November 2024
November 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
Resolved: Assurance Reimbursement Management Performance Issues
This issue has been resolved.
Action Required: none
Original Notification Sent on November 26, 2024:
Assurance Reimbursement Management is experiencing an issue with intermittent performance.
This may result in:
- Error Message: Access to IDX.linkhealth.com was denied
- Inability to log in
Optum is working to resolve this issue. We will notify you as soon as additional information becomes available.
We apologize for any inconvenience.
Action Required: None.
REF 828056 11/27/2024
Delay in Electronic Remittance Advice (ERA) for Multiple CPIDs
Due to a processing issue, there has been a delay in Professional and Institutional Electronic Remittance Advice (ERA) for the following payers beginning on Oct. 15, 2024 to present:
- CPID 1913 Medicare Plus Blue of MI(MAP)
- CPID 2287 Medicare Plus Blue of MI(MAP)
- CPID 3514 Michigan Blue Cross Blue Shield
- CPID 3531 Michigan Blue Cross Blue Shield Federal Employee Program
- CPID 3532 Michigan Blue Care Network
- CPID 1421 Michigan Blue Cross Blue Shield
- CPID 2426 Michigan Blue Care Network
Additional updates will be forwarded as more information becomes available.
Action Required: Please be aware of a delay in the delivery of ERA for the dates above.
If you have any questions, feel free to contact your Customer Support Team and refer to case 09269679.
REF 828050 11/27/2024
New Electronic Claims Connections Available - Assurance Reimbursement Management
This message is intended for Assurance Reimbursement Management customers.
Optum has new electronic claims connections available:
Payer Name: Auxiant
Institutional CPID: 8059
Professional CPID: 1121
Payer-assigned Payer ID: AUX01
Payer Enrollment Required: No
Secondary Claims Accepted: Yes
Payer Location: Iowa, Wisconsin
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 827553 11/26/2024
New Electronic Claims Connections Available - Assurance EDI
This message is intended for Assurance EDI customers.
Optum has new electronic claims connections available:
Payer Name: Auxiant
Institutional CPID: 8059
Professional CPID: 1121
Payer-assigned Payer ID: AUX01
Payer Enrollment Required: No
Secondary Claims Accepted: Yes
Payer Location: Iowa, Wisconsin
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 827552 11/26/2024
Electronic Claims Connection Suspended
This message is intended for Assurance EDI and Assurance Reimbursement Management customers.
Effective immediately, the payer listed below has been temporarily suspended at Optum for claims processing, and was removed from the payer list.
Payer Name: Peak Pace Solutions
CPIDs: 5663
Payer ID: 27034
Action Required: Please refrain from submitting claims until further notice.
REF 827250 11/26/2024
Claim Processing Suspended for CPID 2098 Physicians Medical Group of San Jose
This message is intended for Assurance EDI and Assurance Reimbursement Management customers.
Effective immediately, the payer listed below has been temporarily suspended at Optum for claims, and was removed from the payer list.
Payer Name: Physicians Medical Group of San Jose
CPID: 2098
Payer ID: EXC01
Reason: Payer unavailable electronically
Action Required: Please refrain from submitting claims until further notice.
REF 827645 11/26/2024
New Electronic Claims Connections Available
This message intended for Assurance Reimbursement Management customers.
Optum has new electronic claims connections available:
Payer Name: US Family Health Plan - NW Region
Institutional CPID: 8071
Professional CPID: 2868
Payer-assigned Payer ID: 87347
Payer Enrollment Required: No
Secondary Claims Accepted: No
Payer Location: California, Idaho, Oregon, Washington
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 827430 11/26/2024
New Electronic Claims Connections Available
This message is intended for Assurance EDI customers.
Optum has new electronic claims connections available:
Payer Name: US Family Health Plan - NW Region
Institutional CPID: 8071
Professional CPID: 2868
Payer-assigned Payer ID: 87347
Payer Enrollment Required: No
Secondary Claims Accepted: No
Payer Location: California, Idaho, Oregon, Washington
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 827429 11/26/2024
Update: Report Generation Delay for CPIDs 1682 and 2830 CarePlus Health Plans
Update: The payer intermediary has been unable to generate and deliver the reports for some claims submitted on Oct. 25, 2024 and Oct. 26, 2024.
Action Required: Please resubmit claims if payment has not been received.
Original notify sent Nov. 13, 2024:
A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted since Oct. 25, 2024.
Payer impacted:
- CPID 1682 CarePlus Health Plans
- CPID 2830 CarePlus Health Plans
Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.
Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.
REF 817907 826166 11/26/2024
New Electronic Claims Connections Available
Optum has new electronic claims connections available:
Assurance EDI:
Payer Name: Longevity Health Plan of Colorado
Institutional CPID: 8073
Professional CPID: 2863
Payer-assigned Payer ID: LCO01
Payer Enrollment Required: No
Secondary Claims Accepted: No
Payer Location: Colorado
Claims Fee: $0.10
Assurance Reimbursement Management:
Payer Name: Longevity Health Plan of Colorado
Institutional CPID: 8073
Professional CPID: 2863
Payer-assigned Payer ID: LCO01
Payer Enrollment Required: No
Secondary Claims Accepted: No
Payer Location: Colorado
Claims Fee: N/A
Action Required:
- Add the payers to your system to begin using the new payer connection.
- When a payer requires enrollment, forms must be submitted and approved to begin submitting transactions.
Please note: We are providing you with a list of new electronic connections, please review and choose payers that are appropriate for your business.
REF 827450, 827451 11/26/2024
Update: Report generation delay for CPIDs 3678 and 4279 El Paso Health-STAR
Update: The payer intermediary has been unable to generate and deliver the reports for some claims submitted on Oct. 25, 2024.
Action Required: Please resubmit claims if payment has not been received.
Original notify sent Nov. 11, 2024:
A payer intermediary is experiencing issues affecting institutional and professional report generation for some claims submitted on Oct. 25, 2024.
Payer impacted:
- CPID 3678 El Paso Health-STAR
- CPID 4279 El Paso Health-STAR
Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.
Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.
REF 826165 11/26/2024
Update: Report generation delay for multiple CPIDs
Update: The payer intermediary has been unable to generate and deliver the reports for some claims submitted on Oct. 25, 2024.
Action Required: Please resubmit claims if payment has not been received.
Original notify sent Nov. 11, 2024:
A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted on Oct. 25, 2024.
Payers impacted:
- CPID 1529 Utah Regence Blue Cross Blue Shield
- CPID 2412 Utah Regence Blue Cross Blue Shield
- CPID 1530 Utah Regence Blue Cross Blue Shield Federal Employee Program
- CPID 2788 Utah Regence Blue Cross Blue Shield Federal Employee Program
Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.
Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.
REF 826160 11/26/2024
Update: Report Generation Delay for CPIDs 3540 and 7426 Idaho Regence Blue Shield
Update: The payer intermediary has been unable to generate and deliver the reports for some claims submitted Oct. 25, 2024 and Nov. 5, 2024.
Action Required: Please resubmit claims if payment has not been received.
Original notify REF 814953 sent Nov. 11, 2024:
A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted since Oct. 25, 2024.
Payer impacted:
- CPID 3540 Idaho Regence Blue Shield
- CPID 7426 Idaho Regence Blue Shield
Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.
Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.
REF 826161 11/26/2024
Update: Report Generation Delay for CPIDs 2920 and 1723 HealthCare Partners IPA
The payer intermediary has been unable to generate and deliver the reports for some claims submitted on Oct. 25, 2024.
Action Required: Please resubmit claims if payment has not been received.
Original message sent Nov. 8, 2024:
A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted on Oct. 25, 2024.
Payer impacted:
- CPID 2920 HealthCare Partners IPA
- CPID 1723 HealthCare Partners IPA
Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.
Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.
REF 826159 11/26/2024
New Electronic Claims Connections Available
This message is intended for Assurance EDI and Assurance Reimbursement Management customers.
Optum has new electronic claims connections available:
Payer Name: Audionet - National Elevator
Professional CPID: 2861
Payer-assigned Payer ID: AUDIO
Payer Enrollment Required: No
Secondary Claims Accepted: Yes
Payer Location: National
Claims Fee: N/A
Action Required:
- Add the payers to your system to begin using the new payer connection.
- When a payer requires enrollment, forms must be submitted and approved to begin submitting transactions.
Please note: We are providing you with a list of new electronic connections, please review and choose payers that are appropriate for your business.
REF 826430 11/25/2024
Luminare Health Internal Electronic Remittance Connection No Longer Available - Assurance Reimbursement Management
This message is intended for Assurance Reimbursement Management customers.
Effective immediately, the payer listed below will no longer be available at Optum for remittance processing.
Payer Name: Luminare Health Internal
Claim CPIDs: 3983, 4771
Remittance LOB: H5K
Reason: Payer does not offer an electronic connection.
Action Required: None.
REF 826750 11/25/2024
Luminare Health Internal Electronic Remittance Connection No Longer Available - Assurance EDI
This message is intended for Assurance EDI customers.
Effective immediately, the payer listed below will no longer be available at Optum for remittance processing.
Payer Name: Luminare Health Internal
Remittance CPIDs: 3983, 4771
Reason: Payer does not offer an electronic connection.
Action Required: None.
REF 826157 11/25/2024
Electronic Claims Connection Suspended
This message is intended for Assurance EDI and Assurance Reimbursement Management customers.
Effective immediately, the payer listed below has/have been temporarily suspended at Optum for claims processing and removed from the payer list.
Payer Name: Team Choice PNS
CPIDs: 5021, 8869
Payer ID: 75133
Action Required: Please refrain from submitting claims until further notice.
REF 826150 11/25/2024
New Electronic Claims Connections Available
This message is intended for Assurance Reimbursement Management customers.
Optum has new electronic claims connections available:
Payer Name: BlueCross BlueShield of South Carolina Medicare Advantage
Institutional CPID: 7997
Professional CPID: 2857
Payer-assigned Payer ID: 00C63
Payer Enrollment Required: No
Secondary Claims Accepted: No
Payer Location: South Carolina
Claims Fee: N/A
Action Required:
- Add the payers to your system to begin using the new payer connection.
- When a payer requires enrollment, forms must be submitted and approved to begin submitting transactions.
Please note: We are providing you with a list of new electronic connections, please review and choose payers that are appropriate for your business.
REF 826155 11/25/2024
New Electronic Claims Connections Available
This message is intended for Assurance EDI (Exchange) customers.
Optum has new electronic claims connections available:
Payer Name: BlueCross BlueShield of South Carolina Medicare Advantage
Institutional CPID: 7997
Professional CPID: 2857
Payer-assigned Payer ID: 00C63
Payer Enrollment Required: No
Secondary Claims Accepted: No
Payer Location: South Carolina
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 826156 11/25/2024
Report Generation Delay for multiple CPIDs
A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted since Nov. 15, 2024.
Payers impacted:
- CPID 3514 Michigan Blue Cross Blue Shield
- CPID 1421 Michigan Blue Cross Blue Shield
- CPID 3531 Michigan Blue Cross Blue Shield Federal Employee Program
Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.
Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.
REF 827047 11/25/2024
Report Generation Delay for CPID 1258 Global Healthcare Alliance
A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted on Nov. 15, 2024.
Payer impacted:
- CPID 1258 Global Healthcare Alliance
The payer intermediary has been unable to generate and deliver the reports.
Action Required: None. Please resubmit claims if payment has not been received.
REF 826701 11/25/2024
Report Generation Delay for CPID 1214 AgeRight Advantage Health Plan
A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted Nov. 15, 2024.
Payer impacted:
- CPID 1214 AgeRight Advantage Health Plan
Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.
Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.
REF 827048 11/25/2024
Remittance Reactivation for CPIDs 9664, 7288 Hamaspik Choice
Optum recently restored electronic remittance connectivity for the following payer:
Payer Name: Hamaspik Choice
Professional CPID: 7288
Institutional CPID: 9664
Industry Payer ID: 47738
Remittance Enrollment Requirements:
- Payer enrollment for electronic remittance is required:
- Providers currently receiving electronic remittance for this payer do not need to complete a new enrollment form.
- 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.
REF826600 11/25/2024
Report Generation Delay for CPID 2979 Prominence Administrative Services
A payer intermediary is experiencing issues affecting Institutional report generation for some claims submitted since Nov. 11, 2024.
Payer impacted:
- CPID 2979 Prominence Administrative Services
Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.
Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.
REF 826700 11/25/2024
New Electronic Claims Connections Available
Optum has new electronic claims connections available:
Assurance EDI:
Payer Name: Access Behavioral Health
Institutional CPID: 7979
Professional CPID: 2848
Payer-assigned Payer ID: ABH02
Payer Enrollment Required: No
Secondary Claims Accepted: No
Payer Location: Florida
Claims Fee: $0.10
Assurance Reimbursement Management:
Payer Name: Access Behavioral Health
Institutional CPID: 7979
Professional CPID: 2848
Payer-assigned Payer ID: ABH02
Payer Enrollment Required: No
Secondary Claims Accepted: No
Payer Location: Florida
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 826153 826154 11/25/2024
New Electronic Professional Claim Connections Available on RPA
This message is intended for Revenue Performance Advisor (RPA) customers.
Professional claim transactions have recently been added for the following payers:
13123 – Medigold PPO
34009 – Carelon Anthem Home Health
36117 – Guarantee Trust Life
41204 – TCC BASIC PLUS
41822 – Dean Health Plan by Medica DOS After 12312023
50322 – Special Agents Mutual Benefit Association (SAMBA) Teledoc only
54138 – VHN
75309 – Pacific Southwest Administrators
76253 – UCS Benveo
83309 – FenyxHealth
86070 – IMX Easy
87892 – UTMB Health Plans, Inc
90210 – Kempton Group Administrators (USC)
93235 – Electrical Workers Insurance Fund Local 5800
95386 – CenCal Health
98480 – Covet Health
ARMC1 – Arrowhead Regional Medical Center
AXM01 – Axminister Medical Group
A6864– Doctors Professional Services Consultants (DPSC)
A7637 – Snedeker Risk Management
CX084 – American Benefit Corporation
CX100 – Southwest Service Administrators
CXJAS – Jensen Administrative Services, Inc.
EAP20 – Aetna Employee Assistance Program
IECCA – IEHP Covered (Covered California)
MC721 – Blue Cross Community Centennial
MDADV – MDwise Medicare Advantage
MHC01 – Mountain Health CO-OP
MPM62 – Emanate Health IPA
PREPD – My Patient Prepaid
PSN22 – Paysign
RP118 – Highmark Health Options of West Virginia
SAGE1 – Sage
SB911 – Utah Regence Blue Cross Blue Shield FEP
TVMG1 – Tri-Valley Medical Group
VNSPC – Volunteers of America National Services
Submitter Action: Add the payers to your system to begin using the new payer connection.
REF 826451 11/25/2024
Electronic Routing Change for CPIDs 1932 and 7847 Northeast Medical Services (NEMS)
This message intended for Assurance EDI customers.
Effective immediately, Optum will be changing electronic claims routing for the following payer:
Payer Name: Northeast Medical Services (NEMS)
Professional CPID: 7847
Institutional CPID: 1932
Current Payer-assigned Payer ID: NEMS1
New Payer-assigned Payer ID: NEMS
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 826152 11/25/2024
Electronic Routing Change for CPIDs 1932 and 7847 Northeast Medical Services (NEMS)
This message intended for Assurance Reimbursement Management customers.
Effective immediately, Optum will be reactivating and changing electronic claims routing for the following payer:
Payer Name: Northeast Medical Services (NEMS)
Professional CPID: 7847
Current Edit Master: PE_O007
New Edit Master: PE_T007
Institutional CPID: 1932
Current Edit Master: HE9O007
New Edit Master: HE9T007
Current Payer-assigned Payer ID: NEMS1
New Payer-assigned Payer ID: NEMS
Enrollment Requirements:
Claims:
- Payer enrollment for electronic claims is not required.
Report Changes:
- You may see some differences in the payer reports you are receiving.
Action Required: Please make the following changes to accommodate the routing change:
- Revalidate unreleased claims to edit correctly under new edit master.
- Modify any bridge routines based on edit masters.
- No Payer Alias changes are required. Payer name and CPIDs are not changing.
- When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.
REF 826151 11/25/2024
Report Generation Delay for multiple CPIDs
Update: The payer intermediary has been unable to generate and deliver the reports for some claims submitted on Oct. 25, 2024.
Action Required: Please resubmit claims if payment has not been received.
Original notify sent Nov. 8, 2024:
A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted on Oct. 25, 2024.
Payer impacted:
- CPID 1510 Iowa Wellmark Blue Cross Blue Shield
- CPID 1404 Iowa Wellmark Blue Cross Blue Shield
- CPID 6672 Iowa Wellmark Blue Cross Blue Shield Crossover
- CPID 6733 Iowa Wellmark Blue Cross Blue Shield Crossover
Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.
Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.
REF 814162 / 826203 11/25/2024
Remittance Reactivation for CPID 6130 Premier Eye Care
Optum recently restored electronic remittance connectivity for the following payer:
Payer Name: Premier Eye Care
Professional CPID: 6130
Industry Payer ID: 65054
Remittance Enrollment Requirements:
- Payer enrollment for electronic remittance is required:
- Providers currently receiving electronic remittance for this payer must complete a new enrollment form.
- 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 826500 11/25/2024
New Electronic Institutional Claim Connections Available on RPA
This message is intended for Revenue Performance Advisor (RPA) customers.
Institutional claim transactions have recently been added for the following payers:
10311 – Rural Health Medicare
13123 – Medigold PPO
36117 – Guarantee Trust Life
37330 – University of Michigan Health Plan
3833C – McLaren Health Plan Medicaid
3833R – McLaren Advantage SNP
41204 – TCC BASIC PLUS
41822 – Dean Health Plan by Medica DOS After 12312023
54138 – VHN
75309 – Pacific Southwest Administrators
76253 – UCS Benveo
88082 – Saint Mary's Health Plan (Encounters)
83309 – FenyxHealth
87892 – UTMB Health Plans, Inc
90210 – Kempton Group Administrators (USC)
93235 – Electrical Workers Insurance Fund Local 5800
95386 – CenCal Health
98480 – Covet Health
ARMC1 – Arrowhead Regional Medical Center
A7637 – Snedeker Risk Management
CX084 – American Benefit Corporation
CX100 – Southwest Service Administrators
CXJAS – Jensen Administrative Services, Inc.
IECCA – IEHP Covered (Covered California)
MC721 – Blue Cross Community Centennial
MDADV – MDwise Medicare Advantage
MHC01 – Mountain Health CO-OP
MPM32 – AlphaCare Medical Group
MPM62 – Emanate Health IPA
PREPD – My Patient Prepaid
PSN22 – Paysign
RP118 – Highmark Health Options of West Virginia
SAGE1 – Sage
TVMG1 – Tri-Valley Medical Group
VNSPC – Volunteers of America National Services
Submitter Action:
Add the payers to your system to begin using the new payer connection.
REF 826450 11/25/2024
New Payer Edit Multiple CPIDs
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 edits Dec. 3, 2024.
- INM109B9DZ: INVALID SUBSCRIBER MEMBER ID- When entered, the Active Subscriber Member ID must begin with a valid, two character State Code prefix. LOOP 2010BA NM109
- PNM109E0DZ: INVALID SUBSCRIBER MEMBER ID- When entered, the Active Subscriber Member ID must begin with a valid, two character State Code prefix. LOOP 2010BA NM109
Edit applies to:
- CPID 5681 CENTURION MANAGED CARE
- CPID 6700 CENTURION MANAGED CARE
Action Required: Please be aware of updated edit requirements.
REF 826350 11/25/2024
Resolved: Report Generation Delay for CPID 7435 FirstCare Health Plans
The payer intermediary has been unable to generate and deliver the reports for some claims submitted on Oct. 25, 2024.
Action Required: Please resubmit claims if payment has not been received.
Original message sent Nov. 8, 2024:
A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted on Oct. 25, 2024.
Payer impacted:
- CPID 7435 FirstCare Health Plans
Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.
Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.
REF 826201 11/25/2024
A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted on Oct. 25, 2024.
Payer impacted:
CPID 7435 FirstCare Health Plans
Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.
Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.
REF 826201 11/25/2024
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 on Oct. 25, 2024 and Nov. 5, 2024.
Action Required: Please resubmit claims if payment has not been received.
Original notify sent Nov. 7, 2024:
A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted since Oct. 24, 2024.
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.
REF 826100 11/25/2024
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 Oct. 25, 2024 and Nov. 5, 2024.
Action Required: Please resubmit claims if payment has not been received.
Original notify REF 814157 sent Nov. 8, 2024:
A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted since Oct. 24, 2024.
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.
REF 826200 11/25/2024
Report Generation Delay for CPIDs 8918 and 4445 Insurance Management Services TX
Update: The payer intermediary has been unable to generate and deliver the reports for some claims submitted on Oct. 24, 2024 and Oct. 25, 2024.
Action Required: Please resubmit claims if payment has not been received.
Original notify sent Nov. 7, 2024:
A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted since Oct. 24, 2024.
Payer impacted:
- CPID 8918 Insurance Management Services TX
- CPID 4445 Insurance Management Services TX
Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.
Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.
REF 812900 / 825255 11/25/2024
New Electronic Remittance Connections Available
This message is intended for Assurance EDI customers.
Optum has new electronic remittance connections available:
Payer Name: TRPN Direct Pay, Inc.
Professional CPID: 2860
Payer-assigned Payer ID: TRDP1
Payer Enrollment Required: Yes
Remittance Fee: N/A
Payer Location: National
Action Required:
- Add the payers to your system to begin using the new payer connection.
- Enrollment forms must be submitted and approved to begin receiving electronic remittance through Optum.
REF 825656 11/22/2024
New Electronic Remittance Connections Available
This message is intended for Assurance EDI and Assurance Reimbursement Management customers.
Optum has new electronic remittance connections available:
Payer Name: Care To Care
Institutional CPID: 7671
Professional CPID: 7114
Payer-assigned Payer ID: 41222
Line of Business (LOB) Code: N32
Payer Enrollment Required: Yes
Remittance Fee: N/A
Payer Location: New York
Action Required:
- Add the payers to your system to begin using the new payer connection.
- Enrollment forms must be submitted and approved to begin receiving electronic remittance through Optum.
REF 825150 11/22/2024
Report Generation Delay for CPID 3044 University of Michigan Health Medicare
This message is intended for Assurance EDI and Assurance Reimbursement Management customers.
A payer is experiencing issues affecting Institutional report generation for some claims submitted on Nov. 4, 2024.
Payer impacted:
- CPID 3044 University of Michigan Health Medicare
Optum is working diligently with the payer to resolve the issue and ensure reports are received.
Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.
REF 825105 11/22/2024
New Electronic Remittance Connections Available
Optum has new electronic remittance connections available:
Payer Name: TRPN Direct Pay, Inc.
Professional CPID: 2860
Payer-assigned Payer ID: TRDP1
Line of Business (LOB) Code: N47
Payer Enrollment Required: Yes
Remittance Fee: N/A
Payer Location: National
Action Required:
- Add the payers to your system to begin using the new payer connection.
- Enrollment forms must be submitted and approved to begin receiving electronic remittance through Optum.
REF 825655 11/22/2024
Report Generation Delay for multiple CPIDs
The payers listed below are experiencing issues affecting professional and institutional report generation for some claims submitted since Nov. 18, 2024.
Payers impacted:
- CPID 7045 AmeriHealth Caritas Ohio
- CPID 9428 AmeriHealth Caritas Ohio
- CPID 7071 Anthem Ohio Medicaid
- CPID 9461 Anthem Ohio Medicaid
- CPID 7068 Buckeye Ohio Medicaid
- CPID 9457 Buckeye Ohio Medicaid
- CPID 7070 CareSource Ohio Medicaid
- CPID 9458 CareSource Ohio Medicaid
- CPID 9708 CareSource Ohio Medicaid Vision
- CPID 7073 Humana Ohio Medicaid
- CPID 9463 Humana Ohio Medicaid
- CPID 9462 Molina Ohio Medicaid
- CPID 9455 Molina Ohio Medicaid Vision
- CPID 2481 Ohio Medicaid
- CPID 3509 Ohio Medicaid
- CPID 9465 UnitedHealthcare Ohio Medicaid
Optum is working diligently with the payers to resolve the issue and ensure reports are received.
Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.
REF 825400 11/22/2024
Report Generation Delay for multiple CPIDs
A payer intermediary is experiencing issues affecting professional report generation for some claims submitted on Nov. 15, 2024.
Payers impacted:
- CPID 2438 Tufts Health Plan
- CPID 5475 Tufts Health Public Plans
Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.
Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.
REF 825104 11/22/2024
New Electronic Claims Connections Available
Optum has new electronic claims connections available:
Payer Name: MemorialCare Select Health Plan Encounters
Institutional CPID: 7940
Professional CPID: 2768
Payer-assigned Payer ID: E4618
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 824722 11/22/2024
Report Generation Delay for CPID 2165 District of Columbia Metropolitan Area (DCMA) Medicare
A payer is experiencing issues affecting Institutional report generation for some claims submitted Nov. 7, 2024-Nov. 8, 2024.
Payer impacted:
- CPID 2165 District of Columbia Metropolitan Area (DCMA) Medicare
Optum is working diligently with the payer to resolve the issue and ensure reports are received.
Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.
REF 825106 11/22/2024
New Electronic Remittance Connections Available on Revenue Performance Advisor
ERA (Remittance) transactions have recently been added for the following payers:
- 13123 – Medigold PPO
- 74147 – USAA
- MHC01 – Mountain Health CO-OP
- RP128 – Promise Health Plan
ERA enrollment/set up is required for all ERA transactions on Revenue Performance Advisor. You can access the payer enrollment intake form on the Revenue Performance Advisor (RPA) restoration resources page in the User Community.
If you’re in evenue Performance Advisor, you can also open the evenue Performance Advisor Resource Center, click the Quick Reference Guides tab, and then click the Billing Provider Enrollment link to find the payer enrollment intake form.
REF 824508 11/22/2024
Update: Payer Transmit Delay for CPID 5599 Capital Blue Cross
Update: A resolution has been implemented and the claims were transmitted to the payer on Nov. 19, 2024.
Action Required: Please be aware of the transmit delay.
Update sent Nov. 19, 2024: Due to a payer system issue, a delay occurred in some of the transmissions to the following payer since Nov. 18, 2024.
Payer impacted:
- CPID 5599 Capital Blue Cross
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 3 p.m. CT on Nov. 15, 2024.
Action Required: Be aware of the transmit delay above.
REF 824714 11/21/2024
Payer Change for CPIDs 7897, 1069 Alexian Brothers Community Service of Tennessee
This message is intended for Assurance EDI (exchange) customers.
Effective immediately, claims currently exchanged with the following payer must use different CPIDs.
Payer Name: Alexian Brothers Community Service of Tennessee
Professional CPID: 7897
Institutional CPID: 1069
Payer-assigned Payer ID: 44423
Claims must begin using the following new payer connection:
Payer Name: Alexian PACE
Professional CPID: 2842
Institutional CPID: 7968
Payer-assigned Payer ID: R3471
Claim Fee: N/A
Claims:
Payer enrollment for electronic claims is not required.
Effective December 2, 2024, Alexian Brothers Community Service of Tennessee - Payer ID 44423 will no longer be available at Optum for claims.
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 824950 11/21/2024
Update: Payer Transmit Delay for multiple CPIDs
Update: A resolution has been implemented and the claims were transmitted to the payers Nov. 15, 2024.
Action Required: Please be aware of the transmit delay.
Original Notify REF 821000 sent Nov. 15, 2024:
Due to a payer system issue, a delay occurred in some of the transmissions to the following payers Nov. 14, 2024.
Payers impacted:
- CPID 1483 New Jersey Medicaid
- CPID 5505 New Jersey Medicaid
- CPID 5575 New Jersey Charity Care Inpatient
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 Nov. 13, 2024, 3:00 p.m. CT.
Action Required: Be aware of the transmit delay above.
REF 824715 11/20/2024
Report Generation Delay for multiple CPIDs
Due to a payer intermediary processing issue, some Professional claims transmitted to the payers listed below Nov. 21, 2024 were not processed by the payers.
Payers impacted:
- 1214 AgeRight Advantage Health Plan
- 9267 Align Senior Care of Florida
- 8454 Align Senior Care of Michigan
- 4101 AllCare Advantage
- 2113 Allcare Health Plan
- 8714 Allstate - Except New Jersey
- 1764 Ambetter From Absolute Total Care
- 9278 Ambetter from Nebraska Total Care
- 9431 Ambetter from WellCare of Kentucky
- 9775 Ambetter of Alabama
- 9433 Ambetter of Oklahoma
- 2138 American Family Insurance
- 9429 American Health Advantage of Idaho & Utah
- 9142 American Health Advantage of Mississippi
- 7280 American Health Advantage of Missouri
- 9117 American Health Advantage of Texas
- 4468 Americas Choice Healthplan
- 1741 Amerigroup
- 1412 Anthem Blue Cross and Blue Shield - Indiana
- 2421 Anthem Blue Cross and Blue Shield - Kentucky
- 1413 Anthem Blue Cross and Blue Shield (Virginia)
- 2418 Anthem Blue Cross and Blue Shield of Ohio
- 4437 Anthem Blue Cross Blue Shield New York
- 8749 Anthem MaineHealth
- 6220 Arizona Priority Care Plus
- 4477 Asuris Northwest Medadvantage Regence
- 4881 Asuris Northwest Regence
- 7272 Axminster Medical Group
- 3845 Banner Health Network
- 8482 Benefit Plan Administrators - Roanoke, VA
- 1415 Blue Cross Blue Shield of Colorado
- 1407 Blue Cross Blue Shield of Georgia
- 7496 Blue Cross Blue Shield of Nevada
- 1169 Blue Cross Blue Shield of Western New York Medicaid/CHP
- 1401 Blue Cross Blue Shield of Wisconsin
- 1243 Blue Cross Community Centennial
- 1167 Blue Cross Medicare Advantage PPO/HMO
- 9162 Blue Medicare Advantage
- 4110 Bollinger Inc
- 6165 Bridgeview
- 1750 Brown & Toland Physicians
- 4246 Capital Health Plan
- 2810 Capitol Administrators
- 8146 Care N Care Insurance Co.
- 2289 Care1st Health Plan of Arizona Medicaid DOS after 11/30/2022
- 9759 Care1st Health Plan of Arizona Medicaid DOS before 12/01/2022
- 9762 Care1st Health Plan of Arizona Medicare
- 4743 Carelon Behavioral Health
- 6127 Carelon Behavioral Health, MBHP
- 3293 Carelon Health
- 2830 CarePlus Health Plans
- 9722 CareSource North Carolina
- 1194 CareSource of Georgia
- 7143 CareSource of Indiana
- 3826 CareSource of Ohio
- 7263 CareSource of West Virginia
- 9226 CareSource PASSE of Arkansas
- 6777 Centers Plan for Healthy Living
- 6700 Centurion Managed Care
- 7275 Citrus Valley Physicians Group
- 8123 Clear Health Alliance
- 7416 Colorado Anthem Blue Cross Blue Shield HMO
- 7763 Columbine Health Plan
- 8834 Commonwealth Care Alliance DOS after 3/31/2023
- 8477 Community Care Plan
- 2160 Community Care Plan (Commercial)
- 6865 Community Care Plan (Medicaid)
- 1420 Connecticut Anthem Blue Cross Blue Shield
- 2427 Connecticut BlueCare Family Plan
- 3419 Connecticut Federal Employee Health Benefits
- 3420 Connecticut Medicare Blue (Risk)
- 6795 Contra Costa Health Plan
- 5862 CorrectCare Integrated Health
- 7292 CorrectCare Integrated Health- Louisiana
- 6241 Correctional Health Partners
- 7738 CountyCare Health Plan
- 9747 Delaware First Health
- 2433 Denver Health and Hospital Authority
- 1232 Denver Health Medical Plan, Inc. - Medicare Choice
- 8135 Doctors HealthCare Plans
- 1733 Doctors Professional Services Consultants (DPSC)
- 1119 Easy Choice Health Plan of California
- 7787 El Paso First Health Plans - Health Care Options (HCO)
- 4289 El Paso Health-CHIP
- 4279 El Paso Health-STAR
- 5483 Employee Benefit Management Services (EBMS)
- 1834 Employee Plans
- 8137 Empower Healthcare Solutions
- 1795 Envolve Benefit Options
- 5238 Evolent Specialty Cardiology
- 3792 Fidelis Care
- 2875 First Health Network (Coventry Health Care National Network)
- 7435 FirstCare Health Plans
- 1414 Florida Blue Cross Blue Shield
- 3417 Florida Blue Cross Blue Shield Health Options HMO
- 9128 Florida Blue Medicare
- 9417 Florida Complete Care
- 2150 Florida Health Care Plans
- 5440 Fox Valley Medicine
- 6851 Friday Health Plans
- 8189 Gemcare IPA
- 8879 Georgia Health Advantage
- 1258 Global Healthcare Alliance
- 2720 GlobalCare
- 5853 GMS Insurance
- 9766 Gold Kidney Health Plan
- 1772 HAP CareSource
- 1797 HAP CareSource Michigan Dual Medicare/Medicaid
- 8716 Health Choice Generations Utah
- 5243 Healthcare Management Administrators
- 1723 HealthCare Partners IPA
- 4448 HealthLink PPO
- 8750 Healthy Blue Dual Advantage Louisiana
- 7760 Healthy Blue Louisiana
- 8867 Healthy Blue Missouri
- 8870 Healthy Blue Nebraska
- 9133 Healthy Blue North Carolina
- 6272 Hispanic Physicians IPA (Encounters Only)
- 7715 Hopkins Health Advantage
- 6259 Humana - CareSource of Kentucky
- 7426 Idaho Regence Blue Shield
- 1405 Illinois Blue Cross Blue Shield
- 2234 Illinois Health Partners
- 5865 Indian Health Services
- 5404 Insight Benefit Administrators
- 4445 Insurance Management Services TX
- 4116 IntegraNet Health
- 1107 Integrated Health Partners (IHP)
- 8814 Integrated Homecare Services
- 9713 Iowa Health Advantage
- 1404 Iowa Wellmark Blue Cross Blue Shield
- 6733 Iowa Wellmark Blue Cross Blue Shield Crossover
- 5479 IU Health Plan Medicare Advantage
- 5432 Johns Hopkins Healthcare / Priority Partners
- 5882 Kane County IPA
- 8467 Keycare
- 9412 Leon Health Plans
- 1205 Lifeworks Advantage (ISNP Plan)
- 7446 Maine Anthem Blue Cross Blue Shield
- 8812 Maryland Physicians Care
- 3476 Masters, Mates and Pilots
- 8860 Medica Government Programs
- 7859 Medica Health Plan Solutions
- 6799 Medica Individual and Family (IFB)
- 2287 Medicare Plus Blue of MI(MAP)
- 3475 Memorial Hermann Health Solutions
- 9102 Meridian Medicare Medicaid Plan
- 9118 MeridianComplete Michigan
- 2426 Michigan Blue Care Network
- 1421 Michigan Blue Cross Blue Shield
- 1402 Minnesota Blue Cross Blue Shield
- 1410 Minnesota Blue Cross Blue Shield CC Systems
- 7892 Minnesota Blue Cross Blue Shield Health Care Programs
- 1429 Minnesota Blue Cross Blue Shield HMO
- 1408 Missouri Anthem Blue Cross Blue Shield
- 7450 Montana Blue Cross Blue Shield
- 7422 New Hampshire Anthem Blue Cross Blue Shield
- 7403 New Mexico Blue Cross Blue Shield
- 8864 NextBlue of North Dakota
- 1213 NHC Advantage
- 2411 North Dakota Blue Cross Blue Shield
- 1403 Oklahoma Blue Cross Blue Shield
- 2404 Oregon Regence Blue Cross Blue Shield
- 7829 Passport Advantage
- 9123 Perennial Advantage
- 9421 Perennial Advantage of Colorado
- 9199 Piedmont Community Health Plan
- 8128 Pool Administrators, Inc.
- 5838 Preferred Administrators
- 3198 Preferred Benefit Administrators (Longwood, Florida)
- 4252 Presbyterian Salud
- 8468 Procare Advantage of TX
- 2807 Professional Benefit Administrators (Oakbrook, Illinois)
- 4253 Prominence Administrative Services
- 7281 PruittHealth Premier Medicare Advantage
- 5428 QualChoice of Arkansas
- 7264 Quartz ASO
- 1209 Regence Group Administrators
- 3257 ResourceOne Administrators
- 6879 RHA VestaCare
- 1776 RIS Rx
- 6246 Riverside Medical Clinic
- 8256 Saudi Health Mission
- 4464 SCAN Health Plan
- 2254 Scott & White Health Plan
- 4480 SelectHealth
- 9438 Shared Health Mississippi
- 7225 Sharp Community Medical Group
- 7138 Sierra Medical Group
- 8124 Simply Healthcare Plans, Inc.
- 1891 Snedeker Risk Management
- 8708 SOMOS Anthem
- 8816 SOMOS Emblem
- 1740 Sonder Health Plans
- 2490 South Dakota Blue Cross Blue Shield
- 8134 Summit Community Care
- 1406 Texas Blue Cross Blue Shield
- 1729 Texas Childrens Health Plan (CHIP)
- 2483 Texas Childrens Health Plan (STAR Medicaid)
- 4278 The Boon Group
- 8763 U.S. Networks and Administrative Services
- 7810 UMass Medical School Health and Criminal Justice Program
- 8473 Unicare (TX,MA,KS,WV,RI,IL)
- 6849 United Group Programs
- 2412 Utah Regence Blue Cross Blue Shield
- 2788 Utah Regence Blue Cross Blue Shield Federal Employee Program
- 8720 Vanderbilt Health
- 7493 Vermont Blue Cross Blue Shield
- 4258 VNS Health
- 7451 Washington Regence Blue Shield
- 9293 Wellcare by Allwell from Nebraska Total Care
- 9430 Wellcare by Allwell of Oklahoma
- 1844 Wellcare Health Plans
- 3211 Wellcare Health Plans (Encounters)
- 1775 Wellpoint
- 2448 Wellpoint Encounters
- 9441 Wellspace NEXUS LLC
- 7489 Wyoming Blue Cross Blue Shield
A resolution has been implemented and the claims were retransmitted to the payer intermediary Nov. 21, 2024.
This delay affected claims released to Optum Nov. 21, 2024, 3:00 a.m.-8:00 a.m. CT.
Action Required: Be aware of the processing issue above.
REF 824711 11/21/2024
Electronic Routing Change for Multiple CareFirst Payers
Effective immediately, Optum will be changing electronic remittance routing for the following payers:
Payer Name: CareFirst Blue Cross Blue Shield Community Health Plan Maryland
Professional CPID: 6749
Institutional CPID: 6647
Payer-assigned Payer ID: 45281
Payer Name: CareFirst Blue Cross Blue Shield Medicare Advantage
Professional CPID: 7487
Institutional CPID: 9643
Payer-assigned Payer ID: 45282
Payer Name: CareFirst Administrators/NCAS
Professional CPID: 1730
Institutional CPID: 2914
Payer-assigned Payer ID: 75190
Payer Name: NCAS - Charlotte, North Carolina
Professional CPID: 3874
Institutional CPID: 4943
Payer-assigned Payer ID: 75191
Enrollment Requirements:
Payer enrollment for electronic remittance is required.
- Providers currently receiving electronic remittance through Optum must complete a new enrollment form.
- New providers must complete a new enrollment form.
Action Required: Please consider the following to allow transactions to process properly due to the above changes:
- Make any necessary system changes.
- When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.
REF 824704 11/21/2024
Payer Change for CPIDs 7897, 1069 Alexian Brothers Community Service of Tennessee
This message is intended for Assurance Reimbursement Management customers.
Effective immediately, claims currently exchanged with the following payer must use different CPIDs.
Assurance Reimbursement Management:
Payer Name: Alexian Brothers Community Service of Tennessee
Professional CPID: 7897
Professional Edit Master: PE_T007
Institutional CPID: 1069
Institutional Edit Master: HE9T007
Payer-assigned Payer ID: 44423
Claims must begin using the following new payer connection:
Payer Name: Alexian PACE
Professional CPID: 2842
Professional Edit Master: PE_B800
Institutional CPID: 7968
Institutional Edit Master: HE9B801
Payer-assigned Payer ID: R3471
Claims:
- Payer enrollment for electronic claims is not required.
Effective Dec. 2, 2024, Alexian Brothers Community Service of Tennessee - Payer ID 44423 will no longer be available at Optum for claims.
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 824951 11/21/2024
New Electronic Claims Connections Available
This message is intended for Assurance EDI and Assurance Reimbursement Management customers.
Optum has new electronic claims connections available:
Payer Name: Ascension Living St. Vincent PACE
Institutional CPID: 8053
Professional CPID: 2829
Payer-assigned Payer ID: R3459
Payer Enrollment Required: No
Secondary Claims Accepted: Yes
Payer Location: Tennessee
Claims Fee: N/A
Action Required:
- Add the payers to your system to begin using the new payer connection.
- When a payer requires enrollment, forms must be submitted and approved to begin submitting transactions.
Please note: We are providing you with a list of new electronic connections, please review and choose payers that are appropriate for your business.
REF 824404 11/21/2024
Medicare HETS - Upcoming HETS2024-4 System Release - December 2024
This message is intended for Clearance Patient Access, Clearance EDI, and AhiQA customers.
Centers for Medicare & Medicaid Services (CMS) announces an update to the HETS2024-4 Companion Guide. The updated document (linked below) is version 10-38-1. Health Insurance Portability and Accountability Act (HIPAA) Eligibility Transaction System (HETS) submitters should review all documented changes and please take special note that HCPCS codes G0106 & G0120 are being terminated effective Jan. 1, 2025. HETS submitters must ensure that they cease sending either or both of these HCPCS codes on HETS 270 requests by this date. Effective Jan. 1, 2025 HETS will send a 999 error to any 270 request that includes either HCPCS G0106 or G0120.
The HETS2024-4 system release will introduce potential changes to the HETS 270 request and the HETS 271 response. HETS 270/271 submitters should carefully review the linked documentation for more information
HETS2024-4 Release Summary (version 3.0): https://www.cms.gov/files/document/hets2024-4-hets-270/271-release-summary.pdf
HETS2024-4 Companion Guide (version 10-38-1): https://www.cms.gov/files/document/hets2024-4-hets-270/271-companion-guide-v10-38-1.pdf
The HETS2024-4 release is scheduled for December 2024. submitters will be notified when additional information is available regarding this release.
Action Required: Review updated details on the potential changes that are linked above and distribute as appropriate within your facility.
REF 823068 11/21/2024
Electronic Routing Change for Multiple CareFirst Payers
Effective immediately, Optum will be changing electronic remittance routing for the following payers:
Payer Name: CareFirst Blue Cross Blue Shield Community Health Plan Maryland
Professional CPID: 6749
Institutional CPID: 6647
Line of Business Code (LOB): J78
Payer-assigned Payer ID: 45281
Payer Name: CareFirst Blue Cross Blue Shield Medicare Advantage
Professional CPID: 7487
Institutional CPID: 9643
Line of Business Code (LOB): H57
Payer-assigned Payer ID: 45282
Payer Name: CareFirst Administrators/NCAS
Professional CPID: 1730
Institutional CPID: 2914
Line of Business Code (LOB): H29
Payer-assigned Payer ID: 75190
Payer Name: NCAS - Charlotte, North Carolina
Professional CPID: 3874
Institutional CPID: 4943
Line of Business Code (LOB): H29
Payer-assigned Payer ID: 75191
Enrollment Requirements:
- 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 names and CPIDs are not changing.
- When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.
REF 824703 11/21/24
Resolved: Invalid Error Message for CPIDs 4551, 5405 1199 SEIU Family of Funds
Due to a payer intermediary processing issue, Professional and Institutional claims from July 25, 2024-Nov. 12, 2024 for the payers listed below may have received:
- Erroneous rejections
- Claim not on file error
Payers affected:
- CPID 4551 1199 SEIU Family of Funds
- CPID 5405 1199 SEIU Family of Funds
Action Required: Please be aware of the invalid error messages. Please resubmit any impacted claims.
REF 824702 11/21/2024
New Electronic Claims Connection Available
Optum has new electronic claims connections available:
Payer Name: Ascension Living Hope PACE
Institutional CPID: 8035
Professional CPID: 2859
Payer-assigned Payer ID: R3470
Payer Enrollment Required: No
Secondary Claims Accepted: Yes
Payer Location: Tennessee
Claims Fee: N/A
Action Required:
- Add the payers to your system to begin using the new payer connection.
- When a payer requires enrollment, forms must be submitted and approved to begin submitting transactions.
Please note: We are providing you with a list of new electronic connections, please review and choose payers that are appropriate for your business.
REF 824403 11/21/2024
New Electronic Claims Connections Available
Optum has new electronic claims connections available:
Payer Name: Alexian PACE
Institutional CPID: 7968
Professional CPID: 2842
Payer-assigned Payer ID: R3471
Payer Enrollment Required: No
Secondary Claims Accepted: Yes
Payer Location: Tennessee
Claims Fee: N/A
Action Required:
- Add the payers to your system to begin using the new payer connection.
- When a payer requires enrollment, forms must be submitted and approved to begin submitting transactions.
Please note: We are providing you with a list of new electronic connections, please review and choose payers that are appropriate for your business.
REF 824402 11/21/2024
Edit Master for CPIDs 7114 and 7671 Care To Care
This message is intended for Assurance Reimbursement Management customers.
Effective immediately, Optum will be changing Edit Masters for the following payer:
Payer Name: Care To Care
Professional CPID: 7114
Current Edit Master: PE_E049
New Edit Master: PE_T007
Institutional CPID: 7671
Current Edit Master: HE9E049
New Edit Master: HE9T007
Payer-assigned Payer ID: 41222
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 824250 11/20/2024
Payer Processing Issue for CPID 5988 LA Care Health Plan
Due to a payer processing issue, some Institutional claims transmitted to the payer listed below between Sept. 30, 2024 and Oct. 11, 2024 were not processed by the payer.
Payer impacted:
- CPID 5988 LA Care Health Plan
A resolution has been implemented and the claims were retransmitted to the payer on Nov. 20, 2024.
This delay affected claims released to Optum between 12 p.m. CT on Sept. 29, 2024 and 12 p.m. CT on Oct. 11, 2024.
Action Required: Be aware of the processing issue above.
REF 823902 11/20/2024
Electronic Routing Change for CPIDs 2149, 2997 Central California Alliance for Health
Effective November 20, 2024, Optum will be changing electronic claims routing for the following payer:
Payer Name: Central California Alliance for Health
Professional CPID: 2149
Current Edit Master: PE_O007
New Edit Master: PE_T007
Institutional CPID: 2997
Current Edit Master: HE9O007
New Edit Master: HE9T007
Current Payer-assigned Payer ID: CCA01
New Payer-assigned Payer ID: SX169
Enrollment Requirements
Claims:
- Payer enrollment for electronic claims is not required.
Report Changes:
You may see some differences in the payer reports you are receiving.
Action Required: Please make the following changes to accommodate the routing change:
- Revalidate unreleased claims to edit correctly under new edit master.
- Modify any bridge routines based on edit masters.
- No Payer Alias changes are required. Payer name and CPIDs are not changing.
- When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.
REF 824067 11/20/2024
Report Generation Delay for CPIDs 5661 and 6423 RevClaims
A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted Nov. 11, 2024.
Payer impacted:
- CPID 5661 RevClaims
- CPID 6423 RevClaims
Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.
Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.
REF 824150 11/20/2024
Electronic Routing Change for CPIDs 2149, 2997 Central California Alliance for Health
Effective November 20, 2024, Optum will be changing electronic claims routing for the following payer:
Payer Name: Central California Alliance for Health
Professional CPID: 2149
Institutional CPID: 2997
Current Payer-assigned Payer ID: CCA01
New Payer-assigned Payer ID: SX169
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 824066 11/20/2024
Update: Report Generation Delay for multiple CPIDs
Update: The payers are unable to generate and deliver the reports for some claims submitted between Nov. 6, 2024 and Nov. 13, 2024.
Action Required: Please resubmit claims if payment has not been received.
Original notify sent Nov. 18, 2024: The payers listed below are experiencing issues affecting Professional and Institutional report generation for some claims submitted since Nov. 6, 2024.
Payers impacted:
- CPID 7045 AmeriHealth Caritas Ohio
- CPID 9428 AmeriHealth Caritas Ohio
- CPID 7071 Anthem Ohio Medicaid
- CPID 9461 Anthem Ohio Medicaid
- CPID 7068 Buckeye Ohio Medicaid
- CPID 9457 Buckeye Ohio Medicaid
- CPID 7070 CareSource Ohio Medicaid
- CPID 9458 CareSource Ohio Medicaid
- CPID 7073 Humana Ohio Medicaid
- CPID 9463 Humana Ohio Medicaid
- CPID 9462 Molina Ohio Medicaid
- CPID 9455 Molina Ohio Medicaid Vision
- CPID 2481 Ohio Medicaid
- CPID 3509 Ohio Medicaid
- CPID 9465 UnitedHealthcare Ohio Medicaid
Optum is working diligently with the payers to resolve the issue and ensure reports are received.
Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.
REF 823750 11/20/2024
Remittance Reactivation for CPIDs 2098, 3430 Physicians Medical Group of San Jose
Optum recently restored electronic remittance connectivity for the following payer:
Payer Name: Physicians Medical Group of San Jose
Professional CPID: 3430
Institutional CPID: 2098
Industry Payer ID: EXC01
Remittance Enrollment Requirements:
- Payer enrollment for electronic remittance is required:
- Providers currently receiving electronic remittance for this payer will need to complete a new enrollment form.
- 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 821961 11/20/2024
Vibra Health Plan 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.
Assurance EDI:
Payer Name: Vibra Health Plan
Claim and Remittance CPIDs: 2553 and 1181
Reason: Payer no longer offers an electronic connection.
Action Required: None.
Assurance Reimbursement Management:
Payer Name: Vibra Health Plan
Claim and Remittance CPIDs: 2553 and 1181
Remittance LOB: H1J
Reason: Payer no longer offers an electronic connection.
Action Required: None.
REF 823069 11/20/2024
Arise Health Plan Electronic Claims and Remittance Connections No Longer Available
Effective immediately, the payer listed below will no longer be available at Optum for claims or remittance processing.
Assurance EDI:
Payer Name: Arise Health Plan
Claim and Remittance CPIDs: 2832, 7579, 4512, 2131
Reason: Payer no longer offers an electronic connection.
Action Required: None.
Assurance Reimbursement Management:
Payer Name: Arise Health Plan
Claim and Remittance CPIDs: 2832, 7579, 4512, 2131
Remittance LOB Code: J13
Reason: Payer no longer offers an electronic connection.
Action Required: None.
REF 823070 11/19/2024
Report Generation Delay for multiple CPIDs
This message is intended for Assurance EDI and Assurance Reimbursement Management customers.
Due to a payer intermediary processing issue, some Professional claims transmitted to the payers listed below on Nov. 18, 2024, were not processed by the payers.
Payers impacted:
9267 Align Senior Care of Florida
2113 Allcare Health Plan
1764 Ambetter From Absolute Total Care
9278 Ambetter from Nebraska Total Care
9431 Ambetter from WellCare of Kentucky
9432 Ambetter from WellCare of New Jersey
9775 Ambetter of Alabama
9433 Ambetter of Oklahoma
2138 American Family Insurance
9142 American Health Advantage of Mississippi
7854 American Health Advantage of Oklahoma
9117 American Health Advantage of Texas
1741 Amerigroup
1412 Anthem Blue Cross and Blue Shield - Indiana
2421 Anthem Blue Cross and Blue Shield - Kentucky
1413 Anthem Blue Cross and Blue Shield (Virginia)
2418 Anthem Blue Cross and Blue Shield of Ohio
4437 Anthem Blue Cross Blue Shield New York
8749 Anthem MaineHealth
4881 Asuris Northwest Regence
7272 Axminster Medical Group
3845 Banner Health Network
1415 Blue Cross Blue Shield of Colorado
1407 Blue Cross Blue Shield of Georgia
7496 Blue Cross Blue Shield of Nevada
1169 Blue Cross Blue Shield of Western New York Medicaid/CHP
1401 Blue Cross Blue Shield of Wisconsin
1243 Blue Cross Community Centennial
1167 Blue Cross Medicare Advantage PPO/HMO
9162 Blue Medicare Advantage
6779 Bridgespan Regence
6165 Bridgeview
1750 Brown & Toland Physicians
4246 Capital Health Plan
2810 Capitol Administrators
8146 Care N Care Insurance Co.
2289 Care1st Health Plan of Arizona Medicaid DOS after 11/30/2022
9759 Care1st Health Plan of Arizona Medicaid DOS before 12/01/2022
9762 Care1st Health Plan of Arizona Medicare
4743 Carelon Behavioral Health
6127 Carelon Behavioral Health, MBHP
3293 Carelon Health
2830 CarePlus Health Plans
1194 CareSource of Georgia
7143 CareSource of Indiana
3826 CareSource of Ohio
7263 CareSource of West Virginia
6777 Centers Plan for Healthy Living
9765 Central Valley Medical Providers
7275 Citrus Valley Physicians Group
8123 Clear Health Alliance
7763 Columbine Health Plan
8834 Commonwealth Care Alliance DOS after 3/31/2023
8477 Community Care Plan
2160 Community Care Plan (Commercial)
6865 Community Care Plan (Medicaid)
8147 Community Care Plan (Palm Beach Health District)
1420 Connecticut Anthem Blue Cross Blue Shield
3419 Connecticut Federal Employee Health Benefits
6795 Contra Costa Health Plan
6241 Correctional Health Partners
7738 CountyCare Health Plan
9747 Delaware First Health
2433 Denver Health and Hospital Authority
8135 Doctors HealthCare Plans
3477 Early Intervention Central Billing
1119 Easy Choice Health Plan of California
4289 El Paso Health-CHIP
5483 Employee Benefit Management Services (EBMS)
1834 Employee Plans
8137 Empower Healthcare Solutions
1795 Envolve Benefit Options
9215 Everpointe
5238 Evolent Specialty Cardiology
3792 Fidelis Care
2875 First Health Network (Coventry Health Care National Network)
7435 FirstCare Health Plans
1414 Florida Blue Cross Blue Shield
3417 Florida Blue Cross Blue Shield Health Options HMO
9417 Florida Complete Care
2150 Florida Health Care Plans
5440 Fox Valley Medicine
6851 Friday Health Plans
8189 Gemcare IPA
8879 Georgia Health Advantage
2720 GlobalCare
9766 Gold Kidney Health Plan
1797 HAP CareSource Michigan Dual Medicare/Medicaid
5243 Healthcare Management Administrators
1723 HealthCare Partners IPA
4448 HealthLink PPO
7760 Healthy Blue Louisiana
8867 Healthy Blue Missouri
9133 Healthy Blue North Carolina
7715 Hopkins Health Advantage
6259 Humana - CareSource of Kentucky
7426 Idaho Regence Blue Shield
1405 Illinois Blue Cross Blue Shield
5865 Indian Health Services
4445 Insurance Management Services TX
4116 IntegraNet Health
1107 Integrated Health Partners (IHP)
8814 Integrated Homecare Services
1404 Iowa Wellmark Blue Cross Blue Shield
6733 Iowa Wellmark Blue Cross Blue Shield Crossover
5479 IU Health Plan Medicare Advantage
5432 Johns Hopkins Healthcare / Priority Partners
5882 Kane County IPA
7782 Kansas Health Advantage
9412 Leon Health Plans
7446 Maine Anthem Blue Cross Blue Shield
8812 Maryland Physicians Care
8860 Medica Government Programs
7859 Medica Health Plan Solutions
6799 Medica Individual and Family (IFB)
2287 Medicare Plus Blue of MI(MAP)
3475 Memorial Hermann Health Solutions
9102 Meridian Medicare Medicaid Plan
9118 MeridianComplete Michigan
2426 Michigan Blue Care Network
1421 Michigan Blue Cross Blue Shield
1402 Minnesota Blue Cross Blue Shield
1410 Minnesota Blue Cross Blue Shield CC Systems
7892 Minnesota Blue Cross Blue Shield Health Care Programs
1429 Minnesota Blue Cross Blue Shield HMO
5871 Mission Community IPA Medical Group
1408 Missouri Anthem Blue Cross Blue Shield
7450 Montana Blue Cross Blue Shield
7422 New Hampshire Anthem Blue Cross Blue Shield
7403 New Mexico Blue Cross Blue Shield
8864 NextBlue of North Dakota
1213 NHC Advantage
2411 North Dakota Blue Cross Blue Shield
1403 Oklahoma Blue Cross Blue Shield
2404 Oregon Regence Blue Cross Blue Shield
7829 Passport Advantage
9123 Perennial Advantage
9199 Piedmont Community Health Plan
8128 Pool Administrators, Inc.
4252 Presbyterian Salud
8468 Procare Advantage of TX
4253 Prominence Administrative Services
7281 PruittHealth Premier Medicare Advantage
5428 QualChoice of Arkansas
7264 Quartz ASO
1209 Regence Group Administrators
6879 RHA VestaCare
1776 RIS Rx
6246 Riverside Medical Clinic
4464 SCAN Health Plan
2254 Scott & White Health Plan
9438 Shared Health Mississippi
7225 Sharp Community Medical Group
8124 Simply Healthcare Plans, Inc.
8816 SOMOS Emblem
1740 Sonder Health Plans
2490 South Dakota Blue Cross Blue Shield
8134 Summit Community Care
1406 Texas Blue Cross Blue Shield
1729 Texas Childrens Health Plan (CHIP)
2483 Texas Childrens Health Plan (STAR Medicaid)
4278 The Boon Group
8763 U.S. Networks and Administrative Services
8473 Unicare (TX,MA,KS,WV,RI,IL)
2412 Utah Regence Blue Cross Blue Shield
2788 Utah Regence Blue Cross Blue Shield Federal Employee Program
7493 Vermont Blue Cross Blue Shield
4258 VNS Health
7451 Washington Regence Blue Shield
9430 Wellcare by Allwell of Oklahoma
1844 Wellcare Health Plans
3211 Wellcare Health Plans (Encounters)
1775 Wellpoint
9441 Wellspace NEXUS LLC
7489 Wyoming Blue Cross Blue Shield
A resolution has been implemented and the claims were retransmitted to the payer intermediary on Nov. 19, 2024.
This delay affected claims released to Optum between 11 a.m. and 3 p.m. ET on Nov. 18, 2024.
Action Required: Be aware of the processing issue above.
REF 822981 11/19/2024
Electronic Routing Change for CPIDs 7228, 8645 UC Irvine Health
This message is intended for Assurance EDI customers.
Effective immediately, Optum will be reactivating and changing electronic claims routing for the following payer:
Payer Name: UC Irvine Health
Professional CPID: 7228
Institutional CPID: 8645
Payer-assigned Payer ID: MMFUC
Claims Fee: $0.10
Enrollment Requirements:
- 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.
REF 823351 11/19/2024
Electronic Routing Change for CPIDs 8609 and 7168 Premier Healthcare Exchange (PHX)
This message is intended for Assurance Reimbursement Management customers.
Effective immediately, Optum will be changing electronic claims routing for the following payer:
Payer Name: Premier Healthcare Exchange (PHX)
Professional CPID: 7168
Current Edit Master: PE_E049
New Edit Master: PE_B800
Institutional CPID: 8609
Current Edit Master: HE9E049
New Edit Master: HE9B801
Payer-assigned Payer ID: 88051
Enrollment Requirements:
Claims:
- Payer enrollment for electronic claims is not required.
Report Changes: You may see some differences in the payer reports you are receiving.
Action Required: Please make the following changes to accommodate the routing change:
- Revalidate unreleased claims to edit correctly under new edit master.
- Modify any bridge routines based on edit masters.
- No Payer Alias changes are required. Payer name and CPIDs are not changing.
- When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.
REF 823067 11/19/2024
Electronic Routing Change for CPIDs 8609 and 7168 Premier Healthcare Exchange (PHX)
This message is intended for Assurance EDI (Exchange) customers.
Effective immediately, Optum will be changing electronic claims routing for the following payer:
Payer Name: Premier Healthcare Exchange (PHX)
Professional CPID: 7168
Institutional CPID: 8609
Payer-assigned Payer ID: 88051
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 823066 11/19/2024
Electronic Routing Change for CPIDs 3049 and 8298 Community Family Care
Effective immediately, Optum will be changing electronic remittance routing for the following payer:
Payer Name: Community Family Care
Professional CPID: 8298
Institutional CPID: 3049
Payer-assigned Payer ID: NMM05
Remittance:
Payer enrollment for electronic remittance is required.
Providers currently receiving electronic remittance through Optum must complete a new enrollment form.
New providers must complete a new enrollment form.
Action Required: Please consider the following to allow transactions to process properly due to the above changes:
Make any necessary system changes.
When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.
REF 823200 11/19/2024
Electronic Routing Change for CPIDs 7228, 8645 UC Irvine Health
Effective immediately, Optum will be reactivating and changing electronic claims routing for the following payer:
Payer Name: UC Irvine Health
Professional CPID: 7228
Current Edit Master: PE_O007
New Edit Master: PE_B800
Institutional CPID: 8645
Current Edit Master: HE9O007
New Edit Master: HE9B801
Payer-assigned Payer ID: MMFUC
Enrollment Requirements:
- 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.
REF 823350 11/19/2024
Electronic Routing Change for CPIDs 6630 and 6731 Zelis
Effective immediately, Optum will be changing electronic claims routing for the following payer:
Payer Name: Zelis
Professional CPID: 6731
Current Edit Master: PE_T007
New Edit Master: PE_B800
Institutional CPID: 6630
Current Edit Master: HE9T007
New Edit Master: HE9B801
Payer-assigned Payer ID: 88057
Enrollment Requirements:
Claims:
- Payer enrollment for electronic claims is not required.
Report Changes:
You may see some differences in the payer reports you are receiving.
Action Required: Please make the following changes to accommodate the routing change:
- Revalidate unreleased claims to edit correctly under new edit master.
- Modify any bridge routines based on edit masters.
- No Payer Alias changes are required. Payer name and CPIDs are not changing.
- When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.
REF 823064 11/19/2024
Report Generation Delay for CPID 6671 HealthSun
A payer intermediary is experiencing issues affecting Institutional report generation for some claims submitted on Nov. 8, 2024.
Payer impacted:
- CPID 6671 HealthSun
The payer intermediary has been unable to generate and deliver the reports.
Action Required: None. Please resubmit claims if payment has not been received.
REF 822980 11/19/2024
Report Generation Delay for CPID 5077 Perennial Advantage
A payer intermediary is experiencing issues affecting Institutional report generation for some claims submitted on Nov. 7, 2024.
Payer impacted:
- CPID 5077 Perennial Advantage
The payer intermediary has been unable to generate and deliver the reports.
Action Required: None. Please resubmit claims if payment has not been received.
REF 822975 11/19/2024
Report Generation Delay for CPIDs 2526 and 3826 CareSource of Ohio
A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted on Nov. 6, 2024.
Payer impacted:
- CPID 2526 CareSource of Ohio
- CPID 3826 CareSource of Ohio
Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.
Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.
REF 822951 11/19/2024
Report Generation Delay for CPID 2208 Texas Medicare
A payer is experiencing issues affecting Professional report generation for some claims submitted on Nov. 4, 2024.
Payer impacted:
- CPID 2208 Texas Medicare
The payer has been unable to generate and deliver the reports.
Action Required: Please resubmit claims if payment has not been received.
REF 822560 11/19/2024
Electronic Routing Change for CPIDs 6630 and 6731 Zelis
Effective immediately, Optum will be changing electronic claims routing for the following payer:
Payer Name: Zelis
Professional CPID: 6731
Institutional CPID: 6630
Payer-assigned Payer ID: 88057
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 823063 11/19/2024
Electronic Routing Change for CPIDs 3049 and 8298 Community Family Care
Effective immediately, Optum will be changing electronic remittance routing for the following payer:
Payer Name: Community Family Care
Professional CPID: 8298
Institutional CPID: 3049
Line of Business Code (LOB): U2S
Payer-assigned Payer ID: NMM05
Remittance:
- Payer enrollment for electronic remittance is required.
- Providers currently receiving electronic remittance through Optum must complete a new enrollment form.
- New providers must complete a new enrollment form.
Action Required: Please make the following changes to accommodate the routing change:
- No Payer Alias changes are required. Payer name and CPIDs are not changing.
- When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.
REF 823201 11/19/2024
Report Generation Delay for CPIDs 3066 and 8468 Procare Advantage of TX
A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted Nov. 7, 2024.
Payer impacted:
- CPID 3066 Procare Advantage of TX
- CPID 8468 Procare Advantage of TX
Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.
Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.
REF 822977 11/19/2024
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 Nov. 8, 2024.
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.
REF 822979 11/19/2024
Report Generation Delay for CPIDs 6992 and 4110 Bollinger Inc
A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted since Nov. 8, 2024.
Payer impacted:
- CPID 6992 Bollinger Inc
- CPID 4110 Bollinger Inc
Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.
Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.
REF 822978 11/19/2024
Payer Name Changes
This message is intended for Revenue Performance Advisor customers.
Effective immediately, please be aware of the following payer name changes:
Payer ID: 86066
Previous Name: HMA Hawaii
New Payer Name: Verdegard Administrators
Payer ID: 86070
Previous Name: IMX Easy
New Payer Name: Verdegard Employee Plan
Action Required: Please be aware and make any changes within your software to accommodate the payer name change.
REF 822566 11/19/2024
Report Generation Delay for CPID 3935 NHC Advantage
A payer intermediary is experiencing issues affecting Institutional report generation for some claims submitted on Nov. 7, 2024.
Payer impacted:
- CPID 3935 NHC Advantage
The payer intermediary has been unable to generate and deliver the reports.
Action Required: None. Please resubmit claims if payment has not been received.
REF 822976 11/19/2024
Payer Transmit Delay for Idaho Blue Cross Boise
This message is intended for Revenue Performance Advisor customers.
Due to a payer system issue, a delay occurred in the transmissions to Idaho Blue Cross Boise (IDs SB612, 12B07) for claims released to Optum Nov. 8, 2024, 2:00 p.m.-Nov. 13, 2024, 2:00 p.m. CT. A resolution has been implemented and the affected claims were transmitted to the payer on Nov. 14, 2024.
Action Required:
Please be aware of the transmit delay noted above.
REF 823051 11/19/2024
Resolved: Novitas Medicare Claims and ERA Delivery Delay
This message is intended for Revenue Performance Advisor customers.
UPDATE: The below issue has been resolved as of November 12, 2024.
We are collaborating with our partners regarding ongoing issues causing intermittent disruptions resulting in delays in Professional and Institutional Electronic Remittance Advice (ERA), Claims, and Reporting delivery for the following payers from Thursday, Oct. 17, 2024, through present:
|
State |
Part A Payer ID |
Part B Payer ID |
|
Arkansas |
12022 |
SMAR0 |
|
Colorado |
12M03 |
SMCO0 |
|
Delaware |
12M76 |
SMDE0 |
|
Idaho |
12M07 |
SMID0 |
|
Louisiana |
12M12 |
SMLA0 |
|
Maryland |
12010 |
SMMD0 |
|
Mississippi |
12M17 |
SMMS0 |
|
New Jersey |
12005 |
SMNJ0 |
|
New Mexico |
12M22 |
SMNM0 |
|
Oklahoma |
12M37 |
SMOK0 |
|
Pennsylvania |
12M60 |
SMPA0 |
|
Tennessee |
12M53 |
SMTN0 |
|
Texas |
12M31 |
SMTX0 |
Action Required:
Please be aware of a delay in the delivery of ERA, claims, and reporting for the dates above.
REF 808350 / 822500 11/19/2024
Payer Processing Issue for multiple CPIDs
Due to a payer processing issue, some institutional and professional claims transmitted to the payers listed below on Nov. 14, 2024 were not processed by the payers.
Payers impacted:
- CPID 2423 Alabama Blue Cross Blue Shield
- CPID 5558 Alabama Blue Cross Blue Shield
- CPID 1002 Alabama Blue Cross Blue Shield Medicare Advantage
A resolution has been implemented and the claims were retransmitted to the payers on Nov. 19, 2024.
This delay affected claims released to Optum between 1 p.m. CT on Nov. 13, 2024 and 1 p.m. CT on Nov. 14, 2024.
Action Required: Be aware of the processing issue above.
REF 822564 11/19/2024
Health First Health Plan (95019) ERA Enrollment and Routing Update
This message is intended for Revenue Performance Advisor customers.
Effective immediately, Optum is changing electronic remittance routing for the following payer:
Payer Name: Health First Health Plan
RPA Payer ID: 95019
Enrollment Requirements for Remittance:
- Providers currently receiving electronic remittance through Optum must complete a new enrollment form.
- New providers must complete a new enrollment form.
Submitter Action Required:
- Please be aware of the changes above and complete a new enrollment form to receive remittance.
- For providers needing to add or update enrollment, 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 823053 11/19/2024
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 since Nov. 7, 2024.
Payer impacted:
- CPID 8900 Allcare Health Plan
- CPID 2113 Allcare Health Plan
Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.
Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.
REF 822952 11/19/2024
Payer Transmit Delay for CPID 5599 Capital Blue Cross
Due to a payer system issue, a delay occurred in some of the transmissions to the following payer since Nov. 18, 2024.
Payer impacted:
- CPID 5599 Capital Blue Cross
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 4 p.m. ET on Nov. 15, 2024.
Action Required: Be aware of the transmit delay above.
REF 822565 11/19/2024
Electronic claims connection has been reactivated
Effective immediately, the payer listed below has been reactivated at Optum for claims processing.
Payer Name: Care to Care
Institutional CPID: 7671
Payer-assigned Payer ID: 41222
REF 822850 11/19/2024
Report Generation Delay for CPID 9401 TPAC/ USPCPS/ Amerivantage
A payer experiencing issues affecting professional report generation for some claims submitted between Sept 20, 2024 and Oct. 27, 2024.
Payer impacted:
- CPID 9401 TPAC/ USPCPS/ Amerivantage
The payer has been unable to generate and deliver the reports.
Action Required: None. Please resubmit claims if payment has not been received.
REF 821957 11/19/2024
Electronic Routing Change for CPIDs 4062, 9183, Syntriq Health Solutions
Effective immediately, Optum will be changing electronic claims routing for the following payer:
Payer Name: Syntriq Health Solutions
Professional CPID: 9183
Current Edit Master: PE_T007
New Edit Master: PE_C051
Institutional CPID: 4062
Current Edit Master: HE9T007
New Edit Master: HE9C051
Payer-assigned Payer ID: SNTRQ
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.
REF 822451 11/19/2024
Electronic Routing Change for CPIDs 4062, 9183, Syntriq Health Solutions
Effective immediately, Optum will be changing electronic claims remittance routing for the following payer:
Payer Name: Syntriq Health Solutions
Professional CPID: 9183
Institutional CPID: 4062
Current Payer-assigned Payer ID: SNTRQ
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.
REF 822450 11/19/2024
New Electronic Claims Connection Available
Optum has new electronic claims connections available:
Payer Name: DH Cook
Institutional CPID: 7978
Professional CPID: 2847
Payer-assigned Payer ID: 82347
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.
REF 822050 11/18/2024
Electronic Routing Change for CPIDs 7075, 7480 Med-Pay
Effective immediately, please be aware of the following electronic routing change:
Payer Name: Med-Pay
Professional CPID: 7480
Edit Master: PE_T007
Institutional CPID: 7075
Edit Master: HE9T007
Payer-assigned Payer ID: 88058
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:
- No Payer Alias changes are required. Payer name(s) and CPID(s) are not changing.
- When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.
REF 822203 11/18/2024
Electronic Routing Change for CPIDs 7075, 7480 Med-Pay
Effective Nov. 19, 2024, Optum will be changing electronic claims routing for the following payer:
Payer Name: Med-Pay
Professional CPID: 7480
Institutional CPID: 7075
Payer-assigned Payer ID: 88058
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 822202 11/18/2024
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 on Nov. 5, 2024.
Payer impacted:
- CPID 3577 Regence Group Administrators
- CPID 1209 Regence Group Administrators
The payer intermediary has been unable to generate and deliver the reports.
Action Required: None. Please resubmit claims if payment has not been received.
REF 820969 11/18/2024
Report Generation Delay for CPIDs 2513 and 1167 Blue Cross Medicare Advantage PPO/HMO
A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted on Nov. 5, 2024.
Payer impacted:
- CPID 2513 Blue Cross Medicare Advantage PPO/HMO
- CPID 1167 Blue Cross Medicare Advantage PPO/HMO
The payer intermediary has been unable to generate and deliver the reports.
Action Required: None. Please resubmit claims if payment has not been received.
REF 820973 11/18/2024
Report Generation Delay for CPIDs 1937 and 2720 GlobalCare
A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted on Nov. 5, 2024.
Payer impacted:
- CPID 1937 GlobalCare
- CPID 2720 GlobalCare
The payer intermediary has been unable to generate and deliver the reports.
Action Required: None. Please resubmit claims if payment has not been received.
REF 820964 11/18/2024
Report Generation Delay for CPIDs 4093 and 8834 Commonwealth Care Alliance Date of Service (DOS) after March 31, 2023
A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted on Nov. 5, 2024.
Payer impacted:
- CPID 4093 Commonwealth Care Alliance DOS after March 31, 2023
- CPID 8834 Commonwealth Care Alliance DOS after March 31, 2023
Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.
Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.
REF 820961 11/18/2024
New Electronic Remittance (ERA) Connections Available on RPA
This message is intended for Revenue Performance Advisor (RPA) customers.
ERA (Remittance) transactions have recently been added for the following payers:
- 48005 – Companion Life
- 55069 – EBIX Health Administration Exchange (EHAE)
- 98480 – Covet Health
- EDHP1 – Employer Driven Insurance Services
- RP118 – Highmark Health Options of West Virginia
- RP122 – HAP CareSource Michigan Dual Medicare/Medicaid
REF 821701 11/18/2024
Report Generation Delay for CPIDs 3935 and 1213 NHC Advantage
A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted on Nov. 5, 2024.
Payer impacted:
- CPID 3935 NHC Advantage
- CPID 1213 NHC Advantage
The payer intermediary has been unable to generate and deliver the reports.
Action Required: None. Please resubmit claims if payment has not been received.
REF 820974 11/18/2024
New Electronic Remittance Connections Available
Optum has new electronic remittance connection available:
Assurance EDI:
Payer Name: Johns Hopkins Home Care Group
Professional CPID: 8201
Payer-assigned Payer ID: JHHCG
Payer Enrollment Required: Yes
Remittance Fee: N/A
Payer Location: Maryland
Assurance Reimbursement Management:
Payer Name: Johns Hopkins Home Care Group
Professional CPID: 8201
Payer-assigned Payer ID: JHHCG
Line of Business (LOB) Code: N43
Payer Enrollment Required: Yes
Remittance Fee: N/A
Payer Location: Maryland
Action Required:
Add the payers to your system to begin using the new payer connection.
Enrollment forms must be submitted and approved to begin receiving electronic remittance through Optum.
REF 822100 11/18/2024
Report Generation Delay for CPIDs 3514 and 1421 Michigan Blue Cross Blue Shield
A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted Nov. 5, 2024.
Payer impacted:
- CPID 3514 Michigan Blue Cross Blue Shield
- CPID 1421 Michigan Blue Cross Blue Shield
The payer intermediary has been unable to generate and deliver the reports.
Action Required: None. Please resubmit claims if payment has not been received.
REF 820972 11/18/2024
Delay in Electronic Remittance Advice (ERA) for HEALTHNET CPID: 2855/6514/7715/7515
Due to a processing issue, there has been a delay in Professional and Institutional Electronic Remittance Advice (ERA) for the following payers beginning on August 1, 2024, through present:
- CPID 2855 Health Net of California
- CPID 6514 Health Net of California
- CPID 7751 Health Net of CA, OR
- CPID 7515 Health Net of CA, OR
Additional updates will be forwarded as more information becomes available.
Action Required: Please be aware of a delay in the delivery of ERA for the dates above.
If you have any questions, feel free to contact your Customer Support Team and refer to case 09133419.
REF 821903 11/18/2024
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 Nov. 5, 2024.
Payer impacted:
- CPID 8920 Healthcare Management Administrators
- CPID 5243 Healthcare Management Administrators
The payer intermediary has been unable to generate and deliver the reports.
Action Required: None. Please resubmit claims if payment has not been received.
REF 820971 11/18/2024
Report Generation Delay for CPIDs 3584 and 7489 Wyoming Blue Cross Blue Shield
A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted Nov. 5, 2024.
Payer impacted:
- CPID 3584 Wyoming Blue Cross Blue Shield
- CPID 7489 Wyoming Blue Cross Blue Shield
The payer intermediary has been unable to generate and deliver the reports.
Action Required: None. Please resubmit claims if payment has not been received.
REF 820968 11/18/2024
Report Generation Delay for CPIDs 5593 and 2411 North Dakota Blue Cross Blue Shield
A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted on Nov. 5, 2024.
Payer impacted:
- CPID 5593 North Dakota Blue Cross Blue Shield
- CPID 2411 North Dakota Blue Cross Blue Shield
The payer intermediary has been unable to generate and deliver the reports.
Action Required: None. Please resubmit claims if payment has not been received.
REF 820970 11/18/2024
Report Generation Delay for CPIDs 4557 and 2875 First Health Network (Coventry Health Care National Network)
A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted on Nov. 5, 2024.
Payer impacted:
- CPID 4557 First Health Network (Coventry Health Care National Network)
- CPID 2875 First Health Network (Coventry Health Care National Network)
The payer intermediary has been unable to generate and deliver the reports.
Action Required: None. Please resubmit claims if payment has not been received.
REF 820967 11/18/2024
Report Generation Delay for multiple CPIDs
A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted on Nov. 5, 2024.
Payers impacted:
- CPID 1513 Minnesota Blue Cross Blue Shield
- CPID 1402 Minnesota Blue Cross Blue Shield
- CPID 1410 Minnesota Blue Cross Blue Shield CC Systems
- CPID 1429 Minnesota Blue Cross Blue Shield HMO
The payer intermediary has been unable to generate and deliver the reports.
Action Required: None. Please resubmit claims if payment has not been received.
REF 820965 11/18/2024
Report Generation Delay for CPID 8146 Care N Care Insurance Co.
A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted Nov. 5, 2024.
Payer impacted:
- CPID 8146 Care N Care Insurance Co.
The payer intermediary has been unable to generate and deliver the reports.
Action Required: None. Please resubmit claims if payment has not been received.
REF 820966 11/18/2024
Report Generation Delay for CPIDs 1985 and 4246 Capital Health Plan
A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted on Nov. 5, 2024.
Payer impacted:
- CPID 1985 Capital Health Plan
- CPID 4246 Capital Health Plan
The payer intermediary has been unable to generate and deliver the reports.
Action Required: None. Please resubmit claims if payment has not been received.
REF 820962 11/18/2024
Report Generation Delay for CPID 3531 Michigan Blue Cross Blue Shield Federal Employee Program
A payer intermediary is experiencing issues affecting Institutional report generation for some claims submitted Nov. 5, 2024.
Payer impacted:
- CPID 3531 Michigan Blue Cross Blue Shield Federal Employee Program
The payer intermediary has been unable to generate and deliver the reports.
Action Required: None. Please resubmit claims if payment has not been received.
REF 820963 11/18/2024
Report Generation Delay for CPIDs 7056 and 9438 Shared Health Mississippi
A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted on Nov. 5, 2024.
Payer impacted:
- CPID 7056 Shared Health Mississippi
- CPID 9438 Shared Health Mississippi
The payer intermediary has been unable to generate and deliver the reports.
Action Required: None. Please resubmit claims if payment has not been received.
REF 820960 11/18/2024
New Electronic Real Time Connections Available on Revenue Performance Advisor
This message is intended for Revenue Performance Advisor (RPA) customers.
Eligibility transactions have recently been added for the following payers:
|
Payer ID |
Payer Name |
|
36338 |
Group Administrators LTD |
|
SFHP1 |
San Francisco Health Plan |
|
128KS |
Aetna Better Health of Kansas |
Claim Status Inquiry transactions have recently been added for the following payers:
|
Payer ID |
Payer Name |
|
128KS |
Aetna Better Health of Kansas |
|
128LA |
Aetna Better Health of Louisiana |
|
128VA |
Aetna Better Health of Virginia |
|
26337 |
Aetna Better Health Illinois - MMAI |
|
33628 |
Mercy Care RBHA |
|
34734 |
Aetna Better Health of New York |
|
46320 |
Aetna Better Health of New Jersey |
|
50023 |
Aetna Better Health of Ohio |
|
87042 |
Iron Road Healthcare |
|
MHC01 |
Mountain Health CO-OP |
REF 821700 11/18/2024
New Payer Name
Effective immediately, please be aware of the following payer name changes:
Assurance EDI:
Previous Payer Name: Mid-American Benefits (Elite Choice)
New Payer Name: Point C/Mid-American Benefits
Professional CPID: 6424
Institutional CPID: 5668
Edit Master: HE9T007, PE_T007
Assurance Reimbursement Management:
Previous Payer Name: Mid-American Benefits (Elite Choice)
New Payer Name: Point C/Mid-American Benefits
Professional CPID: 6424
Institutional CPID: 5668
Edit Master: HE9T007, PE_T007
Remit Line of Business (LOB) Code: J14
Your existing Payer Alias entries will continue to work as they do currently; the new payer name is being provided for your reference. Be aware all future communications for these CPIDs will reference the new payer name only.
Action Required: You may choose to update the Payer Alias in your system to accommodate the new payer name.
REF 821703 11/18/2024
Report Generation Delay for multiple CPIDs
The payers listed below are experiencing issues affecting Professional and Institutional report generation for some claims submitted since Nov. 6, 2024.
Payers impacted:
|
Payer ID |
Payer Name |
|
7045 |
AmeriHealth Caritas Ohio |
|
9428 |
AmeriHealth Caritas Ohio |
|
7071 |
Anthem Ohio Medicaid |
|
9461 |
Anthem Ohio Medicaid |
|
7068 |
Buckeye Ohio Medicaid |
|
9457 |
Buckeye Ohio Medicaid |
|
7070 |
CareSource Ohio Medicaid |
|
9458 |
CareSource Ohio Medicaid |
|
7073 |
Humana Ohio Medicaid |
|
9463 |
Humana Ohio Medicaid |
|
9462 |
Molina Ohio Medicaid |
|
9455 |
Molina Ohio Medicaid Vision |
|
2481 |
Ohio Medicaid |
|
3509 |
Ohio Medicaid |
|
9465 |
UnitedHealthcare Ohio Medicaid |
Optum is working diligently with the payers to resolve the issue and ensure reports are received.
Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.
REF 821764 11/18/2024
Report Generation Delay for CPIDs 3061 and 8454 Align Senior Care of Michigan
A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted since Nov. 4, 2024.
Payer impacted:
- CPID 3061 Align Senior Care of Michigan
- CPID 8454 Align Senior Care of Michigan
Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.
Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.
REF 820959 11/18/2024
Report Generation Delay for CPID 7829 Passport Advantage
A payer intermediary is experiencing issues affecting Institutional report generation for some claims submitted on Oct. 25, 2024.
Payer impacted:
- CPID 7829 Passport Advantage
The payer intermediary has been unable to generate and deliver the reports.
Action Required: None. Please resubmit claims if payment has not been received.
REF 820958 11/18/2024
Update: Report Generation Delay for CPID 2483 Texas Childrens Health Plan (STAR Medicaid)
The payer intermediary has been unable to generate and deliver the reports for some claims submitted from Oct. 4, 2024 through Nov. 11, 2024.
Action Required: Please resubmit claims if payment has not been received.
Original message sent Oct. 14, 2024:
A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted since Oct. 4, 2024.
Payer impacted:
- CPID 2483 Texas Childrens Health Plan (STAR 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.
REF 820957 11/18/2024
Electronic Claims Connection No Longer Available for HPH Hospice
Effective immediately, the payer listed below will no longer be available at Optum for claims processing.
Payer Name: HPH Hospice
Claim CPIDs: 2064, 8204
Reason: Payer no longer offers an electronic connection for which Optum can build connectivity.
Action Required: None.
REF 821604 11/18/2024
Good Shepherd Hospice Electronic Claims Connection No Longer Available
Effective immediately, the payer listed below will no longer be available at Optum for claims processing.
Payer Name: Good Shepherd Hospice
Claim CPIDs: 5647 and 6285
Reason: Payer does not offer an electronic connection for which Optum can build connectivity.
Action Required: None.
REF 821501 11/15/2024
Update: Payer Change for CPID 1750 Brown & Toland Physicians
Update: Effective November 25, 2024, the payer listed below will no longer be available at Optum for claims and remittance.
Action Required: Claims must be sent to CPID 6867 Brown and Toland Health Services.
Original notification REF 814352 sent 11/8/2024:
Effective immediately, claims and remittance currently exchanged with the following payer must use a different CPID.
Assurance EDI:
Payer Name: Brown & Toland Physicians
Claim and Remittance CPID: 1750
Claims and remittance must begin using the following:
Payer Name: Brown & Toland Health Services
Professional CPID: 6867
Remittance Available: Yes
Payer-assigned Payer ID: BTHS1
Claim Fee: N/A Claims:
- Payer enrollment for electronic claims is not required.
Remittance:
- Payer enrollment for electronic remittance is required.
- Providers currently receiving electronic Optum for CPID 6867 Brown & Toland Health Services do not need to complete a new enrollment form.
- Providers not receiving electronic remittance through Optum for CPID 6867 Brown & Toland Health Services 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.
Assurance Reimbursement Management:
Payer Name: Brown & Toland Physicians
Professional CPID: 1750
Professional Edit Master: PE_T007
Payer-assigned Payer ID: BTHS1
Line of Business Code (LOB): BAT_COM
Claims and remittance must begin using the following:
Payer Name: Brown & Toland Health Services
Professional CPID: 6867
Professional Edit Master: PE_T007
Payer-assigned Payer ID: BTHS1
Line of Business Code (LOB): BAT_COM
Claims:
- Payer enrollment for electronic claims is not required.
- Payer enrollment for electronic remittance is required.
- Providers currently receiving electronic remittance through Optum for 6867 Brown & Toland Health Services do not need to complete a new enrollment form.
REF 821403 11/15/2024
New Electronic Remittance Connections Available - Zurich American Insurance Company
Optum has new electronic remittance connections available:
Payer Name: Zurich American Insurance Company
Institutional CPID: 7992
Professional CPID: 2852
Payer-assigned Payer ID: 36423
Line of Business (LOB) Code: E05
Payer Enrollment Required: Yes
Remittance Fee: N/A
Payer Location: National
Action Required:
- Add the payers to your system to begin using the new payer connection.
- Enrollment forms must be submitted and approved to begin receiving electronic remittance through Optum.
REF 821400 11/15/2024
Update: Report Generation Delay for CPIDs 5959 and 4258 VNS Health
Update: The payer intermediary has been unable to generate and deliver the reports for some claims submitted from Oct. 10, 2024 through Nov. 5, 2024.
Action Required: Please resubmit claims if payment has not been received.
Original notify sent Oct. 14, 2024: A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted since Sept. 30, 2024.
Payer impacted:
- CPID 5959 VNS Health
- 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.
REF 821303 11/15/2024
Centivo Direct Network Access Electronic Claims Connection No Longer Available
Effective immediately, the payer listed below will no longer be available at Optum for claims processing.
Payer Name: Centivo Direct Network Access
Claim CPIDs: 5059 and 9103
Reason: Payer no longer offers an electronic connection.
Action Required: None.
REF 821500 11/15/2024
Electronic Routing Change for CPIDs 4959, 4750 Johns Hopkins - USFHP
Effective Nov. 18, 2024, Optum will be changing electronic remittance routing for the following payer:
Payer Name: Johns Hopkins - USFHP
Professional CPID: 4750
Institutional CPID: 4959
Line of Business Code (LOB): H01
Payer-assigned Payer ID: 52123
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:
- Make any necessary system changes.
- 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 821402 11/15/2024
Update: Report Generation Delay for CPIDs 7907 and 2254 Scott & White Health Plan
The payer intermediary has been unable to generate and deliver the reports for some claims submitted from Oct. 24, 2024, through Nov. 7, 2024.
Action Required: Please resubmit claims if payment has not been received.
Original message sent Nov. 6, 2024:
A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted since Oct. 24, 2024.
Payer impacted:
- CPID 7907 Scott & White Health Plan
- CPID 2254 Scott & White Health Plan
Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.
Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.
REF 821306 11/15/2024
Payer Processing Issue for multiple CPIDs
Due to a payer intermediary processing issue, some Professional claims transmitted to the payers listed below on Nov. 14, 2024 were not processed by the payers.
Payers impacted:
|
CPID |
Payer Name |
|
1214 |
AgeRight Advantage Health Plan |
|
9409 |
Align Senior Care of California |
|
8454 |
Align Senior Care of Michigan |
|
8465 |
Align Senior Care of Virginia |
|
2113 |
Allcare Health Plan |
|
8714 |
Allstate - Except New Jersey |
|
1764 |
Ambetter From Absolute Total Care |
|
9431 |
Ambetter from WellCare of Kentucky |
|
9775 |
Ambetter of Alabama |
|
9433 |
Ambetter of Oklahoma |
|
7280 |
American Health Advantage of Missouri |
|
9218 |
American Health Advantage of Tennessee |
|
9117 |
American Health Advantage of Texas |
|
4468 |
Americas Choice Healthplan |
|
1741 |
Amerigroup |
|
1412 |
Anthem Blue Cross and Blue Shield - Indiana |
|
2421 |
Anthem Blue Cross and Blue Shield - Kentucky |
|
1413 |
Anthem Blue Cross and Blue Shield (Virginia) |
|
2418 |
Anthem Blue Cross and Blue Shield of Ohio |
|
4437 |
Anthem Blue Cross Blue Shield New York |
|
8749 |
Anthem MaineHealth |
|
6220 |
Arizona Priority Care Plus |
|
4477 |
Asuris Northwest Medadvantage Regence |
|
4881 |
Asuris Northwest Regence |
|
7272 |
Axminster Medical Group |
|
3845 |
Banner Health Network |
|
1415 |
Blue Cross Blue Shield of Colorado |
|
1407 |
Blue Cross Blue Shield of Georgia |
|
7496 |
Blue Cross Blue Shield of Nevada |
|
1401 |
Blue Cross Blue Shield of Wisconsin |
|
1243 |
Blue Cross Community Centennial |
|
1167 |
Blue Cross Medicare Advantage PPO/HMO |
|
4110 |
Bollinger Inc |
|
6779 |
Bridgespan Regence |
|
1750 |
Brown & Toland Physicians |
|
4246 |
Capital Health Plan |
|
2810 |
Capitol Administrators |
|
8146 |
Care N Care Insurance Co. |
|
2289 |
Care1st Health Plan of Arizona Medicaid |
|
9759 |
Care1st Health Plan of Arizona Medicaid |
|
4743 |
Carelon Behavioral Health |
|
6127 |
Carelon Behavioral Health, MBHP |
|
3293 |
Carelon Health |
|
2830 |
CarePlus Health Plans |
|
1194 |
CareSource of Georgia |
|
7143 |
CareSource of Indiana |
|
3826 |
CareSource of Ohio |
|
7263 |
CareSource of West Virginia |
|
9226 |
CareSource PASSE of Arkansas |
|
6777 |
Centers Plan for Healthy Living |
|
6700 |
Centurion Managed Care |
|
7275 |
Citrus Valley Physicians Group |
|
8123 |
Clear Health Alliance |
|
7416 |
Colorado Anthem Blue Cross Blue Shield HMO |
|
8834 |
Commonwealth Care Alliance DOS after 3/31/2023 |
|
8228 |
Community Care Plan (Broward Health PPUC) |
|
2160 |
Community Care Plan (Commercial) |
|
6865 |
Community Care Plan (Medicaid) |
|
8147 |
Community Care Plan (Palm Beach Health District) |
|
1420 |
Connecticut Anthem Blue Cross Blue Shield |
|
3419 |
Connecticut Federal Employee Health Benefits |
|
3420 |
Connecticut Medicare Blue (Risk) |
|
6795 |
Contra Costa Health Plan |
|
7292 |
CorrectCare Integrated Health- Louisiana |
|
7738 |
CountyCare Health Plan |
|
9747 |
Delaware First Health |
|
1119 |
Easy Choice Health Plan of California |
|
4289 |
El Paso Health-CHIP |
|
4279 |
El Paso Health-STAR |
|
5483 |
Employee Benefit Management Services (EBMS) |
|
8137 |
Empower Healthcare Solutions |
|
1795 |
Envolve Benefit Options |
|
3792 |
Fidelis Care |
|
2875 |
First Health Network (Coventry Health Care National Network) |
|
7435 |
FirstCare Health Plans |
|
1414 |
Florida Blue Cross Blue Shield |
|
3417 |
Florida Blue Cross Blue Shield Health Options HMO |
|
9128 |
Florida Blue Medicare |
|
9417 |
Florida Complete Care |
|
2150 |
Florida Health Care Plans |
|
6851 |
Friday Health Plans |
|
8189 |
Gemcare IPA |
|
8879 |
Georgia Health Advantage |
|
1258 |
Global Healthcare Alliance |
|
2720 |
GlobalCare |
|
5853 |
GMS Insurance |
|
9766 |
Gold Kidney Health Plan |
|
1772 |
HAP CareSource |
|
1797 |
HAP CareSource Michigan Dual Medicare/Medicaid |
|
5243 |
Healthcare Management Administrators |
|
1723 |
HealthCare Partners IPA |
|
4448 |
HealthLink PPO |
|
7760 |
Healthy Blue Louisiana |
|
8867 |
Healthy Blue Missouri |
|
8870 |
Healthy Blue Nebraska |
|
9133 |
Healthy Blue North Carolina |
|
7715 |
Hopkins Health Advantage |
|
6259 |
Humana - CareSource of Kentucky |
|
7426 |
Idaho Regence Blue Shield |
|
1405 |
Illinois Blue Cross Blue Shield |
|
2234 |
Illinois Health Partners |
|
5865 |
Indian Health Services |
|
4445 |
Insurance Management Services TX |
|
4116 |
IntegraNet Health |
|
1107 |
Integrated Health Partners (IHP) |
|
8814 |
Integrated Homecare Services |
|
1404 |
Iowa Wellmark Blue Cross Blue Shield |
|
6733 |
Iowa Wellmark Blue Cross Blue Shield Crossover |
|
5479 |
IU Health Plan Medicare Advantage |
|
5432 |
Johns Hopkins Healthcare / Priority Partners |
|
7782 |
Kansas Health Advantage |
|
8467 |
Keycare |
|
9412 |
Leon Health Plans |
|
1205 |
Lifeworks Advantage (ISNP Plan) |
|
7446 |
Maine Anthem Blue Cross Blue Shield |
|
8812 |
Maryland Physicians Care |
|
8860 |
Medica Government Programs |
|
7859 |
Medica Health Plan Solutions |
|
6799 |
Medica Individual and Family (IFB) |
|
2287 |
Medicare Plus Blue of MI(MAP) |
|
3475 |
Memorial Hermann Health Solutions |
|
9102 |
Meridian Medicare Medicaid Plan |
|
9118 |
MeridianComplete Michigan |
|
2426 |
Michigan Blue Care Network |
|
1421 |
Michigan Blue Cross Blue Shield |
|
1402 |
Minnesota Blue Cross Blue Shield |
|
1410 |
Minnesota Blue Cross Blue Shield CC Systems |
|
7892 |
Minnesota Blue Cross Blue Shield Health Care Programs |
|
1429 |
Minnesota Blue Cross Blue Shield HMO |
|
1408 |
Missouri Anthem Blue Cross Blue Shield |
|
7450 |
Montana Blue Cross Blue Shield |
|
1859 |
Neighborhood Healthcare PACE |
|
7422 |
New Hampshire Anthem Blue Cross Blue Shield |
|
7403 |
New Mexico Blue Cross Blue Shield |
|
8864 |
NextBlue of North Dakota |
|
1213 |
NHC Advantage |
|
2411 |
North Dakota Blue Cross Blue Shield |
|
1403 |
Oklahoma Blue Cross Blue Shield |
|
2404 |
Oregon Regence Blue Cross Blue Shield |
|
7829 |
Passport Advantage |
|
9123 |
Perennial Advantage |
|
9199 |
Piedmont Community Health Plan |
|
4252 |
Presbyterian Salud |
|
8468 |
Procare Advantage of TX |
|
2807 |
Professional Benefit Administrators (Oakbrook, Illinois) |
|
4253 |
Prominence Administrative Services |
|
8182 |
PruittHealth Premier NC/SC |
|
5428 |
QualChoice of Arkansas |
|
7264 |
Quartz ASO |
|
1209 |
Regence Group Administrators |
|
6246 |
Riverside Medical Clinic |
|
9410 |
Sante Community Medical Centers |
|
4464 |
SCAN Health Plan |
|
2254 |
Scott & White Health Plan |
|
9438 |
Shared Health Mississippi |
|
7225 |
Sharp Community Medical Group |
|
7138 |
Sierra Medical Group |
|
8124 |
Simply Healthcare Plans, Inc. |
|
8816 |
SOMOS Emblem |
|
1740 |
Sonder Health Plans |
|
2490 |
South Dakota Blue Cross Blue Shield |
|
1116 |
Special Agents Mutual Benefit Association (SAMBA) Teledoc only |
|
8134 |
Summit Community Care |
|
1406 |
Texas Blue Cross Blue Shield |
|
1729 |
Texas Childrens Health Plan (CHIP) |
|
2483 |
Texas Childrens Health Plan (STAR Medicaid) |
|
4278 |
The Boon Group |
|
2812 |
Troy Medicare |
|
8763 |
U.S. Networks and Administrative Services |
|
7810 |
UMass Medical School Health and Criminal Justice Program |
|
8473 |
Unicare (TX,MA,KS,WV,RI,IL) |
|
6849 |
United Group Programs |
|
2412 |
Utah Regence Blue Cross Blue Shield |
|
2788 |
Utah Regence Blue Cross Blue Shield Federal Employee Program |
|
7493 |
Vermont Blue Cross Blue Shield |
|
4258 |
VNS Health |
|
7451 |
Washington Regence Blue Shield |
|
1844 |
Wellcare Health Plans |
|
3211 |
Wellcare Health Plans (Encounters) |
|
1775 |
Wellpoint |
|
9441 |
Wellspace NEXUS LLC |
|
7489 |
Wyoming Blue Cross Blue Shield |
A resolution has been implemented and the claims were retransmitted to the payer intermediary on Nov. 15, 2024.
This delay affected claims released to Optum between 4 a.m. ET and 9 a.m. ET on Nov. 14, 2024.
Action Required: Be aware of the processing issue above.
REF 821300 11/15/2024
Update: Report Generation Delay for CPIDs 2426 and 3532 Michigan Blue Care Network
Update: A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted Oct. 10, 2024-Nov. 5, 2024.
Payer impacted:
- CPID 2426 Michigan Blue Care Network
- CPID 3532 Michigan Blue Care Network
The payer intermediary has been unable to generate and deliver the reports.
Action Required: None. Please resubmit claims if payment has not been received.
Original notify REF 801101 sent Oct. 21, 2024:
A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted since Oct. 9, 2024.
Payer impacted:
- CPID 2426 Michigan Blue Care Network
Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.
Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.
REF 821305 11/15/2024
Update: Report Generation Delay for CPIDs 2502 and 5479 IU Health Plan Medicare Advantage
Update: The payer intermediary has been unable to generate and deliver the reports for some claims submitted from Oct. 9, 2024 through Nov. 5, 2024.
Action Required: Please resubmit claims if payment has not been received.
Original notify sent Oct. 14, 2024:
A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted since Oct. 1, 2024.
Payer impacted:
- CPID 2502 IU Health Plan Medicare Advantage
- CPID 5479 IU Health Plan Medicare Advantage
Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.
Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.
REF 796104 821304 11/15/2024
Payer Change for CPID 1188 WellSpan Employee Assistance Program
Payer Name: WellSpan Employee Assistance Program
Claim CPID: 1188
Payer-assigned Payer ID: CB457
Claims must begin using the following:
Payer Name: Quest EAP
Professional CPID: 8251
Remittance Available: No
Payer-assigned Payer ID: 10956
Claim Fee: N/A
Enrollment Requirements:
Claims:
- Payer enrollment for electronic claims is not required.
Action Required:
- Please be aware of the changes above and make any necessary changes in your system.
- To access the new enrollment forms, please visit Enrollment Central.
REF 821052 11/15/2024
Edit Master for Multiple Payers – Molina Healthcare
This message is intended for Assurance Reimbursement Management customers.
Effective with the November 21, 2024 edit release, Optum will be changing the Institutional Edit Master to HE9C051 and the Professional Edit Master to PE_C051 for the following payers:
Payer Name: Molina Complete Care of Arizona
Professional CPID: 8127
Current Edit Master: PE_T007
Institutional CPID: 1098
Current Edit Master: HE9T007
Payer-assigned Payer ID: MCC01
Payer Name: Molina Complete Care of Virginia
Professional CPID: 8291
Current Edit Master: PE_T007
Institutional CPID: 3042
Current Edit Master: HE9T007
Payer-assigned Payer ID: MCC02
Payer Name: Molina Healthcare of Virginia Encounters
Professional CPID: 1756
Current Edit Master: PE_T007
Institutional CPID: 1965
Current Edit Master: HE9T007
Payer-assigned Payer ID: 10101
Payer Name: Molina Complete Care of California
Professional CPID: 1423
Current Edit Master: PE_T007
Institutional CPID: 3539
Current Edit Master: HE9E049
Payer-assigned Payer ID: 38333
Payer Name: Molina Complete Care of California (Encounters Only)
Professional CPID: 7844
Current Edit Master: PE_T007
Institutional CPID: 1019
Current Edit Master: HE9T007
Payer-assigned Payer ID: 33373
Payer Name: Molina Healthcare of Florida
Professional CPID: 4879
Current Edit Master: PE_E049
Institutional CPID: 8913
Current Edit Master: HE9E049
Payer-assigned Payer ID: 51062
Payer Name: Molina Healthcare of Florida Encounters
Professional CPID: 1718
Current Edit Master: PE_T007
Payer-assigned Payer ID: 00513
Payer Name: Molina Healthcare of Idaho
Professional CPID: 7842
Current Edit Master: PE_T007
Institutional CPID: 1018
Current Edit Master: HE9T007
Payer-assigned Payer ID: 61799
Payer Name: Molina Healthcare of Illinois
Professional CPID: 6806
Current Edit Master: PE_E049
Institutional CPID: 6907
Current Edit Master: HE9E049
Payer-assigned Payer ID: 20934
Payer Name: Molina Healthcare of Illinois
Professional CPID: 6806
Current Edit Master: PE_E049
Institutional CPID: 6907
Current Edit Master: HE9E049
Payer-assigned Payer ID: 20934
Payer Name: Passport Health Plan by Molina Healthcare
Professional CPID: 8863
Current Edit Master: PE_T007
Institutional CPID: 5015
Current Edit Master: HE9T007
Payer-assigned Payer ID: 61325
Payer Name: Molina Healthcare of Michigan
Professional CPID: 5443
Current Edit Master: PE_N000
Institutional CPID: 3551
Current Edit Master: HE9E049
Payer-assigned Payer ID: 38334
Payer Name: Molina Healthcare of New Mexico
Professional CPID: 3848
Current Edit Master: PE_T007
Institutional CPID: 8914
Current Edit Master: HE9E049
Payer-assigned Payer ID: 09824
Payer Name: Molina Healthcare of Nevada
Professional CPID: 9247
Current Edit Master: PE_T007
Institutional CPID: 6086
Current Edit Master: HE9T007
Payer-assigned Payer ID: MLNNV
Payer Name: Molina Healthcare of Ohio
Professional CPID: 2286
Current Edit Master: PE_N000
Institutional CPID: 1908
Current Edit Master: HE9E049
Payer-assigned Payer ID: 20149
Payer Name: Molina Healthcare of South Carolina
Professional CPID: 6794
Current Edit Master: PE_E049
Institutional CPID: 6998
Current Edit Master: HE9E049
Payer-assigned Payer ID: 46299
Payer Name: Molina Healthcare of Texas
Professional CPID: 4226
Current Edit Master: PE_T007
Institutional CPID: 4957
Current Edit Master: HE9E049
Payer-assigned Payer ID: 20554
Payer Name: Molina Healthcare of Utah
Professional CPID: 4237
Current Edit Master: PE_E049
Institutional CPID: 3611
Current Edit Master: HE9T007
Payer-assigned Payer ID: 12X09
Payer Name: Molina Healthcare of Washington
Professional CPID: 1863
Current Edit Master: PE_T007
Institutional CPID: 2561
Current Edit Master: HE9E049
Payer-assigned Payer ID: 38336
Payer Name: Molina Healthcare of Washington (Encounters only)
Professional CPID: 8212
Current Edit Master: PE_T007
Payer-assigned Payer ID: 43174
Payer Name: Molina Healthcare of Wisconsin
Professional CPID: 2119
Current Edit Master: PE_E049
Institutional CPID: 5951
Current Edit Master: HE9T007
Payer-assigned Payer ID: ABRI1
Payer Name: Senior Whole Health New York
Professional CPID: 9115
Current Edit Master: PE_T007
Institutional CPID: 5068
Current Edit Master: HE9T007
Payer-assigned Payer ID: SWHNY
Payer Name: Senior Whole Health Massachusetts
Professional CPID: 9246
Current Edit Master: PE_T007
Institutional CPID: 6085
Current Edit Master: HE9T007
Payer-assigned Payer ID: SWHMA
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 821001 11/15/2024
Payer Transmit Delay for multiple CPIDs
Due to a payer system issue, a delay occurred in some of the transmissions to the following payers on Nov. 14, 2024.
Payers impacted:
- CPID 1483 New Jersey Medicaid
- CPID 5505 New Jersey Medicaid
- CPID 5575 New Jersey Charity Care Inpatient
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 4 p.m. ET on Nov. 13, 2024.
Action Required: Be aware of the transmit delay above.
REF 821000 11/15/2024
Restored Payer Connectivity
Effective November 12, 2024, Optum is pleased to announce payer connectivity has been restored and real-time eligibility and claims status transactions for the below payer may now be submitted:
Payer ID: 94036
Payer name: Blue Cross of California
Transaction type: Eligibility 270/271 & Claim Status 276/277
Action Required:
Please update your system to take advantage of this payer transaction. For assistance with submitting real-time transactions, please contact your Practice Management System Vendor or Optum Customer Care Hub. For new entities, before submitting or receiving a 276 or 277 transaction, you must register as a trading partner with BSC to ensure you are established and recognized in our system. To register, please fill out the enrollment application and trading partner agreements forms found on Provider Connection.
Updated payer lists may be obtained from your software vendor or Payer Lists | Change Healthcare.
REF 820902 11/15/2024
Electronic Claims Connection Suspended
Effective immediately, the payer listed below has/have been temporarily suspended at Optum for claims processing and removed from the payer list.
Payer Name: Renaissance Physicians Organization
CPIDs: 3197, 7948
Payer ID: 76066
Action Required: Please refrain from submitting claims until further notice.
REF 820601 11/14/2024
New Payer Name from Jensen Administrative Service, Inc to Southwest Service Admins
Effective immediately, please be aware of the following payer name changes:
Assurance EDI:
Previous Payer Name: Jensen Administrative Service, Inc
New Payer Name: Southwest Service Admins
Professional CPID: 2705
Institutional CPID: 7575
Action Required: Please make the appropriate changes to accommodate the name change.
Assurance Reimbursement Management:
Previous Payer Name: Jensen Administrative Service, Inc
New Payer Name: Southwest Service Admins
Professional CPID: 2705
Edit Master: PE_E049
Institutional CPID: 7575
Edit Master: HE9E049
Your existing Payer Alias entries will continue to work as they do currently; the new payer name is being provided for your reference. Be aware all future communications for these CPIDs will reference the new payer name only.
Action Required: You may choose to update the Payer Alias in your system to accommodate the new payer name.
REF 820550 11/14/2024
Report Generation Delay for CPID 6781 Bienvivir Senior Health Services
The payer listed below is experiencing issues affecting Professional report generation for some claims submitted on Nov. 6, 2024.
Payer impacted:
- CPID 6781 Bienvivir Senior Health Services
Optum is working diligently with the payer to resolve the issue and ensure reports are received.
Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.
REF 820600 11/14/2024
Update: Payer Transmit Delay for CPIDs 5582 and 7430 Idaho Blue Cross Boise
Update: A resolution has been implemented and the affected claims were transmitted to the payer Nov. 14, 2024.
This delay affected claims released to Optum Nov. 8, 2024, 2:00 p.m.-Nov. 13, 2024, 2:00 p.m. CT.
Action Required: Please be aware of the transmit delay.
Original notify REF 817300 sent Nov. 12, 2024:
Due to a payer system issue, a delay occurred in the transmissions to the following payer since Nov. 11, 2024.
Payer impacted:
- CPID 5582 Idaho Blue Cross Boise
- CPID 7430 Idaho Blue Cross Boise
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 Nov. 8, 2024, 2:00 p.m. CT.
Action Required: Be aware of the transmit delay above.
REF 820650 11/14/2024
Report Generation Delay for CPID 5568 Global Healthcare Alliance
A payer intermediary is experiencing issues affecting Institutional report generation for some claims submitted on Oct. 31, 2024.
Payer impacted:
- CPID 5568 Global Healthcare Alliance
The payer intermediary has been unable to generate and deliver the reports.
Action Required: None. Please resubmit claims if payment has not been received.
REF 820201 11/14/2024
Electronic Routing Change for CPIDs 6685, 3205 Health First Health Plan
Effective immediately, Optum will be changing electronic remittance routing for the following payer:
Payer Name: Health First Health Plan
Professional CPID: 3205
Institutional CPID: 6685
Line of Business Code (LOB): J85
Payer-assigned Payer ID: 95019
Enrollment Requirements:
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(s) and CPID(s) are not changing.
- When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.
REF 819521 11/14/2024
Report Generation Delay for CPID 8763 U.S. Networks and Administrative Services
A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted on Oct. 25, 2024.
Payer impacted:
- CPID 8763 U.S. Networks and Administrative Services
The payer intermediary has been unable to generate and deliver the reports.
Action Required: None. Please resubmit claims if payment has not been received.
REF 819702 11/14/2024
Update: Report Generation Delay for CPIDs 1876 and 8990 Group Health Cooperative of South Central Wisconsin
Update: The payer is unable to generate and deliver the reports for some claims submitted from Oct. 31, 2024 through Nov. 2, 2024.
Action Required: Please resubmit claims if payment has not been received.
Original notify sent Nov. 11, 2024:
A payer is experiencing issues affecting Professional and Institutional report generation for some claims submitted since Oct. 31, 2024.
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.
REF 815150 819451 11/14/2024
Electronic Routing Change for CPID 9661 Key Medical Group
Effective immediately, Optum will be reactivating and changing electronic claims routing for the following payers:
Payer Name: Key Medical Group
Institutional CPID: 9661
Payer-assigned Payer ID: Z1338
Enrollment Requirements:
- 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.
REF 820251 11/14/2024
Electronic Routing Change for CPID 9661 Key Medical Group
Effective immediately, Optum will be reactivating and changing electronic claims routing for the following payer:
Payer Name: Key Medical Group
Institutional CPID: 9661
Current Edit Master: HE9O007
New Edit Master: HE9T007
Payer-assigned Payer ID: Z1338
Enrollment Requirements:
- 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.
REF 820250 11/14/2024
Report Generation Delay for CPID 6879 RHA VestaCare
A payer intermediary is experiencing issues affecting professional report generation for some claims submitted on Oct. 29, 2024.
Payer impacted:
- CPID 6879 RHA VestaCare
The payer intermediary has been unable to generate and deliver the reports.
Action Required: None. Please resubmit claims if payment has not been received.
REF 819750 11/14/2024
Report Generation Delay for CPID 4101 AllCare Advantage
A payer intermediary is experiencing issues affecting professional report generation for some claims submitted on Oct. 25, 2024.
Payer impacted:
- CPID 4101 AllCare Advantage
The payer intermediary has been unable to generate and deliver the reports.
Action Required: None. Please resubmit claims if payment has not been received.
REF 819701 11/14/2024
Report Generation Delay for CPID 2490 South Dakota Blue Cross Blue Shield
A payer intermediary is experiencing issues affecting professional report generation for some claims submitted on Oct. 25, 2024.
Payer impacted:
- CPID 2490 South Dakota Blue Cross Blue Shield
The payer intermediary has been unable to generate and deliver the reports.
Action Required: None. Please resubmit claims if payment has not been received.
REF 819405 11/14/2024
Report Generation Delay for CPID 8124 Simply Healthcare Plans, Inc
A payer intermediary is experiencing issues affecting professional report generation for some claims submitted on Oct. 25, 2024.
Payer impacted:
- CPID 8124 Simply Healthcare Plans, Inc.
The payer intermediary has been unable to generate and deliver the reports.
Action Required: None. Please resubmit claims if payment has not been received.
REF 819404 11/14/2024
Report Generation Delay for CPID 5243 Healthcare Management Administrators
A payer intermediary is experiencing issues affecting professional report generation for some claims submitted on Oct. 25, 2024.
Payer impacted:
- CPID 5243 Healthcare Management Administrators
The payer intermediary has been unable to generate and deliver the reports.
Action Required: None. Please resubmit claims if payment has not been received.
REF 819401 11/14/2024
Report Generation Delay for CPIDs 1064 and 7892 Minnesota Blue Cross Blue Shield Health Care Programs
A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted since Oct. 30, 2024.
Payer impacted:
- CPID 1064 Minnesota Blue Cross Blue Shield Health Care Programs
- CPID 7892 Minnesota Blue Cross Blue Shield Health Care Programs
Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.
Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.
REF 819751 11/14/2024
Electronic Routing Change for CPIDs 6685, 3205 Health First Health Plan
Effective immediately, Optum will be changing electronic remittance routing for the following payer:
Payer Name: Health First Health Plan
Professional CPID: 3205
Institutional CPID: 6685
Payer-assigned Payer ID: 95019
Enrollment Requirements:
Payer enrollment for electronic remittance is required.
- Providers currently receiving electronic remittance through Optum must complete a new enrollment form.
- New providers must complete a new enrollment form.
Action Required: Please consider the following to allow transactions to process properly due to the above changes:
- Make any necessary system changes.
- When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.
REF 819522 11/14/2024
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 Oct. 28, 2024.
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.
REF 819704 11/14/2024
Report Generation Delay for CPID 6795 Contra Costa Health Plan
A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted on Oct. 25, 2024.
Payer impacted:
- CPID 6795 Contra Costa Health Plan
The payer intermediary has been unable to generate and deliver the reports.
Action Required: None. Please resubmit claims if payment has not been received.
REF 819700 11/14/2024
Report Generation Delay for CPID 2979 Prominence Administrative Services
A payer intermediary is experiencing issues affecting Institutional report generation for some claims submitted Oct. 28, 2024.
Payer impacted:
- CPID 2979 Prominence Administrative Services
The payer intermediary has been unable to generate and deliver the reports.
Action Required: None. Please resubmit claims if payment has not been received.
REF 819703 11/14/2024
Report Generation Delay for CPID 1209 Regence Group Administrators
A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted on Oct. 25, 2024.
Payer impacted:
- CPID 1209 Regence Group Administrators
The payer intermediary has been unable to generate and deliver the reports.
Action Required: None. Please resubmit claims if payment has not been received.
REF 819551 11/14/2024
Report Generation Delay for CPID 4448 HealthLink PPO
A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted on Oct. 25, 2024.
Payer impacted:
- CPID 4448 HealthLink PPO
The payer intermediary has been unable to generate and deliver the reports.
Action Required: None. Please resubmit claims if payment has not been received.
REF 819402 11/14/2024
Update: Report Generation Delay for multiple CPIDs
Update: It has been determined that the report delay below was due to a payer claims processing issue. We have retransmitted the impacted claims to the payers Nov. 14, 2024. Reports will be delivered once the claims have successfully processed at the payers.
Action Required: Please be aware of delays.
Original Notice REF 815151 Sent 11/11/24:
The payers listed below are experiencing issues affecting Professional report generation for some claims submitted since Nov. 5, 2024.
Payers impacted:
- CPID 9457 Buckeye Ohio Medicaid
- CPID 9458 CareSource Ohio Medicaid
Optum is working diligently with the payers to resolve the issue and ensure reports are received.
Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.
REF 819453 11/14/2024
Report Generation Delay for CPID 9428 AmeriHealth Caritas Ohio
A payer is experiencing issues affecting Professional report generation for some claims submitted since Nov. 6, 2024.
Payer impacted:
- CPID 9428 AmeriHealth Caritas Ohio
Optum is working diligently with the payer to resolve the issue and ensure reports are received.
Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.
REF 819452 11/14/2024
Report Generation Delay for CPID 4480 SelectHealth
A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted Oct. 25, 2024.
Payer impacted:
- CPID 4480 SelectHealth
The payer intermediary has been unable to generate and deliver the reports.
Action Required: None. Please resubmit claims if payment has not been received.
REF 819403 11/14/2024
Report Generation Delay for CPID 7738 CountyCare Health Plan
A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted on Oct. 25, 2024.
Payer impacted:
- CPID 7738 CountyCare Health Plan
The payer intermediary has been unable to generate and deliver the reports.
Action Required: None. Please resubmit claims if payment has not been received.
REF 819400 11/14/2024
Report Generation Delay for CPIDs 4093 and 8834 Commonwealth Care Alliance DOS after 3/31/2023
A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted on Oct. 25, 2024.
Payer impacted:
- CPID 4093 Commonwealth Care Alliance DOS after 3/31/2023
- CPID 8834 Commonwealth Care Alliance DOS after 3/31/2023
The payer intermediary has been unable to generate and deliver the reports.
Action Required: None. Please resubmit claims if payment has not been received.
REF 817904 11/14/2024
ABLPY - AblePay Health, LLC - Real-Time Transaction Available
Effective November 13, 2024, Optum is pleased to announce the availability of real time Eligibility transactions for the below payer:
IMN Payer ID: ABLPY
Payer Name: AblePay Health, LLC
Transaction Type: 270/271
Action Required:
Please update your system to take advantage of this payer transaction. For assistance with submitting Real-Time transactions, please contact your Practice Management System Vendor or Optum Customer Care Hub.
Updated Payer Lists may be obtained from your software vendor or Payer Lists | Change Healthcare.
REF 819200 11/14/2024
New Payer Names Verdegard Administrators and Verdegard Employee Plan
Effective immediately, please be aware of the following payer name changes:
Assurance EDI:
Previous Payer Name: HMA Hawaii
New Payer Name: Verdegard Administrators
Professional CPID: 4753
Institutional CPID: 1981
Previous Payer Name: IMX Easy
New Payer Name: Verdegard Employee Plan
Professional CPID: 2755
Institutional CPID: 7931
Action Required: Please make the appropriate changes to accommodate the name change.
Assurance Reimbursement Management:
Previous Payer Name: HMA Hawaii
New Payer Name: Verdegard Administrators
Professional CPID: 4753
Current Edit Master: PE_B800
New Edit Master: PE_T007
Institutional CPID: 1981
Current Edit Master: HE9B801
New Edit Master: HE9T007
Remit Line of Business (LOB) Code: J6Q
Previous Payer Name: IMX Easy
New Payer Name: Verdegard Employee Plan
Professional CPID: 2755
Institutional CPID: 7931
Edit Master: HE9T007, PE_T007
Your existing Payer Alias entries will continue to work as they do currently; the new payer name is being provided for your reference. Be aware all future communications for these CPIDs will reference the new payer name only.
Action Required:
- You may choose to update the Payer Alias in your system to accommodate the new payer name.
- Revalidate unreleased claims to edit correctly under new edit master.
- Modify any bridge routines based on the edit master.
REF 818200 11/13/2024
Electronic Routing Change for Multiple CPIDs / Multiple Payers
Effective Nov. 13, 2024, Optum will be changing electronic claims routing for the following payers:
Payer Name: Alta Bates Medical Group
Professional CPID: 5846
Edit Master: PE_T007
Institutional CPID: 4028
Edit Master: HE9T007
Payer-assigned Payer ID: A0701
Payer Name: Brown & Toland Health Services
Professional CPID: 6867
Edit Master: PE_T007
Institutional CPID: 7645
Edit Master: HE9T007
Payer-assigned Payer ID: BTHS1
Payer Name: Brown & Toland Medical Group
Professional CPID: 1289
Edit Master: PE_T007
Institutional CPID: 6547
Edit Master: HE9T007
Payer-assigned Payer ID: 94316
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:
- 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 818303 11/13/2024
Report Generation Delay for CPIDs 1682 and 2830 CarePlus Health Plans
A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted since Oct. 25, 2024.
Payer impacted:
- CPID 1682 CarePlus Health Plans
- CPID 2830 CarePlus Health Plans
Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.
Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.
REF 817907 11/13/2024
Report Generation Delay for CPIDs 8921 and 5865 Indian Health Services
A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted since Oct. 25, 2024.
Payer impacted:
- CPID 8921 Indian Health Services
- CPID 5865 Indian Health Services
Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.
Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.
REF 817903 11/13/2024
Electronic Routing Change for Multiple CPIDs /Multiple Payers
This notice is intended for Assurance EDI (Exchange) customers
Effective November 13, 2024, Optum will be changing electronic claims routing for the following payers:
Payer Name: Alta Bates Medical Group
Professional CPID: 5846
Institutional CPID: 4028
Payer-assigned Payer ID: A0701
Payer Name: Brown & Toland Health Services
Professional CPID: 6867
Institutional CPID: 7645
Payer-assigned Payer ID: BTHS1
Payer Name: Brown & Toland Medical Group
Professional CPID: 1289
Institutional CPID: 6547
Payer-assigned Payer ID: 94316
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.
REF818302 11/13/2024
Report Generation Delay for CPID 5440 Fox Valley Medicine
A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted Oct. 25, 2024.
Payer impacted:
- CPID 5440 Fox Valley Medicine
The payer intermediary has been unable to generate and deliver the reports.
Action Required: None. Please resubmit claims if payment has not been received.
REF 817908 11/13/2024
Report Generation Delay for CPID 5404 Insight Benefit Administrators
A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted on Oct. 25, 2024.
Payer impacted:
- CPID 5404 Insight Benefit Administrators
The payer intermediary has been unable to generate and deliver the reports.
Action Required: None. Please resubmit claims if payment has not been received.
REF 817906 11/13/2024
Electronic Claims Connection No Longer Available for Inter Valley Health Plan Encounters
Effective immediately, the payer listed below will no longer be available at Optum for claims processing.
Assurance EDI:
Payer Name: Inter Valley Health Plan Encounters
Claim and Remittance CPIDs: 2476, 7087
Reason: Payer not longer has a connection for which Optum can build connectivity.
Action Required: None.
Assurance Reimbursement Management:
Payer Name: Inter Valley Health Plan Encounters
Claim CPIDs: 2476, 7087
Reason: Payer not longer has a connection for which Optum can build connectivity.
Action Required: None.
REF818500 11/13/2024
Report Generation Delay for CPID 6671 HealthSun
A payer intermediary is experiencing issues affecting Institutional report generation for some claims submitted Oct. 25, 2024.
Payer impacted:
- CPID 6671 HealthSun
The payer intermediary has been unable to generate and deliver the reports.
Action Required: None. Please resubmit claims if payment has not been received.
REF 817905 11/13/2024
Report Generation Delay for CPID 2234 Illinois Health Partners
A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted on Oct. 25, 2024.
Payer impacted:
- CPID 2234 Illinois Health Partners
The payer intermediary has been unable to generate and deliver the reports.
Action Required: None. Please resubmit claims if payment has not been received.
REF 817902 11/13/2024
Report Generation Delay for multiple CPIDs
A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted on Oct. 25, 2024.
Payers impacted:
- CPID 8057 Ambetter of Alabama
- CPID 9775 Ambetter of Alabama
- CPID 7051 Ambetter of Oklahoma
- CPID 9433 Ambetter of Oklahoma
- CPID 1970 Ambetter From Absolute Total Care
- CPID 1764 Ambetter From Absolute Total Care
- CPID 1765 Ambetter From Louisiana Healthcare Connections
- CPID 6574 Ambetter from Nebraska Total Care
- CPID 9278 Ambetter from Nebraska Total Care
- CPID 9431 Ambetter from WellCare of Kentucky
- CPID 2949 Care1st Health Plan of Arizona Medicaid
- CPID 9747 Delaware First Health
- CPID 9293 Wellcare by Allwell from Nebraska Total Care
- CPID 9430 Wellcare by Allwell of Oklahoma
Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.
Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.
REF 817901 11/13/2024
Update: Report Generation Delay for CPIDs 5072 and 9102 Meridian Medicare Medicaid
The payer intermediary has been unable to generate and deliver the reports for some claims submitted on Oct. 25, 2024, and Nov. 5, 2024.
Action Required: Please resubmit claims if payment has not been received.
Original message sent Nov. 11, 2024:
A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted since Oct. 25, 2024.
Payer impacted:
- CPID 5072 Meridian Medicare Medicaid
- CPID 9102 Meridian Medicare 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.
REF 817900 11/13/2024
Delay in Electronic Remittance Advice (ERA) for CPIDs 1421/3514 Michigan Blue Cross Blue Shield
Due to a payer processing issue, there has been a delay in Professional and Institutional Electronic Remittance Advice (ERA) for the following payers for dates of Oct. 15th, 2024 through present:
- 1421 Michigan Blue Cross Blue Shield
- 3514 Michigan Blue Cross Blue Shield
Action Required: Please be aware of a delay in the delivery of ERA for dates above.
If you have any questions, feel free to contact your Customer Support Team and refer to INC-000002003.
REF 817450 11/13/2024
Electronic Routing Change for CPIDs 1981 and 4753 HMA Hawaii
Effective November 12, 2024, Optum will be changing electronic remittance routing for the following payer:
Payer Name: HMA Hawaii
Professional CPID: 4753
Institutional CPID: 1981
Line of Business Code (LOB): J6Q
Payer-assigned Payer ID: 86066
Enrollment Requirements:
Remittance:
- Payer enrollment for electronic remittance is required.
- Providers currently receiving electronic remittance through Optum must login to Zelis and review their enrollment and verify ‘Change Healthcare Medical’ is selected as the clearinghouse.
- If ‘Change Healthcare Medical’ is selected as the clearinghouse, providers do not need to complete a new enrollment form.
- If ‘Change Healthcare Medical’ is NOT selected as the clearinghouse and providers would like to continue receiving remittance through Optum, providers must update the clearinghouse name.
- Providers who moved their enrollment to another clearinghouse will need to re-enroll with Optum to receive ERAs for this payer from Optum.
- New providers must complete a new enrollment form.
- Providers currently receiving electronic remittance through Optum must login to Zelis and review their enrollment and verify ‘Change Healthcare Medical’ is selected as the clearinghouse.
Action Required: Please make the following changes to accommodate the routing change:
- When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.
REF 816300 11/12/2024
Upcoming Utah Medicaid Eligibility Enrollment Requirements
UTAH Medicaid Eligibility ID UDOH0 will be going live soon with the 270/271. This payer has Enrollment requirements you need to be aware of prior to go live and post go live.
Providers will need to be enrolled with Utah Medicaid and complete the EDI Enrollment for Eligibility transactions.
Enroll at: https://medicaid.utah.gov/prism-faq/
Please select the Provider FAQ: Electronic Data Interchange (EDI) listed under Provider FAQs.
Providers can access the PRISM Portal here: https://medicaid.utah.gov/accessing-prism/
The provider can log into PRISM and verify the Trading Partner Number they are currently set up with in Step 9 (Associate Billing Agent) of the Business Process Wizard (BPW).
If using a Clearinghouse and that Clearinghouse is not located in the PRISM portal, the provider should choose Utah Health Information Network (UHIN), and then add the correct Trading Partner Number of the clearinghouse they are using.
To contact Provider Enrollment, please call 801-538-6155 and then select option 3 and then option 4.
REF 816850 11/12/2024
New Electronic Claims Connections Available
Optum has new electronic claims connections available:
Payer Name: American Health Advantage of Indiana
Institutional CPID: 7966
Professional CPID: 2841
Payer-assigned Payer ID: RP115
Payer Enrollment Required: No
Secondary Claims Accepted: Yes
Payer Location: Indiana
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 816251 11/12/2024
Health Choice Generations Utah Electronic Claims and Remittance Connections No Longer Available
This message is intended for Assurance EDI and Assurance Reimbursement Management customers.
Effective immediately, the payer listed below will no longer be available at Optum for claims and remittance processing.
Assurance EDI:
Payer Name: Health Choice Generations Utah
Claim and Remittance CPIDs: 3092, 8716
Reason: Payer no longer in business.
Action Required: None.
Assurance Reimbursement Management:
Payer Name: Health Choice Generations Utah
Claim CPIDs: 3092, 8716
Remittance LOB: U28
Reason: Payer no longer in business.
Action Required: None.
REF 817050 11/12/2024
Edit Master for CPID 1795 Envolve Benefit Options
Effective immediately, Optum will be changing Edit Masters for the following payer[s]:
Payer Name: Envolve Benefit Options
Professional CPID: 1795
Current Edit Master: PE_E049
New Edit Master: PE_T007
Payer-assigned Payer ID: 56190
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 817251 11/12/2024
New Electronic Claims Connection Available
Optum has new electronic claims connection available:
Payer Name: Companion Life Insurance Company of California
Institutional CPID: 7965
Professional CPID: 2838
Payer-assigned Payer ID: CLICA
Payer Enrollment Required: No
Secondary Claims Accepted: No
Payer Location: California
Claims Fee: N/A
Action Required:
- Add the payers to your system to begin using the new payer connection.
- When a payer requires enrollment, forms must be submitted and approved to begin submitting transactions.
REF817550 11/12/2024
Utah Medicaid eligibility upcoming action needed
Utah Medicaid Eligibility ID UDOH0 will soon be live for 270/271 transactions. The payer has enrollment requirements you need to be aware of prior to go live and post go live.
Providers will need to enroll with Utah Medicaid and complete the EDI Enrollment for Eligibility transactions.
- Select the Provider FAQ: Electronic Data Interchange (EDI) listed under Provider FAQs.
Provider access to the PRISM Portal.
- The provider can log into PRISM and verify the Trading Partner Number they are currently set up with in Step 9 (Associate Billing Agent) of the Business Process Wizard (BPW).
If using a clearinghouse that is not located in the PRISM portal, the provider should choose Utah Health Information Network (UHIN) and then add the correct Trading Partner Number for clearinghouse they are using.
To contact Provider Enrollment, please call 801-538-6155 and then select option 3 and then option 4.
REF817350 11/12/2024
Payer Transmit Delay for CPIDs 5582 and 7430 Idaho Blue Cross Boise
Due to a payer system issue, a delay occurred in the transmissions to the following payer since Nov. 11, 2024.
Payer impacted:
- CPID 5582 Idaho Blue Cross Boise
- CPID 7430 Idaho Blue Cross Boise
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 3 p.m. ET on Nov. 8, 2024.
Action Required: Be aware of the transmit delay above.
REF 817300 11/12/2024
RESOLVED: Medicare FI Claims and ERA Delivery Delay
The below issue has been resolved for claims and reporting delivery beginning on Thursday, October 17, 2024, through present.
Original message sent Nov. 11, 2024:
We are collaborating with our partners regarding ongoing issues causing intermittent disruptions resulting in delays in Professional and Institutional Electronic Remittance Advice (ERA), Claims and Reporting delivery for the following payers Oct. 17, 2024, through present:
|
State |
Intermediary |
Pat B |
Part A |
|
ARIArkansas |
Novitas JH |
ARMCR |
CHCMR |
|
COIColorado |
Novitas JH |
COMCR |
4111 |
|
DEIDeleware |
Novitus JL |
00902 |
CHCMR |
|
IDIIdaho |
Novitus JL |
IDMCR |
CHCMR |
|
LAILouisiana |
Novitas JH |
LAMCR |
07201 |
|
MDIMaryland |
Novitus JL |
00901 |
CHCMR |
|
MSIMississippi |
Novitas JH |
CHCMR |
CHCMR |
|
NJINew Jersey |
Novitas JH |
NJMCR |
CHCMR |
|
NMINew Mexico |
Novitas JH |
NMMCR |
CHCMR |
|
OKI Oaklahoma |
Novitas JH |
OKMCR |
04311 |
|
PAIPennsylvania |
Novitus JL |
PAMCR |
12501 |
|
TXITexas |
Novitas JH |
TXMCR |
04411 |
|
TNITennessee |
Novitas JH |
TNMCR |
12M53 |
Action Required: Please be aware of a delay in the delivery of ERA claims and reporting for the dates above.
Additional updates will be forwarded as more information becomes available.
Please direct any questions to the Support Team at 1-866-OptumGo.
REF 816615 11/12/2024
New Electronic Claims Connections Available
Optum has new electronic claims connections available:
Payer Name: Horace Mann
Institutional CPID: 5990
Professional CPID: 2189
Payer-assigned Payer ID: HMLIC
Payer Enrollment Required: No
Secondary Claims Accepted: No
Payer Location: National
Claims Fee: $0
Payer Name: Preferred Community Choice PPO
Institutional CPID: 8515
Professional CPID: 1791
Payer-assigned Payer ID: 73145
Payer Enrollment Required: No
Secondary Claims Accepted: No
Payer Location: Oklahoma
Claims Fee: $0
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 817100 11/12/2024
New Electronic Claims Connection Available
Optum has new electronic claims connection available:
Payer Name: Consolidated Associates Railroad
Institutional CPID: 7967
Payer-assigned Payer ID: 75284
Payer Enrollment Required: No
Secondary Claims Accepted: Yes
Payer Location: Texas
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.
REF816500 11/12/2024
Resolved: Delay in Electronic Remittance Advice (ERA) for multiple CPIDs
Resolved: The issue has been resolved. All affected remittance files for check dates of October 15, 2024, through present, have been sent.
Original notification sent October 31, 2024:
Due to a payer intermediary processing issue, there has been a delay in some Professional and Institutional Electronic Remittance Advice (ERA) for the following payers for file dates of Oct. 15, 2024, through present:
Payers impacted:
|
CPID |
Payer Name |
|
2161 |
AR MEDICARE OKC ONLY |
|
2455 |
AR MEDICARE |
|
1526 |
ARKANSAS MEDICARE |
|
2162 |
CO MEDICARE OKC ONLY |
|
1449 |
COLORADO MEDICARE |
|
1547 |
COLORADO MEDICARE |
|
2165 |
DC MEDICARE OKC ONLY |
|
1522 |
DC MEDICARE |
|
2163 |
DELAWARE MEDICARE OKC ONLY |
|
2456 |
DELAWARE MEDICARE |
|
5912 |
DELAWARE MEDICARE |
|
3650 |
JH MUTUAL OF OMAHA CO NM OK TX |
|
3677 |
JL MUTUAL OMAHA DC DE MD NJ PA |
|
2171 |
LOUISIANA MEDICARE OKC ONLY |
|
1460 |
LOUISIANA MEDICARE |
|
3579 |
LOUISIANA MEDICARE |
|
2464 |
MARYLAND MEDICARE |
|
7402 |
MARYLAND MEDICARE |
|
2201 |
MD MEDICARE OKC ONLY |
|
5554 |
MD MEDICARE |
|
2451 |
MISSISSIPPI MEDICARE |
|
5556 |
MS MEDICARE |
|
1465 |
NEW JERSEY MEDICARE |
|
1457 |
NEW MEXICO MEDICARE |
|
2205 |
NJ MEDICARE OKC ONLY |
|
4938 |
NJ MEDICARE OKC ONLY |
|
5503 |
NJ MEDICARE UB92 |
|
2204 |
NM MEDICARE OKC ONLY |
|
2206 |
OK MEDICARE OKC ONLY |
|
4942 |
OK MEDICARE OKC ONLY |
|
1458 |
OKLAHOMA MEDICARE |
|
1558 |
OKLAHOMA MEDICARE |
|
2207 |
PA MEDICARE OKC ONLY |
|
4944 |
PA MEDICARE OKC ONLY |
|
5598 |
PA MEDICARE |
|
2457 |
PENNSYLVANIA MEDICARE |
|
5502 |
TEXAS MEDICARE UB92 |
|
1440 |
TEXAS MEDICARE |
|
2208 |
TX MEDICARE OKC ONLY |
|
4946 |
TX MEDICARE OKC ONLY |
|
2459 |
WASHINGTON DC MEDICARE |
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.
REF 816700 11/12/2024
New Electronic Claims Connections Available
Optum has new electronic claims connections available:
Payer Name: American Health Advantage of Indiana
Institutional CPID: 7966
Professional CPID: 2841
Payer-assigned Payer ID: RP115
Payer Enrollment Required: No
Secondary Claims Accepted: Yes
Payer Location: Indiana
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.
REF816250 11/12/2024
BCFLC - Blue Cross Blue Shield Florida - New Real-Time Transaction Available
Effective November 23, 2024, Optum is pleased to announce the availability of New real time Claim Status transactions for the below payer:
IMN Payer ID: BCFLC
Payer Name: Blue Cross Blue Shield Florida
Transaction Type: 276/277
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 visit the Optum Customer Care Hub.
Updated Payer Lists may be obtained from your software vendor or Payer Lists | Change Healthcare
REF 815901 11/12/2024
NH - New Hampshire Medicaid - Real-Time Transaction Available
Effective October 23, 2024, Optum is pleased to announce the availability of real time Eligibility transactions for the below payer:
IMN Payer ID: NH
Payer Name: New Hampshire Medicaid
Transaction Type: 270/271
Action Required:
Please update your system to take advantage of this payer transaction. For assistance with submitting Real-Time transactions, please contact your Practice Management System Vendor or Optum Customer Care Hub.
Updated Payer Lists may be obtained from your software vendor or Payer Lists | Change Healthcare.
REF 815900 11/12/2024
Report Generation Delay for multiple CPIDs
A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted on Oct. 25, 2024.
Payers impacted:
- CPID 1529 Utah Regence Blue Cross Blue Shield
- CPID 2412 Utah Regence Blue Cross Blue Shield
- CPID 1530 Utah Regence Blue Cross Blue Shield Federal Employee Program
- CPID 2788 Utah Regence Blue Cross Blue Shield Federal Employee Program
Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.
Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.
REF 815401 11/11/2024
Report Generation Delay for CPID 1167 Blue Cross Medicare Advantage PPO/HMO
A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted on Oct. 25, 2024.
Payer impacted:
- CPID 1167 Blue Cross Medicare Advantage PPO/HMO
The payer intermediary has been unable to generate and deliver the reports.
Action Required: None. Please resubmit claims if payment has not been received.
REF 815404 11/11/2024
New Electronic Claims Connections Available
Optum has new electronic claims connections available:
Payer Name: Troy Medicare
Institutional CPID: 7953
Professional CPID: 2812
Payer-assigned Payer ID: TRYMC
Payer Enrollment Required: No
Secondary Claims Accepted: No
Payer Location: North Carolina
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 815550 11/11/2024
Report Generation Delay for CPIDs 8867 and 5019 Healthy Blue Missouri
A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted on Oct. 25, 2024.
Payer impacted:
- CPID 8867 Healthy Blue Missouri
- CPID 5019 Healthy Blue Missouri
The payer intermediary has been unable to generate and deliver the reports.
Action Required: None. Please resubmit claims if payment has not been received.
REF 815407 11/11/2024
Report Generation Delay for CPID 2113 Allcare Health Plan
A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted Oct. 25, 2024.
Payer impacted:
- 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.
REF 815409 11/11/2024
Report Generation Delay for CPIDs 8923 and 4289 El Paso Health-CHIP
A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted Oct. 25, 2024.
Payer impacted:
- CPID 8923 El Paso Health-CHIP
- CPID 4289 El Paso Health-CHIP
The payer intermediary has been unable to generate and deliver the reports.
Action Required: None. Please resubmit claims if payment has not been received.
REF 815406 11/11/2024
New Electronic Claims Connections Available
Optum has new electronic claims connections available:
Payer Name: Clearwater
Institutional CPID: 7960
Professional CPID: 2834
Payer-assigned Payer ID: DCRSS
Payer Enrollment Required: No
Secondary Claims Accepted: Yes
Payer Location: National
Claims Fee: N/A
Action Required:
- Add the payers to your system to begin using the new payer connection.
- When a payer requires enrollment, forms must be submitted and approved to begin submitting transactions.
Please note: We are providing you with a list of new electronic connections, please review and choose payers that are appropriate for your business.
REF 815500 11/11/2024
New Electronic Claims and Remittance Connections Available
Optum has new electronic claims and remittance connections available:
Payer Name: Promise health Plan
Institutional CPID: 7928
Professional CPID: 2751
Payer-assigned Payer ID: RP128
Line of Business(LOB) Code: N41
Payer Claim Enrollment Required: No
Payer Remittance Enrollment Required: Yes
Secondary Claims Accepted: Yes
Payer Location: National
Claims Fee: N/A
Remittance Fee: N/A
Action Required:
- Add the payers to your system to begin using the new payer connection.
- When a payer requires claims enrollment, forms must be submitted and approved to begin submitting transactions.
- Enrollment forms must be submitted and approved to begin receiving electronic remittance through Optum.
Please note: We are providing you with a list of new electronic connections, please review and choose payers that are appropriate for your business.
REF 815403 11/11/2024
Report Generation Delay for multiple CPIDs
A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted on Oct. 25, 2024.
Payers impacted:
- CPID 3531 Michigan Blue Cross Blue Shield Federal Employee Program
- CPID 1421 Michigan Blue Cross Blue Shield
The payer intermediary has been unable to generate and deliver the reports.
Action Required: None. Please resubmit claims if payment has not been received.
REF 815408 11/11/2024
Report Generation Delay for CPID 8814 Integrated Homecare Services
A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted on Oct. 25, 2024.
Payer impacted:
- CPID 8814 Integrated Homecare Services
The payer intermediary has been unable to generate and deliver the reports.
Action Required: None. Please resubmit claims if payment has not been received.
REF 815405 11/11/2024
CareFirst Administrators/NCAS Electronic Eligibility Connection No Longer Available (Payer ID NCAS)
Effective Nov. 22, 2024, electronic eligibility for the payer(s) listed below will no longer be available at Optum:
Payer Name: CareFirst Administrators/NCAS
Real Time ID:
Old Eligibility ID to be terminated: NCAS
New Eligibility ID: CFSAD
CPID(s): 2914, 1730
Industry Payer ID: 75190
Connection Type: X12
Reason: Exchange Payer ID NCAS will no longer available after Nov. 22. 2024. Eligibility transactions should be submitted via Payer ID CFSAD instead.
Action Required: Please update your system immediately with the new Exchange Payer ID to avoid transactions rejecting for the payer above.
REF 815450 11/11/2024
Report Generation Delay for CPID 1569 Amerigroup
A payer intermediary is experiencing issues affecting Institutional report generation for some claims submitted on Oct. 25, 2024.
Payer impacted:
- CPID 1569 Amerigroup
The payer intermediary has been unable to generate and deliver the reports.
Action Required: None. Please resubmit claims if payment has not been received.
REF 815400 11/11/2024
Report Generation Delay for multiple CPIDs
A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted on Oct. 25, 2024.
Payer impacted:
- CPID 9504 Community Care Plan (Commercial)
- CPID 2160 Community Care Plan (Commercial)
- CPID 7662 Community Care Plan (Medicaid)
- CPID 6865 Community Care Plan (Medicaid)
- CPID 8147 Community Care Plan (Palm Beach Health District)
- CPID 2014 Community Care Plan (Palm Beach Health District)
The payer intermediary has been unable to generate and deliver the reports.
Action Required: None. Please resubmit claims if payment has not been received.
REF 815402 11/11/2024
Payer Processing Delay for Alabama BCBS
This message is intended for Revenue Performance Advisor customers.
Due to a payer processing issue, some Institutional and Professional claims transmitted to Alabama Blue Cross Blue Shield on Oct. 31, 2024, were not processed by the payer.
A resolution was implemented and the claims were retransmitted to the payer on Nov. 7, 2024.
Payer IDs: SB510 & 12B54
Action Required: Be aware of the above processing delay.
REF 814902 11/11/2024
Electronic Claims Connection Suspended
Effective immediately, the payer listed below has been temporarily suspended at Optum for claims processing and was removed from the payer list.
Payer Name: Centivo Direct Network Access
CPIDs: 5059, 9103
Payer ID: IHS04
Action Required: Please refrain from submitting claims until further notice.
REF 815200 11/11/2024
New Electronic Claims Connections Available
Optum has new electronic claims connections available:
Payer Name: Central States Health & Welfare Fund
Institutional CPID: 4507
Professional CPID: 6492
Payer-assigned Payer ID: 36215
Payer Enrollment Required: No
Secondary Claims Accepted: No
Payer Location: National
Claims Fee: N/A
Action Required:
- Add the payers to your system to begin using the new payer connection.
- When a payer requires enrollment, forms must be submitted and approved to begin submitting transactions.
Please note: We are providing you with a list of new electronic connections, please review and choose payers that are appropriate for your business.
REF 815250 11/11/2024
Report Generation Delay for CPIDs 3540 and 7426 Idaho Regence Blue Shield
A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted since Oct. 25, 2024.
Payer impacted:
- CPID 3540 Idaho Regence Blue Shield
- CPID 7426 Idaho Regence Blue Shield
Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.
Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.
REF 814954 11/11/2024
Report Generation Delay for CPIDs 5516 and 2404 Oregon Regence Blue Cross Blue Shield
A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted since Oct. 25, 2024.
Payer impacted:
- CPID 5516 Oregon Regence Blue Cross Blue Shield
- CPID 2404 Oregon Regence Blue Cross Blue Shield
Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.
Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.
REF 814953 11/1/2024
Report Generation Delay for multiple CPIDs
The payers listed below are experiencing issues affecting Professional report generation for some claims submitted since Nov. 5, 2024.
Payers impacted:
- CPID 9457 Buckeye Ohio Medicaid
- CPID 9458 CareSource Ohio Medicaid
Optum is working diligently with the payers to resolve the issue and ensure reports are received.
Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.
REF 815151 11/1/2024
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 Oct. 31, 2024.
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.
REF 815150 11/1/2024
Report Generation Delay for CPIDs 3678 and 4279 El Paso Health-STAR
A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted Oct. 25, 2024.
Payer impacted:
- CPID 3678 El Paso Health-STAR
- CPID 4279 El Paso Health-STAR
Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.
Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.
REF 814952 11/11/2024
Report Generation Delay for CPIDs 5072 and 9102 Meridian Medicare Medicaid
A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted since Oct. 25, 2024.
Payer impacted:
- CPID 5072 Meridian Medicare Medicaid
- CPID 9102 Meridian Medicare 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.
REF 814951 11/11/2024
Payer Transmit Delay - New York Medicaid
This message is intended for Revenue Performance Advisor customers.
Due to a payer system issue, a delay occurred in the transmissions to New York Medicaid (payer IDs12K35, SKNY0). This delay affected claims released to Optum Oct. 25, 2024, 10:00 p.m.-Oct. 31, 2024, 10:00 p.m. ET.
A resolution has been implemented and claims were transmitted to New York Medicaid Oct. 31, 2024-Nov. 1, 2024. Some of the claims sent to the payer during this time frame did not receive payer reports. Those claims were resubmitted to the payers Nov. 5, 2024, and reports have been received.
Providers may receive denials or rejections for duplicate claim submission.
Action Required:
Be aware of the transmit delay. Please be aware of possible denials or rejections for duplicate claim submission.
REF 814762 11/8/2024
Payer Change for CPID 1750 Brown & Toland Physicians
Effective immediately, claims and remittance currently exchanged with the following payer must use a different CPID:
Payer Name: Brown & Toland Physicians
Claim and Remittance CPID: 1750
Claims and remittance must begin using the following:
Payer Name: Brown & Toland Health Services
Professional CPID: 6867
Remittance Available: Yes
Payer-assigned Payer ID: BTHS1
Claim Fee: N/A
Claims:
-
Payer enrollment for electronic claims is not required.
Remittance:
-
Payer enrollment for electronic remittance is required.
-
Providers currently receiving electronic remittance for CPID 6867 Brown & Toland Health Services do not need to complete a new enrollment form.
-
Providers not receiving electronic remittance through Optum for CPID 6867 Brown & Toland Health Services 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.
Assurance Reimbursement Management:
Payer Name: Brown & Toland Physicians
Professional CPID: 1750
Professional Edit Master: PE_T007
Payer-assigned Payer ID: BTHS1
Line of Business Code (LOB): BAT_COM
Claims and remittance must begin using the following:
Payer Name: Brown & Toland Health Services
Professional CPID: 6867
Professional Edit Master: PE_T007
Payer-assigned Payer ID: BTHS1
Line of Business Code (LOB): BAT_COM
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 6867 Brown & Toland Health Services do not need to complete a new enrollment form.
-
Providers not receiving electronic remittance through Optum for 6867 Brown & Toland Health Service must complete a new enrollment form.
-
REF 814352 11/8/2024
Report Generation Delay for CPIDs 8909 and 5838 Preferred Administrators
A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted on Oct. 25, 2024.
Payer impacted:
-
CPID 5838 Preferred Administrators
-
CPID 5838 Preferred Administrators
The payer intermediary has been unable to generate and deliver the reports.
Action Required: None. Please resubmit claims if payment has not been received.
REF 814171 11/8/2024
Report Generation Delay for CPIDs 2920 and 1723 HealthCare Partners IPA
A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted Oct. 25, 2024.
Payer impacted:
-
CPID 2920 HealthCare Partners IPA
-
CPID 1723 HealthCare Partners IPA
Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.
Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.
REF 814167 11/8/2024
New Electronic Remittance (ERA) Connections Available on RPA
This message is intended for Revenue Performance Advisor (RPA) customers.
ERA (Remittance) transactions have recently been added for the following payers:
• 39856 Angle Health
• 61184 Superior Select Health Plan
• A7637 Snedeker Risk Management
• BOONG Boon Administrative Services
• IECCA IEHP Covered (Covered California)
• IHS03 People 1st Health Strategies
• LFL01 Longevity Health Plan of Florida
• LNJ01 Longevity Health Plan of New Jersey
• OMNIA Leading Edge Administrators
REF 814757 11/8/2024
Report Generation Delay for CPID 8870 Healthy Blue Nebraska
A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted on Oct. 25, 2024.
Payer impacted:
-
CPID 8870 Healthy Blue Nebraska
The payer intermediary has been unable to generate and deliver the reports.
Action Required: None. Please resubmit claims if payment has not been received.
REF 814170 11/8/2024
Payer Transmit Delay for CPID 7480 Med-Pay
Due to a payer system issue, a delay occurred in the transmission to the following payer on Nov. 8, 2024.
Payer impacted:
-
CPID 7480 Med-Pay
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 7 a.m. ET on Nov. 8, 2024.
Action Required: Be aware of the transmit delay above.
REF 814552 11/8/2024
New Electronic Claim Status Inquiry Connections Available on RPA
This message is intended for Revenue Performance Advisor (RPA) customers.
Claim status inquiry transactions have recently been added for the following payers:
-
46299 Molina Healthcare South Carolina
-
ABRI1 Molina Healthcare of Wisconsin
-
SKMD0 Maryland Medicaid
-
SKNE0 Nebraska Medicaid
-
SKND0 North Dakota Medicaid
REF 814756 11/8/2024
Report Generation Delay for CPID 9133 Healthy Blue North Carolina
A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted on Oct. 25, 2024.
Payer impacted:
-
CPID 9133 Healthy Blue North Carolina
The payer intermediary has been unable to generate and deliver the reports.
Action Required: None. Please resubmit claims if payment has not been received.
REF 814169 11/8/2024
Report Generation Delay for CPIDs 5016 and 8864 NextBlue of North Dakota
A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted on Oct. 25, 2024.
Payer impacted:
-
CPID 5016 NextBlue of North Dakota
-
CPID 8864 NextBlue of North Dakota
Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.
Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.
REF 814161 11/8/2024
Report Generation Delay for CPIDs 2920 and 1723 HealthCare Partners IPA
A payer intermediary is experiencing issues affecting institutional and professional report generation for some claims submitted on Oct. 25, 2024.
Payer impacted:
-
CPID 2920 HealthCare Partners IPA
-
CPID 1723 HealthCare Partners IPA
Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.
Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.
REF 814168 11/8/2024
New Electronic Remittance Connections Available
Optum has new electronic remittance connections available:
Payer Name: Highmark Health Options of West Virginia
Institutional CPID: 3957
Professional CPID: 1881
Payer-assigned Payer ID: RP118
Line of Business (LOB) Code: U96
Payer Enrollment Required: Yes
Remittance Fee: $0
Payer Location: West Virginia
Action Required: Add the payers to your system to begin using the new payer connection.
Enrollment forms must be submitted and approved to begin receiving electronic remittance through Optum.
REF 814501 11/8/2024
Report Generation Delay for CPID 7264 Quartz ASO
A payer intermediary is experiencing issues affecting professional report generation for some claims submitted on Oct. 25, 2024.
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.
REF 814165 11/8/2024
Report Generation Delay for CPID 4626 CSI Network Services
A payer intermediary is experiencing issues affecting Institutional report generation for some claims submitted Oct. 25, 2024.
Payer impacted:
-
CPID 4626 CSI Network Services
The payer intermediary has been unable to generate and deliver the reports.
Action Required: None. Please resubmit claims if payment has not been received.
REF 814166 11/8/2024
Report Generation Delay for CPID 4252 Presbyterian Salud
A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted on Oct. 25, 2024.
Payer impacted:
-
CPID 4252 Presbyterian Salud
The payer intermediary has been unable to generate and deliver the reports.
Action Required: None. Please resubmit claims if payment has not been received.
REF 814164 11/8/2024
Report Generation Delay for CPID 3475 Memorial Hermann Health Solutions
A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted Oct. 25, 2024.
Payer impacted:
-
CPID 3475 Memorial Hermann Health Solutions
The payer intermediary is unable to generate and deliver the reports.
Action Required: None. Please resubmit claims if payment has not been received.
REF 814163 11/8/2024
Report Generation Delay for CPIDs 1913 and 2287 Medicare Plus Blue of MI(MAP)
A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted since Oct. 25, 2024.
Payer impacted:
-
CPID 1913 Medicare Plus Blue of MI(MAP)
-
CPID 2287 Medicare Plus Blue of MI(MAP)
Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.
Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.
REF 814158 11/8/2024
Electronic Routing Change for CPIDs 2787 and 1566 Hennepin Health
Effective immediately, Optum will be changing electronic claims and remittance routing for the following payer:
Payer Name: Hennepin Health
Professional CPID: 2787
Institutional CPID: 1566
Payer-assigned Payer ID: 60058
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 do not need to complete a new enrollment form.
-
New providers must complete a new enrollment form.
-
Report Changes:
You may see some differences in the payer reports you are receiving.
Action Required: Please consider the following to allow transactions to process properly due to the above changes:
-
Make any necessary system changes.
-
When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.
REF 814551 11/8/2024
Report Generation Delay for multiple CPIDs
A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted on Oct. 25, 2024.
Payer impacted:
-
CPID 1510 Iowa Wellmark Blue Cross Blue Shield
-
CPID 1404 Iowa Wellmark Blue Cross Blue Shield
-
CPID 6672 Iowa Wellmark Blue Cross Blue Shield Crossover
-
CPID 6733 Iowa Wellmark Blue Cross Blue Shield Crossover
Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.
Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.
REF 814162 11/8/2024
Report Generation Delay for CPID 6700 Centurion Managed Care
A payer intermediary is experiencing issues affecting professional report generation for some claims submitted on Oct. 25, 2024.
Payer impacted:
CPID 6700 Centurion Managed Care
The payer intermediary is unable to generate and deliver the reports.
Action Required: None. Please resubmit claims if payment has not been received.
REF 814160 11/8/2024
Update: Payer Transmit Delay for Multiple CPIDs
A resolution has been implemented and the affected claims were transmitted to the payers on Nov. 1, 2024, or Nov. 8, 2024.
This delay affected claims released to Optum between 3 p.m. ET on Oct. 15, 2024, and 3 p.m. ET on Nov. 1, 2024.
Action Required: Please be aware of the transmit delay.
Original message sent Oct. 17, 2024:
Due to a payer system issue, a delay occurred in the transmissions to the following payer since Oct. 16, 2024.
Payer impacted:
-
CPID 5575 New Jersey Charity Care Inpatient
-
CPID 5576 New Jersey Charity Care Outpatient
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 3 p.m. ET on Oct. 15, 2024.
Action Required: Be aware of the transmit delay above.
REF 814450 11/8/2024
New Electronic Claim Connection Available
Optum has a new electronic claims connection available:
Payer Name: OSU Centene Oklahoma Complete Health
Professional CPID: 2828
Payer-assigned Payer ID: OSUCE
Edit Master: PE_T007
Payer Enrollment Required: Yes
Secondary Claims Accepted: Yes
Payer Location: Oklahoma
Claims Fee: N/A
Action Required:
-
Add the payers to your system to begin using the new payer connection.
-
When a payer requires claims enrollment, forms must be submitted and approved to begin submitting transactions.
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 814002 11/8/2024
Report Generation Delay for CPIDs 4615 and 6127 Carelon Behavioral Health, MBHP
A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted since Oct. 24, 2024.
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.
REF 814157 11/8/2024
Electronic Routing Change for CPIDs 2787 and 1566 Hennepin Health
Effective immediately, Optum will be changing electronic claims and remittance routing for the following payer:
Payer Name: Hennepin Health
Professional CPID: 2787
Current Edit Master: PE_N000
Institutional CPID: 1566
Current Edit Master: HE9N000
Line of Business Code (LOB): U48
Payer-assigned Payer ID: 60058
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 do not need to complete a new enrollment form.
-
New providers must complete a new enrollment form.
Report Changes:
You may see some differences in the payer reports you are receiving.
Action Required: Please make the following changes to accommodate the routing change:
-
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 814550 11/8/2024
Report Generation Delay for CPID 7435 FirstCare Health Plans
A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted Oct. 25, 2024.
Payer impacted:
-
CPID 7435 FirstCare Health Plans
Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.
Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.
REF 814159 11/8/2024
Electronic Claims Connection Suspended for CPID 8005 Pacific Administrators, Inc.
Effective immediately, the connection listed below has been temporarily suspended at Optum for claims processing and removed from the payer list.
Payer Name: Pacific Administrators, Inc.
CPID: 8005
Payer ID: PCFAD
Reason: Payer unavailable electronically for this CPID.
Action Required: Please refrain from submitting claims until further notice.
REF814004 11/8/2024
Remittance Reactivation for CPIDs 4505, 1845 Provider Partners Health Plan of Maryland
Optum recently restored electronic remittance connectivity for the following payer:
Payer Name: Provider Partners Health Plan of Maryland
Professional CPID: 1845
Institutional CPID: 4505
Industry Payer ID: 31118
Remittance Enrollment Requirements:
-
Payer enrollment for electronic remittance is required:
-
Providers who were previously enrolled with Optum (Change Healthcare) and did not switch their enrollment away from Optum (Change Healthcare) will need to complete a new enrollment.
-
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 814000 11/8/2024
New Electronic Claim Connection Available CPID 2828 OSU Centene Oklahoma Complete Health
This message is intended for Exchange customers.
Optum has a new electronic claims connection available:
Payer Name: OSU Centene Oklahoma Complete Health
Professional CPID: 2828
Payer-assigned Payer ID: OSUCE
Payer Enrollment Required: Yes
Secondary Claims Accepted: Yes
Payer Location: Oklahoma
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: A list of new electronic connections has been provided, please review and choose payers that are appropriate for your business.
REF 814001 11/8/2024
Update: Report Generation Delay for CPID 1795 Envolve Benefit Options
The payer intermediary is unable to generate and deliver the reports for some claims submitted from Oct. 17, 2024, through Oct. 25, 2024.
Action Required: Please resubmit claims if payment has not been received.
Update sent Oct. 31, 2024:
Update: A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted since Oct. 17, 2024.
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.
Original notify sent Oct. 28, 2024:
A payer intermediary is experiencing issues affecting professional report generation for some claims submitted on Oct. 17, 2024 and Oct. 18, 2024.
Payer impacted:
-
CPID 1795 Envolve Benefit Options
Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.
Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.
REF 814156 11/8/2024
Update: Report Generation Delay for CPIDs 2013 and 8146 Care N Care Insurance Co.
The payer intermediary is unable to generate and deliver the reports for some claims submitted on Oct. 25, 2024.
Action Required: Please resubmit claims if payment has not been received.
Original message sent Oct. 14, 2024:
A payer intermediary is experiencing issues affecting institutional and professional report generation for some claims submitted since Sept. 30, 2024.
Payer impacted:
-
CPID 2013 Care N Care Insurance Co.
-
CPID 8146 Care N Care Insurance Co.
Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.
Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.
REF 814155 11/8/2024
Update: Report Generation Delay for CPIDs 1592 and 5432 Johns Hopkins Healthcare / Priority Partners
The payer intermediary is unable to generate and deliver the reports for some claims submitted on Oct. 25, 2024.
Action Required: Please resubmit claims if payment has not been received.
Original message sent Oct. 14, 2024:
A payer intermediary is experiencing issues affecting institutional and professional report generation for some claims submitted since Sept. 30, 2024.
Payer impacted:
-
CPID 1592 Johns Hopkins Healthcare / Priority Partners
-
CPID 5432 Johns Hopkins Healthcare / Priority Partners
Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.
Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.
REF 814153 11/8/2024
Date of Service Claim Edits Removed from Multiple Payer Plans
Effective immediately, the Date of Service claim edits have been removed from the following payer plans. If claim rejections were received whose facility claims related to emergency room, inpatient, or outpatient surgery services rendered to CalOptima Health Medi-Cal patients assigned to AHN as their health network, please resubmit the claim to Payer ID 95712.
Payer Name: CalOptima Direct
Professional CPID: 4221
Professional Edit Master: PE_O007
Institutional CPID: 5914
Institutional Edit Master: HE9O007
Payer-assigned Payer ID: CALOP
Payer Name: CalOptima ICF
Institutional CPID: 2903
Institutional Edit Master: HE9C061
Payer-assigned Payer ID: CALOP
Payer Name: CalOptima Long Term Care
Institutional CPID: 5986
Institutional Edit Master: HE9T007
Payer-assigned Payer ID: COLTC
Action Required: Please make the following updates to accommodate these payer changes:
-
Modify any bridge routines based on edit masters.
-
Modify related Payer Alias names to the new CPIDs.
REF 813850 11/8/2024
MetroPlusHealth Enrollment and Historical ERA
This message is intended for Assurance Reimbursement Management, Exchange, and Revenue Performance Advisor customers.
Providers enrolled with Change Healthcare (formally Emdeon) to receive electronic remittance advice (ERA) from MetroPlusHealth (payer ID 13265) will need to complete an enrollment with Optum. If you have not been receiving ERAs for this payer, please review the ERA enrollment instructions. If you have a request for historical ERAs, please submit an Optum support case.
Payer Name: MetroPlusHealth
Payer ID: 13265
Institutional CPID: 8972
Professional CPID: 2296
Remittance Enrollment Requirement:
-
This payer requires enrollment for electronic remittance:
-
Providers who were previously enrolled with Optum (Change Healthcare) and did not switch their enrollment away from Optum (Change Healthcare) are receiving ERAs as they are sent.
-
New providers must complete a new enrollment form.
-
Providers who moved their enrollment to another clearinghouse will need to re-enroll with Optum (Change Healthcare).
-
Action Required:
-
Enrollment requirements and forms are available for self-service through Enrollment Central. For assistance, please submit a support case.
REF813400 11/7/2024
Massachusetts Medicaid Real Time Enrollment and Routing Update
In preparation for the upcoming routing change for the following payer, all submitters will need to change their billing intermediary if they are enrolled to submit real time transactions (Eligibility/Claim Status Inquiry):
Massachusetts Medicaid – Payer ID SKMA0
Adding or Changing Billing Intermediary to Optum Insight - Requirement to submit, or receive, Massachusetts Medicaid EDI transactions with Optum:
To participate in submitting or receiving EDI real time transactions to Massachusetts Medicaid through Optum, please go to Enrollment Central for a template to submit the following information on your company letterhead to MassHealth.
-
MassHealth Provider ID / Service Location (PIDSL)
-
National Provider ID (NPI) Number
-
Provider Federal Tax Identification Number (TIN) or Employer Identification Number (EIN)
-
Provider Full Mailing Address
-
Contact Information (Name, Phone Number, and Email Address)
-
Signed with typed/printed name
-
Brief description of the request with HIPAA transactions specified (for example, institutional or professional claims or ERA)
-
Vendor Name and Vendor’s MassHealth Submitter ID (PIDSL)
-
Vendor Name: Optum Insight
-
Massachusetts Medicaid PID/SL: 110210691A
Action Required:
-
Providers are responsible for emailing the information above to MassHealth at [email protected] to receive or submit real time transactions with Optum.
REF 813800 11/7/2024
Report Generation Delay for CPIDs 8918 and 4445 Insurance Management Services TX
A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted on Oct. 24, 2024, and Oct. 25, 2024.
Payer impacted:
-
CPID 8918 Insurance Management Services TX
-
CPID 4445 Insurance Management Services TX
Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.
Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.
REF 812900 11/7/2024
Payer Processing Issue for multiple CPIDs
Due to a payer processing issue, some Institutional and Professional claims transmitted to the payers listed below on Oct. 31, 2024, were not processed by the payers.
Payers impacted:
-
CPID 2423 Alabama Blue Cross Blue Shield
-
CPID 5558 Alabama Blue Cross Blue Shield
-
CPID 1002 Alabama Blue Cross Blue Shield Medicare Advantage
A resolution has been implemented and the claims were retransmitted to the payers on Nov. 7, 2024.
This delay affected claims released to Optum between 2 p.m. ET on Oct. 30, 2024, and 2 p.m. ET on Oct. 31, 2024.
Action Required: Be aware of the processing issue above.
REF 813250 11/7/2024
Report Generation Delay for CPID 9458 CareSource Ohio Medicaid
A payer is experiencing issues affecting Professional report generation for some claims submitted on Nov. 4, 2024.
Payer impacted:
-
CPID 9458 CareSource Ohio Medicaid
The payer has been unable to generate and deliver the reports.
Action Required: Please resubmit claims if payment has not been received.
REF 813450 11/7/2024
New Payer Edit, for CPID 6694
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 November 12, 2024:
-
INM109A067: INVALID SUBSCRIBER MEMBER ID – When entered, the Active Subscriber Member ID must begin with “0” or “3” followed by nine numeric characters. Note: If this requirement does not apply to your billing situation, you can override the edit within the Error Text. LOOP 2010BA NM109.
Edit applies to:
-
CPID 6694 Medica Individual and Family (IFB)
Action Required: Please be aware of updated edit requirements.
REF 813350 11/7/2024
Report Generation Delay for CPIDs 4881 and 4477 Asuris Northwest Regence
A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted on Oct. 24, 2024 and Oct. 25, 2024.
Payer impacted:
-
CPID 4881 Asuris Northwest Regence
-
CPID 4477 Asuris Northwest Regence
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.
REF813200 11/7/2024
Report Generation Delay for CPIDs 1997 and 7451 Washington Regence Blue Shield
A payer intermediary is experiencing issues affecting institutional and professional report generation for some claims submitted since Oct. 24, 2024.
Payer impacted:
-
CPID 1997 Washington Regence Blue Shield
-
CPID 7451 Washington Regence Blue Shield
Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.
Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.
REF 813150 11/7/2024
Report Generation Delay for CPIDs 5909 and 4743 Carelon Behavioral Health
A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted since Oct. 24, 2024.
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.
REF 812853 11/7/2024
CMS HETS NGS Attestation
CMS is now requiring that Medicare Suppliers attest to a known Medicare eligibility relationship with their Billing Agent (AKA Clearinghouse). Pharmacies using Change Healthcare (CHC) clearinghouse services must complete the HETS 3rd Party Attestation Form to report the relationship with our company as the 270/271 eligibility processor.
To complete this attestation the pharmacy's Authorized Official (AO) or Authorized Delegate (AD) must submit the required form via the online NGS website. This is a similar process to the NGS Registration Packet that must be submitted when a store enrolls with CHC Clearinghouse services for Medicare Part B Immunization claims. This is accomplished via the following steps:
-
Open the HETS 3rd Party Attestation Form by using the below URL: https://enrolledi.ngsmedicare.com/hets-attestation
-
Begin at Getting Started
-
The first task is the Terms and Conditions: the user must select all boxes.
-
Follow the prompts and complete each required field. The user will need the following information:
-
The Pharmacy’s Immunization PTAN
-
The Pharmacy’s NPI
-
The Contractor code for your pharmacy’s Jurisdiction
-
06102 - J6 Pat B IL
-
06202 – J6 Part B MN
-
06302 – J6 Part B WI
-
13102 – JK Part B CT
-
13202 – JK Part B NY (downstate) PTAN begins with A
-
13282 – JK Part B NY (upstate) PTAN begins with J
-
13292 – JK Part B NY (queens) PTAN begins with G
-
14112 – JK Part B ME
-
14212 – JK Part B MA
-
14312 – JK Part B NH
-
14412 – JK Part B RI
-
14512 – JK Part B VT
-
-
Unique ID = VUK5 (This will match eRx Network DBA Change Healthcare)
-
-
Continue to follow the prompts until the form has been fully submitted.
-
The user will then receive an email confirmation of the completion of this request.
-
At this time CHC is not requiring pharmacies to return proof of completion to us as the Enrollment team will be receiving regular databases of which users have completed the attestation. Once the above steps are complete no further action is required.
-
For questions, please reach out to NGS:
-
CT, ME, MA, NH, NY, RI, VT 866-837-0241
-
IL, MN, WI 866-234-734
-
REF 812350 11/7/2024
Ahi Performance Issue - Resolved
This message is intended for Ahi customers.
Ahi experienced a performance issue that resulted in: Errors logging into AHI (502 Bad Gateway). This issue has been resolved.
REF 812800 11/7/2024
Payer Deactivation - Sentinel Security Life payers
This message is intended for Revenue Performance Advisor customers.
Effective immediately, the payers listed below will no longer be available at Optum for claims processing. Optum no longer has a valid claims connection available.
Payer ID: 87020
Payer Names:
Atlantic Coast Life Insurance
Catholic Life Insurance
Catholic United Financial
National Guardian Life Insurance Company
Pan-American Life Insurance Company (SSLCO)
Polish Falcons of America
Renaissance Life and Health Insurance Company of America
Sentinel Security Life
Action Required:
Please discontinue use of the above Payer ID. Providers should review the patient's current insurance ID card for claim filing information.
REF 812100 11/6/2024
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 Oct. 24, 2024.
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.
REF 811752 11/6/2024
Report Generation Delay for CPIDs 7907 and 2254 Scott & White Health Plan
A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted since Oct. 24, 2024.
Payer impacted:
-
CPID 7907 Scott & White Health Plan
-
CPID 2254 Scott & White Health Plan
Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.
Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.
REF811751 11/6/2024
Update: Payer Transmit Delay for Multiple CPIDs
A resolution has been implemented and claims were transmitted to the payers between Oct. 31, 2024, and Nov. 1, 2024. Some of the claims sent to the payers during this time frame did not receive reports from the payers. Those claims were resubmitted to the payers on Nov. 5, 2024, and reports have been received.
Providers may receive denials or rejections for duplicate claim submission.
This delay affected claims released to Optum between 10 p.m. ET on Oct. 25, 2024, and 10 p.m. ET on Oct. 31, 2024.
Action Required: Be aware of the transmit delay. Please be aware of possible denials or rejections for duplicate claim submission.
Original message sent on Oct. 29, 2024:
Due to a payer system issue, a delay occurred in the transmissions to the following payers since Oct. 28, 2024.
Payers impacted:
-
CPID 1422 New York Medicaid
-
CPID 1500 New York Medicaid
-
CPID 1502 New York Medicaid Outpatient
-
CPID 2429 New York Medicaid
-
CPID 2743 New York Medicaid
-
CPID 2745 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 10 p.m. ET on Oct. 25, 2024.
Action Required: Be aware of the transmit delay above.
REF 811650 11/6/2024
Electronic Routing Change for CPIDs 6600 and 6885 Medico Insurance Company
This message is intended for Assurance Reimbursement Management customers.
Effective immediately, Optum will be changing electronic remittance routing for the following payer:
Payer Name: Medico Insurance Company
Professional CPID: 6885
Institutional CPID: 6600
Payer-assigned Payer ID: 23160
Enrollment Requirements:
-
Payer enrollment for electronic remittance is required.
-
Providers currently receiving electronic remittance through Optum must complete a new enrollment form.
-
New providers must complete a new enrollment form.
-
Action Required: Please consider the following to allow transactions to process properly due to the above changes:
-
Make any necessary system changes.
-
When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.
REF 811502 11/5/2024
Intelligent EDI - Claims for PID 41222
This message is intended for Intelligent EDI customers.
New Payer Announcement - The following items are covered in this announcement:
Optum Intelligent EDI is pleased to announce new claim payer connectivity for the following transaction types.
Please incorporate claims into existing files you submit to Optum today.
Care To Care (Payer ID 41222)
Transactions: 837 Institutional
Effective Date: Nov. 6, 2024
Please direct any questions to the Support Team at 1-866-OptumGo.
REF 811451 11/5/2024
Electronic Routing Change for CPIDs 6600 and 6885 Medico Insurance Company
Effective immediately, Optum will be changing electronic remittance routing for the following payer:
Payer Name: Medico Insurance Company
Professional CPID: 6885
Institutional CPID: 6600
Line of Business Code (LOB): J60
Payer-assigned Payer ID: 23160
Enrollment Requirements:
-
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:
-
When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.
REF 811501 11//2024
Report Generation Delay for multiple CPIDs
A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted on Oct. 23, 2024.
Payers impacted:
-
CPID 1513 Minnesota Blue Cross Blue Shield
-
CPID 1402 Minnesota Blue Cross Blue Shield
-
CPID 1410 Minnesota Blue Cross Blue Shield CC Systems
-
CPID 1429 Minnesota Blue Cross Blue Shield HMO
The payer intermediary has been unable to generate and deliver the reports.
Action Required: Please resubmit claims if payment has not been received from the payers.
REF 811352 11/5/2024
Report Generation Delay for CPIDs 2431 Colorado Access
A payer experienced issues affecting Institutional report generation for some claims submitted on Oct. 16, 2024.
Payer impacted:
-
CPID 2431 Colorado Access
The payer is unable to generate and deliver the reports.
Action Required: None. Please resubmit claims if payment has not been received.
REF 811250 11/5/2024
Report Generation Delay for CPID 5428 QualChoice of Arkansas
A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted Oct. 22, 2024 and Oct. 25, 2024.
Payer impacted:
-
CPID 5428 QualChoice of Arkansas
The payer intermediary has been unable to generate and deliver the reports.
Action Required: Please resubmit claims if payment has not been received from the payer.
REF 811350 11/4/2024
Report Generation Delay for CPIDs 3584 and 7489 Wyoming Blue Cross Blue Shield
A payer intermediary is experiencing issues affecting institutional and professional report generation for some claims submitted on Oct. 22, 2024, and Oct. 25, 2024.
Payer impacted:
-
CPID 3584 Wyoming Blue Cross Blue Shield
-
CPID 7489 Wyoming Blue Cross Blue Shield
The payer intermediary has been unable to generate and deliver the reports.
Action Required: Please resubmit claims if payment has not been received from the payer.
REF 811351 11/5/2024
Assurance Attachments Performance Issue
This message is intended for Assurance EDI and Assurance Reimbursement Management customers.
Assurance Attachments is experiencing an issue with performance.
This may result in:
-
Errors indicating “This site cant be reached”
-
Inability to load URL https://assuranceattachments.changehealthcare.com/
Optum is working to resolve this issue. We will notify you as soon as additional information becomes available.
We apologize for any inconvenience.
Action Required: None.
REF 811150 11/5/2024
ERA Delivery Delay for some Medicare Payers
Due to a payer intermediary processing issue, there was a delay in some professional and institutional Electronic Remittance Advice (ERA) for the following payers for file dates of Oct. 18-31, 2024. The issue has been resolved. All impacted ERA files have been received and processed.
Payers impacted:
-
SMCO0, 12M03 - Colorado Medicare
-
SMDE0, 12M76 - Delaware Medicare
-
SMMS0, 12M76 - Mississippi Medicare
-
SMOK0, 12M37 - Oklahoma Medicare
-
SMPA0, 12M60 - Pennsylvania Medicare
-
SMTX0, 12M53 - Texas Medicare
-
12M88 - Mutual of Omaha CO, NM, OK, TX
Action Required:
Please be aware of a delay in the delivery of ERA for file dates above.
REF 811100 11/5/2024
PKNLF, PEKIN LIFE INSURANCE - 270/271
Eligibility Inquiry and Response 270/271.
Effective Oct. 9, 2024, Optum is pleased to announce the availability of Real-Time Eligibility transactions for the below payer:
IMN Payer ID: PKNLF
Payer Name: PEKIN LIFE INSURANCE
Transaction Type: 270/271
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 open an Optum Customer Care Hub ticket at https://customercare.changehealthcare.com/public/home.html.
Updated Payer Lists may be obtained from your software vendor or Payer Lists | Change Healthcare.
REF 810616 11/4/2024
Eligibility Inquiry and Response 270/271 for Payer ID 87843 Wellfleet Group LLC
Effective Oct. 23, 2024, Optum is pleased to announce the availability of real time Eligibility transactions for the below payer:
IMN Payer ID: 87843
Payer Name: Wellfleet Group LLC
Transaction Type: 270/271
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.
Updated Payer Lists may be obtained from your software vendor or Payer Lists | Change Healthcare
REF 810617 11/4/2024
Medicaid Massachusetts Real Time 270/271 Eligibility, 276/277 claim status inquiry
In preparation for the upcoming routing change for the following payer, all submitters will need to change their billing intermediary if they are enrolled to submit real time transactions.
Payer Name: Medicaid Massachusetts
IMN Payer ID: AID45
Exchange Payer ID: MACAID
CPIDs: 5529, 4491, 4492
Adding or changing billing intermediary to Optum Insight - Requirement to submit, or receive, Massachusetts Medicaid EDI transactions with Optum:
To participate in submitting or receiving EDI real time transactions to Massachusetts Medicaid through Optum please go to Enrollment Central for a template to submit the following information on your company letterhead to MassHealth. For assistance, please submit a support case.
Current Date
MassHealth Provider ID / Service Location (PIDSL)
National Provider ID (NPI) Number
Provider Federal Tax Identification Number (TIN) or Employer Identification Number (EIN)
Provider Full Mailing Address
Contact Information (Name, Phone Number, and Email Address)
Signed with typed/printed name
Brief description of the request with HIPAA transactions specified (for example 270/271 real time eligibility, 276/277 real time claim status inquiry).
Vendor Name and Vendor’s MassHealth Submitter ID (PIDSL)
Vendor Name: Optum Insight
Massachusetts Medicaid PID/SL: 110210691A
Action Required:
Providers are responsible for emailing the information above to MassHealth at [email protected] to receive or submit real time transactions with Optum.
REF 810651 11/4/2024
Eligibility Inquiry and Response 270/271 and claim status inquiry 276/277
Effective Oct. 29, 2024, Optum is pleased to announce the availability of Real-time Eligibility and Claim Status transactions for the below payer:
IMN Payer ID: SKMS0
Payer Name: Mississippi Medicaid
Transaction Type: 270/271 and 276/277
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.
Updated Payer Lists may be obtained from your software vendor or Payer Lists | Change Healthcare
REF 810615 11/4/2024
Electronic Routing Change for CPIDs 4480 and 1532, SelectHealth and CPIDs 4410 and 8654, EMI Health
Effective Nov. 1, 2024, Optum will be changing electronic remittance routing for the following payers:
Payer Name: SelectHealth
Professional CPID: 4480
Institutional CPID: 1532
Line of Business Code (LOB): U3P
Payer-assigned Payer ID: SX107
Payer Name: EMI Health
Professional CPID: 4410
Institutional CPID: 8654
Line of Business Code (LOB): H7N
Payer-assigned Payer ID: SX110
Enrollment Requirements:
Remittance:
-
Payer enrollment for electronic remittance is required.
-
Providers currently receiving electronic remittance through Optum do not need to complete a new enrollment form.
-
New providers must complete a new enrollment form.
-
Action Required: Please consider the following to allow transactions to process properly due to the above changes:
-
Make any necessary system changes.
-
When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.
REF 810310 11/4/2024
Remittance Reactivation for CPIDs 7623, 6775 Health Choice Utah
Optum recently restored electronic remittance connectivity for the following payer:
Payer Name: Health Choice Utah
Professional CPID: 6775
Institutional CPID: 7623
Industry Payer ID: 45399
Remittance Enrollment Requirements:
-
Payer enrollment for electronic remittance is required:
-
Providers who were previously enrolled with Optum (Change Healthcare) and did not switch their enrollment away from Optum (Change Healthcare) will need to complete a new enrollment.
-
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 810250 11/4/2024
UHIN Real Time Payer Update
Effective Nov. 1, 2024, real-time transactions (270/271 and 276/277) are currently unavailable. This impacts current real-time transactions for the Payer IDs listed below. We are working with UHIN to restore these connections as soon as possible and will continue to keep you posted on our progress.
The affected UHIN payers are:
-
Public Employee Health Plan of UTAH (PEHPU/SX106)
-
Select Health (SX107/SELHT)
-
University of Utah Health Plan (UNUTHP/Sx155)
Action Required by Customer:
Please do not send 270/271 or 276/277 transactions to the above payers until connection has been restored. We will keep you updated on restoration of this connections as soon as it is available.
Updated Payer Lists may be obtained from your software vendor.
Action Taken by Optum:
Optum continues to work closely with the payers to re-establish these connections for our customers.
REF 11/1/2024 REF 810100
New Electronic Remittance (ERA) Connections Available on RPA
This message is intended for Revenue Performance Advisor (RPA) customers.
ERA (Remittance) transactions have recently been added for the following payers:
-
23249 Sentinel Management Services
-
36347 Northern Illinois Health Plan
-
36480 Collective Dialysis
-
38221 Regency Employee Benefits
-
3833R McLaren Advantage SNP
-
41822 Dean Health Plan by Medica DOS After 12312023
-
42137 Select Benefit Administrators Iowa
-
42140 Centurion Managed Care
-
43178 Joplin Claims
-
48116 OhioHealthy
-
51037 Brokerage Concepts
-
52613 Partners Health Management
-
75309 Pacific Southwest Administrators
-
76031 New Era Emp Welfare Ben Plan
-
95386 CenCal Health
-
99915 Vxtra Health
-
AVA02 Avalon Administrative Services - BCBSNC
-
AVA03 Avalon - Capital Blue Cross
-
AVA04 Avalon Administrative Services - BCBSVT
-
COMCL Commons Clinic, Inc.
-
MC721 Blue Cross Community Centennial
-
MPM62 Emanate Health IPA
-
STJOE St. Joseph Heritage
-
TRULI Truli for Health
-
X1787 Massachusetts Laborers' Benefit Funds
REF 810001 11/1/2024
New Electronic Claims Connections Available
Optum has new electronic claims connections available:
Payer Name: Sutter Connect - SIP,SMG,SWMG encounters
Institutional CPID: 7956
Payer-assigned Payer ID: 77306
Payer Enrollment Required: No
Secondary Claims Accepted: Yes
Payer Location: California
Claims Fee: N/A
REF 810200 11/1/2024
Update: Delay in Electronic Remittance Advice (ERA) for multiple CPIDs
Update: The issue has been resolved. All impacted ERA files have been received and processed.
Original Notice Sent 10/24/24:
Due to a payer intermediary processing issue, there has been a delay in some Professional and Institutional Electronic Remittance Advice (ERA) for the following payers for file dates of Oct. 18, 2024 through present:
Payers impacted:
• CPID 1449 Colorado Medicare
• CPID 2456 Delaware Medicare
• CPID 3650 JH Mutual of Omaha CO, NM, OK, TX
• CPID 2451 Mississippi Medicare
• CPID 1458 Oklahoma Medicare
• CPID 5598 Pennsylvania Medicare
• CPID 1440 Texas Medicare
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.
REF 809961 11/1/2024
Report Generation Delay for multiple CPIDs
Due to a payer intermediary processing issue, some Professional claims transmitted to the payers listed below Oct. 31, 2024 were not processed by the payers.
Payers impacted:
|
CPID |
Payer Name |
|
1214 |
AgeRight Advantage Health Plan |
|
9267 |
Align Senior Care of Florida |
|
8454 |
Align Senior Care of Michigan |
|
4101 |
AllCare Advantage |
|
2113 |
Allcare Health Plan |
|
8714 |
Allstate - Except New Jersey |
|
1764 |
Ambetter From Absolute Total Care |
|
9278 |
Ambetter from Nebraska Total Care |
|
9431 |
Ambetter from WellCare of Kentucky |
|
9775 |
Ambetter of Alabama |
|
9433 |
Ambetter of Oklahoma |
|
2138 |
American Family Insurance |
|
9429 |
American Health Advantage of Idaho & Utah |
|
9142 |
American Health Advantage of Mississippi |
|
7280 |
American Health Advantage of Missouri |
|
9117 |
American Health Advantage of Texas |
|
4468 |
Americas Choice Healthplan |
|
1741 |
Amerigroup |
|
1412 |
Anthem Blue Cross and Blue Shield - Indiana |
|
2421 |
Anthem Blue Cross and Blue Shield - Kentucky |
|
1413 |
Anthem Blue Cross and Blue Shield (Virginia) |
|
2418 |
Anthem Blue Cross and Blue Shield of Ohio |
|
4437 |
Anthem Blue Cross Blue Shield New York |
|
8749 |
Anthem MaineHealth |
|
6220 |
Arizona Priority Care Plus |
|
4477 |
Asuris Northwest Medadvantage Regence |
|
4881 |
Asuris Northwest Regence |
|
7272 |
Axminster Medical Group |
|
3845 |
Banner Health Network |
|
8482 |
Benefit Plan Administrators - Roanoke, VA |
|
1415 |
Blue Cross Blue Shield of Colorado |
|
1407 |
Blue Cross Blue Shield of Georgia |
|
7496 |
Blue Cross Blue Shield of Nevada |
|
1169 |
Blue Cross Blue Shield of Western New York Medicaid/CHP |
|
1401 |
Blue Cross Blue Shield of Wisconsin |
|
1243 |
Blue Cross Community Centennial |
|
1167 |
Blue Cross Medicare Advantage PPO/HMO |
|
9162 |
Blue Medicare Advantage |
|
4110 |
Bollinger Inc |
|
6165 |
Bridgeview |
|
1750 |
Brown & Toland Physicians |
|
4246 |
Capital Health Plan |
|
2810 |
Capitol Administrators |
|
8146 |
Care N Care Insurance Co. |
|
2289 |
Care1st Health Plan of Arizona Medicaid DOS after 11/30/2022 |
|
9759 |
Care1st Health Plan of Arizona Medicaid DOS before 12/01/2022 |
|
9762 |
Care1st Health Plan of Arizona Medicare |
|
4743 |
Carelon Behavioral Health |
|
6127 |
Carelon Behavioral Health, MBHP |
|
3293 |
Carelon Health |
|
2830 |
CarePlus Health Plans |
|
9722 |
CareSource North Carolina |
|
1194 |
CareSource of Georgia |
|
7143 |
CareSource of Indiana |
|
3826 |
CareSource of Ohio |
|
7263 |
CareSource of West Virginia |
|
9226 |
CareSource PASSE of Arkansas |
|
6777 |
Centers Plan for Healthy Living |
|
6700 |
Centurion Managed Care |
|
7275 |
Citrus Valley Physicians Group |
|
8123 |
Clear Health Alliance |
|
7416 |
Colorado Anthem Blue Cross Blue Shield HMO |
|
7763 |
Columbine Health Plan |
|
8834 |
Commonwealth Care Alliance DOS after 3/31/2023 |
|
8477 |
Community Care Plan |
|
2160 |
Community Care Plan (Commercial) |
|
6865 |
Community Care Plan (Medicaid) |
|
1420 |
Connecticut Anthem Blue Cross Blue Shield |
|
2427 |
Connecticut BlueCare Family Plan |
|
3419 |
Connecticut Federal Employee Health Benefits |
|
3420 |
Connecticut Medicare Blue (Risk) |
|
6795 |
Contra Costa Health Plan |
|
5862 |
CorrectCare Integrated Health |
|
7292 |
CorrectCare Integrated Health- Louisiana |
|
6241 |
Correctional Health Partners |
|
7738 |
CountyCare Health Plan |
|
9747 |
Delaware First Health |
|
2433 |
Denver Health and Hospital Authority |
|
1232 |
Denver Health Medical Plan, Inc. - Medicare Choice |
|
8135 |
Doctors HealthCare Plans |
|
1733 |
Doctors Professional Services Consultants (DPSC) |
|
1119 |
Easy Choice Health Plan of California |
|
7787 |
El Paso First Health Plans - Health Care Options (HCO) |
|
4289 |
El Paso Health-CHIP |
|
4279 |
El Paso Health-STAR |
|
5483 |
Employee Benefit Management Services (EBMS) |
|
1834 |
Employee Plans |
|
8137 |
Empower Healthcare Solutions |
|
1795 |
Envolve Benefit Options |
|
5238 |
Evolent Specialty Cardiology |
|
3792 |
Fidelis Care |
|
2875 |
First Health Network (Coventry Health Care National Network) |
|
7435 |
FirstCare Health Plans |
|
1414 |
Florida Blue Cross Blue Shield |
|
3417 |
Florida Blue Cross Blue Shield Health Options HMO |
|
9128 |
Florida Blue Medicare |
|
9417 |
Florida Complete Care |
|
2150 |
Florida Health Care Plans |
|
5440 |
Fox Valley Medicine |
|
6851 |
Friday Health Plans |
|
8189 |
Gemcare IPA |
|
8879 |
Georgia Health Advantage |
|
1258 |
Global Healthcare Alliance |
|
2720 |
GlobalCare |
|
5853 |
GMS Insurance |
|
9766 |
Gold Kidney Health Plan |
|
1772 |
HAP CareSource |
|
1797 |
HAP CareSource Michigan Dual Medicare/Medicaid |
|
8716 |
Health Choice Generations Utah |
|
5243 |
Healthcare Management Administrators |
|
1723 |
HealthCare Partners IPA |
|
4448 |
HealthLink PPO |
|
8750 |
Healthy Blue Dual Advantage Louisiana |
|
7760 |
Healthy Blue Louisiana |
|
8867 |
Healthy Blue Missouri |
|
8870 |
Healthy Blue Nebraska |
|
9133 |
Healthy Blue North Carolina |
|
6272 |
Hispanic Physicians IPA (Encounters Only) |
|
7715 |
Hopkins Health Advantage |
|
6259 |
Humana - CareSource of Kentucky |
|
7426 |
Idaho Regence Blue Shield |
|
1405 |
Illinois Blue Cross Blue Shield |
|
2234 |
Illinois Health Partners |
|
5865 |
Indian Health Services |
|
5404 |
Insight Benefit Administrators |
|
4445 |
Insurance Management Services TX |
|
4116 |
IntegraNet Health |
|
1107 |
Integrated Health Partners (IHP) |
|
8814 |
Integrated Homecare Services |
|
9713 |
Iowa Health Advantage |
|
1404 |
Iowa Wellmark Blue Cross Blue Shield |
|
6733 |
Iowa Wellmark Blue Cross Blue Shield Crossover |
|
5479 |
IU Health Plan Medicare Advantage |
|
5432 |
Johns Hopkins Healthcare / Priority Partners |
|
5882 |
Kane County IPA |
|
8467 |
Keycare |
|
9412 |
Leon Health Plans |
|
1205 |
Lifeworks Advantage (ISNP Plan) |
|
7446 |
Maine Anthem Blue Cross Blue Shield |
|
8812 |
Maryland Physicians Care |
|
3476 |
Masters, Mates and Pilots |
|
8860 |
Medica Government Programs |
|
7859 |
Medica Health Plan Solutions |
|
6799 |
Medica Individual and Family (IFB) |
|
2287 |
Medicare Plus Blue of MI(MAP) |
|
3475 |
Memorial Hermann Health Solutions |
|
9102 |
Meridian Medicare Medicaid Plan |
|
9118 |
MeridianComplete Michigan |
|
2426 |
Michigan Blue Care Network |
|
1421 |
Michigan Blue Cross Blue Shield |
|
1402 |
Minnesota Blue Cross Blue Shield |
|
1410 |
Minnesota Blue Cross Blue Shield CC Systems |
|
7892 |
Minnesota Blue Cross Blue Shield Health Care Programs |
|
1429 |
Minnesota Blue Cross Blue Shield HMO |
|
1408 |
Missouri Anthem Blue Cross Blue Shield |
|
7450 |
Montana Blue Cross Blue Shield |
|
7422 |
New Hampshire Anthem Blue Cross Blue Shield |
|
7403 |
New Mexico Blue Cross Blue Shield |
|
8864 |
NextBlue of North Dakota |
|
1213 |
NHC Advantage |
|
2411 |
North Dakota Blue Cross Blue Shield |
|
1403 |
Oklahoma Blue Cross Blue Shield |
|
2404 |
Oregon Regence Blue Cross Blue Shield |
|
7829 |
Passport Advantage |
|
9123 |
Perennial Advantage |
|
9421 |
Perennial Advantage of Colorado |
|
9199 |
Piedmont Community Health Plan |
|
8128 |
Pool Administrators, Inc. |
|
5838 |
Preferred Administrators |
|
3198 |
Preferred Benefit Administrators (Longwood, Florida) |
|
4252 |
Presbyterian Salud |
|
8468 |
Procare Advantage of TX |
|
2807 |
Professional Benefit Administrators (Oakbrook, Illinois) |
|
4253 |
Prominence Administrative Services |
|
7281 |
PruittHealth Premier Medicare Advantage |
|
5428 |
QualChoice of Arkansas |
|
7264 |
Quartz ASO |
|
1209 |
Regence Group Administrators |
|
3257 |
ResourceOne Administrators |
|
6879 |
RHA VestaCare |
|
1776 |
RIS Rx |
|
6246 |
Riverside Medical Clinic |
|
8256 |
Saudi Health Mission |
|
4464 |
SCAN Health Plan |
|
2254 |
Scott & White Health Plan |
|
4480 |
SelectHealth |
|
9438 |
Shared Health Mississippi |
|
7225 |
Sharp Community Medical Group |
|
7138 |
Sierra Medical Group |
|
8124 |
Simply Healthcare Plans, Inc. |
|
1891 |
Snedeker Risk Management |
|
8708 |
SOMOS Anthem |
|
8816 |
SOMOS Emblem |
|
1740 |
Sonder Health Plans |
|
2490 |
South Dakota Blue Cross Blue Shield |
|
8134 |
Summit Community Care |
|
1406 |
Texas Blue Cross Blue Shield |
|
1729 |
Texas Childrens Health Plan (CHIP) |
|
2483 |
Texas Childrens Health Plan (STAR Medicaid) |
|
4278 |
The Boon Group |
|
8763 |
U.S. Networks and Administrative Services |
|
7810 |
UMass Medical School Health and Criminal Justice Program |
|
8473 |
Unicare (TX,MA,KS,WV,RI,IL) |
|
6849 |
United Group Programs |
|
2412 |
Utah Regence Blue Cross Blue Shield |
|
2788 |
Utah Regence Blue Cross Blue Shield Federal Employee Program |
|
8720 |
Vanderbilt Health |
|
7493 |
Vermont Blue Cross Blue Shield |
|
4258 |
VNS Health |
|
7451 |
Washington Regence Blue Shield |
|
9293 |
Wellcare by Allwell from Nebraska Total Care |
|
9430 |
Wellcare by Allwell of Oklahoma |
|
1844 |
Wellcare Health Plans |
|
3211 |
Wellcare Health Plans (Encounters) |
|
1775 |
Wellpoint |
|
2448 |
Wellpoint Encounters |
|
9441 |
Wellspace NEXUS LLC |
|
7489 |
Wyoming Blue Cross Blue Shield |
A resolution has been implemented and the claims were retransmitted to the payer intermediary Nov. 1, 2024.
This delay affected claims released to Optum Oct. 31, 2024, 10:00 a.m.-2:00 p.m. CT.
Action Required: Be aware of the processing issue above.
REF 809850 11/1/2024
Older Payer Updates
Click the link below to access payer updates prior to October 1st, 2024.