New Real Time Connections Available on RPA

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

13337 – WellSense Health Plan
36373 – Prairie States
VCIPA – Valley Care IPA

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

GACS1 – CareSource of Georgia
SB530 – Blue Cross Blue Shield of Arizona
SB720 – Blue Cross Blue Shield of Minnesota
SKDC0 – District of Columbia Medicaid
SKIA0 – Iowa Medicaid
SKNH0 – New Hampshire Medicaid
SKNV0 – Nevada Medicaid

11/26/2025

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New Electronic Remittance (ERA) Connections Available on RPA

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

Payer ID – Payer name

36364 – Guidehealth NPA

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

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

11/26/2025

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835 File Delivery Delay

The Department of Veterans Affairs VA payer has notified Optum of a delay in 835s for checks dates of November 18th. They are working on the issue but do not anticipate the ERAs being delivered until after the Thanksgiving holiday.

11/26/2025

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835 Delivery Issue

The Department of Veterans Affairs VA payer has identified an issue with 835s specifically for check dates of November 12th and the 14th. They are aware of the issue and are working on getting the information sent to the clearinghouse. 

Current ETA will not be until after the Thanksgiving holiday.

11/26/2025

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New Electronic Eligibility Connection Available

Optum is pleased to announce the availability of Real-time Eligibility Inquiry and Response 270/271 for the below payer, effective November 13, 2025:

Payer Name: Group Hospitalization and Medical Services
Industry Payer ID: 10964
IMN Real Time ID: 10964
Exchange Real Time ID: GHMDS
Optum IEDI Real Time ID: 10964
Payer Enrollment Required: No
Connection Type: X12

Eligibility Subscriber

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

Action Required by customer:

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

11/26/2025

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Report Generation Delay for CPID 2162 Colorado Medicare

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted on Nov. 18, 2025 and Nov. 19, 2025.

Payer impacted: 

• CPID 2162 Colorado Medicare

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09790334.

11/26/2025

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Report Generation Delay for CPID 6195 Superior Vision Services

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted since Nov. 12, 2025.

Payer impacted: 

• CPID 6195 Superior Vision 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.

If you have any questions, please contact Customer Support and refer to Case Number 09790283.

11/26/2025

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New Electronic Eligibility Connection Available

Optum is pleased to announce the availability of Real-time Eligibility Inquiry and Response 270/271 for the below payer, effective November 24, 2025:

Payer Name: Medica2
Industry Payer ID: 11171
IMN Real Time ID: 11171
Exchange Real Time ID: MDICA
Optum IEDI Real Time ID: 11171
Payer Enrollment Required: No
Connection Type: X12

Eligibility Subscriber

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

Action Required by customer:

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

11/26/2025

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New Electronic Eligibility Connection Available

Optum is pleased to announce the availability of Real-time Eligibility Inquiry and Response 270/271 for the below payer, effective November 21, 2025:

Payer Name: EPSI, Inc
Industry Payer ID: 11011
IMN Real Time ID: 11011
Exchange Real Time ID: EPSII
Optum IEDI Real Time ID: 11011
Payer Enrollment Required: No
Connection Type: X12

Eligibility Subscriber

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

Action Required by customer:

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

11/26/2025

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New Electronic Claim Status Connection Available

Optum is pleased to announce the availability of Real-time Claim Status Inquiry and Response 276/277 for the below payer, effective September 24, 2025:

Payer Name: Massachusetts Medicaid
Industry Payer ID: DMA7384
IMN Real Time ID: AID45
Exchange Real Time ID: MACAID
CPID(s): 5529, 4491, 4492
Optum IEDI Real Time ID: MAMCD
Payer Enrollment Required: No
Connection Type: X12

Search Options:

Claim Status Inquiry subscriber

• Member id, first name, last name, date of birth
• Payer claim number

Optional additional elements:

• Total submitted charges

Action Required by customer:

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

11/26/2025

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New Electronic Claims Auth Inquiry and Referral Connections Available

Optum is pleased to announce the availability of Real-time Auth Inquiry and Response 278/215 & 217 for the below payer, effective November 21, 2025 .

Payer Name: United Healthcare
IMN Real Time ID: 87726
Payer Enrollment Required: No
Connection Type: X12

Action Required by customer:

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

11/26/2025

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New Electronic Eligibility Connection Available

Optum is pleased to announce the availability of Real-time Eligibility Inquiry and Response 270/271 for the below payer, effective Nov. 25, 2025:

Payer Name: Valley Health Plan
Industry Payer ID: VHP01
IMN Real Time ID: VHP01
Exchange Real Time ID: VALHP
CPID(s):  6818, 9647
Optum IEDi Real Time ID: 10949
Payer Enrollment Required: No
Connection Type: X12

Search Options: 

Eligibility Subscriber

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

Action Required by customer:

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

11/26/2025

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New Electronic Claim Status Connection Available

Optum is pleased to announce the availability of Real-time Claim Status Inquiry and Response 276/277 for the below payer, effective November 20, 2025:

Payer Name: Optum Medical Network
Industry Payer ID: LIFE1
IMN Real Time ID: LIFE1
Exchange Real Time ID: LFPRT
CPID(s): 4608, 6101
Optum IEDI Real Time ID: LIFE1
Payer Enrollment Required: No
Connection Type: X12

Search Options:

Claim Status Inquiry subscriber

• Member id, first name, last name, date of birth

Optional additional elements:

• Payer claim number, Total submitted charges

Action Required by customer:

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

11/26/2025

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New Electronic Eligibility, Claim Status Connection Available

Optum is pleased to announce the availability of Real-time Eligibility Inquiry and Response 270/271 and Claim Status Inquiry and Response 276/277 for the below payer, effective Nov. 25, 2025:

Payer Name: Insurance Administrative Corporation
Industry Payer ID: 86304
IMN Real Time ID: 86304
Exchange Real Time ID: IACRT
CPID(s): 2484, 4913
Optum IEDi Real Time ID: 11021
Payer Enrollment Required: No
Connection Type: X12

Search Options: 

Eligibility Subscriber

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

Eligibility Dependent

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

Claim Status Inquiry Subscriber

• Member id, first name, last name, date of birth

 Claim Status Inquiry Dependent

• Member ID, dependent first name, dependent last name, dependent date of birth, subscriber last name

              Claim status Inquiry Optional additional elements:

              Payer claim number, Total submitted charges

Action Required by customer:

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

11/26/2025

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New Electronic Eligibility Connection Available

Optum is pleased to announce the availability of Real-time Eligibility Inquiry and Response 270/271 for the below payer. effective Nov. 24, 2025:

Payer Name: Erie Family Life Insurance
Industry Payer ID: 13284
IMN Real Time ID: 13284
Exchange Real Time ID: EFMLI
CPID(s): N/A
Optum IEDi Real Time ID: 13284
Payer Enrollment Required: No
Connection Type: X12

Search Options:
Eligibility Subscriber

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

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

11/25/2025

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New Electronic Eligibility Connection Available

Optum is pleased to announce the availability of Real-time Eligibility Inquiry and Response 270/271 for the below payer, effective Nov. 24, 2025:

Payer Name: Group Health Northwest
Industry Payer ID: 11041
IMN Real Time ID: 11041
Exchange Real Time ID: GPHNW
CPID(s): N/A
Optum IEDi Real Time ID: 11041
Payer Enrollment Required: No
Connection Type: X12

Search Options:
Eligibility Subscriber

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

Eligibility Dependent

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

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

11/25/2025

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New Electronic Eligibility Connection Available

Optum is pleased to announce the availability of Real-time Eligibility Inquiry and Response 270/271 for the below payer, effective Nov. 24, 2025:

Payer Name: Everest Reinsurance Company
Industry Payer ID: 11164
IMN Real Time ID: 11164
Exchange Real Time ID: EVERT
CPID(s): N/A
Optum IEDi Real Time ID: 11164
Payer Enrollment Required: No
Connection Type: X12

Search Options:
Eligibility Subscriber

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

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

11/25/2025

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New Electronic Eligibility Connection Available

Optum is pleased to announce the availability of Real-time Eligibility Inquiry and Response 270/271 for the below payer, effective Nov. 21, 2025:

Payer Name: Crum & Forster
Industry Payer ID: 31348
IMN Real Time ID: 31348
Exchange Real Time ID: CMFSR
CPID(s): N/A
Optum IEDi Real Time ID: 14314
Payer Enrollment Required: No
Connection Type: X12

Search Options:
Subscriber

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

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.

11/25/2025

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Report Generation Delay for CPID 8996 Premier Eye Care

The payer listed below is experiencing issues affecting Institutional report generation for some claims submitted Nov. 18, 2025.

Payer impacted:

• CPID 8996 Premier Eye Care

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09789189.

11/25/2025

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Payer Processing Issue for CPID 4479 Alabama Medicaid

Due to a payer processing issue, some Professional claims transmitted to the payer listed below Nov. 19, 2025 were not processed by the payer.

Payer impacted: 

• CPID 4479 Alabama Medicaid

A resolution has been implemented and the claims were retransmitted to the payer Nov. 25, 2025.

This delay affected claims released to Optum Nov. 18, 2025, 3:00 p.m.-Nov. 19, 2025, 3:00 p.m. CT.

Action Required: Be aware of the processing issue above.

If you have any questions, please contact Customer Support and refer to Case Number 09788651.

11/25/2025

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

A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted since Nov. 10, 2025.

Payer impacted: 

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

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09788010.

11/24/2025

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Eligibility Fee Change Delaware Medicaid

Effective 12/1/25 the eligibility fee is changing for the following payer:

Payer Name: Delaware Medicaid
Industry ID: SKDE0
IMN ID: SKDE0
Current Fee: $0.065
New Fee: $0.045

Action Required: Please be aware of the upcoming fee change.

11/24/2025

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Report Generation Delay for CPIDs 2593 and 5428 QualChoice of Arkansas

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

Payer impacted: 

• CPID 2593 QualChoice of Arkansas
• CPID 5428 QualChoice of Arkansas

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

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

11/24/2025

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Report Generation Delay for CPID 5942 Asuris Northwest Regence

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

Payer impacted: 

• CPID 5942 Asuris Northwest Regence

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09787892.

11/24/2025

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Report Generation Delay for CPIDs 1997 and 7451 Regence Blue Shield of Washington

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

Payer impacted: 

• CPID 1997 Regence Blue Shield of Washington
• CPID 7451 Regence Blue Shield of Washington

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09787853.

11/24/2025

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New Electronic Claims Connections Available on Revenue Performance Advisor

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

• AMM24 – Korean American Medical Group
• FLBPP – Broward PACE Program
• IHS29 – Point C
• JUDIH – Judi Health
• TH040 – Wellmed (Encounters)

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

• AMM24 – Korean American Medical Group
• FLBPP – Broward PACE Program
• IHS29 – Point C
• JUDIH – Judi Health
• TXCPL – Texas Childrens Health Plan (Medicaid Managed Care)
• TXCSM – Texas Childrens Health Plan (Star Medicaid) (Medicaid Managed Care)

11/21/2025

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Payer Processing Issue for multiple CPIDs

Due to a payer intermediary processing issue, some Professional and Institutional claims transmitted to the payers listed below Nov. 18, 2025 were not processed by the payer intermediary.

Payers impacted:

• CPID 7045 AmeriHealth Caritas Ohio
• CPID 9428 AmeriHealth Caritas Ohio
• CPID 7072 Molina Ohio Medicaid
• CPID 9462 Molina Ohio Medicaid
• CPID 7052 OhioRISE - Aetna Better Health of Ohio
• CPID 9435 OhioRISE - Aetna Better Health of Ohio
• CPID 9465 UnitedHealthcare Ohio Medicaid

A resolution has been implemented and the claims were retransmitted to the payer intermediary Nov. 21, 2025.

This delay affected claims released to Optum Nov. 18, 2025, 10:00 a.m.-5:00 p.m. CT.

Action Required: Be aware of the processing issue above.

If you have any questions, please contact Customer Support and refer to Case Number 09785433.

11/21/2025

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Delay in Electronic Remittance Advice (ERA) for CPIDs 1467 and 5510 Wisconsin Medicaid

There has been a delay in Professional and Institutional Electronic Remittance Advice (ERA) for the following payer for check dates since Nov. 19, 2025:

• CPID 1467 Wisconsin Medicaid
• CPID 5510 Wisconsin Medicaid

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09785619.

11/21/2025

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Delay in Electronic Remittance Advice (ERA) for CPIDs 1474, 3501

There has been a delay in Professional and Institutional Electronic Remittance Advice (ERA) for the following payer for check dates since Nov. 17, 2025: 

• CPID 1474 Indiana Medicaid
• CPID 3501 Indiana Medicaid

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09785586.

11/21/2025

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New Electronic Claim Status Connection Available

Optum is pleased to announce the availability of Real-time Claim Status Inquiry and Response 276/277 for the below payer, effective Nov. 11, 2025:

Payer Name: KAISER FOUNDATION HEALTH PLAN OF WASHINGTON
Industry Payer ID: 91051
IMN Real Time ID: 91051
Exchange Real Time ID: GRPNW
CPID(s): 6511, 8405
Optum IEDI Real Time ID: 10608
Payer Enrollment Required: No
Connection Type: X12

Search Options:
Claim Status Inquiry subscriber

• Member id, first name, last name, date of birth

Optional additional elements:

• Payer claim number, Total submitted charges

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

11/21/2025

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CPR Share Plans, Electronic Claims Connection No Longer Available

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

Payer Name: CPR Share Plans
Claim CPIDs: 8707, 3079
Payer-assigned Payer ID: CB695
Reason: Payer no longer offers an electronic connection to which Optum can connect. 

Action Required: None. 

11/20/2025

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Update: Electronic Claims Connection Suspended

Optum reactivated and changed electronic claims routing for the following payer, effective Nov. 13, 2025: 

Payer Name: Trilogy Health Network
Payer ID: 62777
Payer Claim Enrollment Required: No
Secondary Claims Accepted: No 

Enrollment Requirements:
Claims:

• Payer enrollment for electronic claims is not required. 

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

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

• No Payer Alias changes are required. Payer name and payer IDs are not changing. 

Original notification sent Oct. 31, 2025:
Effective immediately, the payer listed below has been suspended at Optum for claim processing and removed from the payer list. 

Payer Name: Trilogy Health Network
Payer ID: 62777
Reason: Payer unavailable electronically 

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

11/20/2025

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New Electronic Claims Auth Inquiry and Referral Connections Available

Optum is pleased to announce the availability of Real-time Auth Inquiry and Response 278/215 & 217 for the below payer, effective Nov. 17, 2025 .

Payer Name: Anthem Blue Cross Blue Shield of New York
IMN Real Time ID: SB803
Payer Enrollment Required: No
Connection Type: X12

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

11/20/2025

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New Electronic Claims Auth Inquiry and Referral Connections Available

Optum is pleased to announce the availability of Real-time Auth Inquiry and Response 278/215 & 217 for the below payer, effective Nov. 17, 2025.

Payer Name: Amerigroup
IMN Real Time ID: 27514
Payer Enrollment Required: No
Connection Type: X12

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

11/20/2025

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999 Payer Batch Rejections for CPID 1844 Wellcare Health Plans

Professional claims transmitted to the payer listed below from Optum Nov. 17, 2025 were not processed by the payer due to a 999 Batch Rejection. 

• CPID 1844 Wellcare Health Plans

A resolution has been implemented and the claims were retransmitted to the payer Nov. 20, 2025.

Action Required: None.

If you have any questions, please contact Customer Support and refer to Case Number 09784640.

11/20/2025

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Real-Time Fee changes correction

Correction:
Effective Dec. 1, 2025, the following fee will change:

Delaware Medicaid
Industry Payer ID: SKDE0
Exchange RT ID: DECAID
CPIDs: 1545, 2726
Eligibility Fee: Current $0.05; New $0.045

Action Required: Please be aware of the fee changes.

11/20/2025

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Update: Electronic Claims Connection Suspended

Effective Nov. 13, 2025, Optum has reactivated and changed electronic claims routing for the following payer:

Payer Name: Trilogy Health Network
Professional CPID: 5835
Current Edit Master: PE_E049
New Edit Master: PE_B800
Institutional CPID: 3624
Current Edit Master: HE9E049
New Edit Master: HE9B801
Payer-assigned Payer ID: 62777
Payer Claim Enrollment Required: No
Secondary Claims Accepted: No 

Enrollment Requirements:
Claims:

• Payer enrollment for electronic claims is not required. 

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

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

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

Original notification sent Oct. 31, 2025:
Effective immediately, the payer listed below has been suspended at Optum for claim processing and removed from the payer list. 

Payer Name: Trilogy Health Network
CPID(s): 3624, 5835
Payer ID: 62777
Reason: Payer unavailable electronically 

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

11/20/2025

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Update: Electronic Claims Connection Suspended

Effective Nov. 13, 2025, Optum has reactivated and changed electronic claims routing for the following payer: 

Payer Name: Trilogy Health Network
Professional CPID: 5835
Institutional CPID: 3624
Payer-assigned Payer ID: 62777
Payer Claim Enrollment Required: No
Secondary Claims Accepted: No
Claims Fee: $0.10 

Enrollment Requirements:
Claims:

• Payer enrollment for electronic claims is not required. 

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

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

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

Original notification sent Oct. 31, 2025:
Effective immediately, the payer listed below has been suspended at Optum for claim processing and removed from the payer list. 

Payer Name: Trilogy Health Network
CPID(s): 3624, 5835
Payer ID: 62777
Reason: Payer unavailable electronically 

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

11/20/2025

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999 Payer Batch Rejections for CPID 1844 Wellcare Health Plans

Professional claims transmitted to the payer listed below from Optum Nov. 19, 2025 were not processed by the payer due to a 999 Batch Rejection. 

• CPID 1844 Wellcare Health Plans

A resolution has been implemented and the claims were retransmitted to the payer Nov. 20, 2025.

Action Required: None.

If you have any questions, please contact Customer Support and refer to Case Number 09784227.

11/20/2025

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Payer Processing Issue for multiple CPIDs

Due to a payer intermediary processing issue, some Professional and Institutional claims transmitted to the payers listed below Nov. 18, 2025 were not processed by the payer intermediary.

Payers impacted:  

• CPID 2481 Ohio Medicaid
• CPID 7073 Humana Ohio Medicaid
• CPID 9463 Humana Ohio Medicaid
• CPID 7071 Anthem Ohio Medicaid
• CPID 9461 Anthem Ohio Medicaid
• CPID 7068 Ohio Medicaid Buckeye Community Health Plan
• CPID 9457 Ohio Medicaid Buckeye Community Health Plan
• CPID 7070 CareSource Ohio Medicaid
• CPID 9458 CareSource Ohio Medicaid

A resolution has been implemented and the claims were retransmitted to the payer intermediary Nov. 20, 2025.

This delay affected claims released to Optum Nov. 18, 2025, 10:00 a.m.-5:00 p.m. CT.

Action Required: Be aware of the processing issue above.

If you have any questions, please contact Customer Support and refer to Case Number 09783864.

11/20/2025

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Update: Report Generation Delay for multiple CPIDs

Update: The payer intermediary has been unable to generate and deliver the reports for some claims submitted Oct. 20, 2025.

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

Original notice sent Nov. 3, 2025:
A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted Oct. 20, 2025.

Payers impacted: 

• CPID 1402 Blue Cross Blue Shield of Minnesota
• CPID 1410 Blue Cross Blue Shield of Minnesota Comprehensive Care 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.

If you have any questions, please contact Customer Support and refer to Case Number 09756637.

11/20/2025

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Payer Processing Issue for CPID 9458 CareSource Ohio Medicaid

Due to a payer intermediary processing issue, some Professional claims transmitted to the payer listed below Nov. 17, 2025 were not processed by the payer.

Payer impacted:

• CPID 9458 CareSource Ohio Medicaid

A resolution has been implemented and the claims were retransmitted to the payer intermediary Nov. 20, 2025.

This delay affected claims released to Optum Nov. 17, 2025, 10:00 a.m.-1:00 p.m. CT.

Action Required: Be aware of the processing issue above.

If you have any questions, please contact Customer Support and refer to Case Number 09783670.

11/20/2025

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Update: Report Generation Delay for CPID 3232 Health Choice Arizona

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

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

Original notice sent Nov. 17, 2025:
A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted Nov. 7, 2025.

Payer impacted:

• CPID 3232 Health Choice Arizona

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09777638.

11/20/2025

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Report Generation Delay for multiple CPIDs

A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted since Nov. 11, 2025.

Payers impacted:

• CPID 8047 Central Valley Medical Providers
• CPID 9765 Central Valley Medical Providers
• CPID 8226 Community Care 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.

If you have any questions, please contact Customer Support and refer to Case Number 09781418.

11/20/2025

---

Update: Report Generation Delay for CPIDs 7736 and 9685 Direct Care

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

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

Original notice sent Nov. 17, 2025:
A payer intermediary is experiencing issues affecting Professional and Institutional report generation for some claims submitted Nov. 11, 2025.

Payer impacted:

• CPID 7736 Direct Care Administrators
• CPID 9685 Direct Care Administrators

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09777544.

11/20/2025

---

Electronic Claims Connection Suspended

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

Payer Name: Facey Medical Foundation
CPID: 4896
Payer ID: 95432
Reason: Payer unavailable electronically

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

11/20/2025

---

Report Generation Delay for CPID 7146 Camp Lejeune Family Member Program

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted Nov. 11, 2025.

Payer impacted:

• CPID 7146 Camp Lejeune Family Member 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.

If you have any questions, please contact Customer Support and refer to Case Number 09782483.

11/19/2025

---

New Electronic Eligibility Connection Available - Plan de Salud Hospital Menonita

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

Payer Name: Plan de Salud Hospital Menonita
Industry Payer ID: 66062
IMN Real Time ID: PDSHM
iEDI Real Time ID: PDSHM
Exchange Real Time ID: PDSHM
CPID(s): 7676, 7127
Payer Enrollment Required: Yes
Connection Type: X12

Search Options:
Subscriber

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

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

11/19/2025

---

New Electronic Eligibility Connection Available - Auxilio Plan de Socios

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

Payer Name: Auxilio Plan de Socios
Industry Payer ID: 660178704
IMN Real Time ID: PDSAM
iEDI Real Time ID: PDSAM
Exchange Real Time ID: PDSAM
CPID(s): None
Payer Enrollment Required: Yes
Connection Type: X12

Search Options:
Subscriber

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

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

11/19/2025

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New Electronic Eligibility Connection Available - Vital - Plan de Salud Menonita Reform

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

Payer Name: Vital - Plan de Salud Menonita Reform
Industry Payer ID: 66063
IMN Real Time ID: 66063
iEDI Real Time ID: 66063
Exchange Real Time ID: PDSMV
CPID(s): 3058, 8448
Payer Enrollment Required: Yes
Connection Type: X12

Search Options:
Subscriber

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

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

11/19/2025

---

New Electronic Eligibility Connection Available - Auxilio Salud Plus Inc.

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

Payer Name: Auxilio Salud Plus Inc.
Industry Payer ID: 47362
IMN Real Time ID: 47362
IEDI Real Time ID: 47362
Exchange Real Time ID: AUXSP
CPID(s): None
Payer Enrollment Required: Yes
Connection Type: X12

Search Options:
Subscriber

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

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

11/19/2025

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New Electronic Claim Status Connection Available - Michigan Medicaid

Optum is pleased to announce the availability of Real-time Claim Status Inquiry 276/277 for the below payer, effective Nov. 7, 2025:

Payer Name: Michigan Medicaid
Industry Payer ID: SKMI0
IMN Real Time ID: SKMI0
IEDI Real Time ID: MIMCD
Exchange Real Time ID: MICAID
CPID(s): 3512, 2480
Payer Enrollment Required: No
Connection Type: X12

Search Options:
Subscriber

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

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

11/19/2025

---

New Electronic Claim Status Connection Available - Indiana Medicaid

Optum is pleased to announce the availability of Real-time Claim Status Inquiry 276/277 for the below payer, effective Nov. 6, 2025:

Payer Name: Indiana Medicaid
Industry Payer ID: SKIN0
IMN Real Time ID: SKIN0
IEDI Real Time ID: 10103
Exchange Real Time ID: INCAID
CPID(s):  3501, 1474
Payer Enrollment Required: No
Connection Type: X12

Search Options:
Subscriber

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

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

11/19/2025

---

New Electronic Claim Status Connection Available

Optum is pleased to announce the availability of Real-time Claim Status Inquiry 276/277 for the below payer, effective Nov. 3, 2025:

Payer Name: District of Columbia Medicaid
Industry Payer ID: 77033
IMN Real Time ID: SKDC0
IEDI Real Time ID: DCMCD
Exchange Real Time ID: DCCAID
CPID(s): 5550, 4425
Payer Enrollment Required: No
Connection Type: X12

Search Options:
Subscriber

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

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

11/19/2025

---

New Electronic Claim Status Connection Available

Optum is pleased to announce the availability of Real-time Claim Status Inquiry 276/277 for the below payer, effective Oct. 28, 2025:

Payer Name: Evernorth Care Solutions
Industry Payer ID: 62350
IMN Real Time ID: 62350
iEDIReal Time ID: 62350
Exchange Real Time ID: ENCSL
CPID(s): 2789  (Prof only)
Payer Enrollment Required: No
Connection Type: X12

Search Options:
Subscriber

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

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

11/19/2025

---

Delay in Electronic Remittance Advice (ERA) for CPIDs 1487 and 5594 North Dakota Medicaid

There has been a delay in Professional and Institutional Electronic Remittance Advice (ERA) for the following payer for check dates since Nov. 14, 2025: 

• CPID 1487 North Dakota Medicaid
• CPID 5594 North Dakota Medicaid 

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09780106.

11/19/2025

---

Enrollment Form Now Required

The following payer now requires providers to submit a Eligibility enrollment form:

• SKMI0 – Michigan Medicaid

To access the new agreement form, please visit https://business.optum.com/en/support/enrollment-forms.html

Action Required: All providers should submit an enrollment form to obtain authorization for this payer.

11/19/2025

---

Update: Report Generation Delay for CPIDs 6631 and 6732 McLaren Health Plan Medicaid
Update: The payer intermediary has been unable to generate and deliver the reports for some claims submitted Oct. 20, 2025 and Oct. 21, 2025.

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

Original notice sent Oct. 30, 2025:
A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted since Oct. 20, 2025.

Payer impacted:

• CPID 6631 McLaren Health Plan Medicaid
• CPID 6732 McLaren Health Plan Medicaid

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09752766.

11/18/2025

---

Optum Alert: Report Generation Delay for CPID 8985 Health Choice Pathway

The payer intermediary listed below is experiencing issues affecting Institutional report generation for some claims submitted from Oct. 31, 2025 to Nov. 3, 2025.

Payer impacted:

• CPID 8985 Health Choice Pathway

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09778434.

11/17/2025

---

Meritage Medical Network Electronic Claims and Remittance Connections No Longer Available

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

Payer Name: Meritage Medical Network
Claim and Remittance CPIDs: 6609, 2183
Remittance LOB: J9D
Payer-assigned Payer ID: IP097
Reason: Payer no longer offers an electronic connection to which Optum can connect. 

Action Required: None. 

11/17/2025

---

Meritage Medical Network Electronic Claims and Remittance Connections No Longer Available

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

Payer Name: Meritage Medical Network
Claim and Remittance CPIDs: 6609, 2183
Payer-assigned Payer ID: IP097
Reason: Payer no longer offers an electronic connection to which Optum can connect. 

Action Required: None. 

11/17/2025

---

Report Generation Delay for CPID 7264 Quartz ASO

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

Payer impacted: 

• CPID 7264 Quartz ASO

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09777986.

11/17/2025

---

999 Payer Batch Rejections for CPID 1844 Wellcare Health Plans

Professional claims transmitted to the payer listed below from Optum Nov. 14, 2025 were not processed by the payer due to a 999 Batch Rejection. 

• CPID 1844 Wellcare Health Plans

A resolution has been implemented and the claims were retransmitted to the payer Nov. 17, 2025.

Action Required: None.

If you have any questions, please contact Customer Support and refer to Case Number 09777940.

11/17/2025

---

Report Generation Delay for CPID 2426 Michigan Blue Care Network

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

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.

If you have any questions, please contact Customer Support and refer to Case Number 09777827.

11/17/2025

---

Report Generation Delay for CPID 3232 Health Choice Arizona

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

Payer impacted:

• CPID 3232 Health Choice Arizona

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09777638.

11/17/2025

---

Report Generation Delay for CPIDs 7736 and 9685 Direct Care Administrators

A payer intermediary is experiencing issues affecting Professional and Institutional report generation for some claims submitted Nov. 11, 2025.

Payer impacted:

• CPID 7736 Direct Care Administrators
• CPID 9685 Direct Care Administrators

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09777544.

11/17/2025

---

Mutual of Omaha Plan Real Time Claim Status Connection Available

Optum is pleased to announce the availability of Real-time Claim Status Inquiry and Response 276/277 for the below payer, effective Nov. 13, 2025:

Payer Name: Mutual of Omaha

Industry Payer ID: 71412

IMN Real Time ID: 71412

Exchange Real Time ID: MUTOMH

CPID(s): 4530, 2420

Payer Enrollment Required: No

Connection Type: X12

Search Option:

Claim Status Inquiry subscriber

• Member id, first name, last name, date of birth
• Optional additional elements: Payer claim number; Total submitted charges

Action Required by customer:

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

11/17/2025

---

Real-Time Fee Changes

Effective 12/01/25, the following fees will change:

Connecticut Medicaid
Industry Payer ID: 06127
Exchange RT ID: CTCAID
CPIDs: 3535, 4476
Eligibility Fee: Current $0.045; New $0.065
Claim Status Fee: Current $0.00; New $0.065

Delaware Medicaid
Industry Payer ID: SKDE0
Exchange RT ID: DECAID
CPIDs: 1545, 2726
Eligibility Fee: Current $0.05; New $0.065

District of Columbia Medicaid
Industry Payer ID: 77033
Exchange RT ID: DCCAID
CPIDs: 5550, 4425
Eligibility Fee: Current $0.03; New $0.0325
Claim Status Fee: Current $0.00; New $0.0325

Montana Medicaid
Industry Payer ID: SKMT0
Exchange RT ID: MTCAID
CPIDs: 5586, 4427
Eligibility Fee: Current $0.03; New $0.0325
Claim Status Fee: Current $0.00; New $0.0325

New Mexico Medicaid
Industry Payer ID: 77048
Exchange RT ID: NMCAID
CPIDs: 5562, 1492
Eligibility Fee: Current $0.03; New $0.0325

Tennessee Medicaid
Industry Payer ID: 00390
Exchange RT ID: TNCAID
CPIDs: 5514, 2495
Eligibility Fee: Current $0.02; New $0.04

Action Required: Please be aware of the fee changes.

11/17/2025

---

Real-Time Fee Changes

Effective 12/01/25, the following payer fees will change:

Connecticut Medicaid
Industry Payer ID: 06127
IMN Payer ID: SKCT0
Claim Status Fee: Current $0.00; New $0.065

Tennessee Medicaid
Industry Payer ID: 00390
IMN Payer ID: SKTN2
Eligibility Fee: Current $0.02; New $0.04

Action Required: Please note the fee changes

11/17/2025

---

New Payer Name

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

Previous Payer Name: Anthem Blue Cross Blue Shield of California Medi-Cal MCO
New Payer Name: California Medi-Cal MCO through Anthem Blue Cross of California
Institutional CPID: 1684
Institutional Edit Master: HE9B146
Remit Line of Business (LOB) Code: X68 

Previous Payer Name: Anthem Blue Cross Blue Shield of California
New Payer Name: Anthem Blue Cross of California
Professional CPID: 4417
Professional Edit Master: PE_T007
Institutional CPID: 3511
Institutional Edit Master: HE9T007
Remit Line of Business (LOB) Code:X68 

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. 

11/14/2025

---

New Payer Name

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

Previous Payer Name: Anthem Blue Cross Blue Shield of California

New Payer Name: Anthem Blue Cross of California 

Professional CPID: 4417 

Institutional CPID: 3511 

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

11/14/2025 

---

FirstCare STAR Medicaid MCO/FirstCare & FirstCare Advantage HMO Electronic Remittance Connection No Longer Available

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

Payer Name: FirstCare STAR Medicaid MCO/FirstCare & FirstCare Advantage HMO

Payer ID: 94998

Reason: Payer no longer offers an electronic connection to which Optum can connect. 

Action Required: None

11/14/2025.

---

New Electronic Remittance Connections Available - Guidehealth NPA (36364)

Optum has new electronic remittance connections available:  

Payer Name: Guidehealth NPA

Payer ID: 36364 

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.

11/14/2025

---

New Electronic Remittance (ERA) Connections Available on RPA

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

Payer ID – Payer name

45687 – Compass Health Administrators
GI813 – Guardian Retail

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

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

11/14/2025

---

New Electronic Remittance Connections Available

Optum has new electronic remittance connections available:  

Payer Name: Guidehealth NPA
Institutional CPID: 8018
Professional CPID: 9735
Payer-assigned Payer ID: 36364
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. 

11/14/2025

---

New Electronic Remittance Connections Available

Optum has new electronic remittance connections available:  

Payer Name: Guidehealth NPA
Institutional CPID: 8018
Professional CPID: 9735
Payer-assigned Payer ID: 36364
Line of Business (LOB) Code: H9Q
Payer Enrollment Required: Yes
Payer Location: National 

Action Required: 

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

11/14/2025

---

Report Generation Delay for CPID 2207 Pennsylvania Medicare

Update: The payer intermediary has been unable to generate and deliver the reports for some claims submitted on Oct. 23, 2025 and Oct. 24, 2025.

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

Original notice sent Nov. 5, 2025:

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

Payer impacted:

• CPID 2207 Pennsylvania Medicare

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09760641.

11/14/2025

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Electronic Routing Change for CPIDs 6538 and 1748 MVP Health Plan

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

Payer Name: MVP Health Plan
Professional CPID: 1748
Institutional CPID: 6538
Payer-assigned Payer ID: 14165
Line of Business Code (LOB): U66
Payer Remittance Enrollment Required: Yes

Enrollment Requirements:

Remittance:

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

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

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

11/14/2025

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Electronic Routing Change for CPIDs 6538 and 1748 MVP Health Plan

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

Payer Name: MVP Health Plan
Professional CPID: 1748
Institutional CPID: 6538
Payer-assigned Payer ID: 14165
Payer Remittance Enrollment Required: Yes
Remittance Fee: N/A

Enrollment Requirements:

Remittance:

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

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

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

11/14/2025

---

Meritage First Choice Electronic Claims Connection No Longer Available

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

Payer Name: Meritage First Choice
Claim CPIDs: 5082, 9130
Payer-assigned Payer ID: FC002 

Reason: Payer no longer offers an electronic connection to which Optum can connect. 

Action Required: None. 

11/13/2025

---

Meritage First Choice Electronic Claims Connection No Longer Available

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

Payer Name: Meritage First Choice
Claim CPIDs: 5082, 9130
Payer-assigned Payer ID: FC002

Reason: Payer no longer offers an electronic connection to which Optum can connect.

Action Required: None.

11/13/2025

---

New Electronic Claims Connections Available

Optum has new electronic claims connections available:  

Payer Name: San Diego County Medical Services (CMS)
Institutional CPID: 4662
Payer-assigned Payer ID: MSO11
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. 

11/13/2025

---

FirstCare STAR Medicaid MCO/FirstCare & FirstCare Advantage HMO Electronic Remittance Connection No Longer Available

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

Payer Name: FirstCare STAR Medicaid MCO/FirstCare & FirstCare Advantage HMO
Remittance CPIDs: 1656, 5854
Remittance LOB: U24
Payer-assigned Payer ID: 94998
Reason: Payer no longer offers an electronic connection to which Optum can connect. 

Action Required: None.

11/13/2025

---

Report Generation Delay for CPIDs 7543 and 2803 UPMC Health Plan

The payer listed below is experiencing issues affecting Institutional and Professional report generation for some claims submitted on Nov. 6, 2025.

Payer impacted:

• CPID 7543 UPMC Health Plan
• CPID 2803 UPMC Health Plan

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09773179.

11/13/2025

---

999 Payer Batch Rejections for CPID 1844 Wellcare Health Plans

Professional claims transmitted to the payer listed below from Optum on Nov. 12, 2025 were not processed by the payer due to a 999 Batch Rejection. 

• CPID 1844 Wellcare Health Plans

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

Action Required: None.

If you have any questions, please contact Customer Support and refer to Case Number 09773284.

11/13/2025

---

Update: Report Generation Delay for multiple CPIDs

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

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

Original notice sent Oct. 27, 2025:

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

Payers impacted:

• CPID 1491 Pennsylvania Medicaid
• CPID 5509 Pennsylvania Medicaid
• CPID 1605 Pennsylvania Medicaid Long Term Care

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09747121.

11/13/2025

---

Update: Report Generation Delay for CPID 7264 Quartz ASO

Update: The payer intermediary has been unable to generate and deliver the reports for some claims submitted Oct. 31, 2025.

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

Original notice sent Sept. 23, 2025:
A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted since Sept. 10, 2025.

Payer impacted: 

• CPID 7264 Quartz ASO

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09695472.

11/13/2025

---

New Payer Edit for CPID 2740

The payer below has informed Optum of a new edit requirement:

• PREF02A310: MISSING PROVIDER NUMBER – Payer Provider Number is required.

Exception: When the Active Payer Secondary ID is present with G2 qualifier, this requirement does not apply.

Note: If this requirement does not apply to your billing situation, you can override the edit within the Error Text. LOOP 2010BB REF02

Edit applies to: 

• CPID 2740 UNITEDHEALTHCARE WEST - PACIFICARE OF CALIFORNIA

Action Required: Please be aware of updated edit requirements.  

11/13/2025

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Report Generation Delay for CPID 6195 Superior Vision Services

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

Payer impacted: 

• CPID 6195 Superior Vision 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.

If you have any questions, please contact Customer Support and refer to Case Number 09771377.

11/12/2025

---

Report Generation Delay for CPID 7009 AllCare PACE

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

Payer impacted: 

• CPID 7009 AllCare PACE

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09771277.

11/12/2025

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Report Generation Delay for CPID 5016 NextBlue of North Dakota

A payer intermediary is experiencing issues affecting Institutional report generation for some claims submitted on Oct. 30, 2025.

Payer impacted: 

• CPID 5016 NextBlue of North Dakota

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09771037.

11/12/2025

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Error Message for Payer ID 87726

Optum has received confirmation from the payer that the A7:799 rejections are true rejections. The claims did not reject in error.

Effective April 1, 2025 we will enforce CMS and health plan guidelines by rejecting or denying the following types of claims: Multiple new claim submissions for the same date of service Submit 1 claim for all services rendered on the same date(s) of service by the same health care provider for an individual member. If you submit multiple original claims for the same date(s) of service, the original will adjudicate, and the system will reject subsequent claims and request a corrected claim.

The 799 rejections are related to newly enforced duplicate claim rules and provider education is available at:

Avoid claim rejections and denials | UHCprovider.com

Action Required: Review rejected claim and make adjustments as necessary.

Previous Announcement:

Optum is aware of an ongoing issue affecting UnitedHealthcare (payer ID 87726) claims that are rejecting incorrectly for A7:799. We are working closely with the payer to resolve this situation. We appreciate your patience and understanding.

If you have any questions, please contact Customer Support and refer to Global Incident Number INC-000003617

Action Required: Please be aware of the ongoing issue.

11/12/2025

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Eligibility & Claim Status payer termination

Effective November 10, Real Time Eligibility 270/271, and Claim Status 276/277 for the payer listed below is no longer available at Optum.

Payer Name: United American Insurance Company
Industry Payer ID: 92916
IMN Real Time ID: UNAMN
Exchange Real Time ID: UNTDA / UNTDA1 (Portal)
CPID(s): 5084 / 8179
Optum IEDi Real Time ID: 14298
Connection Type: X12/ Portal

Reason: Payer no longer offers an electronic connection

Action Required by customer:

For assistance with submitting Real-Time transactions, please contact your Practice Management System Vendor or Optum Customer Care Hub ticket.

11/12/2025

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New Electronic Claims Connections Available

Optum has new electronic claims and remittance connections available:  

Payer Name: Horizon Pace
Institutional CPID: 9046
Professional CPID: 3766
Payer-assigned Payer ID: R4569
Payer Claim Enrollment Required: No
Secondary Claims Accepted: Yes 

Action Required:

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

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

11/11/2025

---

New Electronic Claims Connections Available

Optum has a new electronic claims connection available:  

Payer Name: Horizon Pace
Institutional CPID: 9046
Professional CPID: 3766
Payer-assigned Payer ID: R4569
Payer Claim Enrollment Required: No
Secondary Claims Accepted: Yes
Claims Fee: $0.10 

Action Required:

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

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

11/11/2025

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999 Payer Batch Rejections for CPID 1844 Wellcare Health Plans

Professional claims transmitted to the payer listed below from Optum Nov. 11, 2025 were not processed by the payer due to a 999 Batch Rejection. 

• CPID 1844 Wellcare Health Plans

A resolution has been implemented and the claims were retransmitted to the payer on Nov. 12, 2025.

Action Required: None.

If you have questions, please contact Customer Support and refer to Case Number 09770696.

11/12/2025

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Report Generation Delay for CPID 8074 Pool Administrators, INC. (PAI) - CA Dept of Public Health Institutional Claims

A payer intermediary is experiencing issues affecting Institutional report generation for some claims submitted Oct. 29, 2025.

Payer impacted: 

• CPID 8074 Pool Administrators, INC. (PAI) - CA Dept of Public Health Institutional Claims

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09769153.

11/11/2025

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Report Generation Delay for CPID 9021 Inspira Health Network Life

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

Payer impacted: 

• CPID 9021 Inspira Health Network Life

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09768917.

11/11/2025

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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 since Oct. 28, 2025.

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.

If you have any questions, please contact Customer Support and refer to Case Number 09768836.

11/11/2025

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Report Generation Delay for CPIDs 9010 and 3480 ArchCare

A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted since Oct. 28, 2025.

Payer impacted: 

• CPID 9010 ArchCare
• CPID 3480 ArchCare

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09768755.

11/11/2025

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Update: Report Generation Delay for CPIDs 1510 and 1404 Wellmark Blue Cross Blue Shield of Iowa

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

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

Original notice sent Oct. 23, 2025:
A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted Oct. 10, 2025.

Payer impacted: 

• CPID 1510 Wellmark Blue Cross Blue Shield of Iowa
• CPID 1404 Wellmark Blue Cross Blue Shield of Iowa

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09743971.

11/11/2025

---

Update: Report Generation Delay for CPID 4278 The Boon Group

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

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

Original notice sent Oct. 23, 2025:
A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted Oct. 9, 2025.

Payer impacted: 

• CPID 4278 The Boon Group

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09743781.

11/11/2025

---

999 Payer Batch Rejections for CPID 1844 Wellcare Health Plans

Professional claims transmitted to the payer listed below from Optum on Nov. 10, 2025 were not processed by the payer due to a 999 Batch Rejection. 

• CPID 1844 Wellcare Health Plans

A resolution has been implemented and the claims were retransmitted to the payer on Nov. 11, 2025.

Action Required: None.

If you have any questions, please contact Customer Support and refer to Case Number 09768463.

11/11/2025

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Electronic Claims Connection Suspended

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

Payer Name: CPR Share Plans
CPIDs: 3079, 8707
Payer ID: CB695
Reason: Payer unavailable electronically.

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

11/11/2025

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Error Message for Payer ID 87726

Optum is aware of an ongoing issue affecting UnitedHealthcare (payer ID 87726) claims that are rejecting incorrectly for A7:799. We are working closely with the payer to resolve this situation. We appreciate your patience and understanding.

If you have any questions, please contact Customer Support and refer to Global Incident Number INC-000003617

Action Required: Please be aware of the ongoing issue.

11/10/2025

---

Error Message for Payer ID 87726

Optum is aware of an ongoing issue affecting UnitedHealthcare claims (payer ID 87726) that are rejecting incorrectly for A7:799. We are working closely with the payer to resolve this situation. We appreciate your patience and understanding.

If you have any questions, please contact Customer Support and refer to Global Incident Number INC-000003400.

Action Required: Please be aware of the ongoing issue.

11/10/2025

---

Electronic Routing Change for Payer ID 88350 HealthTeam Management Diabetes and Heart Care Plan

Effective Nov. 5, 2025, Optum changed electronic claims routing for the following payer:

Payer Name: HealthTeam Management Diabetes and Heart Care Plan
Payer ID: 88350
Payer Claim Enrollment Required: No
Secondary Claims Accepted: Yes

Enrollment Requirements
Claims:

• Payer enrollment for electronic claims is not required.

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

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

• Revalidate unreleased claims to edit correctly under new edit master.
• No Payer Alias changes are required. Payer name and payer IDs are not changing.

11/7/2025

---

New Electronic Claims Connections Available

Optum has new electronic claims connections available:  

Payer Name: Benefit Health Plan
Payer ID: 52682
Payer Enrollment Required: No
Secondary Claims Accepted: No 

Payer Name: Broward PACE Program
Payer ID: FLBPP
Payer Enrollment Required: No
Secondary Claims Accepted: Yes
Payer Location: Florida
Claims Fee: N/A

Action Required:

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

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

11/7/2025

---

Payer Change for Payer ID HPFFS Hispanic Physicians IPA Fee For Service

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

Payer Name: Hispanic Physicians IPA Fee For Service
Payer ID: HPFFS

Claims submitted must begin using the following:
Payer Name: Hispanic Physicians IPA
Payer ID: HPIPA

Hispanic Physicians IPA Fee For Service will be terminated effective Nov. 20, 2025.

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.

11/7/2025

---

Electronic Claims Connections Suspended

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

Payer Name: Meritage Medical Network
CPIDs: 2183, 6609
Payer ID: IP097
Reason: Payer unavailable electronically 

Payer Name: Meritage First Choice
CPIDs: 5082, 9130
Payer ID: FC002
Reason: Payer unavailable electronically 

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

11/7/2025

---

Update: Report Generation Delay for CPIDs 2839 and 2960 Hometown Health

Update: The payer has been unable to generate and deliver the reports for some claims submitted Sept. 16, 2025.

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

Original notify sent Sept. 29, 2025:
A payer is experiencing issues affecting Professional and Institutional report generation for some claims submitted since Sept. 16, 2025.

Payer impacted:

• CPID 2839 Hometown Health
• CPID 2960 Hometown Health

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09708529.

11/7/2025

---

Update: Report Generation Delay for CPID 4410 Educators Mutual Insurance

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

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

Original notify sent Oct. 24, 2025:
A payer is experiencing issues affecting Professional report generation for some claims submitted Oct. 7, 2025.

Payer impacted: 

• CPID 4410 Educators Mutual Insurance

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09745180.

11/7/2025

---

New Electronic Claim Status Connection Available

Optum is pleased to announce the availability of Real-time Claim Status Inquiry and Response 276/277 for the below payer, effective Oct. 27, 2025:

Payer Name: CareSource of Georgia
Industry Payer ID: GACS1
IMN Real Time ID: GACS1
Exchange Real Time ID: CASGA
CPID(s): 2570, 1194
Optum IEDI Real Time ID: GACS1
Payer Enrollment Required: No
Connection Type: X12

Search Options:
Claim Status Inquiry subscriber

• Member id, first name, last name, date of birth

Optional additional elements:

• Payer claim number, Total submitted charges

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

11/7/2025

---

Payer Change for CPID 7704 Hispanic Physicians IPA Fee For Service

Effective immediately, claims currently exchanged with the following payer must use a different CPID:
Payer Name: Hispanic Physicians IPA Fee For Service
Professional CPID: 7704
Professional Edit Master: PE_O007
Payer-assigned Payer ID: HPFFS

Claims submitted must begin using the following:
Payer Name: Hispanic Physicians IPA
Professional CPID: 6272
Professional Edit Master: PE_T007
Payer-assigned Payer ID: HPIPA

CPID 7704 Hispanic Physicians IPA Fee For Service will be terminated effective Nov. 13, 2025.

Enrollment Requirements:
Claims:

• Payer enrollment for electronic claims is not required.

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 CPID.
• To access the new enrollment forms, please visit Enrollment Central.

11/7/2025

---

Payer Change for CPID 7704 Hispanic Physicians IPA Fee For Service

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

Payer Name: Hispanic Physicians IPA Fee For Service
Professional CPID: 7704
Payer-assigned Payer ID: HPFFS

Claims submitted must begin using the following:
Payer Name: Hispanic Physicians IPA
Professional CPID: 6272
Payer-assigned Payer ID: HPIPA
Claim Fee: NA

CPID 7704 Hispanic Physicians IPA Fee For Service will be terminated effective Nov. 13, 2025.

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.

11/7/2025

---

New Electronic Eligibility Connection Available

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

Payer Name: Anthem Vivity
Industry Payer ID: 10993
IMN Real Time ID: 10993
Exchange Real Time ID: ATMVT
Optum IEDI Real Time ID: 10993
Payer Enrollment Required: No
Connection Type: X12

Search Options:
Eligibility Subscriber

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

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

11/7/2025

---

New Electronic Claim Status Connection Available

Optum is pleased to announce the availability of Real-time Claim Status Inquiry and Response 276/277 for the below payer, effective Oct. 27, 2025:

Payer Name: BRIDGESPAN
Industry Payer ID: BRIDG
IMN Real Time ID: BRIDG
Exchange Real Time ID: BDSPH
CPID(s): 6675, 6779
Optum IEDI Real Time ID: BRIDG
Payer Enrollment Required: No
Connection Type: X12

Search Options:
Claim Status Inquiry subscriber

• Member id, first name, last name, date of birth

Optional additional elements:

• Payer claim number, Total submitted charges

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

11/7/2025

---

New Electronic Claims Connections Available on Revenue Performance Advisor

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

28189 – UCLA Health Medicare Advantage Plan
98578 – Show Me Health Administrators
EGPIN – Enterprise Group Planning, Inc.
HALOS – Halos Systems
HMG01 – Blue Zones Health
MSCMG – MD Senior Care Medical Group
NB123 – NorthBay Health
R3460 – PACE Southeast Michigan
R3467 – High Desert PACE
R3469 – PACE at Hudson Headwaters

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

28189 – UCLA Health Medicare Advantage Plan
98578 – Show Me Health Administrators
EGPIN – Enterprise Group Planning, Inc.
HALOS – Halos Systems
HMG01 – Blue Zones Health
MCS04 – California Department of Corrections
MSCMG – MD Senior Care Medical Group
NB123 – NorthBay Health
R3460 – PACE Southeast Michigan
R3467 – High Desert PACE
R3469 – PACE at Hudson Headwaters

11/7/2025

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Division of Immigration Health Services Electronic Claims and Remittance Connections No Longer Available

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

Payer Name: Division of Immigration Health Services
Payer-assigned Payer ID: VAICE
Reason: Payer no longer offers an electronic connection to which Optum can connect.   

Payer will no longer accept paper claims. 

Action Required: None

11/6/2025

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Electronic Claims Connection Suspended - California Department of Corrections (MCS04)

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

Payer Name: California Department of Corrections
Payer ID: MCS04
Reason: Payer unavailable electronically

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

11/6/2025

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New Electronic Claim Status Connection Available Platform

Optum is pleased to announce the availability of Real-time Claim Status Inquiry and Response 276/277 for the below payer, effective Sept. 15, 2025:

Payer Name: NEW YORK MEDICAID
Industry Payer ID: SKNY0
IMN Real Time ID: SKNY0
Exchange Real Time ID: NYCAID
CPID(s): 1422 / 1500 / 1501 / 1502
Optum iEDI Real Time ID: NYMCD
Payer Enrollment Required: YES
Connection Type: X12

Search Options

Claim Status Inquiry subscriber:

• Member id, first name, last name, date of birth

Optional additional elements:

• Payer claim number, Total submitted charges

Action Required by customer:

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

11/6/2025

---

Claim Status payer termination

Real Time Claim Status 276/277 for the payer listed below is no longer available at Optum, effective Nov. 3, 2025:

Payer Name: Blue Cross of Idaho Boise
Industry Payer ID: BLUEC
IMN Real Time ID: SB612
Exchange Real Time ID: IDBLCB
Optum IEDi Real Time ID: IDBLCB
Connection Type: X12
Reason: Payer no longer offers an electronic connection.

Action Required by customer:
For assistance with submitting Real-Time transactions, please contact your Practice Management System Vendor or Optum Customer Care Hub ticket.

11/6/2025

---

PAR Status Change for Claim Payers

Effective immediately, the PAR status is changing for the following claim payers:

Payer Name: Alterwood Advantage
Industry Payer ID: RP016
Exchange CPIDs: 6008, 9167
Current Par Status: Non Par
New Par Status: Gateway

Payer Name: AmeriHealth Caritas Delaware
Industry Payer ID: 77799
Exchange CPIDs: 7507, 7746
Current Par Status: Non Par
New Par Status: Par

Payer Name: AmeriHealth Caritas District of Columbia
Industry Payer ID: 77002
Exchange CPIDs: 5670, 6441
Current Par Status: Non Par
New Par Status: Par

Payer Name: AmeriHealth Caritas Florida
Industry Payer ID: 77003
Exchange CPIDs: 8963, 2106
Current Par Status: Non Par
New Par Status: Par

Payer Name: AmeriHealth Caritas Louisiana
Industry Payer ID: 27357
Exchange CPIDs: 4638, 6156
Current Par Status: Non Par
New Par Status: Par

Payer Name: AmeriHealth Caritas New Hampshire
Industry Payer ID: 87716
Exchange CPIDs: 2090, 8238
Current Par Status: Non Par
New Par Status: Par                                                                                 

Payer Name: AmeriHealth Caritas Next A Product of AmeriHealth Caritas Florida, Inc.
Industry Payer ID: 45408
Exchange CPIDs: 7044, 9427
Current Par Status: Non Par
New Par Status: Par

Payer Name: AmeriHealth Caritas Next A Product of AmeriHealth Caritas VIP Next, Inc.
Industry Payer ID: 47073
Exchange CPIDs: 7043, 9426
Current Par Status: Non Par
New Par Status: Par

Payer Name: AmeriHealth Caritas Next North Carolina
Industry Payer ID: 83148
Exchange CPIDs: 6038, 9192
Current Par Status: Non Par
New Par Status: Par

Payer Name: AmeriHealth Caritas Pennsylvania
Industry Payer ID: 22248
Exchange CPIDs: 4547, 1710
Current Par Status: Non Par
New Par Status: Par

Payer Name: AmeriHealth Caritas VIP Care - Delaware DSNP
Industry Payer ID: 87406
Exchange CPIDs: 7081, 9484
Current Par Status: Non Par
New Par Status: Par

Payer Name: AmeriHealth Caritas VIP Care - Florida DSNP
Industry Payer ID: 88232
Exchange CPIDs: 7082, 9485
Current Par Status: Non Par
New Par Status: Par

Payer Name: AmeriHealth Caritas VIP Care PA CommHealthChoices
Industry Payer ID: 77062
Exchange CPIDs: 6501, 1268
Current Par Status: Non Par
New Par Status: Par

Payer Name: AmeriHealth Caritas VIP Care Plus (Michigan)
Industry Payer ID: 77013
Exchange CPIDs: 8656, 7212
Current Par Status: Non Par
New Par Status: Par

Payer Name: Blue Cross Complete of Michigan
Industry Payer ID: 32002
Exchange CPIDs: 5096, 7409
Current Par Status: Non Par
New Par Status: Par

Payer Name: First Choice by Select Health of South Carolina
Industry Payer ID: 23285
Exchange CPIDs: 7544, 2890
Current Par Status: Non Par
New Par Status: Par

Payer Name: First Choice Next A Product of Select Health of South Carolina, Inc.
Industry Payer ID: 57103
Exchange CPIDs: 7042, 9425
Current Par Status: Non Par
New Par Status: Par

Payer Name: First Choice VIP Care by Select Health of South Carolina
Industry Payer ID: 32456
Exchange CPIDs: 6087, 9248
Current Par Status: Non Par
New Par Status: Par

Payer Name: First Choice VIP Care Plus by Select Health of SC
Industry Payer ID: 77009
Exchange CPIDs: 8631, 7193
Current Par Status: Non Par
New Par Status: Par

Payer Name: Keystone First
Industry Payer ID: 23284
Exchange CPIDs: 6531, 8475
Current Par Status: Non Par
New Par Status: Par

Payer Name: Keystone First - CHIP
Industry Payer ID: 30070
Exchange CPIDs: 8098, 2897
Current Par Status: Non Par
New Par Status: Par

Payer Name: Keystone First Community Health Choices
Industry Payer ID: 42344
Exchange CPIDs: 1093, 8121
Current Par Status: Non Par
New Par Status: Par

Payer Name: Keystone First VIP Choice
Industry Payer ID: 77741
Exchange CPIDs: 6649, 6751
Current Par Status: Non Par
New Par Status: Par

Payer Name: PerformCare
Industry Payer ID: 65391
Exchange CPIDs: 4657, 6183
Current Par Status: Non Par
New Par Status: Par

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

11/6/2025

---

New Electronic Claims Connections Available

Optum has new electronic claims connections available:  

Payer Name: Benefit Health Plan
Institutional CPID: 9044
Professional CPID: 3762
Payer-assigned Payer ID: 52682
Payer Enrollment Required: No
Secondary Claims Accepted: No 

Action Required:

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

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

11/6/2025

---

New Electronic Eligibility Connection Available

Optum is pleased to announce the availability of Real-time Eligibility Inquiry and Response 270/271 for the below payer, effective Nov. 6, 2025:

Payer Name: Prairie States
Industry Payer ID: 36373
IMN Real Time ID: 36373
Exchange Real Time ID: PRSTE
CPID(s): 3984, 3891
Payer Enrollment Required: No
Connection Type: X12

Search Options
Eligibility Subscriber

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

Eligibility Dependent

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

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

11/6/2025

---

New Electronic Eligibility Connection Available
Optum is pleased to announce the availability of Real-time Eligibility Inquiry and Response 270/271 for the below payer, effective Nov. 6, 2025:

Payer Name: Valley Care IPA
Industry Payer ID: VCIPA
IMN Real Time ID: VCIPA
Exchange Real Time ID: VCIPA
CPID(s): 7124
Payer Enrollment Required: No
Connection Type: X12

Search Options
Subscriber:

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

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

11/6/2025

---

Electronic Claims Connections Suspended

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

Payer Name: Meritage Medical Network
CPIDs: 2183, 6609
Payer ID: IP097
Reason: Payer unavailable electronically 

Payer Name: Meritage First Choice
CPIDs: 5082, 9130
Payer ID: FC002
Reason: Payer unavailable electronically 

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

11/6/2025

---

Update: Report Generation Delay for CPID 2554 Louisiana Medicaid Medicare Advantage Crossovers

Update: It’s been determined that the payer had a processing issue.

A resolution has been implemented and the claims were retransmitted to the payer intermediary on Nov. 5, 2025.

This delay affected claims released to Optum between 10 a.m. CT on Oct. 30, 2025 and 7 p.m. CT on Nov. 3, 2025.

Action Required: Be aware of the processing issue above and of possible invalid duplicate rejections.

Original notice sent Nov. 5, 2025:

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

Payer impacted:

• CPID 2554 Louisiana Medicaid Medicare Advantage Crossovers

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09761562.

11/5/2025

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Report Generation Delay for CPID 2554 Louisiana Medicaid Medicare Advantage Crossovers

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

Payer impacted:

• CPID 2554 Louisiana Medicaid Medicare Advantage Crossovers

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09761562.

11/5/2025

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Electronic Routing Change for CPIDs 6815 Kern Health Care Network (Kern County)

Effective Nov. 5, 2025, Optum is reactivating and changing electronic claims routing for the following payer:

Payer Name: Kern Health Care Network (Kern County)
Professional CPID: 6815
Edit Master: PE_T007
Payer-assigned Payer ID: 22149
Payer Claim Enrollment Required: No
Secondary Claims Accepted: No

Enrollment Requirements
Claims:

• Payer enrollment for electronic claims is not required.

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

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

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

11/5/2025

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Electronic Routing Change for CPID 6815 Kern Health Care Network (Kern County)

Effective Nov. 5, 2025, Optum is reactivating and changing electronic claims routing for the following payer:

Payer Name: Kern Health Care Network (Kern County)
Professional CPID: 6815
Payer-assigned Payer ID: 22149
Payer Claim Enrollment Required: No
Secondary Claims Accepted: No
Claims Fee: $0.10

Enrollment Requirements
Claims:

• Payer enrollment for electronic claims is not required.

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

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

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

11/5/2025

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Report Generation Delay for CPID 2207 Pennsylvania Medicare

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

Payer impacted:

• CPID 2207 Pennsylvania Medicare

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09760641.

11/5/2025

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Transmit Delay for Multiple CPIDs

Due to a payer system issue, a delay occurred in some of the transmissions to the following payers since Oct. 4, 2025.

Payers impacted: 

• CPID 2758 Blue Cross Blue Shield of Louisiana
• CPID 8853 Louisiana Blue Advantage

Optum is working diligently with the payers to resolve the issue.

This delay affected claims released to Optum since Oct. 3, 2025, 1:00 p.m. CT.

Action Required: Be aware of the transmit delay above.

11/5/2025

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Report Generation Delay for multiple CPIDs

A payer intermediary is experiencing issues affecting Professional and Institutional report generation for some claims submitted Oct. 31, 2025 and Nov. 1, 2025.

Payers impacted: 

• CPID 6405 Cigna Health Plans
• CPID 4509 Cigna Health Plans
• CPID 1841 Evernorth Behavioral Health, Inc
• CPID 5943 Evernorth Behavioral Health, Inc
• CPID 4516 Cigna Select Great-West Healthcare
• CPID 6408 Cigna Select Great-West Healthcare

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09760525.

11/5/2025

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Update: Electronic Claims Connection Suspended - Silver Star PACE (97691)

Update: This payer has been reactivated and rerouted. Providers may submit claims to this payer.

Payer Name: Silver Star PACE
Payer ID: 97691
Payer Claim Enrollment Required: No
Payer Type: NonPar

Original notification sent on 10/14/2025

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

Payer Name: Silver Star PACE
Payer ID: 97691
Reason: Payer is unavailable electronically 

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

11/4/2025

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Report Generation Delay for Multiple CPIDs

A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted since Oct. 28, 2025.

Payers impacted: 

• CPID 8047 Central Valley Medical Providers
• CPID 9765 Central Valley Medical Providers
• CPID 2081 Community Care IPA
• CPID 8226 Community Care 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.

If you have any questions, please contact Customer Support and refer to Case Number 09759312.

11/4/2025

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Multiple Payers Electronic Claims Connections No Longer Available

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

Payer Name: Anthem Blue Cross Blue Shield of Indiana HMO Home Infusion Therapy
Claim CPID: 5482
Payer-assigned Payer ID: ANTINHP

Payer Name: Anthem Blue Cross Blue Shield of Missouri Home Infusion Therapy
Claim CPID: 5467
Payer-assigned Payer ID: 12

Payer Name: Anthem Blue Cross Blue Shield of Ohio Home Infusion Therapy
Claim CPID: 5464
Payer-assigned Payer ID: ANTOH

Reason: Payer no longer offers an electronic connection. Claims should be submitted directly to Anthem. Please contact Provider Services via the number on the back of the member ID card with any questions.

Action Required: None.

11/4/2025

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Electronic Routing Change for CPIDs 8735 and 4010 HealthTeam Management Diabetes and Heart Care Plan

Effective Nov. 5, 2025, Optum will be changing electronic claims routing for the following payer:

Payer Name: HealthTeam Management Diabetes and Heart Care Plan
Professional CPID: 8735
Current Edit Master: PE_C051
New Edit Master: PE_T007
Institutional CPID: 4010
Current Edit Master: HE9C051
New Edit Master: HE9T007
Payer-assigned Payer ID: 88350
Payer Claim Enrollment Required: No
Secondary Claims Accepted: Yes

Enrollment Requirements

Claims:

• Payer enrollment for electronic claims is not required.

Report Changes:

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

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

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

11/4/2025

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999 Payer Batch Rejections for CPID 1844 Wellcare Health Plans

Professional claims transmitted to the payer listed below from Optum Nov. 3, 2025 were not processed by the payer due to a 999 Batch Rejection. 

• CPID 1844 Wellcare Health Plans

A resolution has been implemented and the claims were retransmitted to the payer Nov. 4, 2025.

Action Required: None.

If you have any questions, please contact Customer Support and refer to Case Number 09759070.

11/4/2025

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Electronic Routing Change for CPIDs 8735 and 4010 HealthTeam Management Diabetes and Heart Care Plan

Effective Nov. 5, 2025, Optum will be changing electronic claims routing for the following payer:

Payer Name: HealthTeam Management Diabetes and Heart Care Plan
Professional CPID: 8735
Current Edit Master: PE_C051
New Edit Master: PE_T007
Institutional CPID: 4010
Current Edit Master: HE9C051
New Edit Master: HE9T007
Payer-assigned Payer ID: 88350
Payer Claim Enrollment Required: No
Secondary Claims Accepted: Yes

Enrollment Requirements
Claims:

• Payer enrollment for electronic claims is not required.

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

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

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

11/4/2025

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Electronic Routing Change for CPIDs 8735 and 4010 HealthTeam Management Diabetes and Heart Care Plan

Effective Nov. 5, 2025, Optum will be changing electronic claims routing for the following payer:

Payer Name: HealthTeam Management Diabetes and Heart Care Plan
Professional CPID: 8735
Institutional CPID: 4010
Payer-assigned Payer ID: 88350
Payer Claim Enrollment Required: No
Secondary Claims Accepted: Yes
Claims Fee: N/A

Enrollment Requirements
Claims:

• Payer enrollment for electronic claims is not required.

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

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

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

11/4/2025

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Report Generation Delay for CPIDs 4908 and 5832 Cannon Cochran Management Services

A payer is experiencing issues affecting Institutional and Professional report generation for some claims submitted Oct. 27, 2025-Oct. 28, 2025.

Payer impacted:

• CPID 4908 Cannon Cochran Management Services
• CPID 5832 Cannon Cochran Management Services

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09745540.

11/4/2025

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Electronic Claims Connection Suspended

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

Payer Name: California Department of Corrections
CPID: 7222
Payer ID: MCS04
Reason: Payer unavailable electronically

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

11/4/2025

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Report Generation Delay for CPIDs 4070 and 8814 Integrated Homecare Services

A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted Oct. 23, 2025.

Payer impacted:

• CPID 4070 Integrated Homecare Services
• 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.

If you have any questions, please contact Customer Support and refer to Case Number 09758532.

11/4/2025

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New Electronic Claim Status Connection Available

Optum is pleased to announce the availability of Real-time Claim Status Inquiry and Response 276/277 for the below payer, effective Oct. 23, 2025:

Payer Name: WELLCARE HEALTH PLANS
Industry Payer ID: 14163
IMN Real Time ID: WLLCR
Exchange Real Time ID: WELLCR
CPID(s): 1844, 8551
Optum IEDI Real Time ID: 10488
Payer Enrollment Required: No
Connection Type: X12

Search Options

Claim Status Inquiry subscriber:

Member ID, first name, last name, date of birth

Action Required by customer:

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

11/4/2025

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New Payer Edit for CPID 8793

The payer listed below has informed Optum of a new edit requirement effective immediately. In order to meet the new requirement, we are adding the following edit Nov. 4, 2025:

• PHI-01A153: INVALID PRINCIPAL DIAGNOSIS - The ICD-10-CM Principal Diagnosis Code must not be B9562.

Note: If this requirement does not apply to your billing situation, you can override the edit within the Error Text. LOOP 2300 HI01-2

Edit applies to:

• CPID 8793 AMBETTER FROM PENNSYLVANIA HEALTH AND WELLNESS

Action Required: Please be aware of updated edit requirements.

11/4/2025

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Health Tradition Real Time Eligibility 270/271 No Longer Available

Effective immediately, Real Time Eligibility 270/271 for the payer listed below will no longer be available at Optum.

Payer Name: Health Tradition
Industry Payer ID: HLTHT
IMN Real Time ID: HLTHT
Optum IEDi Real Time ID: HLTHT
Connection Type: X12

Reason: Payer no longer offers an electronic connection

Action Required: None

11/3/2025

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Electronic Claims Connection Suspended

Update: This payer has been reactivated and rerouted. Providers may submit claims to this payer.

Payer Name: Silver Star PACE
Professional CPID: 1146
Institutional CPID: 1571
Payer-assigned Payer ID: 97691
Payer Claim Enrollment Required: No
Secondary Claims Accepted: No
Claims Fee: $0.10

Original notification sent on 10/14/2025

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

Payer Name: Silver Star PACE
CPIDs:1571, 1146
Payer ID: 97691

Reason: Payer is unavailable electronically 

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

11/3/2025

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Electronic Claims Connection Suspended

Update: This payer has been reactivated and rerouted. Providers may submit claims to this payer.

Payer Name: Silver Star PACE
Professional CPID: 1146
Current Edit Master: PE_E049
New Edit Master: PE_B800
Institutional CPID: 1571
Current Edit Master: HE9E049
New Edit Master: HE9B801
Payer-assigned Payer ID: 97691
Payer Claim Enrollment Required: No
Secondary Claims Accepted: No

Original notification sent on 10/14/2025

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

Payer Name: Silver Star PACE
CPIDs:1571, 1146
Payer ID: 97691
Reason: Payer is unavailable electronically 

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

11/3/2025

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Report Generation Delay for CPID 2788 Regence Blue Cross Blue Shield of Utah Federal Employee Program

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

Payer impacted: 

• CPID 2788 Regence Blue Cross Blue Shield of Utah 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.

If you have any questions, please contact Customer Support and refer to Case Number 09757337.

11/3/2025

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New Electronic Eligibility Connection Available

Optum is pleased to announce the availability of Real-time Eligibility Inquiry and Response 270/271 for the below payer, effective Oct. 17, 2025:

Payer Name: First Medical Network
Industry Payer ID: 10916
IMN Real Time ID: 10916
Exchange Real Time ID: FMDNW
Optum IEDI Real Time ID:10916
Payer Enrollment Required: No
Connection Type: X12

Search Options
Eligibility Subscriber:

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

Action Required by customer:
For assistance with submitting Real-Time transactions, please contact your Practice Management System Vendor or Optum Customer Care Hub ticket.

11/3/2025

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Report Generation Delay for multiple CPIDs

A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted since Oct. 20, 2025.

Payers impacted: 

• CPID 3514 Blue Cross Blue Shield of Michigan
• CPID 1421 Blue Cross Blue Shield of Michigan
• CPID 3531 Blue Cross Blue Shield of Michigan Federal Employee 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.

If you have any questions, please contact Customer Support and refer to Case Number 09757279.

11/3/2025

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Update: Error Message for CPID 3237, 1595 Insurance Administrators of America

Update:
The below notify pertains to the following payer:

• Insurance Administrators of America
• CPIDs 3237, 1595

Original Notice:
Optum has received information that the payer below does accept secondary claims. Claims for the payer listed below may have received the following error message:

• PSBR0135:INVALID PAYER RESP SEQ NUM CODE

This issue began Oct. 21, 2025, and was resolved Oct. 30, 2025. If you believe you received this message in error, you may resubmit your claims.

11/3/2025

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Electronic Routing Change for CPIDs 7722 and 8912 illumifin Corporation

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

Payer Name: illumifin Corporation
Professional CPID: 7722
Institutional CPID: 8912
Payer-assigned Payer ID: 26119
Line of Business Code (LOB): J6R
Payer Remittance Enrollment Required: Yes

Plans accepted with this connection:

• Bankers Reserve/Wellcare
• Combined Insurance Company of America
• Companion Life Insurance Company
• Forethought Life Insurance Company
• Liberty Bankers Life Insurance Company
• Shenandoah Life Insurance Company (AIA)
• Standard Life And Casualty Insurance Company
• Thrivent
• Western Catholic Union

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:

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

11/3/2025

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Electronic Routing Change for CPIDs 7722 and 8912 illumifin Corporation

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

Payer Name: illumifin Corporation
Professional CPID: 7722
Institutional CPID: 8912
Payer-assigned Payer ID: 26119
Payer Remittance Enrollment Required: Yes
Remittance Fee: N/A

Plans accepted with this connection:

• Bankers Reserve/Wellcare
• Combined Insurance Company of America
• Companion Life Insurance Company
• Forethought Life Insurance Company
• Liberty Bankers Life Insurance Company
• Shenandoah Life Insurance Company (AIA)
• Standard Life And Casualty Insurance Company
• Thrivent
• Western Catholic Union

Enrollment Requirements:

Remittance:

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

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

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

11/3/2025

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Report Generation Delay for Multiple CPIDs

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted on Oct. 20, 2025.

Payers impacted: 

• CPID 1402 Blue Cross Blue Shield of Minnesota
• CPID 1410 Blue Cross Blue Shield of Minnesota Comprehensive Care 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.

If you have any questions, please contact Customer Support and refer to Case Number 09756637.

11/3/2025

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Update: Report Generation Delay for CPIDs 1507 and 3887 Veterans Administration Fee Basis Programs

Update: The payer intermediary has been unable to generate and deliver the reports for some claims submitted between Oct. 13, 2025 and Oct. 15, 2025.

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

Original notice sent Oct. 23, 2025:

A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted since Oct. 13, 2025.

Payer impacted:

• CPID 3887 Veterans Administration Fee Basis Programs
• CPID 1507 Veterans Administration Fee Basis 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.

If you have any questions, please contact Customer Support and refer to Case Number 09743725.

11/3/2025

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New Electronic Claims Connections Available

Optum has new electronic claims connections available:

Payer Name: Broward PACE Program
Institutional CPID: 9048
Professional CPID: 3775
Payer-assigned Payer ID: FLBPP
Payer Enrollment Required: No
Secondary Claims Accepted: Yes
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.

11/3/2025

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Payer Change - BoldAge PACE

Effective Oct. 29, 2025, claims currently exchanged with the following payer must use different CPIDs.

Payer Name: BoldAge PACE Kentucky Owensboro
Payer ID: 65435

Claims must begin using the following:
Previous Payer Name: BoldAge PACE Indiana Evansville
New Payer Name: BoldAge PACE
Current Payer ID: 65433
New Payer ID: BOLD1

Payer ID 65433 BoldAge PACE Kentucky Owensboro will be terminated effective Nov. 11, 2025.

Enrollment Requirements
Claims:

• Payer enrollment for electronic claims is not required.

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

Action Required: Please make the following updates to accommodate these payer changes for new payer name BoldAge PACE and new Payer ID BOLD1:

• Revalidate unreleased claims to edit correctly under new edit masters.
• Modify any bridge routines based on edit masters.
• Modify related Payer Alias names to the payer ID.

11/3/2025

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Providence Preferred PPO Electronic Claims Connection No Longer Available

Effective immediately, the payer listed below is longer available at Optum for claims processing. 

Payer Name: Providence Preferred PPO
Payer ID: PHP01, SX187
Reason: Payer no longer offers an electronic connection to which Optum can connect. 

11/3/2025

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Electronic Claims Connection Suspended - Trilogy Health Network (62777)

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

Payer Name: Trilogy Health Network
Payer ID: 62777
Reason: Payer unavailable electronically.

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

11/3/2025