A resolution has been implemented and all claims were transmitted to the payer on May 2, 2025. There is a delay in processing payer reports, Optum is working diligently to resolve the issue to ensure delivery of reports on or after May 9, 2025.

We apologize for any inconvenience. 

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

Original notify sent April 28, 2025:

Due to a payer processing issue, some Professional and Institutional claims transmitted to the payer listed below since April 21, 2025 were not processed by the payer.

Payer(s) impacted: 

  • CPID 2872 TRICARE East Region
  • CPID 5979 TRICARE East Region

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

This delay affected claims released to Optum since 3 p.m. CT on April 21, 2025.

Action Required: Be aware of the processing issue above.

If you have any questions, please contact Customer Support and refer to Case Number 09479475.

REF 17511562 5/2/3035

Restoration and Electronic Routing Change for CPIDs 8732, 4007 Pokagon Health Services

Effective May 5, 2025, Optum will be restoring and changing electronic claims routing for the following payer:

Payer Name: Pokagon Health Services
Professional CPID: 8732
Edit Master: PE_T007
Institutional CPID: 4007
Edit Master: HE9T007
Payer-assigned Payer ID: 78535
Payer Claim Enrollment Required: No
Secondary Claims Accepted: Yes

Enrollment Requirements: 

Payer enrollment for electronic claims is not required.

Report Changes:

Payer does not generate reports currently.

Additional Changes:

Pokagon Health Services has recently issued new identification cards and assigned new member ID’s to their members.  Please ensure the new member ID’s are submitted on claims.

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

  • Edit Masters are not changing, no modification to the bridge routines needed. 
  • No Payer Alias changes are required. Payer name(s) and CPID(s) are not changing.
  • When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.
  • Ensure that the new member ID’s are submitted on claims

REF 17509911 5/2/2025

Restoration and Electronic Routing Change for CPIDs 8732, 4007 Pokagon Health Services

Effective May 5, 2025, Optum will be restoring and changing electronic claims routing for the following payer:

Payer Name: Pokagon Health Services
Professional CPID: 8732
Institutional CPID: 4007
Payer-assigned Payer ID: 78535
Payer Claim Enrollment Required: No
Secondary Claims Accepted: Yes
Claims Fee: N/A

Enrollment Requirements:
Payer enrollment for electronic claims is not required.

Report Changes:
Payer does not generate reports currently.

Additional Changes:
Pokagon Health Services has recently issued new identification cards and assigned new member ID’s to their members. Please ensure the new member ID’s are submitted on claims.

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.
  • Ensure that the new member ID’s are submitted on claims

REF 17509912  5/2/2025

Electronic Restoration and Routing Change for CPIDs 5044 and 8890 ClaimChoice

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

Payer Name: ClaimChoice

Professional CPID:  8890

Institutional CPID:  5044

Payer-assigned Payer ID: 83063

Payer Claim Enrollment Required: No

Secondary Claims Accepted: Yes

Claims Fee:  N/A

Enrollment Requirements: 

Claims:

  • Payer enrollment for electronic claims is not required.

Report Changes:

You may see some differences in the payer reports you 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 17509159 5/2/2025

Electronic Restoration and Routing Change for CPIDs 5044 and 8890 ClaimChoice

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

Payer Name: ClaimChoice

Professional CPID:  8890

Institutional CPID:  5044

Payer-assigned Payer ID: 83063

Payer Claim Enrollment Required: No

Secondary Claims Accepted: Yes

Enrollment Requirements: 

Claims:

  • Payer enrollment for electronic claims is not required.

Report Changes:

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

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

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

REF 17509158 5/2/2025

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

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

Updated Notification Sent on April 28, 2025
Update: This issue is now resolved for the following payers. All impacted ERAs have been reprocessed.

  • CPID 3429 United Healthcare
  • CPID 3550 United Healthcare
  • CPID 6485 Oxford Health Plans
  • CPID 6549 Oxford Health Plans

Please be aware there is still a delay for the below payer. Optum will continue to work with this payer.

  • CPID 4590 United Medical Resources
  • CPID 5402 United Medical Resources

Action Required: None.

Original notification sent April 24, 2025:
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 April 14, 2025 and deposit dates April 12, 2025-April 16, 2025:

  • CPID 3429 United Healthcare
  • CPID 3550 United Healthcare
  • CPID 4590 United Medical Resources
  • CPID 5402 United Medical Resources
  • CPID 6485 Oxford Health Plans
  • CPID 6549 Oxford Health Plans

Additional updates will be forwarded as more information becomes available.

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

If you have any questions, feel free to contact your Customer Support Team and refer to Case Number INC-000002574.

REF 17508612  5/2/2025

New Electronic Claims Connections Available on Revenue Performance Advisor

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

31406 – Provider Partners Health Plans of North Carolina
65433 – BoldAge PACE IN Evansville
65435 – BoldAge PACE KY Owensboro
91026 – AHS Plans
BDIUS – Best Doctors Insurance Services
CCH25 – Community Care Health (CCH)
COMG1 – Coachella Medical Group
R3476 – Life Armstrong DOS after 10/31/24
R3478 – Chinatown Service Center
RP133 – Oxbridge Health
TRUCO – TRU Community Care

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

31406 – Provider Partners Health Plans of North Carolina
65433 – BoldAge PACE IN Evansville
65435 – BoldAge PACE KY Owensboro
91026 – AHS Plans
BDIUS – Best Doctors Insurance Services
CCH25 – Community Care Health (CCH)
COMG1 – Coachella Medical Group
R3476 – Life Armstrong DOS after 10/31/24
R3478 – Chinatown Service Center
RP133 – Oxbridge Health\
TRUCO – TRU Community Care

REF 17507308  5/2/2025

New Electronic Remittance (ERA) Connections Available on RPA

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

15060 – IQVIA

DMG01 – Illinois Health Partners

SAGE1 – Sage

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 17507309 5/2/2025

New electronic eligibility connection available

Effective March 18, 2025, Optum is pleased to announce the availability of Real-time Eligibility Inquiry and Response 270/271, and Claim Status 276/277 transactions for the below payer:

Payer Name: ILLINOIS MEDICAID
Industry Payer ID: SKIL0
IMN Real Time ID: SKIL0
Exchange Real Time ID: ILCAID
CPID(s): 1563 / 2488
Optum iEDI Real Time ID: ILMCD
Payer Enrollment Required: No
Connection Type: X12

Search Options: 

Eligibility Subscriber

  • Member ID, First Name, Last Name, Date of Birth
  • SSN, First Name, Last Name
  • SSM, Sub Birth Date
  • First Name, Last Name, Date of Birth
  • Member ID 

Claim Status Inquiry subscriber

  1. Member id, first name, last name, date of birth 

      Optional additional elements:

      Payer claim number: Total submitted charges

Action Required by customer:

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

REF 17507108 5/2/2025

Electronic Medical Attachment Connection Reactivation

Effective May 2, 2025, Optum will be reactivating electronic medical attachments for the following payers:

Payer Name: HealthChoice Oklahoma

Payer ID: 71064

CPIDs: 7511, 7748

Transaction: Medical Attachments

 

Payer Name: HealthSCOPE

Payer ID: 40026

CPIDs: 8011, 9725

Transaction: Medical Attachments

 

Payer Name: Oklahoma Department of Corrections

Payer ID: 71065

CPIDs: 7513, 7750

Transaction: Medical Attachments

 

Payer Name: United Medical Resources

Payer ID: 39026

CPIDs: 4590, 5402

Transaction: Medical Attachments

Action Required: None.  Any transactions that were sent between April 23rd, 2025 and April 25th, 2025 prior to the connection being suspended will be forwarded to the payer for processing.

REF 17505662 5/2/2025

New Electronic Medical Attachment Connections Available

Optum has new electronic medical attachment connections available:

Payer Name: UnitedHealthcare
Professional CPID: 3429
Institutional CPID: 3550
Payer-assigned Payer ID: 87726
Accepted Attachment Type: Unsolicited
Payer Enrollment Required: No
Payer Location: National

Payer Name: UnitedHealthcare Arizona Physicians IPA
Professional CPID: 3432
Institutional CPID: 1585
Payer-assigned Payer ID: 03432
Accepted Attachment Type: Unsolicited
Payer Enrollment Required: No
Payer Location: Arizona

Payer Name: UnitedHealthcare Community Plan Tenncare
Professional CPID: 6442
Institutional CPID: 4523
Payer-assigned Payer ID: 95378
Accepted Attachment Type: Unsolicited
Payer Enrollment Required: No
Payer Location: Tennessee

Payer Name: UnitedHealthcare Community Plan of Kansas
Professional CPID: 6283
Institutional CPID: 5646
Payer-assigned Payer ID: 96385
Accepted Attachment Type: Unsolicited
Payer Enrollment Required: No
Payer Location: Kansas

Payer Name: UnitedHealthcare Community Plan of Michigan
Professional CPID: 1886
Institutional CPID: 8577
Payer-assigned Payer ID: 95467
Accepted Attachment Type: Unsolicited
Payer Enrollment Required: No
Payer Location: Michigan

Payer Name: UnitedHealthcare Community Plan of Missouri
Professional CPID: 1227
Institutional CPID: 4527
Payer-assigned Payer ID: 86050
Accepted Attachment Type: Unsolicited
Payer Enrollment Required: No
Payer Location: Missouri

Payer Name: UnitedHealthcare Community Plan of New Jersey Medicaid
Professional CPID: 2806
Institutional CPID: 7510
Payer-assigned Payer ID: 86047
Accepted Attachment Type: Unsolicited
Payer Enrollment Required: No
Payer Location: New Jersey

Payer Name: Oxford Health Plans
Professional CPID: 6485
Institutional CPID: 6549
Payer-assigned Payer ID: 06111
Accepted Attachment Type: Unsolicited
Payer Enrollment Required: No
Payer Locations: Connecticut, Delaware, New Jersey, New York, Pennsylvania, Rhode Island

Action Required:

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

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

REF 17505660  5/2/2025

New Electronic Medical Attachment Connections Available

Optum has new electronic medical attachment connections available:

Payer Name: UnitedHealthcare
Professional CPID: 3429
Institutional CPID: 3550
Payer-assigned Payer ID: 87726
Accepted Attachment Type: Unsolicited
Payer Enrollment Required: No
Payer Location: National

Payer Name: UnitedHealthcare Arizona Physicians IPA
Professional CPID: 3432
Institutional CPID: 1585
Payer-assigned Payer ID: 03432
Accepted Attachment Type: Unsolicited
Payer Enrollment Required: No
Payer Location: Arizona

Payer Name: UnitedHealthcare Community Plan Tenncare
Professional CPID: 6442
Institutional CPID: 4523
Payer-assigned Payer ID: 95378
Accepted Attachment Type: Unsolicited
Payer Enrollment Required: No
Payer Location: Tennessee

Payer Name: UnitedHealthcare Community Plan of Kansas
Professional CPID: 6283
Institutional CPID: 5646
Payer-assigned Payer ID: 96385
Accepted Attachment Type: Unsolicited
Payer Enrollment Required: No
Payer Location: Kansas

Payer Name: UnitedHealthcare Community Plan of Michigan
Professional CPID: 1886
Institutional CPID: 8577
Payer-assigned Payer ID: 95467
Accepted Attachment Type: Unsolicited
Payer Enrollment Required: No
Payer Location: Michigan

Payer Name: UnitedHealthcare Community Plan of Missouri
Professional CPID: 1227
Institutional CPID: 4527
Payer-assigned Payer ID: 86050
Accepted Attachment Type: Unsolicited
Payer Enrollment Required: No
Payer Location: Missouri

Payer Name: UnitedHealthcare Community Plan of New Jersey Medicaid
Professional CPID: 2806
Institutional CPID: 7510
Payer-assigned Payer ID: 86047
Accepted Attachment Type: Unsolicited
Payer Enrollment Required: No
Payer Location: New Jersey

Payer Name: Oxford Health Plans
Professional CPID: 6485
Institutional CPID: 6549
Payer-assigned Payer ID: 06111
Accepted Attachment Type: Unsolicited
Payer Enrollment Required: No
Payer Locations: Connecticut, Delaware, New Jersey, New York, Pennsylvania, Rhode Island

Action Required:

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

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

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

REF 17505658  5/2/2025

Update: Report Generation Delay for CPID 6802 Center for Elders Independence

Update: The payer has been unable to generate and deliver the reports for some claims submitted March 21, 2025-March 24, 2025.

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

Original notify sent April 16, 2025:
A payer is experiencing issues affecting Professional report generation for some claims submitted March 21, 2025-March 24, 2025.

Payer impacted:

  • CPID 6802 Center for Elders Independence

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 09082004.

REF 17505459  5/2/2025

Update: Report Generation Delay for CPID 5953 Healthy Blue South Carolina

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

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

Original notify sent April 29, 2025:
A payer is experiencing issues affecting Institutional report generation for some claims submitted April 21, 2025.

Payer impacted:

  • CPID 5953 Healthy Blue South Carolina

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 09480633.

REF 17505458  5/2/2025

Update: Report Generation Delay for CPID 7499 Sentara Health Plans

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

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

Original notify sent April 16, 2025:
A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted April 3, 2025.

Payer impacted:

  • CPID 7499 Sentara Health Plans

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09464322.

REF 17502358  5/2/2025

Update: Payer Transmit Delay for CPID 9280 Medequip

Update: A resolution has been implemented and the claims were transmitted to the payer May 1, 2025.

This delay affected claims released to Optum between April 15, 2025, 4:00 a.m.-May 1, 2025, 4:00 a.m. CT.

Action Required: Please be aware of the transmit delay.

Original Notify sent April 17, 2025:
Due to a payer system issue, a delay occurred in some of the transmissions to the following payer since April 16, 2025.

Payer impacted:

  • CPID 9280 Medequip

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

This delay affected claims released to Optum since April 15, 2025, 4:00 a.m. CT.

Action Required: Be aware of the transmit delay above.

If you have any questions, please contact Customer Support and refer to Case Number 09466382.

REF 17488108  5/1/2025

Report Generation Delay for CPID 2824 The Health Plan of West Virginia, Inc

A payer is experiencing issues affecting Professional report generation for some claims submitted since April 20, 2025.

Payer impacted:

  • CPID 2824 The Health Plan of West Virginia, Inc

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 09484936.

REF 17487857  5/1/2025

Edit Master for CPIDs 5071 and 9117 American Health Advantage of Texas

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

Payer Name: American Health Advantage of Texas
Professional CPID: 9117
Current Edit Master: PE_T007
New Edit Master: PE_B800
Institutional CPID: 5071
Current Edit Master: HE9T007
New Edit Master: HE9B801
Payer-assigned Payer ID: 31155

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

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

REF 17487709  5/1/2025

Update: Report Generation Delay for CPID 7736 Direct Care Administrators

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

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

Original notify sent April 7, 2025:
A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted March 26, 2025.

Payer impacted:

  • CPID 7736 Direct Care Administrators

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09452053.

REF 17487008  5/1/2025

Payer Processing Issue for CPIDs 4098 and 8841 Truli for Health

Due to a processing issue, Professional and Institutional claims transmitted to the payer listed below April 1, 2025-April 17, 2025 were not processed by the payer.

Payer impacted:

  • CPID 4098 Truli for Health
  • CPID 8841 Truli for Health

A resolution has been implemented and the claims were retransmitted to the payer May 1, 2025.

This delay affected claims released to Optum March 31, 2025, 10:00 p.m.-April 17, 2025, 10:00 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 09483225.

REF 17485758  5/1/2025

Older Payer Updates

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

GET OLDER UPDATES
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