October 2024
October Payer Processing Issues
Summary
When Optum discovers issues or interruptions to transaction processing, the details* will appear below.
If you're looking for a specific payer or specific transaction type, please use Ctrl + F on Windows or ⌘ + F on Mac to find that term within the page.
*These updates can also be found within Optum Customer Care Hub under Payer Processing Issues: https://customercare.optum.com/public/home.html
Electronic claims connection has been reactivated
Effective immediately, the payer listed below has been reactivated at Optum for claims processing.
Payer Name: Washington Labor and Industry Workers Compensation
CPIDs: 5563
Payer ID: SX064
REF 809450 10/31/2024
Report Generation Delay for multiple CPIDs
Due to a payer intermediary processing issue, some Professional claims transmitted to the payers listed below on Oct. 30, 2024, were not processed by the payers.
Payers impacted:
1214 AgeRight Advantage Health Plan
9267 Align Senior Care of Florida
8454 Align Senior Care of Michigan
2113 Allcare Health Plan
8714 Allstate - Except New Jersey
1765 Ambetter From Louisiana Healthcare Connections
9278 Ambetter from Nebraska Total Care
9431 Ambetter from WellCare of Kentucky
9775 Ambetter of Alabama
9433 Ambetter of Oklahoma
9270 American Benefit Corporation
2138 American Family Insurance
9218 American Health Advantage of Tennessee
9117 American Health Advantage of Texas
4468 Americas Choice Healthplan
1741 Amerigroup
1412 Anthem Blue Cross and Blue Shield - Indiana
2421 Anthem Blue Cross and Blue Shield - Kentucky
1413 Anthem Blue Cross and Blue Shield (Virginia)
2418 Anthem Blue Cross and Blue Shield of Ohio
4437 Anthem Blue Cross Blue Shield New York
6220 Arizona Priority Care Plus
4477 Asuris Northwest Medadvantage Regence
4881 Asuris Northwest Regence
7272 Axminster Medical Group
3845 Banner Health Network
8482 Benefit Plan Administrators - Roanoke, VA
1415 Blue Cross Blue Shield of Colorado
1407 Blue Cross Blue Shield of Georgia
7496 Blue Cross Blue Shield of Nevada
1401 Blue Cross Blue Shield of Wisconsin
1243 Blue Cross Community Centennial
1167 Blue Cross Medicare Advantage PPO/HMO
9162 Blue Medicare Advantage
6779 Bridgespan Regence
6165 Bridgeview
4246 Capital Health Plan
2810 Capitol Administrators
8146 Care N Care Insurance Co.
2289 Care1st Health Plan of Arizona Medicaid DOS after 11/30/2022
9759 Care1st Health Plan of Arizona Medicaid DOS before 12/01/2022
4743 Carelon Behavioral Health
6127 Carelon Behavioral Health, MBHP
3293 Carelon Health
2830 CarePlus Health Plans
1194 CareSource of Georgia
7143 CareSource of Indiana
3826 CareSource of Ohio
7263 CareSource of West Virginia
6777 Centers Plan for Healthy Living
9765 Central Valley Medical Providers
7763 Columbine Health Plan
8834 Commonwealth Care Alliance DOS after 3/31/2023
8477 Community Care Plan
2160 Community Care Plan (Commercial)
6865 Community Care Plan (Medicaid)
8147 Community Care Plan (Palm Beach Health District)
1420 Connecticut Anthem Blue Cross Blue Shield
2427 Connecticut BlueCare Family Plan
3419 Connecticut Federal Employee Health Benefits
6795 Contra Costa Health Plan
7738 CountyCare Health Plan
9747 Delaware First Health
2433 Denver Health and Hospital Authority
1232 Denver Health Medical Plan, Inc. - Medicare Choice
8135 Doctors HealthCare Plans
1733 Doctors Professional Services Consultants (DPSC)
1119 Easy Choice Health Plan of California
4289 El Paso Health-CHIP
4279 El Paso Health-STAR
5483 Employee Benefit Management Services (EBMS)
1834 Employee Plans
8137 Empower Healthcare Solutions
1795 Envolve Benefit Options
5238 Evolent Specialty Cardiology
3792 Fidelis Care
2875 First Health Network (Coventry Health Care National Network)
7435 FirstCare Health Plans
1414 Florida Blue Cross Blue Shield
3417 Florida Blue Cross Blue Shield Health Options HMO
9128 Florida Blue Medicare
2150 Florida Health Care Plans
5440 Fox Valley Medicine
6851 Friday Health Plans
2720 GlobalCare
1772 HAP CareSource
8716 Health Choice Generations Utah
5243 Healthcare Management Administrators
1723 HealthCare Partners IPA
4448 HealthLink PPO
8750 Healthy Blue Dual Advantage Louisiana
7760 Healthy Blue Louisiana
8867 Healthy Blue Missouri
8870 Healthy Blue Nebraska
9133 Healthy Blue North Carolina
6272 Hispanic Physicians IPA (Encounters Only)
7715 Hopkins Health Advantage
6259 Humana - CareSource of Kentucky
7426 Idaho Regence Blue Shield
1405 Illinois Blue Cross Blue Shield
5865 Indian Health Services
4445 Insurance Management Services TX
4116 IntegraNet Health
1107 Integrated Health Partners (IHP)
8814 Integrated Homecare Services
1404 Iowa Wellmark Blue Cross Blue Shield
6733 Iowa Wellmark Blue Cross Blue Shield Crossover
5479 IU Health Plan Medicare Advantage
5432 Johns Hopkins Healthcare / Priority Partners
8467 Keycare
9412 Leon Health Plans
7446 Maine Anthem Blue Cross Blue Shield
8812 Maryland Physicians Care
3476 Masters, Mates and Pilots
8860 Medica Government Programs
7859 Medica Health Plan Solutions
6799 Medica Individual and Family (IFB)
2287 Medicare Plus Blue of MI(MAP)
3475 Memorial Hermann Health Solutions
9102 Meridian Medicare Medicaid Plan
9118 MeridianComplete Michigan
2426 Michigan Blue Care Network
1421 Michigan Blue Cross Blue Shield
1402 Minnesota Blue Cross Blue Shield
1410 Minnesota Blue Cross Blue Shield CC Systems
7892 Minnesota Blue Cross Blue Shield Health Care Programs
1429 Minnesota Blue Cross Blue Shield HMO
1408 Missouri Anthem Blue Cross Blue Shield
7450 Montana Blue Cross Blue Shield
7422 New Hampshire Anthem Blue Cross Blue Shield
7403 New Mexico Blue Cross Blue Shield
8864 NextBlue of North Dakota
1213 NHC Advantage
2411 North Dakota Blue Cross Blue Shield
1403 Oklahoma Blue Cross Blue Shield
2404 Oregon Regence Blue Cross Blue Shield
7829 Passport Advantage
9199 Piedmont Community Health Plan
8128 Pool Administrators, Inc.
4252 Presbyterian Salud
2807 Professional Benefit Administrators (Oakbrook, Illinois)
4253 Prominence Administrative Services
5428 QualChoice of Arkansas
7264 Quartz ASO
1209 Regence Group Administrators
3257 ResourceOne Administrators
1776 RIS Rx
6246 Riverside Medical Clinic
4464 SCAN Health Plan
2254 Scott & White Health Plan
4480 SelectHealth
9438 Shared Health Mississippi
7225 Sharp Community Medical Group
7138 Sierra Medical Group
8124 Simply Healthcare Plans, Inc.
8708 SOMOS Anthem
8816 SOMOS Emblem
1740 Sonder Health Plans
2490 South Dakota Blue Cross Blue Shield
8134 Summit Community Care
7795 Team Choice - Alpha Care Gold
1406 Texas Blue Cross Blue Shield
1729 Texas Childrens Health Plan (CHIP)
2483 Texas Childrens Health Plan (STAR Medicaid)
4278 The Boon Group
8763 U.S. Networks and Administrative Services
8473 Unicare (TX,MA,KS,WV,RI,IL)
6849 United Group Programs
2412 Utah Regence Blue Cross Blue Shield
2788 Utah Regence Blue Cross Blue Shield Federal Employee Program
7493 Vermont Blue Cross Blue Shield
4258 VNS Health
7451 Washington Regence Blue Shield
1844 Wellcare Health Plans
1775 Wellpoint
9441 Wellspace NEXUS LLC
7489 Wyoming Blue Cross Blue Shield
A resolution has been implemented and the claims were retransmitted to the payer intermediary on Oct. 31, 2024.
This delay affected claims released to Optum between 11 a.m. ET and 3 p.m. ET on Oct. 30, 2024.
Action Required: Be aware of the processing issue above.
REF 809350 10/31/2024
Delay in Electronic Remittance Advice (ERA) for multiple CPIDs
Due to a payer intermediary processing issue, there has been a delay in some Professional and Institutional Electronic Remittance Advice (ERA) for the following payers for file dates of Oct. 15, 2024, through present:
Payers impacted:
2161 AR MEDICARE OKC ONLY
2455 AR MEDICARE
1526 ARKANSAS MEDICARE
2162 CO MEDICARE OKC ONLY
1449 COLORADO MEDICARE
1547 COLORADO MEDICARE
2165 DC MEDICARE OKC ONLY
1522 DC MEDICARE
2163 DELAWARE MEDICARE OKC ONLY
2456 DELAWARE MEDICARE
5912 DELAWARE MEDICARE
3650 JH MUTUAL OF OMAHA CO NM OK TX
3677 JL MUTUAL OMAHA DC DE MD NJ PA
2171 LOUISIANA MEDICARE OKC ONLY
1460 LOUISIANA MEDICARE
3579 LOUISIANA MEDICARE
2464 MARYLAND MEDICARE
7402 MARYLAND MEDICARE
2201 MD MEDICARE OKC ONLY
5554 MD MEDICARE
2451 MISSISSIPPI MEDICARE
5556 MS MEDICARE
1465 NEW JERSEY MEDICARE
1457 NEW MEXICO MEDICARE
2205 NJ MEDICARE OKC ONLY
4938 NJ MEDICARE OKC ONLY
5503 NJ MEDICARE UB92
2204 NM MEDICARE OKC ONLY
2206 OK MEDICARE OKC ONLY
4942 OK MEDICARE OKC ONLY
1458 OKLAHOMA MEDICARE
1558 OKLAHOMA MEDICARE
2207 PA MEDICARE OKC ONLY
4944 PA MEDICARE OKC ONLY
5598 PA MEDICARE
2457 PENNSYLVANIA MEDICARE
5502 TEXAS MEDICARE UB92
1440 TEXAS MEDICARE
2208 TX MEDICARE OKC ONLY
4946 TX MEDICARE OKC ONLY
2459 WASHINGTON DC MEDICARE
Additional updates will be forwarded as more information becomes available.
Action Required: Please be aware of a delay in the delivery of ERA for check dates above.
If you have any questions, feel free to contact your Customer Support Team and refer to Global Case # INC-000001960.
REF 809250 10/31/2024
Update: Payer Transmit Delay for Massachusetts Medicaid Multiple CPIDs
Update: A resolution has been implemented and the claims were transmitted to the payers on Oct. 31, 2024.
Action Required: Please be aware of the transmit delay.
Original notify sent Sept. 9, 2024:
Due to a payer system issue, a delay occurred in the transmissions to the following payers since Aug. 27, 2024.
Payers impacted:
- CPID 5529 Massachusetts Medicaid
- CPID 2905 Massachusetts Medicaid Long Term Care
- CPID 4492 Massachusetts Medicaid Format 5
- CPID 4491 Massachusetts Medicaid Format 9
Optum is working with the payers to resolve this issue. We will notify you as soon as additional information becomes available.
This delay affected claims released to Optum since 12 p.m. CT on Aug. 26, 2024.
Action Required: Be aware of the transmit delay above.
REF 809200 10/31/2024
Update: Report Generation Delay for CPID 1795 Envolve Benefit Options
Update: A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted since Oct. 17, 2024.
Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.
Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.
Original notify sent Oct. 28, 2024:
A payer intermediary is experiencing issues affecting professional report generation for some claims submitted on Oct. 17, 2024, and Oct. 18, 2024.
Payer impacted:
- CPID 1795 Envolve Benefit Options
Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.
Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.
REF 806250 / 808950 10/31/2024
Report Generation Delay for CPID 6987 Veterans Affairs Financial Services Center
A payer intermediary is experiencing issues affecting institutional report generation for some claims submitted on Oct. 22, 2024.
Payer impacted:
- CPID 6987 Veterans Affairs Financial Services Center
The payer intermediary has been unable to generate and deliver the reports.
Action Required: Please resubmit claims if payment has not been received from the payer.
REF 808953 10/31/2024
Report Generation Delay for CPIDs 3509 and 2481 Ohio Medicaid
A payer is experiencing issues affecting Institutional and Professional report generation for some claims submitted on Oct. 28, 2024.
Payer impacted:
- CPID 3509 Ohio Medicaid
- CPID 2481 Ohio Medicaid
The payer has been unable to generate and deliver the reports for some claims submitted on Oct. 28, 2024.
Action Required: Please resubmit claims if payment has not been received.
REF 808552 10/31/2024
Meridian Health Plan of Illinois Electronic Eligibility Connection No Longer Available
Effective Nov. 15, 2024, electronic eligibility for the payer listed below will no longer be available at Optum.
Payer Name: Meridian Health Plan of Illinois (DOS before 07/01/2021)
Real Time ID: MERIL
CPID(s): 5916, 4777
Industry Payer ID: 13189
Connection Type: X12
Reason: Payer connection is no longer available – eligibility transactions should be submitted via the following payer going forward:
Payer Name: Meridian Medicare Medicaid Plan
Real Time Payer ID: MCCIL
CPID(s): 5058, 9102
Industry Payer ID: MHPIL
Action Required: Please update your system immediately with the new Payer ID to avoid transactions rejecting for the payer above.
REF 807708 10/31/2024
Resolved: Report Delivery Delay
The below issue has been resolved.
Original message sent Oct. 31, 2024
Optum is currently experiencing an issue that is causing a delay delivering reports and remits to submitters. In addition, this issue is delaying delivering of claims to payers.
Inbound claims processing is not affected by this issue. Please continue to submit claims as normal.
We anticipate resolution later this morning.
REF 80850310/31/2024
Aetna Encounters California IPA Electronic Claims Connection No Longer Available
Effective immediately, the payer listed below will no longer be available at Optum for claims processing.
Payer Name: Aetna Encounters California IPA
Claim CPID: 5075
Reason: Payer no longer contracted.
Action Required: None.
REF 809000 10/31/2024
Electronic Routing Change for CPID 2146 Empire Physician’s Medical Group
This message is intended for Assurance Reimbursement Management customers.
Effective immediately, Optum will be changing electronic claims routing for the following payer:
Payer Name: Empire Physician’s Medical Group
Professional CPID: 2146
Current Edit Master: PE_T007
New Edit Master: PE_C051
Current Payer-assigned Payer ID: EMP01
New Payer-assigned Payer ID: 99999-0AUA
Claims Surcharge: $0.10
Enrollment Requirements:
Claims: Payer enrollment for electronic claims is not required.
Report Changes: You may see some differences in the payer reports you are receiving.
Action Required: Please make the following changes to accommodate the routing change:
- Revalidate unreleased claims to edit correctly under new edit master.
- Modify any bridge routines based on edit masters.
- No Payer Alias changes are required. Payer name and CPID is not changing.
When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.
REF808600 10/31/2024
Electronic Routing Change for CPID 2146 Empire Physician’s Medical Group
This message is intended for Exchange customers.
Effective immediately, Optum will be changing electronic claims routing for the following payer:
Payer Name: Empire Physician’s Medical Group
Professional CPID: 2146
Current Payer-assigned Payer ID: EMP01
New Payer-assigned Payer ID: 99999-0AUA
Claims Surcharge: $0.10
Enrollment Requirements:
Claims:
Payer enrollment for electronic claims is not required.
Report Changes: You may see some differences in the payer reports you are receiving.
Action Required: Please consider the following to allow transactions to process properly due to the above changes:
- Make any necessary system changes.
When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.
REF 808601 10/31/2024
Valley Health Plan (Medi-Cal) Electronic Claims/Remittance Connections No Longer Available
Effective immediately, the payer listed below will no longer be available at Optum for claims or remittance processing.
Payer Name: Valley Health Plan (Medi-Cal)
Claim CPIDs: 9648 and 6238
Payer ID: VHP02
Remittance LOB: H54
Reason: Payer confirmed transactions are sent under payer ID VHP01 for both Commercial and Medi-Cal.
Action Required: Claims must be submitted to Payer ID VHP01, and Remittance will be received via Payer ID VHP01.
REF 808051 10/31/2024
Report Delivery Delay
Optum is currently experiencing an issue that is causing a delay delivering reports and remits to submitters. In addition, this issue is delaying delivering of claims to payers.
Inbound claims processing is not affected by this issue. Please continue to submit claims as normal.
We anticipate resolution later this morning.
REF 80850310/31/2024
Electronic Claims Connection Suspended
Effective immediately, the payer listed below has/have been temporarily suspended at Optum for claims processing and removed from the payer list.
Payer Name: Washington Labor and Industry Workers Compensation
CPIDs: 5563
Payer ID: SX064
Action Required: Please refrain from submitting claims until further notice.
REF 808451 10/31/2024
Electronic Routing Change for CPIDs 4480 and 1532 SelectHealth
Effective Nov. 1, 2024, Optum will be changing electronic claims routing for the following payer:
Payer Name: SelectHealth
Professional CPID: 4480
Institutional CPID: 1532
Payer-assigned Payer ID: SX107
Claims Surcharge: $0.10
Enrollment Requirements:
Claims:
- Payer enrollment for electronic claims is not required.
Report Changes:
You may see some differences in the payer reports you are receiving.
Action Required: Please consider the following to allow transactions to process properly due to the above changes:
- Make any necessary system changes.
When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.
REF 808550 10/31/2024
Novitas Medicare Claims and ERA Delivery Delay
This message is intended for Revenue Performance Advisor customers.
We are collaborating with our partners regarding ongoing issues causing intermittent disruptions resulting in delays in Professional and Institutional Electronic Remittance Advice (ERA), Claims, and Reporting delivery for the following payers from Thursday, Oct. 17, 2024, through present:
| State | Part A Payer ID | Part B Payer ID |
| Arkansas | 12022 | SMAR0 |
| Colorado | 12M03 | SMCO0 |
| Delaware | 12M76 | SMDE0 |
| Idaho | 12M07 | SMID0 |
| Louisiana | 12M12 | SMLA0 |
| Maryland | 12010 | SMMD0 |
| Mississippi | 12M17 | SMMS0 |
| New Jersey | 12005 | SMNJ0 |
| New Mexico | 12M22 | SMNM0 |
| Oklahoma | 12M37 | SMOK0 |
| Pennsylvania | 12M60 | SMPA0 |
| Tennessee | 12M53 | SMTN0 |
| Texas | 12M31 | SMTX0 |
Action Required:
Please be aware of a delay in the delivery of ERA, claims, and reporting for the dates above.
REF 808350 10/30/2024
SKWY0, WYOMING MEDICAID - 270/271 & 276/277
Eligibility Inquiry and Response 270/271 and Claim Status inquiry 276/277.
Effective Sept. 17, 2024, Optum is pleased to announce the availability of Real-time Eligibility and Claim Status transactions for the below payer:
IMN Payer ID: SKWY0
Payer Name: WYOMING MEDICAID
Transaction Type: 270/271 & 276/277
Action Required by customer:
Please update your system to take advantage of this payer transaction. For assistance with submitting Real-Time transactions, please contact your Practice Management System Vendor or Optum Customer Care Hub ticket https://customercare.changehealthcare.com/public/home.html
Updated Payer Lists may be obtained from your software vendor or Payer Lists | Change Healthcare
REF 807706 10/30/2024
New Electronic Claims Connections Available
Optum has new electronic claims connections available:
Payer Name: Benefits Support
Institutional CPID: 7947
Professional CPID: 2808
Payer-assigned Payer ID: 40459
Payer Enrollment Required: No
Secondary Claims Accepted: No
Payer Location: Georgia
Claims Fee: N/A
Action Required:
Add the payers to your system to begin using the new payer connection.
When a payer requires enrollment, forms must be submitted and approved to begin submitting transactions.
Please note: We are providing you with a list of new electronic connections, please review and choose payers that are appropriate for your business.
REF 807900 10/30/2024
Eligibility inquiry and response 270/271 and claim status inquiry 276/277 for SB510, Blue Cross Blue Shield of Alabama
Effective Oct. 2, 2024, Optum is pleased to announce the availability of real time eligibility and claim status transactions for the below payer:
IMN Payer ID: SB510
Payer Name: Blue Cross Blue Shield of Alabama
Transaction Type: 270/271 and 276/277
Action required by customer: Please update your system to take advantage of this payer transaction. For assistance with submitting Real-Time transactions, please contact your Practice Management System Vendor or Optum Customer Care Hub ticket.
Updated Payer Lists may be obtained from your software vendor or Payer Lists | Change Healthcare
REF 807705 10/30/2024
SKNE0, NEBRASKA MEDICAID - 270/271 and 276/277
Effective Sept. 30, 2024, Optum is pleased to announce the availability of real-time eligibility and claim status transactions for the below payer:
IMN Payer id: SKNE0
Payer Name: Nebraska Medicaid
Transaction Type: 270/271 & 276/277
Provide Enrollment Required
Action Required:
Please update your system to take advantage of this payer transaction. For assistance with submitting real-time transactions, please contact your Practice Management System Vendor or Optum Customer Care Hub.
Updated Payer Lists may be obtained from your software vendor or Payer Lists | Change Healthcare.
REF 807704 10/30/2024
Eligibility Inquiry and Response 270/271 or claim status inquiry SKGA0, Georgia Medicaid
Effective Oct. 15, 2024, Optum is pleased to announce the availability of Real time Eligibility and Claim Status transactions for the below payer:
IMN Payer ID: SKGA0
Payer Name: GEORGIA MEDICAID
Transaction Types: 270/271 and 276/277
Provider Enrollment Required
Action Required by customer: Please update your system to take advantage of this payer transaction.
For assistance with submitting Real-Time transactions, please contact your Practice Management System Vendor or Optum Customer Care Hub ticket
Updated Payer Lists may be obtained from your software vendor or Payer Lists | Change Healthcare
REF 807703 10/30/2024
New Electronic Remittance Connections Available
Optum has new electronic remittance connections available:
Payer Name: Angle Health
Institutional CPID: 6032
Professional CPID: 9184
Payer-assigned Payer ID: 39856
Line of Business (LOB) Code: N26
Payer Enrollment Required: Yes
Remittance Fee: N/A
Payer Name: ClaimChoice
Institutional CPID: 5044
Professional CPID: 8890
Payer-assigned Payer ID: 83063
Line of Business (LOB) Code: N25
Payer Enrollment Required: Yes
Remittance Fee: N/A
Action Required:
- Add the payers to your system to begin using the new payer connections.
- Enrollment forms must be submitted and approved to begin receiving electronic remittance through Optum.
REF 808050 10/30/2024
New Electronic Remittance Connections Available for Covet Health
Optum has new electronic remittance connections available:
Payer Name: Covet Health
Institutional CPID: 3909
Professional CPID: 1861
Payer-assigned Payer ID: 98480
Line of Business (LOB) Code: N39
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.
REF807702 10/30/2024
Report Generation Delay for CPID 5516 Oregon Regence Blue Cross Blue Shield
A payer intermediary is experiencing issues affecting institutional report generation for some claims submitted on Oct. 22, 2024.
Payer impacted:
- CPID 5516 Oregon Regence Blue Cross Blue Shield
The payer intermediary has been unable to generate and deliver the reports.
Action Required: None. Please resubmit claims if payment has not been received.
REF 807550 10/30/2024
Electronic Routing Change for CPIDs 6272, Payor Name Hispanic Physicians IPA
Effective immediately, Optum will be changing electronic claims routing for the following payer:
Payer Name: Hispanic Physicians IPA (Encounters Only)
Professional CPID: 6272
Payer-assigned Payer ID: HPIPA
Enrollment Requirements:
Claims:
- Payer enrollment for electronic claims is not required.
Report Changes:
- You may see some differences in the payer reports you are receiving.
Action Required: Please consider the following to allow transactions to process properly due to the above changes:
- Make any necessary system changes.
REF 806801 10/29/2024
New Electronic Claims Connections Available
Optum has new electronic claims connections available:
Payer Name: Avanta IPA
Institutional CPID: 7950
Professional CPID: 2811
Payer-assigned Payer ID: AVANT
Payer Enrollment Required: No
Secondary Claims Accepted: Yes
Payer Location: California
Claims Fee: $0.10
Action Required:
- Add the payers to your system to begin using the new payer connection.
- When a payer requires enrollment, forms must be submitted and approved to begin submitting transactions.
Please note: We are providing you with a list of new electronic connections. Please review and choose payers that are appropriate for your business.
REF 807303 10/29/2024
Report Generation Delay for Multiple CPIDs
A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted on Oct. 2, 2024.
Payers impacted:
• CPID 4083 AmeriHealth Caritas North Carolina
• CPID 4417 Anthem Blue Cross California
• CPID 5596 Arkansas Blue Cross Blue Shield
• CPID 7299 Blue Cross Blue Shield of Texas Medicaid
• CPID 7645 Brown & Toland Health Services
• CPID 6547 Brown & Toland Medical Group
• CPID 6792 CHOC - Childrens Hospital of Orange County Health - Rady
• CPID 6749 CareFirst BlueCross BlueShield Community Health Plan Maryland
• CPID 2795 Cigna HealthSpring Tennessee/Alabama
• CPID 5981 Freedom Health
• CPID 4569 Gateway Health Plan - Medicaid Pennsylvania
• CPID 2912 Gateway Health Plan - Medicare Assured Pennsylvania
• CPID 2559 Geisinger Health Plan
• CPID 5473 Geisinger Health Plan
• CPID 6514 Health Net of California
• CPID 8413 HealthSCOPE Benefits
• CPID 5953 Healthy Blue South Carolina
• CPID 1748 MVP Health Care
• CPID 7518 Maryland CareFirst Blue Cross Blue Shield
• CPID 6533 Medcost PPO
• CPID 3736 NW Suburban IPA/Midland Mgmt
• CPID 7622 Nascentia Health Options
• CPID 7224 National Association of Letter Carriers
• CPID 2475 Optum Care Network - Monarch
• CPID 6294 Sage Breast and Cervical Cancer Screening
• CPID 6736 San Francisco Health Plan
• CPID 6286 TRICARE West Region
• CPID 9169 TriWest Region 5 CCN
• CPID 1038 UCare Plans
The payer intermediary has been unable to generate and deliver the reports for some claims submitted to Optum between 8 p.m. CT on Oct. 1, 2024 and 11 a.m. CT on Oct. 2, 2024.
Action Required: Please resubmit claims if payment has not been received.
REF 806802 10/29/2024
Payer Transmit Delay for Multiple CPIDs
Due to a payer system issue, a delay occurred in the transmissions to the following payers since Oct. 28, 2024.
Payers impacted:
- CPID 1422 New York Medicaid
- CPID 1500 New York Medicaid
- CPID 1502 New York Medicaid Outpatient
- CPID 2429 New York Medicaid
- CPID 2743 New York Medicaid
- CPID 2745 New York Medicaid
- CPID 6540 New York Medicaid
Optum is working with the payers to resolve this issue. We will notify you as soon as additional information becomes available.
This delay affected claims released to Optum since 10 p.m. ET on Oct. 25, 2024.
Action Required: Be aware of the transmit delay above.
REF 806804 10/29/2024
Electronic Routing Change for CPIDs 6272, Payor Name Hispanic Physicians IPA
Effective immediately, Optum will be changing electronic claims routing for the following payer:
Payer Name: Hispanic Physicians IPA (Encounters Only)
Professional CPID: 6272
Current Edit Master: PE_E049
New Edit Master: PE_B800
Payer-assigned Payer ID: HPIPA
Enrollment Requirements:
Claims:
- Payer enrollment for electronic claims not required.
Report Changes:
You may see some differences in the payer reports you are receiving.
Action Required: Please make the following changes to accommodate the routing change:
- Revalidate unreleased claims to edit correctly under new edit master.
- Modify any bridge routines based on edit masters.
- No Payer Alias changes are required. Payer name and CPID are not changing.
REF 806800 10/29/2024
999 Payer Batch Rejections for CPID 3578 Louisiana Medicaid
Some Institutional claims transmitted to the payer listed below from Optum Oct. 28, 2024 were not processed by the payer due to a 999 Batch Rejection.
- CPID 3578 Louisiana Medicaid
A resolution has been implemented and the claims were retransmitted to the payer Oct. 29, 2024.
Action Required: None.
REF 806803 10/29/2024
Inter Valley Health Plan Electronic Claims Connection No Longer Available
Effective immediately, the payer listed below will no longer be available at Optum for claims processing.
Payer Name: Inter Valley Health Plan
Claim CPIDs: 7261, 8675
Reason: Payer no longer in business.
Action Required: None.
REF 806750 10/29/2024
Medicare FI Claims and ERA Delivery Delay
We are collaborating with our partners regarding ongoing issues causing intermittent disruptions resulting in delays in Professional and Institutional Electronic Remittance Advice (ERA), Claims and Reporting delivery for the following payers Oct. 17, 2024-present:
| State | Intermediary | Part B Payer ID | Part A Payer ID |
| AR|Arkansas | Novitas JH | ARMCR | CHCMR |
| CO|Colorado | Novitas JH | COMCR | 04111 |
| DE|Delaware | Novitas JL | 00902 | CHCMR |
| ID|Idaho | Novitas JL | IDMCR | CHCMR |
| LA|Louisiana | Novitas JH | LAMCR | 07201 |
| MD|Maryland | Novitas JL | 00901 | CHCMR |
| MS|Mississippi | Novitas JH | CHCMR | CHCMR |
| NJ|New Jersey | Novitas JH | NJMCR | CHCMR |
| NM|New Mexico | Novitas JH | NMMCR | CHCMR |
| OK|Oklahoma | Novitas JH | OKMCR | 04311 |
| PA|Pennsylvania | Novitas JL | PAMCR | 12501 |
| TX|Texas | Novitas JH | TCMCR | 04411 |
| TN|Tennessee | Novitas JH | TNMCR | 12M53 |
Action Required: Please be aware of a delay in the delivery of ERA claims and reporting for the dates above.
Additional updates will be forwarded as more information becomes available.
Please direct any questions to the Support Team at 1-866-OptumGo. Please do not reply to this email directly.
REF 806202 10/29/2024
Edit Master for Multiple Payers
Effective immediately, Optum will be changing Edit Masters for the following payers:
Payer Name: Cigna Health Plans
Professional CPID: 6405
Current Edit Master: PE_N000
New Edit Master: PE_T007
Institutional CPID: 4509
Current Edit Master: HE9N000
New Edit Master: HE9T007
Payer-assigned Payer ID: 62308
Payer Name: Cigna Healthcare for Seniors
Professional CPID: 5436
Current Edit Master: PE_N000
New Edit Master: PE_T007
Payer-assigned Payer ID: 62308
Payer Name: Cigna Select Great-West Healthcare
Professional CPID: 6408
Current Edit Master: PE_G003
New Edit Master: PE_T007
Institutional CPID: 4516
Current Edit Master: HE9G003
New Edit Master: HE9T007
Payer-assigned Payer ID: 62308
Payer Name: Evernorth Behavioral Health, Inc
Professional CPID: 1841
Current Edit Master: PE_N000
New Edit Master: PE_T007
Institutional CPID: 5943
Current Edit Master: HE9N000
New Edit Master: HE9T007
Payer-assigned Payer ID: 62308
Action Required: Please make the following changes to accommodate the routing change:
- Revalidate unreleased claims to edit correctly under the new Edit Masters.
- Modify any bridge routines based on the Edit Masters.
- No Payer Alias changes are required. Payer names and CPIDs are not changing.
REF 806400 10/28/2024
Invalid Error Message for CPIDs 7617 and 6838 Kennan Associates
Due to a payer processing issue, Institutional and Professional claims for the payer listed below may have received the following invalid error messages on the Payer Batch Totals Report (SB), Payer Batch Totals Data File (SD), Payer Claim Data Report (SR), Payer Claim Data Report (SE), Payer Report Data File (SF):
Reject Code: A3:153
Message: ENTITY'S ID NUMBER
Payer impacted:
- CPID 7617 Kennan Associates
- CPID 6838 Kennan Associates
This issue began on Oct. 28, 2024 and was resolved on Oct. 28, 2024.
Action Required: Please be aware of the invalid error message.
REF 806700 10/28/2024
New Electronic Claims and Remittance Connections Available
Optum has new electronic claims and remittance connections available:
Payer Name: Employer Driven Insurance Services, Inc.
Institutional CPID: 7946
Professional CPID: 2805
Payer-assigned Payer ID: EDHP1
Line of Business (LOB) Code: N38
Payer Claim Enrollment Required: No
Payer Remittance Enrollment Required: Yes
Secondary Claims Accepted: No
Payer Location: National
Claims Fee: N/A
Remittance Fee: N/A
Action Required:
- Add the payers to your system to begin using the new payer connection.
- When a payer requires claims enrollment, forms must be submitted and approved to begin submitting transactions.
- Enrollment forms must be submitted and approved to begin receiving electronic remittance through Optum.
Please note: We are providing you with a list of new electronic connections, please review and choose payers that are appropriate for your business.
REF 806450 10/28/2024
999 Payer Batch Rejections for CPID 3578 Louisiana Medicaid
Some Institutional claims transmitted to the payer listed below from Optum on Oct. 23, 2024, were not processed by the payer due to a 999 Batch Rejection.
- CPID 3578 Louisiana Medicaid
A resolution has been implemented and the claims were retransmitted to the payer on Oct. 28, 2024.
Action Required: None.
REF 806339 10/28/2024
Report Generation Delay for CPID 1795 Envolve Benefit Options
A payer intermediary is experiencing issues affecting professional report generation for some claims submitted on Oct. 17, 2024, and Oct. 18, 2024.
Payer impacted:
- CPID 1795 Envolve Benefit Options
Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.
Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.
REF 806250 10/28/2024
Electronic Routing Change for CPID 1737 PodAmerica
This message is intended for Exchange customers.
Effective immediately, Optum will be changing electronic claims routing for the following payer:
Payer Name: PodAmerica
Professional CPID: 1737
Payer-assigned Payer ID: RP106
Enrollment Requirements:
- Payer enrollment for electronic claims is not required.
Report Changes: You may see some differences in the payer reports you are receiving.
Action Required: Please consider the following to allow transactions to process properly due to the above changes:
- Make any necessary system changes.
REF806002 10/25/2024
Electronic Routing Change for CPID 1737 PodAmerica
Effective immediately, Optum will be changing electronic claims routing for the following payer:
Payer Name: PodAmerica
Professional CPID: 1737
Current Edit Master: PE_T007 (not changing)
Payer-assigned Payer ID: RP106
Enrollment Requirements:
- Payer enrollment for electronic claims is not required.
Report Changes:
You may see some differences in the payer reports you are receiving.
Action Required: None
- No Payer Alias change is required. Payer name and CPID are not changing.
- Edit Master is not changing, no modification to the bridge routines needed.
REF 806003 10/25/2024
Payer Processing Issue for CPIDs 1483 and 5505 New Jersey Medicaid
Due to a payer processing issue, some Institutional and Professional claims transmitted to the payer listed below on Oct. 23, 2024 were not processed by the payer.
Payer impacted:
- CPID 1483 New Jersey Medicaid
- CPID 5505 New Jersey Medicaid
A resolution has been implemented and the claims were retransmitted to the payer on Oct. 25, 2024.
This delay affected claims released to Change Healthcare between 3 p.m. CT on Oct. 22, 2024 and 3 p.m. CT on Oct. 23, 2024.
Action Required: Be aware of the processing issue above.
REF 805154 10/25/2024
Payer ID Update
This message is intended for Revenue Performance Advisor customers.
Effective immediately, Meridian Health Plan of Illinois DOS before July 1, 2021 (ID 13189) will no longer be available for claims and remittance processing.
Claims and Remittance containing Dates of Service on or after July 1, 2021, should be using the following payer:
Payer Name: Meridian Medicare Medicaid Plan
RPA Payer ID: MCCIL
(Industry ID MHPIL)
Enrollment Requirements:
Claims: Payer enrollment for electronic claims is not required.
Remittance: Payer enrollment for electronic remittance is required.
- Providers receiving ERAs do not need to re-enroll.
- Providers who may have received historical ERAs but are experiencing issues receiving current ERAs need to re-enroll.
- New providers must complete a new enrollment form.
Action Required:
For providers needing to add or update enrollment, access the payer enrollment intake form on the Revenue Performance Advisor (RPA) restoration resources page in the User Community.
If you’re in RPA, you can also open the RPA Resource Center, click the Quick Reference Guides tab, and then click the Billing Provider Enrollment link to find the payer enrollment intake form.
REF 805400 10/25/2024
Remittance Reactivation - Mercalis
Effective immediately, Optum has restored 835 connectivity for the following payer:
Payer Name: Mercalis (formerly Interactive Medical Systems TrialCard)
Professional CPID: 7821
Institutional CPID: 9532
Payer ID: 56155
Remittance Enrollment Requirements:
- Payer enrollment for electronic remittance is required:
- Providers who were previously enrolled with Optum (Change Healthcare) and did not switch their enrollment away from Optum (Change Healthcare) will begin receiving ERAs.
- New providers must complete a new enrollment form.
- Providers who moved their enrollment to another clearinghouse or have not received remittance since connectivity was restored will need to re-enroll with Optum (Change Healthcare) to receive ERAs for this payer from Optum (Change Healthcare).
Action Required: Please consider the following to allow transactions to process properly due to the above changes:
- Make any necessary system changes.
When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.
REF 805900 10/25/2024
Remittance Reactivation
Effective immediately, Optum has restored 835 connectivity for the following payer:
Payer Name: Mercalis (formerly Interactive Medical Systems TrialCard)
Professional CPID: 7821
Institutional CPID: 3965
Payer ID: 56155
Remittance Line of Business (LOB) Code: J5M
Remittance Enrollment Requirements:
- Payer enrollment for electronic remittance is required:
- Providers who were previously enrolled with Optum (Change Healthcare) and did not switch their enrollment away from Optum (Change Healthcare) will begin receiving ERAs.
- New providers must complete a new enrollment form.
- Providers who moved their enrollment to another clearinghouse or have not received remittance since connectivity was restored will need to re-enroll with Optum (Change Healthcare) to receive ERAs for this payer from Optum (Change Healthcare).
Action Required: Please consider the following to allow transactions to process properly due to the above changes:
- Make any necessary system changes.
When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.
REF 805901 10/25/24
Delay in Electronic Remittance Advice (ERA) for CPIDs 2576/7498 Moda Health
Due to a payer processing issue, there has been a delay in professional and institutional Electronic Remittance Advice (ERA) for the following payer for dates of October 11, 2024 through October 16, 2024:
- 2576 Moda Health
- 7498 Moda Health
Action Required: Please be aware of a delay in the delivery of ERA for dates above.
If you have any questions, feel free to contact your Customer Support Team and refer to INC-000001942.
REF 805779 10/25/2024
Report Generation Delay for CPID 3509 Ohio Medicaid
A payer is experiencing issues affecting Institutional report generation for some claims submitted on Oct. 21, 2024.
Payer impacted:
- CPID 3509 Ohio Medicaid
The payer has been unable to generate and deliver the reports for some claims submitted on Oct. 21, 2024.
Action Required: Please resubmit claims if payment has not been received.
REF 805152 10/25/2024
Update: Payer Transmit Delay for Multiple CPIDs
Update: Optum is still working with the payers to resolve this issue
Action Required: Please be aware of the transmit delay.
Update sent Sept. 25, 2024:
Update: Optum is still working with the payers to resolve this issue
Action Required: Please be aware of the transmit delay.
Original notify sent Sept. 9, 2024:
Due to a payer system issue, a delay occurred in the transmissions to the following payers since Aug. 27, 2024.
Payers impacted:
- CPID 5529 Massachusetts Medicaid
- CPID 2905 Massachusetts Medicaid Long Term Care
- CPID 4492 Massachusetts Medicaid Format 5
- CPID 4491 Massachusetts Medicaid Format 9
Optum is working with the payers to resolve this issue. We will notify you as soon as additional information becomes available.
This delay affected claims released to Optum since Aug. 26, 2024, 12:00 p.m. CT.
Action Required: Be aware of the transmit delay above.
REF 805153 10/25/24
Update: Report Generation Delay for multiple CPIDs
Update: The payers have been unable to generate and deliver the reports for some claims submitted between Sept. 18, 2024 and Oct. 1, 2024.
Payers impacted:
- CPID 1440 Texas Medicare
- CPID 4946 Texas Medicare
- CPID 2208 Texas Medicare
Action Required: Please resubmit claims if payment has not been received.
Update sent Sept. 24, 2024:
Update: A payer is experiencing issues affecting Professional and Institutional report generation for some claims submitted since Sept. 13, 2024.
Payers impacted:
- CPID 1440 Texas Medicare
- CPID 4946 Texas Medicare
Optum is working diligently with the payer to resolve the issue and ensure reports are received.
Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.
Original notify sent Sept. 20, 2024:
A payer is experiencing issues affecting Professional report generation for some claims submitted since Sept. 15, 2024.
Payer impacted:
- CPID 1440 Texas Medicare
Optum is working diligently with the payer to resolve the issue and ensure reports are received.
Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.
REF805151 10/25/2024
Report Generation Delay for CPID 2464 Maryland Medicare (Montgomery,Prince George)
A payer is experiencing issues affecting professional report generation for some claims submitted between Sept. 20, 2024, and Sept. 22, 2024.
Payer impacted:
- CPID 2464 Maryland Medicare (Montgomery,Prince George)
The payer has been unable to generate and deliver the reports for some claims submitted between Sept. 20, 2024 and Sept. 22, 2024.
Action Required: Please resubmit claims if payment has not been received.
REF: 805150 10/25/2024
Payer Quartz ASO Payer ID 39180/CPIDs 7264 & 8677 Requiring Re-enrollment
This payer now requires an additional step to enroll for ERA. Please see the instructions below.
This affects all customers who submitted enrollments for this payer to Optum before Oct. 16, 2024.
Action Required: If an enrollment was submitted to Optum on Oct. 16, 2024, or before, please complete these steps.
Enrollment Instructions:
Please click the below link to begin enrollment.
https://apps.quartzbenefits.com/providerforms/EDI835/Index
Clearinghouse Information
- Name: Availity LLC
- Contact Name: AAC Enrollment
- Phone: 800-282-4548
Email:
Questions: Please contact the EDI Department at 800-362-3310 or [email protected]
Submission Instructions:
Once the transaction is associated with the Trading Partner (Clearinghouse) on the payer site you can update the enrollment status as Complete in the Availity Transaction Enrollment portal.
REF 804351 10/25/2024
Report Generation Delay for CPID 2207 Pennsylvania Medicare
A payer is experiencing issues affecting Professional report generation for some claims submitted since Oct. 11, 2024.
Payer impacted:
- CPID 2207 Pennsylvania Medicare
Optum is working diligently with the payer to resolve the issue and ensure reports are received.
Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.
REF 804100 10/24/2024
New Payer Name
Effective immediately, please be aware of the following payer name changes:
Previous Payer Name: Interactive Medical Systems TrialCard
New Payer Name: Mercalis
Professional CPID: 7821
Institutional CPID: 9532
Edit Master: PE_T007, HE9T007
Your existing Payer Alias entries will continue to work as they do currently; the new payer name is being provided for your reference. Be aware all future communications for these CPIDs will reference the new payer name only.
Action Required: You may choose to update the Payer Alias in your system to accommodate the new payer name.
REF 804801 10/24/2024
Eligibility Agreement Form Now Required for MICAID / Michigan Medicaid
The following payer now requires providers to submit an Eligibility enrollment form:
MICAID - Michigan Medicaid
Providers already approved to submit and receive transactions through Change Healthcare (Optum) do not need to complete a new enrollment form.
To access the new enrollment form, please visit Enrollment Central.
Action Required: None for existing providers. New providers should begin using the new enrollment form immediately.
REF 804151 10/24/2024
Delay in Electronic Remittance Advice (ERA) for multiple CPIDs
Due to a payer intermediary processing issue, there has been a delay in some Professional and Institutional Electronic Remittance Advice (ERA) for the following payers for file dates of Oct. 18, 2024 through present:
Payers impacted:
- CPID 1449 Colorado Medicare
- CPID 2456 Delaware Medicare
- CPID 3650 JH Mutual of Omaha CO, NM, OK, TX
- CPID 2451 Mississippi Medicare
- CPID 1458 Oklahoma Medicare
- CPID 5598 Pennsylvania Medicare
- CPID 1440 Texas Medicare
Additional updates will be forwarded as more information becomes available.
Action Required: Please be aware of a delay in the delivery of ERA for file dates above.
REF 804850 10/24/2024
Payer Name Change
Effective immediately, please be aware of the following payer name changes:
Assurance EDI:
- Previous Payer Name: Interactive Medical Systems TrialCard
- New Payer Name: Mercalis
- Professional CPID: 7821
- Institutional CPID: 9532
Action Required: Please make the appropriate changes to accommodate the name change.
REF 804800 10/24/2024
MHC01 - Mountain Health CO-OP - New Real-Time Transactions
Optum is pleased to announce the new real-time payer Mountain Healthy CO-OP for the Eligibility and Claim Status transactions for the live dates specified below.
- Payer id: MHC01
- Payer name: Mountain Health CO-OP
- Transaction type: Eligibility (270/271)
- Live date: 9/1/24
- Transaction type: Claim Status (276/277)
- Live date: 10/9/24
Action Required: Please update your system to take advantage of this payer transaction. For assistance with submitting Real-Time transactions, please contact your Practice Management System Vendor or Optum Customer Care Hub ticket https://customercare.changehealthcare.com/public/home.html
Updated Payer Lists may be obtained from your software vendor or Payer Lists | Change Healthcare
REF 804252 10/24/2024
New Restricted Electronic Claims Connections Available
Optum has new restricted electronic claims connections available:
Payer Name: OSU Humana Healthy Horizons (OSU Providers only)
Professional CPID: 2799
Payer-assigned Payer ID: OSUHU
Payer Enrollment Required: Yes
Secondary Claims Accepted: Yes
Payer Location: Oklahoma
Claims Fee: $.10
Action Required: Add the payers to your system to begin using the new payer connection.
When a payer requires enrollment, forms must be submitted and approved to begin submitting transactions.
Please note: We are providing you with a list of new electronic connections, please review and choose payers that are appropriate for your business.
REF 804650 10/24/2024
Update: Report Generation Delay for CPIDs 7543 and 2803 UPMC Health Plan
Update: The payer has been unable to generate and deliver the reports for some claims submitted Oct. 14, 2024.
Action Required: Please resubmit claims if payment has not been received.
Original notify sent Oct. 21, 2024:
The payer listed below is experiencing issues affecting Institutional and Professional report generation for some claims submitted Oct. 14, 2024.
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.
REF 804700 10/24/24
New Electronic Remittance Connections Available
Optum has new electronic remittance connections available:
- Payer Name: EBIX Health Administration Exchange (EHAE)
- Professional CPID: 2783
- Payer-assigned Payer ID: 55069
- Line of Business (LOB) Code: N35
- Payer Enrollment Required: Yes
- Remittance Fee: N/A
- Payer Location: National
- Payer Name: Companion Life
- Professional CPID: 2793
- Payer-assigned Payer ID: 48005
- Line of Business (LOB) Code: N36
- Payer Enrollment Required: Yes
- Remittance Fee: N/A
- Payer Location: National
Action Required: Add the payers to your system to begin using the new payer connection.
Enrollment forms must be submitted and approved to begin receiving electronic remittance through Optum.
REF 803852 10/24/2024
New Electronic Remittance Connections Available
Optum has new electronic remittance connections available:
- Payer Name: First Health Network (Coventry Health Care National Network)
- Institutional CPID: 4557
- Professional CPID: 2875
- Payer-assigned Payer ID: 73159
- Line of Business (LOB) Code: E04
- Payer Enrollment Required: Yes
- Remittance Fee: N/A
- Payer Location: National
Action Required: Add the payers to your system to begin using the new payer connection.
Enrollment forms must be submitted and approved to begin receiving electronic remittance through Optum.
REF 803803 10/24/2024
Electronic Routing Change for CPIDs 7617 and 6838 Keenan Associates
Effective Oct. 23, 2024, Optum will be changing electronic claims routing for the following payer:
- Payer Name: Keenan Associates
- Professional CPID: 6838
- Institutional CPID: 7617
- Old Payer-assigned Payer ID: KEE01
- New Payer-assigned Payer ID: 95279
Enrollment Requirements
Claims:
- Payer enrollment for electronic claims is not required.
Report Changes: You may see some differences in the payer reports you are receiving.
Action Required: Please consider the following to allow transactions to process properly due to the above changes:
- Make any necessary system changes.
- When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.
REF 803401 10/23/2024
Electronic Claim Connections Suspended
Effective immediately, the payers listed below have been temporarily suspended at Optum for claims processing, and have been removed from the payer list.
Payer Name: Continuum Health Solutions Worker Comp
CPIDs: 7013, 9295
Payer ID: 59557
Payer Name: Fresenius Total Health (PPO SNP)
CPID: 9633
Payer ID: 43197
Payer Name: New Mexico Public Schools Insurance Authority
CPID: 4521
Payer ID: 85036
Payer Name: TDS/TP-ACO
CPID: 9212
Payer ID: RP004
Payer Name: Team Choice PNS
CPID: 8869
Payer ID: 75133
Payer Name: Wenatchee Valley Medical Center
CPID: 5992
Payer ID: 91064
Action Required: Please refrain from submitting claims until further notice.
REF 803300 10/23/2024
Update: Report Generation Delay for CPIDs 2979 and 4253 Prominence Administrative Services
The payer intermediary has been unable to generate and deliver the reports for some claims submitted from Aug. 19, 2024 through Oct. 12, 2024.
Action Required: Please resubmit claims if payment has not been received.
Original message sent Sept. 3, 2024:
A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted since Aug. 19, 2024.
Payer impacted:
- CPID 2979 Prominence Administrative Services
- CPID 4253 Prominence Administrative Services
Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.
Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.
REF 803650 10/23/2024
Sage Breast and Cervical Cancer Screening Electronic Remittance Connection No Longer Available
Effective immediately, the payer listed below will no longer be available at Optum for remittance, processing.
Assurance EDI:
- Payer Name: Sage Breast and Cervical Cancer Screening
- Remittance CPIDs: 5653, 6294
- Reason: Optum no longer has a valid ERA connection available.
- Action Required: None.
Assurance Reimbursement Management:
- Payer Name: Sage Breast and Cervical Cancer Screening
- Remit CPIDs: 5353, 6294
- Remittance LOB: U7N
- Reason: Optum no longer has a valid ERA connection available.
- Action Required: None.
REF 803400 10/23/2024
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. 16, 2024.
Payer impacted:
- CPID 5016 NextBlue of North Dakota
The payer intermediary is unable to generate and deliver the reports.
Action Required: None. Please resubmit claims if payment has not been received.
REF803001 10/23/2024
36338 - Group Administrators Ltd. - New Real Time Transaction
Effective October 15, 2024, Optum is pleased to announce the new real time transaction for the payer specified below.
- Payer ID: 36338
- Payer Name: Group Administrators Ltd.
- Transaction Type: Eligibility (270/271)
Action Required: Please update your system to take advantage of this new payer transaction. For assistance with submitting real-time transactions, please contact your Practice Management System Vendor or the Support team for your Optum product or you may request assistance by Submitting a Customer Care Hub ticket.
Updated Payer Lists may be obtained from your software vendor or download the IMN Real-time Eligibility & Claim Status Payer List.
REF 802453 10/23/2024
Report Generation Delay for CPIDs 6695 and 6802 Center for Elders Independence
A payer is experiencing issues affecting Professional and Institutional report generation for claims submitted since June 29, 2024.
Payer impacted:
- CPID 6695 Center for Elders Independence
- CPID 6802 Center for Elders Independence
The payer is unable to generate and deliver the reports.
Action Required: None. Please resubmit claims if payment has not been received.
REF 802153 10/22/2024
Optum Notice: New Electronic Remittance Connections Available
Optum has new electronic remittance connections available:
- Payer Name: HAP CareSource Michigan Dual Medicare/Medicaid
- Institutional CPID: 2697
- Professional CPID: 1797
- Payer-assigned Payer ID: MIMCRCS1
- Line of Business (LOB) Code: K4N
- Payer Enrollment Required: Yes
- Remittance Fee: N/A
- Action Required: Add the payers to your system to begin using the new payer connection.
Enrollment forms must be submitted and approved to begin receiving electronic remittance through Optum.
REF 802302 10/22/2024
Multiple Payers Electronic Claims Connection No Longer Available
Effective immediately, the payers listed below will no longer be available at Optum for claims processing.
Payer Name:
- Sentinel Security Life
- Renaissance Life and Health Insurance Company of America
- Polish Falcons of America
- Pan-American Life Insurance Company (SSLCO)
- National Guardian Life Insurance Company
- Catholic United Financial
- Catholic Life Insurance
- Atlantic Coast Life Insurance
Claim CPIDs: 1140, 4055
Reason: Optum no longer has a valid claims connection available.
Action Required: None.
REF 802500 10/22/2024
New Electronic Remittance Connections Available
Optum has new electronic remittance connections available:
- Payer Name: IEHP Covered (Covered California)
- Institutional CPID: 3950
- Professional CPID: 1879
- Payer-assigned Payer ID: IECCA
- Line of Business (LOB) Code: N31
- Payer Enrollment Required: Yes
- Remittance Fee: N/A
- Payer Name: Longevity Health Plan of Florida
- Institutional CPID: 3018
- Professional CPID: 8268
- Payer-assigned Payer ID: LFL01
- Line of Business (LOB) Code: N33
- Payer Enrollment Required: Yes
- Remittance Fee: N/A
- Payer Name: Longevity Health Plan of New Jersey
- Institutional CPID: 3064
- Professional CPID: 8466
- Payer-assigned Payer ID: LNJ01
- Line of Business (LOB) Code: N34
- Payer Enrollment Required: Yes
- Remittance Fee: N/A
Action Required: Add the payers to your system to begin using the new payer connection.
Enrollment forms must be submitted and approved to begin receiving electronic remittance through Optum.
REF 802300 10/22/2024
New Electronic Remittance Connections Available
Optum has new electronic remittance connections available:
- Payer Name: Snedeker Risk Management
- Institutional CPID: 3964
- Professional CPID: 1891
- Payer-assigned Payer ID: A7637
- Line of Business (LOB) Code: n37
- Payer Enrollment Required: Yes
- Remittance Fee: N/A
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.
REF802301 10/22/2024
Report Generation Delay for CPID 4790 Division of Immigration Health Services
A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted on Oct. 3, 2024.
Payer impacted:
- CPID 4790 Division of Immigration Health Services
The payer intermediary is unable to generate and deliver the reports.
Action Required: Please resubmit claims if payment has not been received from the payer.
REF802051 10/22/2024
Health Choice Arizona Electronic Remittance Connection No Longer Available
Effective immediately, the payer listed below will no longer be available at Optum for claims and remittance processing.
Payer Name: Health Choice Arizona
Remittance CPIDs: 2930, 3232
Reason: Payer no longer offers an electronic connection.
Action Required: None
REF 801401 10/22/2024
Health Choice Arizona Electronic Remittance Connection No Longer Available
Effective immediately, the payer listed below will no longer be available at Optum for claims and remittance processing.
Payer Name: Health Choice Arizona
Remittance CPIDs: 2930, 3232
Remittance LOB: U37
Reason: Payer no longer offers an electronic connection.
Action Required: None
REF 801402 10/22/2024
Report Generation Delay for CPID 2426 Michigan Blue Care Network
A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted since Oct. 9, 2024.
Payer impacted:
- CPID 2426 Michigan Blue Care Network
Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.
Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.
REF 801101 10/21/2024
Effective November 1, 2024, claims currently exchanged with the following payer must use different CPIDs
Claims containing Dates of Service on or prior to Oct. 31, 2024, must continue to use the following:
- Payer Name: CalOptima Direct
- Professional CPID: 4221
- Professional Edit Master: PE_O007
- Institutional CPID: 5914
- Institutional Edit Master: HE9O007
- Payer-assigned Payer ID: CALOP
- Payer Name: CalOptima ICF
- Institutional CPID: 2903
- Institutional Edit Master: HE9C061
- Payer-assigned Payer ID: CALOP
- Payer Name: CalOptima Long Term Care
- Institutional CPID: 5986
- Institutional Edit Master: HE9T007
- Payer-assigned Payer ID: COLTC
Claims containing Dates of Service on or after Nov. 1, 2024, must begin using the following:
- Payer Name: Altura MSO
- Professional CPID: 8152
- Professional Edit Master: PE_T007
- Institutional CPID: 2017
- Institutional Edit Master: HE9T007
- Payer-assigned Payer ID: 95712
Enrollment Requirements:
- Claims: Payer enrollment for electronic claims is not required.
- Remittance: Payer enrollment for electronic remittance is required.
Providers currently receiving electronic remittance through Optum for CPIDs 8152, 2017, Altura MSO, do not need to complete a new enrollment form.
Providers not receiving electronic remittance through Optum for CPIDs 8152, 2017, Altura MSO, must complete a new enrollment form.
New providers must complete a new enrollment form.
Action Required: Please make the following updates to accommodate these payer changes:
- Revalidate unreleased claims to edit correctly under new edit master.
- Modify any bridge routines based on edit masters.
- Modify related Payer Alias names to the new CPIDs.
REF 801459 10/21/2024
Report Generation Delay for CPID 5428 QualChoice of Arkansas
A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted on Oct. 12, 2024.
Payer impacted:
CPID 5428 QualChoice of Arkansas
The payer intermediary is unable to generate and deliver the reports.
Action Required: Please resubmit claims if payment has not been received from the payer.
REF 801103 10/21/2024
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 Oct. 14, 2024.
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.
REF 801109 10/21/2024
Report Generation Delay for CPID 6987 Veterans Affairs Financial Services Center
A payer intermediary is experiencing issues affecting institutional report generation for some claims submitted on Sept. 16, 2024, and Sept. 30, 2024.
Payer impacted:
- CPID 6987 Veterans Affairs Financial Services Center
The payer intermediary is unable to generate and deliver the reports.
Action Required: Please resubmit claims if payment has not been received from the payer.
REF 801108 10/21/2024
Report Generation Delay for CPID 2287 Medicare Plus Blue of MI(MAP)
A payer intermediary is experiencing issues affecting professional report generation for some claims submitted on Oct. 10, 2024, and Oct. 12, 2024.
Payer impacted:
- CPID 2287 Medicare Plus Blue of MI(MAP)
Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.
Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.
REF 801102 10/21/2024
Update: Report Generation Delay for CPIDs 2150 and 3693 Florida Health Care Plans
The payer intermediary has been unable to generate and deliver the reports for some claims submitted on Sep. 14, 2024, and Oct. 12, 2024.
Action Required: Please resubmit claims if payment has not been received.
Update sent Sep. 30, 2024:
A payer intermediary is experiencing issues affecting institutional and professional report generation for some claims submitted since Sep. 4, 2024.
Payer impacted:
- CPID 2150 Florida Health Care Plans
- CPID 3693 Florida Health Care Plans
Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.
Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.
Original message sent Sep. 20, 2024:
A payer intermediary is experiencing issues affecting institutional report generation for some claims submitted since Sep. 4, 2024.
Payer impacted:
- CPID 3693 Florida Health Care Plans
Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.
Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.
REF 801100 10/21/2024
Payer Processing Issue for CPID 3501 Indiana Medicaid
Due to a payer processing issue, some Institutional claims transmitted to the payer listed below on Oct. 16, 2024, were not processed by the payer.
Payer impacted:
- CPID 3501 Indiana Medicaid
A resolution has been implemented and the claims were retransmitted to the payer on Oct. 18, 2024.
This delay affected claims released to Change Healthcare (Optum) between 3 p.m. ET on Oct. 15, 2024, and 11 a.m. ET on Oct. 16, 2024.
Action Required: Be aware of the processing issue above.
REF 800300 10/18/2024
New Electronic Remittance Connections Available
Optum has new electronic remittance connections available:
Payer Name: The Boon Group
Institutional CPID: 3930
Professional CPID: 4278
Payer-assigned Payer ID: BOONG
Line of Business(LOB) Code: J5K
Payer Remittance Enrollment Required: Yes
Payer Location: Texas
Remittance Fee: N/A
Payer Name: Leading Edge Administrators
Professional CPID: 8219
Payer-assigned Payer ID: OMNIA
Line of Business(LOB) Code: E01
Payer Remittance Enrollment Required: Yes
Payer Location: National
Remittance Fee: N/A
Payer Name: People 1st Health Strategies
Institutional CPID: 5057
Professional CPID: 9100
Payer-assigned Payer ID: IHS03
Line of Business(LOB) Code: E02
Payer Remittance Enrollment Required: Yes
Payer Location: National
Remittance Fee: N/A
Payer Name: Superior Select Health Plan
Institutional CPID: 1065
Professional CPID: 7893
Payer-assigned Payer ID: 61184
Line of Business(LOB) Code: E03
Payer Remittance Enrollment Required: Yes
Payer Location: Arkansas
Remittance Fee: N/A
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.
Please note: We are providing you with a list of new electronic connections, please review and choose payers that are appropriate for your business.
REF 800450 10/18/2024
Resolved: Delay in Electronic Remittance Advice (ERA) for HEALTHNET CPIDs 2855, 6514
Update: This issue has been resolved.
Original message sent Sep. 03, 2024
Delay in Electronic Remittance Advice (ERA)
Due to a processing issue, there has been a delay in Professional and Institutional Electronic Remittance Advice (ERA) for the following payers beginning on Aug. 21, 2024, through present:
- CPID 2855 HEALTHNET
- CPID 6514 HEALTHNET
Additional updates will be forwarded as more information becomes available.
Action Required: Please be aware of a delay in the delivery of ERA for the dates above. If you have any questions, feel free to contact your Customer Support Team and refer to case 09070825.
REF 800250 10/18/2024
New Electronic Remittance Connection Available
Optum has new electronic remittance connections available:
Payer Name: Health Plan of San Joaquin
Institutional & Professional CPID: 4682, 3469
Payer-assigned Payer ID: 68035
Line of Business (LOB) Code: J2T
Payer Enrollment Required: Yes
Remittance Fee: N/A
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.
The enrollment form will be available on 10/19/2024.
REF 800301 10/18/2024
Resolved: Delay in Electronic Remittance Advice (ERA) for CPIDs 3550/3429/4523/6442 United Healthcare
The following has been resolved:
Due to a payer processing issue, there has been a delay in Professional and Institutional Electronic Remittance Advice (ERA) for the following payers Oct. 9th, 2024 through present:
- 3550 CPID UnitedHealthcare
- 3429 CPID UnitedHealthcare
- 4523 UnitedHealthcare Community Plan Tenncare
- 6442 UnitedHealthcare Community Plan Tenncare
Action Required: Please be aware of a delay in the delivery of ERA for dates above.
If you have any questions, feel free to contact your Customer Support Team and refer to INC-000001903.
REF 799654 10/18/24
Report Generation Delay for CPID 2426 Michigan Blue Care Network
A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted since Oct. 9, 2024.
Payer impacted:
- CPID 2426 Michigan Blue Care Network
Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.
Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.
REF 801101 10/21/2024
Electronic Routing Change for CPID 5986 CalOptima Long Term Care
Effective immediately, Optum will be reactivating the electronic claims connection and changing the electronic claims routing for the following payer:
Payer Name: CalOptima Long Term Care
Institutional CPID: 5986
Current Edit Master: HE9C060
New Edit Master: HE9T007
Payer-assigned Payer ID: COLTC
Enrollment Requirements:
Claims:
- Payer enrollment for electronic claims is required.
- Providers currently sending electronic claims through Optum must complete a new enrollment form.
- New providers must complete a new enrollment form.
Report Changes:
You may see some differences in the payer reports you are receiving.
Action Required: Please make the following changes to accommodate the routing change:
- Revalidate unreleased claims to edit correctly under new edit master.
- Modify any bridge routines based on edit masters.
- No Payer Alias changes are required. Payer Name and CPID are not changing.
- When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.
REF 799552 10/17/2024
Payer Transmit Delay for Multiple CPIDs
Due to a payer system issue, a delay occurred in the transmissions to the following payer since Oct. 16, 2024.
Payer impacted:
- CPID 5575 New Jersey Charity Care Inpatient
- CPID 5576 New Jersey Charity Care Outpatient
Optum is working with the payer to resolve this issue. We will notify you as soon as additional information becomes available.
This delay affected claims released to Optum since 3 p.m. ET on Oct. 15, 2024.
Action Required: Be aware of the transmit delay above.
REF 799700 10/17/2024
Report Generation Delay for CPID 1120 Community Eye Care
A payer is experiencing issues affecting Professional report generation for some claims submitted since Oct. 11, 2024.
Payer impacted:
- CPID 1120 Community 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.
REF 799702 10/17/2024
Optum Alert: 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. 1, 2024, and Oct. 10, 2024.
Action Required: Please resubmit claims if payment has not been received.
Original notify sent Oct. 14, 2024:
A payer is experiencing issues affecting Institutional and Professional report generation for some claims submitted since Oct. 1, 2024.
Payer impacted:
- CPID 7071 Anthem Ohio Medicaid
- CPID 9458 CareSource Ohio Medicaid
- CPID 2481 Ohio Medicaid
- CPID 3509 Ohio Medicaid
Optum is working diligently with the payer to resolve the issue and ensure reports are received.
Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.
REF799701 10/17/2024
Real time Payer Transaction for Alohacare, ALOHA
Effective Aug. 8, 2024, Optum is pleased to announce the availability of Real-time (Eligibility Inquiry and Response 270/271) transactions for the Real Time ID below:
- ALOHA
Action Required by customer:
Please update your system to take advantage of these payer transactions. For assistance with submitting Real-Time transactions, please contact your Practice Management System Vendor or open a Optum Customer Care Hub ticket.
Updated Payer Lists may be obtained from your software vendor or Payer Lists | Change Healthcare.
REF 797952 10/17/2024
Electronic Routing Change for CPIDs 9517 and 1110 Innovative Integrated Health, Inc.
Effective immediately, Optum will be changing electronic claims routing for the following payer:
Payer Name: Innovative Integrated Health, Inc.
Professional CPID: 1110
Current Edit Master: PE_E049
New Edit Master: PE_T007
Institutional CPID: 9517
Current Edit Master: HE9E049
New Edit Master: HE9T007
Current Payer-assigned Payer ID: 99660
New Payer-assigned Payer ID: IIHPO
Enrollment Requirements:
- Claims: Payer enrollment for electronic claims is not required.
- Report Changes: You may see some differences in the payer reports you are receiving.
Action Required: Please make the following changes to accommodate the routing change:
- Revalidate unreleased claims to edit correctly under new edit master.
- Modify any bridge routines based on edit masters
- No Payer Alias changes are required. Payer name and CPIDs are not changing.
- When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.
REF 799551 10/17/2024
Remittance Reactivation for CPIDs 8651, 3295 Cedars Sinai Medical Network
Optum recently restored electronic remittance connectivity for the following payer:
Payer Name: Cedars Sinai Medical Network
Professional CPID: 3295
Institutional CPID: 8651
Industry Payer ID: 95166
Remittance Enrollment Requirements:
- Payer enrollment for electronic remittance is required:
- Providers currently receiving electronic remittance for this payer do not need to complete a new enrollment form.
- Providers who moved their enrollment to another clearinghouse or have not received remittance will need to re-enroll to receive remittance for this payer from Optum (Change Healthcare).
- New providers must complete a new enrollment form.
Action Required:
Please consider the following to allow transactions to process properly due to the above changes:
- Make any necessary system changes.
- When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.
REF799601 10/17/2024
Remittance Reactivation for CPID 6195 Superior Vision Services
Optum recently restored electronic remittance connectivity for the following payer:
Payer Name: Superior Vision Services
Professional CPID: 6195
Industry Payer ID: 41352
Remittance Enrollment Requirements:
- Payer enrollment for electronic remittance is required:
- Providers currently receiving electronic remittance for this payer do not need to complete a new enrollment form.
- Providers who moved their enrollment to another clearinghouse or have not received remittance will need to re-enroll to receive remittance for this payer from Optum (Change Healthcare).
- New providers must complete a new enrollment form.
Action Required: Please consider the following to allow transactions to process properly due to the above changes:
- Make any necessary system changes.
- When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.
REF 799600 10/17/2024
Electronic Routing Change for CPIDs 9517 and 1110 Innovative Integrated Health, Inc.
Effective immediately, Optum will be changing electronic claims routing for the following payer:
Payer Name: Innovative Integrated Health, Inc.
Professional CPID: 1110
Institutional CPID: 9517
Current Payer-assigned Payer ID: 99660
New Payer-assigned Payer ID: IIHPO
Enrollment Requirements:
Claims:
Payer enrollment for electronic claims is not required.
Report Changes:
You may see some differences in the payer reports you are receiving.
Action Required: Please consider the following to allow transactions to process properly due to the above changes:
Make any necessary system changes.
When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.
REF 799550 10/17/2024
Electronic Reactivation and Routing Change for CPID 5986 CalOptima Long Term Care
Effective immediately, Optum is reactivating the electronic claims connection and changing electronic claims routing for the following payer:
Payer Name: CalOptima Long Term Care
Institutional CPID: 5986
Payer-assigned Payer ID: COLTC
Claims Surcharge: $0.10
Enrollment Requirements
Claims:
- Payer enrollment for electronic claims is required.
- Providers currently sending electronic claims through Optum must complete a new enrollment form.
- New providers must complete a new enrollment form.
Report Changes:
You may see some differences in the payer reports you are receiving.
Action Required: Please consider the following to allow transactions to process properly due to the above changes:
- Make any necessary system changes.
- When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.
REF 799553 10/17/24
Remittance Reactivation for Dean Health Plan by Medica
Effective immediately, Optum has restored 835 connectivity for the following payer:
Payer Name: Dean Health Plan by Medica
Professional CPID: 1497
Institutional CPID: 3581
Industry Payer ID: 39113
Remittance Enrollment Requirements:
Payer enrollment for electronic remittance is required:
- Providers previously enrolled with Optum (Change Healthcare), who did not switch their enrollment away from Optum (Change Healthcare) do not need to re-enroll.
- Providers who moved their enrollment to another clearinghouse will need to re-enroll with Optum (Change Healthcare) to receive ERAs for this payer from Optum (Change Healthcare).
- New providers must complete a new enrollment form.
Action Required: Please consider the following to allow transactions to process properly due to the above changes:
- Make any necessary system changes.
- When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.
REF 799207 10/16/2024
Report Generation Delay for CPID 2991 UMWA H & R Funds
A payer intermediary experienced issues affecting Institutional report generation for some claims submitted on Aug. 28, 2024, and Aug. 29, 2024
Payer impacted:
- CPID 2991 UMWA H & R Funds
The payer intermediary is unable to generate and deliver the reports.
Action Required: None. Please resubmit claims if payment has not been received.
REF 799001 10/16/2024
New Electronic Remittance Connections Available
Optum has new electronic remittance connections available:
Payer Name: Beam Insurance Administrators
Institutional & Professional CPID: 2782
Payer-assigned Payer ID: BEAM1
Line of Business (LOB) Code: E00
Payer Enrollment Required: Yes
Remittance Fee: N/A
Action Required:
- Add the payers to your system to begin using the new payer connection.
- Enrollment forms must be submitted and approved to begin receiving electronic remittance through Optum.
REF 797152 10/16/2024
Electronic Claims Connection Suspended
Effective immediately, the payer listed below has/have been temporarily suspended at Optum for claims processing and removed from the payer list.
Payer Name: Associated Hispanic Physicians IPA
CPIDs: 7794, 8554
Payer ID: MPM44
Action Required: Please refrain from submitting claims until further notice.
REF 799300 10/16/2024
Report Generation Delay for CPID 1853 ElderPlan
A payer intermediary experienced issues affecting Professional report generation for some claims submitted Aug. 17, 2024, and Aug. 19, 2024
Payer impacted:
- CPID 1853 ElderPlan
The payer intermediary is unable to generate and deliver the reports.
Action Required: None. Please resubmit claims if payment has not been received.
REF799000 10/16/2024
Electronic Claims Connection Suspended
Effective immediately, the payer listed below has been temporarily suspended at Optum for claims processing and removed from the payer list.
Payer Name: TDS/SRRIPA/Clover
CPIDs: 6049 and 9202
Payer ID: RP012
Action Required: Please refrain from submitting claims until further notice.
REF 798951 10/16/24
Update: Report Generation Delay for CPID 2162 Colorado Medicare
The payer intermediary has been unable to generate and deliver the reports for some claims submitted on Sept. 17, 2024, and Sept. 18, 2024.
Action Required: Please resubmit claims if payment has not been received.
Original message sent Oct. 15, 2024:
A payer intermediary is experiencing issues affecting professional report generation for some claims submitted on Sept. 17, 2024, and Sept. 18, 2024.
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.
REF 799100 10/16/2024
New Electronic Remittance Connections Available
Optum has a new electronic remittance connection available:
Payer Name: McLaren Advantage SNP
Institutional CPID: 6637
Professional CPID: 6739
Payer-assigned Payer ID: 3833R
Line of Business (LOB) Code: U9O
Payer Enrollment Required: Yes
Remittance Fee: N/A
Action Required:
- Add the payers to your system to begin using the new payer connection.
- Enrollment forms must be submitted and approved to begin receiving electronic remittance through Optum.
REF 798950 10/16/2024
Electronic Claims Connection Suspended
Effective immediately, the payer listed below has been temporarily suspended at Optum for claims processing and removed from the payer list.
Payer Name: AllCare PEBB
CPIDs: 7163, 7696
Payer ID: 26158
Action Required: Please refrain from submitting claims until further notice.
REF 798850 10/16/2024
Report Generation Delay for CPID 2162 Colorado Medicare
A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted on Sept. 17, 2024 and Sept. 18, 2024.
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.
REF 798201 10/15/2024
Delay in Electronic Remittance Advice (ERA) for Noridian Payers - RESOLVED
This message is intended for Revenue Performance Advisor customers.
UPDATE: This issue is now resolved.
Original message sent Sept. 26, 2024:
Due to a payer issue, there has been a delay in professional and institutional Electronic Remittance Advice (ERA/835) delivery for the following payers beginning on Thursday, Sept. 12, 2024, through present:
SMAK0 – Alaska Medicare Part B
12M02 – Arizona Medicare Part A
SMAZ0 – Arizona Medicare Part B 1
2M64 – California Medicare Part A
12M64 – Hawaii Medicare Part A
SMHI0 – Hawaii Medicare Part B
12M07 – Idaho and Alaska Medicare Part A
SMID0 – Idaho Medicare Part B
SKIA0 – Iowa Medicaid
12M65 – Medicare Part A (CA, HI, NV) Legacy
12M77 – Montana Medicare Part A
SMMT0 – Montana Medicare Part B
12M64 – Nevada Medicare Part A
SMNV0 – Nevada Medicare Part B
12M82 – North Dakota Medicare Part A
SMND0 – North Dakota Medicare Part B
SMCA1 – Northern California Medicare Part B
12M41 – Oregon Medicare Part A
SMOR0 – Oregon Medicare Part B
12M83 – South Dakota Medicare Part A
SMSD0 – South Dakota Medicare Part B
SMCA2 – Southern California Medicare Part B
12M84 – Utah Medicare Part A
SMUT0 – Utah Medicare Part B
12M45 – Washington Medicare Part A
SMWA0 – Washington Medicare Part B
12M30 – Wyoming Medicare Part A
SMWY0 – Wyoming Medicare Part B
Action Required: Please be aware of a delay in the delivery of ERA for the dates above.
REF 797552 10/15/2024
Meridian Health Plan of Illinois DOS before July 1, 2021, Electronic Claims/Remittance Connection No Longer Available
Effective immediately, the payer listed below will no longer be available at Optum for claims and remittance processing.
Payer Name: Meridian Health Plan of Illinois DOS before July 1, 2021
Claim and Remittance CPIDs: 5916, 4777
Claims and Remittance containing Dates of Service on or after July 1, 2021, must begin using the following:
Payer Name: Meridian Medicare Medicaid Plan
Professional CPID: 9102
Institutional CPID: 5058
Remittance Available: Yes
Payer-assigned Payer ID: MHPIL
Claim Fee: N/A
Enrollment Requirements:
Claims:
- Payer enrollment for electronic claims is not required.
Remittance:
- Payer enrollment for electronic remittance is required.
- Providers currently receiving electronic remittance through Optum for CPIDs 5058, 9102 Meridian Medicare Medicaid Plan do not need to complete a new enrollment form.
- Providers not receiving electronic remittance through Optum for CPIDs 5058, 9102 Meridian Medicare Medicaid Plan must complete a new enrollment form.
- New providers must complete a new enrollment form.
Action Required:
- Please be aware of the changes above and make any necessary changes in your system.
- To access the new enrollment forms, please visit Enrollment Central.
REF 797950 10/15/2024
Payer Deactivation - Summit America Insurance Services
This message is intended for Revenue Performance Advisor customers.
Effective immediately, the payer listed below will no longer be available at Optum for claims, eligibility and claim status inquiry processing:
- 37301-Summit America Insurance Services
Updated Payer Lists may be obtained from your software vendor or Optum. Optum is removing this payer from the RPA Payer List and any transactions sent using the above payer ID will be rejected.
Action Required:
Please discontinue use of the above payer IDs. Providers should review the patient's current insurance ID card for claim filing information.
REF 798250 10/15/2024
Resolved: Novitas Medicare Electronic Remittance Advice (ERA) - RESOLVED
This message is intended for Revenue Performance Advisor customers.
UPDATE: This issue has been resolved.
Original message sent Sept. 19, 2024:
There were issues that impacted clearinghouse delivery of remits from Novitas Medicare (various payer IDs – see below) issued during the period starting February 19, 2024, through April 19, 2024. Novitas Medicare completed reprocessing remits for this period as of September 16, 2024.
| Noridian payers | RPA Professional, Institutional payer ID |
| AR|Arkansas Novitas JH | (SMAR0, 12022) |
| CO|Colorado Novitas JH | (SMCO0, 12M03) |
| DE|Delaware Novitas JL | (SMDE0, 12M76) |
| ID|Idaho Novitas JL | (SMID0, 12M07) |
| LA|Louisiana Novitas JH | (SMLA0, 12M12) |
| MD|Maryland Novitas JL | (SMMD0, 12010) |
| MS|Mississippi Novitas JH | (SMMS0, 12M76) |
| NJ|New Jersey Novitas JH | (SMNJ0, 12005) |
| NM|New Mexico Novitas JH | (SMNM0, 12M22) |
| OK|Oklahoma Novitas JH | (SMOK0, 12M37) |
| PA|Pennsylvania Novitas JL | (SMPA0, 12M60) |
| TX|Texas Novitas JH | (SMTX0, 12M53) |
Action Required:
If you are missing any remits from Novitas Medicare for the above period, visit the Novitas Medicare website to download them.
REF 797551 10/15/2024
Report Generation Delay for CPIDs 2746 and 7924 SAGE1
A payer is experiencing issues affecting Institutional and Professional report generation for some claims submitted since Sept. 24, 2024.
Payer impacted:
- CPID 2746 SAGE1
- CPID 7924 SAGE1
Optum is working diligently with the payer to resolve the issue and ensure reports are received.
Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.
REF 798200 10/15/24
Meridian Health Plan of Illinois DOS before 07/01/2021 Electronic Claims/Remittance Connection No Longer Available
Effective immediately, the payer listed below will no longer be available at Optum for claims and remittance processing.
- Payer Name: Meridian Health Plan of Illinois DOS before 07/01/2021
- Claim CPIDs: CPIDs: 5916, 4777
- Remittance LOB: U2M
Claims and Remittance containing Dates of Service on or after July 1, 2021, must begin using the following:
- Payer Name: Meridian Medicare Medicaid Plan
- Professional CPID: 9102
- Professional Edit Master: PE_B800
- Institutional CPID: 5058
- Institutional Edit Master: HE9B801
- Payer-assigned Payer ID: MHPIL
- Line of Business Code (LOB): H85
Enrollment Requirements:
Claims:
- Payer enrollment for electronic claims is not required.
Remittance:
- Payer enrollment for electronic remittance is required.
- Providers currently receiving electronic remittance through Optum for CPIDs 5058, 9102 Meridian Medicare Medicaid Plan do not need to complete a new enrollment form.
- Providers not receiving electronic remittance through Optum for CPIDs 5058, 9102 Meridian Medicare Medicaid Plan must complete a new enrollment form.
- New providers must complete a new enrollment form.
Action Required: Please make the following updates to accommodate these payer changes:
- Revalidate unreleased claims to edit correctly under new edit master.
- Modify any bridge routines based on edit masters.
- Modify related Payer Alias names to the new CPIDs.
- To access the new enrollment forms, please visit Enrollment Central.
REF 797951 10/15/2024
Report Generation Delay for CPIDs 2502 and 5479 IU Health Plan Medicare Advantage
A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted since Oct. 1, 2024.
Payer impacted:
- CPID 2502 IU Health Plan Medicare Advantage
- CPID 5479 IU Health Plan Medicare Advantage
Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.
Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.
REF 796104 10/14/2024
Remittance Reactivation for CPIDs 3231, 4945 Medical Benefit Administration
Optum recently restored electronic remittance connectivity for the following payer:
Payer Name: Medical Benefit Administration
Professional CPID: 3231
Institutional CPID: 4945
Industry Payer ID: MBA01
Remittance Enrollment Requirements:
- Payer enrollment for electronic remittance is required:
- Providers currently receiving electronic remittance for this payer do not need to complete a new enrollment form.
- Providers who moved their enrollment to another clearinghouse or have not received remittance will need to re-enroll to receive remittance for this payer from Optum (Change Healthcare).
- New providers must complete a new enrollment form.
Action Required: Please consider the following to allow transactions to process properly due to the above changes:
- Make any necessary system changes.
- When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.
REF 797150 10/14/2024
Claim Processing Suspended
Effective immediately, the payer listed below has been temporarily suspended at Optum for claim processing, and has been removed from the payer list.
Payer Name: Vibra Health Plan
CPIDs: 2553, 1181
Payer ID: 15976
Action Required: Please refrain from submitting claims until further notice.
REF 796107 10/14/2024
Electronic Claim Connection Status for Block Vision CPID 3402 and Superior Vision CPID 6195
Effective immediately, the payers listed below are temporarily suspended at Optum for claim processing and have been removed from the payer list.
Payer Name: Block Vision
CPIDs: 3402
Payer ID: 41352
Payer Name: Superior Vision
CPIDs: 6195
Payer ID: 41352
Action Required: Please do not submit claims for the payers until further notice.
REF 797650 10/14/2024
Report Generation Delay for CPID 2234 Illinois Health Partners
A payer intermediary is experiencing issues affecting professional report generation for some claims submitted on Oct. 2, 2024.
Payer impacted:
- CPID 2234 Illinois Health Partners
Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.
Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.
REF 796105 10/14/2024
Report Generation Delay for CPIDs 1004 and 7829 Passport Advantage
A payer intermediary is experiencing issues affecting institutional and professional report generation for some claims submitted since Sep. 30, 2024.
Payer impacted:
- CPID 1004 Passport Advantage
- CPID 7829 Passport Advantage
Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.
Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.
REF 797201 10/14/2024
Report Generation Delay for CPIDs 5959 and 4258 VNS Health
A payer intermediary is experiencing issues affecting institutional and professional report generation for some claims submitted since Sep. 30, 2024.
Payer impacted:
- CPID 5959 VNS Health
- CPID 4258 VNS Health
Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.
Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.
REF 796102 10/14/2024
Report Generation Delay for CPIDs 6128 and 4616 Gold Coast Health Plan
A payer is experiencing issues affecting Institutional and Professional report generation for some claims submitted since Sept. 23, 2024.
Payer impacted:
- CPID 6128 Gold Coast Health Plan
- CPID 4616 Gold Coast 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.
REF 797252 10/14/2024
Update: Report Generation Delay for CPIDs 2423 and 5558 Alabama Blue Cross Blue Shield
Update: It has been determined that the report delay below was due to a payer claims processing issue. We have retransmitted the impacted claims to the payer on Oct. 14, 2024. Reports will be delivered once the claims have successfully processed at the payer.
Action Required: Please be aware of delays.
Original Notice Sent Oct. 8, 2024:
A payer is experiencing issues affecting Institutional and Professional report generation for some claims submitted on Sept. 27, 2024.
Payer impacted:
- CPID 2423 Alabama Blue Cross Blue Shield
- CPID 5558 Alabama Blue Cross Blue Shield
Optum is working diligently with the payer to resolve the issue and ensure reports are received.
Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.
REF797251 10/14/2024
Report Generation Delay for CPIDs 1592 and 5432 Johns Hopkins Healthcare / Priority Partners
A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted since Sept. 30, 2024.
Payer impacted:
- CPID 1592 Johns Hopkins Healthcare / Priority Partners
- CPID 5432 Johns Hopkins Healthcare / Priority Partners
Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.
Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.
REF 796103 10/14/2024
Report Generation Delay for CPID 2483 Texas Childrens Health Plan (STAR Medicaid)
A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted since Oct. 4, 2024.
Payer impacted:
- CPID 2483 Texas Childrens Health Plan (STAR Medicaid)
Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.
Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.
REF 796106 10/14/24
Report Generation Delay for CPIDs 2013 and 8146 Care N Care Insurance Co.
A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted since Sept. 30, 2024.
Payer impacted:
- CPID 2013 Care N Care Insurance Co.
- CPID 8146 Care N Care Insurance Co.
Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.
Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.
REF 797200 10/14/2024
Report Generation Delay for CPIDs 9656 and 7715 Hopkins Health Advantage
A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted since Oct. 1, 2024.
Payer impacted:
- CPID 9656 Hopkins Health Advantage
- CPID 7715 Hopkins Health Advantage
Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.
Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.
REF 797202 10/14/24
Report Generation Delay for Multiple CPIDs
A payer is experiencing issues affecting Institutional and Professional report generation for some claims submitted since Oct. 1, 2024.
Payer impacted:
- CPID 7071 Anthem Ohio Medicaid
- CPID 2481 Ohio Medicaid
- CPID 3509 Ohio Medicaid
Optum is working diligently with the payer to resolve the issue and ensure reports are received.
Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.
REF 797250 10/14/24
UDOH0 - Utah Medicaid Real-Time Payer Transaction
Effective Oct. 11, 2024, Optum is pleased to announce the availability of Real-Time Eligibility transactions for the below payer:
Payer ID: UDOH0
Payer name: Utah Medicaid
Transaction type: Eigibility (270/271)
Enrollment Instructions:
All submitters must complete enrollment instructions prior to submitting transactions.
Action Required by the Customer:
Please update your system to take advantage of this payer transaction. For assistance with submitting Real-Time transactions, please contact your Practice Management System Vendor or Optum Customer Care Hub ticket https://customercare.changehealthcare.com/public/home.html.
Updated Payer Lists may be obtained from your software vendor or Payer Lists | Change Healthcare
REF 797050 10/11/2024
MHC01 - Mountain Health CO-OP - real-time payer transaction
Effective October 9, 2024, Optum is pleased to announce the availability of real-time claim status transactions for the below payer:
Payer id: MHC01
Payer name: Mountain Health CO-OP
Transaction type: Claim Status inquiry (276/277).
Action Required:
Please update your system to take advantage of this payer transaction. For assistance with submitting real-time transactions, please contact your Practice Management System Vendor or Optum Customer Care Hub.
Updated Payer Lists may be obtained from your software vendor or Payer Lists | Change Healthcare.
REF 796900 10/11/2024
Delay in Electronic Remittance Advice (ERA) for Payer ID 77160, CPIDs 6128 and 4616, Gold Coast Health Plan
Due to a payer processing issue, there has been a delay in professional and institutional Electronic Remittance Advice (ERA) for the following payers for dates of Sept. 3, 2024, through present:
- 6128 Gold Coast Health Plan
- 4616 Gold Coast Health Plan
Action Required: Please be aware of a delay in the delivery of ERA for dates above.
REF 796400 10/11/2024
Resolved: Delay in Electronic Remittance Advice (ERA) for Multiple CPIDs , Noridian Payers
This message is intended for Assurance EDI and Assurance Reimbursement Management customers.
This issue has been resolved.
Original message sent Sep. 29, 2024.
Due to a payer processing issue, there has been a delay in professional and institutional Electronic Remittance Advice (ERA) for the following payers for check dates of Sep. 12, 2024, through present:
- 1456 Arizona Medicare Part B
- 5546 Arizona Medicare Part A
- 3508 California Medicare Part A
- 2467 Hawaii Medicare Part B
- 5567 Hawaii Medicare Part A
- 5581 Idaho and Alaska Medicare Part A
- 2465 Idaho Medicare Part B
- 1455 Alaska Medicare Part B
- 5567 J1 Mutual of Omaha, CA, HI, NV
- 2646 Medicare Part A (CA, HI, NV) Legacy
- 5584 Montana Medicare Part A
- 7400 Montana Medicare Part B
- 1446 Nevada Medicare Part B
- 5907 Nevada Medicare Part A
- 2453 North Dakota Medicare Part B
- 1523 North Dakota Medicare Part A
- 1436 Northern California Medicare Part B
- 1459 Oregon Medicare Part B
- 5515 Oregon Medicare Part A
- 2454 South Dakota Medicare Part B
- 5589 South Dakota Medicare Part A
- 1444 Southern California Medicare Part B
- 2458 Utah Medicare Part B
- 1527 Utah Medicare Part A
- 1462 Washington Medicare Part B
- 5521 Washington Medicare Part A
- 2466 Wyoming Medicare Part B
- 3583 Wyoming Medicare Part A
- 2571 Iowa Medicaid
- 1469 Iowa Medicaid
Additional updates will be forwarded as more information becomes available.
Action Required: Please be aware of a delay in the delivery of ERA for check dates above. If you have any questions, feel free to contact your Customer Support Team.
REF 796100 10/11/2024
Claim Processing Suspended for CPIDs 7818, 9516 Change Healthcare Accident Claims Solution
Effective immediately, the payer listed below has been temporarily suspended at Optum for claim processing, and has been removed from the payer list.
Payer Name: Change Healthcare Accident Claims Solution
CPIDs: 7818, 9516
Payer ID: 88446
Action Required: Please refrain from submitting claims until further notice.
REF 795657 10/10/2024
Invalid Error Message for 6631/6732 McLaren Health Plan Medicaid
Due to a payer intermediary processing issue, Professional and Institutional claims for the payer listed below may have received the following invalid error message[s]:
- A3:249 CLM,ENCNTER BEEN REJECTD AND NOT ENTERD INTO ADJUDICATION SYS.:PLACE OF SERVICE.
- A3:187 CLM,ENCNTER BEEN REJECTD AND NOT ENTERD INTO ADJUDICATION SYS.:DATE-S OF SERVICE.
- A3:453 CLM,ENCNTER BEEN REJECTD AND NOT ENTERD INTO ADJUDICATION SYS.:PROCEDURE CODE MODIFIER(S) FOR SERVICE(S) RENDERED
This issue began on Aug. 15, 2024, and was resolved by the payer intermediary on Oct. 9, 2024. Claims will require resubmission.
Payers impacted:
- CPID 6631 McLaren Health Plan Medicaid
- CPID 6732 McLaren Health Plan Medicaid
Action Required: Please resubmit any impacted claims.
REF 795552 10/10/2024
Electronic Routing Change for CPIDs 8642 and 7225 Sharp Community Medical Group
Effective Oct. 10, 2024, Optum will be changing electronic claims and remittance routing for the following payer:
Payer Name: Sharp Community Medical Group
Professional CPID: 7225
Institutional CPID: 8642
Payer-assigned Payer ID: SCMG1
Payer Surcharge: $0.10
Enrollment Requirements:
Claims:
- Payer enrollment for electronic claims is not required.
Remittance:
- Payer enrollment for electronic remittance is required.
- Providers currently receiving electronic remittance through Optum must complete a new enrollment form.
- New providers must complete a new enrollment form.
Report Changes:
You may see some differences in the payer reports you are receiving.
Action Required:
Please consider the following to allow transactions to process properly due to the above changes:
- Make any necessary system changes.
- When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.
REF 795700 10/10/2024
Update: North American Medical Management (NAMM - N. CA) Payer Processing Issue
This message is intended for Assurance Reimbursement Management, Assurance EDI, RPA, iEDI, and submitters or trading partners to the Exchange or iEDI clearinghouse.
Updated message: Effective Sep. 14, 2024, NAMM – N. CA began sending remittance to Optum. The payer is working with Optum to provide historical ERA’s dating back to February 21, 2024. If you have not received ERAs from this payer since connectivity was restored on Sep. 13th, please verify you are enrolled to receive ERAs from this payer. Claims processing with NAMM – N. CA was reestablished on Jun. 13, 2024. Providers sending claims through Optum and enrolled to receive ERAs through Optum should have received ERAs for remittance posted Sep. 13, 2024, to current. If you have sent claims and enrolled for ERAs with Optum but you are not receiving ERAs, please open a Support ticket to research missing checks.
- Payer Name: North American Medical Management (NAMM – N. CA)
- CPID(s): 1782, 2931
- Payer ID: E3510
Remit Enrollment Requirements:
- Payer enrollment for electronic remittance is required. Enrolment forms must be submitted and approved from Enrollment Central.
- All new providers must complete a new enrollment form to receive electronic remittance for NAMM N. CA.
- Providers who have not received any ERAs for NAMM N. CA and have sent claims may want to verify enrollment status
Previous message sent on September 20, 2024: As of Sep. 20, 2024, North American Medical Management (NAMM - N CA), has extended timely filing through Oct. 31, 2024. Claims will be processed without auto denying for untimely filing through the end of October. Electronic ERAs began going out to submitters Sep.11, 2024, and Optum continues to work with the payer to retrieve historical ERAs. An updated message will be sent as we know more information.
- CPID(s): 1782, 2931
- Payer ID: E3510
Previous message sent on September 18, 2024: As of Sep. 10, 2024, Optum has confirmed that NAMM – N. CA has received claims and responses have been returned. At this time, NAMM – N. CA is working on processing claims from Optum and remits should be available shortly. Claims from June 13, 2024, to September 9, 2024, will be resubmitted to the payer.
Previous message sent on August 27, 2024: As of Aug. 26, 2024, the payer is continuing to work to resolve the issue impacting claims submitted to Optum. Once the payer has completed their testing claims will be reprocessed to the payer for the CPIDs and Payer ID listed below. An updated message will be sent when the issue is resolved.
Previous message sent on August 23, 2024: Due to a processing issue, we are experiencing delays in claims processing with the payer. This issue affected claims submitted to Optum from Jun. 13, 2024, to current. We are working with the payer to resolve the issue and impacted claims will be processed to the payer once testing is completed. An updated message will be sent when the issue is resolved.
We apologize for any inconvenience.
Action Required: None. Please be aware of this delay in claims processing.
REF 779856 / 795600 10/10/2024
Delay in Electronic Remittance Advice (ERA) for CPIDs 3550/3429/4523/6442 United Healthcare
Due to a payer processing issue, there has been a delay in professional and institutional Electronic Remittance Advice (ERA) for the following payers for dates of October 9, 2024, through present:
- 3550 CPID UnitedHealthcare
- 3429 CPID UnitedHealthcare
- 4523 UnitedHealthcare Community Plan Tenncare
- 6442 UnitedHealthcare Community Plan Tenncare
Action Required: Please be aware of a delay in the delivery of ERA for dates above.
If you have any questions, feel free to contact your Customer Support Team and refer to INC-000001903.
REF 795603 10/10/2024
Payer Transmit Delay for CPIDs 2983 and 4464 SCAN Health Plan
Due to a system issue, a delay occurred in the transmissions to the following payer on Oct. 5, 2024.
Payer impacted:
- CPID 2983 SCAN Health Plan
- CPID 4464 SCAN Health Plan
A resolution has been implemented and claims were transmitted to the payer on Oct. 10, 2024.
This delay affected claims released to Optum between 6 a.m. ET on Oct. 4, 2024 and 6 a.m. ET on Oct. 5, 2024.
Action Required: Be aware of the transmit delay above.
REF 795800 10/10/2024
Electronic Routing Change for CPIDs 8642 and 7225 Sharp Community Medical Group
Effective October 10, 2024, Optum will be changing electronic claims and remittance routing for the following payer:
Payer Name: Sharp Community Medical Group
Professional CPID: 7225
Current Edit Master: PE_O007
New Edit Master: PE_B800
Institutional CPID: 8642
Current Edit Master: HE9O007
New Edit Master: HE9B801
Line of Business Code (LOB): J3D
Payer-assigned Payer ID: SCMG1
Enrollment Requirements:
Claims:
- Payer enrollment for electronic claims is not required.
Remittance:
- Payer enrollment for electronic remittance is required.
- Providers currently receiving electronic remittance through Optum must complete a new enrollment form.
- New providers must complete a new enrollment form.
Report Changes:
You may see some differences in the payer reports you are receiving.
Action Required: Please make the following changes to accommodate the routing change:
- Revalidate unreleased claims to edit correctly under new edit master.
- Modify any bridge routines based on edit masters.
- No Payer Alias changes are required. Payer name(s) and CPID(s) are not changing.
- When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.
REF 795701 10/10/2024
Delay in Electronic Remittance Advice (ERA) for Maryland & DC CareFirst, Multiple CPIDs
Due to a payer processing issue, there has been a delay in Professional and Institutional Electronic Remittance Advice (ERA) for the following payers for check dates of May 29, 2024, through present:
CPID Payer Name
2419 Maryland CareFirst Blue Cross Blue Shield
7518 Maryland CareFirst Blue Cross Blue Shield
1509 District of Columbia CareFirst Blue Cross Blue Shield
2425 District of Columbia CareFirst Blue Cross Blue Shield
Additional updates will be forwarded as more information becomes available.
Action Required: Please be aware of a delay in the delivery of ERA for check dates above.
If you have any questions, feel free to contact your Customer Support Team.
REF 794251 10/10/2024
Electronic Claims Connection Suspended
Effective immediately, the payers listed below have been temporarily suspended at Optum for claims processing, and have been removed from the payer list.
Payer Name: WPP Eldercare
CPIDs: 3202, 5983
Payer ID: 77080
Payer Name: Independence Medical Group – Kern County
CPIDs: 6117
Payer ID: IMG01
Payer Name: Independence Medical Group – Tulare County
CPIDs: 6119
Payer ID: IMG01
Payer Name: True Health New Mexico (SS&C)
CPIDs: 3028, 8277
Payer ID: 85824
Payer Name: Liberty Advantage Health Plan
CPIDs: 4056, 8796
Payer ID: LIB01
Payer Name: Pinnacol Assurance
CPIDs: 2978, 3905
Payer ID: CCIA1, 84109
Payer Name: St. Barnabas Health Plan
CPIDs: 1897, 8590
Payer ID: 22240
REF 795192 10/09/2024
Report Generation Delay for CPID 4252 Presbyterian Salud
A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted on Sept. 26, 2024 and Sept. 27, 2024.
Payer impacted:
- CPID 4252 Presbyterian Salud
Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.
Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.
REF 793859 10/9/2024
Update: Report Generation Delay for CPID 3792 Fidelis Care
The payer intermediary has been unable to generate and deliver the reports for some claims submitted on Sep. 17, 2024.
Action Required: Please resubmit claims if payment has not been received.
Original message sent Sep. 30, 2024:
A payer intermediary is experiencing issues affecting professional report generation for some claims submitted on Sep. 17, 2024.
Payer impacted:
- CPID 3792 Fidelis 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.
REF 795000 10/9/2024
Manhattan Life Real Time 270/271 - Member ID format must submit with space
Please be advised that the member ID format must be submitted with a space for Manhattan Life real time 270/271 transactions as shown below.
IMN Payer ID: MNHTN;
Exchange Payer ID: MNHTN
Payer Name: MANHATTAN LIFE
Manhattan Life Real Time 270/271 - Member ID format must be submitted with space
Examples of Member ID format: XXX XXXXXXXXXX, XXX XXXXXXXX, XX XXXXXX
Action required:
Please update your system to take advantage of this payer transaction.
REF 794850 10/9/2024
United American Insurance Electronic Claims Connection No Longer Available
This message is intended for Assurance EDI and Assurance Reimbursement Management customers.
Effective immediately, the payer listed below will no longer be available at Optum for claims processing.
Assurance EDI:
Payer Name: United American Insurance
Claim CPID: 1824
Payer ID: 55004
Reason: Payer no longer offers an electronic connection.
Action Required: None.
Assurance Reimbursement Management:
Payer Name: United American Insurance
Claim CPID: 1824
Payer ID: 55004
Reason: Payer no longer offers an electronic connection.
Action Required: None.
REF 794400 10/08/2024
Royal Health Extended Care MLTC Electronic Claims and Remittance Connections No Longer Available
This message is intended for Assurance EDI and Assurance Reimbursement Management customers.
Effective immediately, the payer listed below will no longer be available at Optum for claims and remittance processing.
Assurance EDI:
Payer Name: Royal Health Extended Care MLTC
Claim and Remittance CPIDs: 6821, 7614
Reason: Payer no longer in business.
Action Required: None.
Assurance Reimbursement Management:
Payer Name: Royal Health Extended Care MLTC
Claim CPIDs: 6821, 7614
Remittance LOB: H2G
Reason: Payer no longer in business.
Action Required: None.
REF 794300 10/08/2024
Report Generation Delay for CPID 1750 Brown & Toland Physicians
A payer intermediary is experiencing issues affecting professional report generation for some claims submitted on Sep. 27, 2024.
Payer impacted:
- CPID 1750 Brown & Toland Physicians
Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.
Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.
REF 793860 10/8/2024
Report Generation Delay for CPID 7138 Sierra Medical Group
Update: The payer intermediary has been unable to generate and deliver the reports for some claims submitted on Sept. 4, 2024.
Action Required: Please resubmit claims if payment has not been received.
Original notify sent Sept. 17, 2024:
A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted on Sept. 4, 2024.
Payer impacted:
- CPID 7138 Sierra Medical 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.
REF793855 10/8/2024
Medical Attachments Restoration: Payer Updates
Optum is pleased to provide an update on payer connectivity for Medical Attachments. Review Connect Center payer search to determine connectivity for Medical Attachments. We will continue to provide additional updates as more payers are restored.
Action Required:
Assurance
- Inform users of this change.
- Assurance providers must be contracted with Assurance Attach Assist to submit electronic medical attachments. Please contact support at 1-800-457-1209 option 2, or by emailing [email protected] for additional information.
- If you have not yet contracted for Attach Assist, contact your Client Executive to learn more about Attach Assist functionality.
- When a payer requires enrollment, forms must be submitted and approved to begin submitting transactions.
REF 793601 10/8/2024
Report Generation Delay for CPIDs 2423 and 5558 Alabama Blue Cross Blue Shield
A payer is experiencing issues affecting Institutional and Professional report generation for some claims submitted on Sept. 27, 2024.
Payer impacted:
- CPID 2423 Alabama Blue Cross Blue Shield
- CPID 5558 Alabama Blue Cross Blue Shield
Optum is working diligently with the payer to resolve the issue and ensure reports are received.
Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.
REF 793858 10/8/2024
Update: Report Generation Delay for CPIDs 4252 and 1691 Presbyterian Salud
The payer intermediary has been unable to generate and deliver the reports for some claims submitted on Sep. 4, 2024 and Sep. 5, 2024.
Action Required: Please resubmit claims if payment has not been received.
Original message sent Sept. 17, 2024:
A payer intermediary is experiencing issues affecting institutional and professional report generation for some claims submitted on Sep. 4, 2024 and Sep. 5, 2024.
Payer impacted:
- CPID 4252 Presbyterian Salud
- CPID 1691 Presbyterian Salud
Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.
Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.
REF 793857 10/8/2024
NYBCNE NEW YORK BLUE CROSS BLUE SHIELD NORTHEASTERN Eligibility Inquiry and Response 270/271
Effective October 3rd, 2024, Optum is pleased to announce the availability of Real-time 270/271 transactions for the below payer:
Exchange Payer ID: NYBCNE
Payer Name: NEW YORK BLUE CROSS BLUE SHIELD NORTHEASTERN
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 case https://customercare.changehealthcare.com/public/home.html Also, if you have not already done so, all Vendors and Direct Submitters must reenroll for Real-Time transactions to successfully process.
Updated Payer Lists may be obtained from your software vendor or Payer Lists | Change Healthcare
REF 794050 10/8/2024
Update: Report Generation Delay for CPID 6220 Arizona Priority Care Plus
Update: The payer intermediary has been unable to generate and deliver the reports for some claims submitted on Sept. 4, 2024 and Sept. 5, 2024.
Action Required: Please resubmit claims if payment has not been received.
Original notify sent Sept. 17, 2024:
A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted on Sept. 4, 2024 and Sept. 5, 2024.
Payer impacted:
- CPID 6220 Arizona Priority Care Plus
Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.
Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.
REF 793851 10/8/2024
Update: Report Generation Delay for CPID 6246 Riverside Medical Clinic
The payer intermediary has been unable to generate and deliver the reports for some claims submitted on Sep. 4, 2024, Sep. 10, 2024, and Sep. 12, 2024.
Action Required: Please resubmit claims if payment has not been received.
Update sent Sep. 26, 2024:
Update: A payer intermediary is experiencing issues affecting professional report generation for some claims submitted on Sep. 4, 2024, Sep. 10, 2024, and Sep. 12, 2024.
Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.
Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.
Original message sent Sep. 17, 2024:
A payer intermediary is experiencing issues affecting professional report generation for some claims submitted on Sep. 4, 2024, and Sep. 10, 2024.
Payer impacted:
- CPID 6246 Riverside Medical Clinic
Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.
Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.
REF 793854 10/8/2024
Update: Report Generation Delay for CPIDs 2983 and 4464 SCAN Health Plan
The payer intermediary has been unable to generate and deliver the reports for some claims submitted on Sep. 24, 2024.
Action Required: Please resubmit claims if payment has not been received.
Original message sent Oct. 7, 2024:
A payer intermediary is experiencing issues affecting institutional and professional report generation for some claims submitted Sep. 24, 2024.
Payer impacted:
- CPID 2983 SCAN Health Plan
- CPID 4464 SCAN Health Plan
Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.
Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.
REF 793850 10/8/2024
SFHP1 SAN FRANCISCO HEALTH PLAN - Real Time Payer Transaction
Eligibility Inquiry and Response 270/271.
Effective October 3, 2024, Optum is pleased to announce the availability of Real-time 270/271 transactions for the below payer:
IMN Payer id: SFHP1
Payer Name: SAN FRANCISCO HEALTH PLAN
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. Also, if you have not already done so, all Vendors and Direct Submitters must reenroll for Real-Time transactions to successfully process.
Updated Payer Lists may be obtained from your software vendor or Payer Lists | Change Healthcare.
REF 792952 10/7/2024
Report Generation Delay for CPID 1116 Special Agents Mutual Benefit Association (SAMBA) Teledoc only
A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted since Sept. 23, 2024.
Payer impacted:
- CPID 1116 Special Agents Mutual Benefit Association (SAMBA) Teledoc only
Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.
Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.
REF 793052 10/07/2024
Electronic Routing Change for CPID 5702 Davis Vision
Effective immediately, Optum will be changing electronic claims routing for the following payer:
Payer Name: Davis Vision
Professional CPID: 5702
Current Payer-assigned Payer ID: V0QJA
New Payer-assigned Payer ID: 00157
Claim Surcharge: $0.10
Enrollment Requirements:
Claims:
- Payer enrollment for electronic claims is required.
- Providers currently sending electronic claims through Optum must complete a new enrollment form.
- New providers must complete a new enrollment form.
Report Changes:
You may see some differences in the payer reports you are receiving.
Action Required: Please make the following changes to accommodate the routing change:
- 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.
REF 793201 10/07/2024
00800 NEW YORK BCBS NORTHEASTERN - Real Time Payer Transaction
Eligibility Inquiry and Response 270/271.
Effective October 3rd, 2024, Optum is pleased to announce the availability of Real-time 270/271 transactions for the below payer:
IMN Payer ID: 00800
Payer Name: NEW YORK BLUE CROSS BLUE SHIELD NORTHEASTERN
Action Required by customer:
Please update your system to take advantage of this payer transaction. For assistance with submitting Real-Time transactions, please contact your Practice Management System Vendor or Optum Customer Care Hub ticket https://customercare.changehealthcare.com/public/home.html Also, if you have not already done so, all Vendors and Direct Submitters must reenroll for Real-Time transactions to successfully process.
Updated Payer Lists may be obtained from your software vendor or Payer Lists | Change Healthcare
REF 792951 10/7/2024
Report Generation Delay for CPIDs 2983 and 4464 SCAN Health Plan
A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted Sept. 24, 2024.
Payer impacted:
- CPID 2983 SCAN Health Plan
- CPID 4464 SCAN Health Plan
Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.
Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.
REF 793053 10/7/2024
Edit Master Change for CPIDs 7690 and 7115 Eversana Life Sciences Services LLC
Effective immediately, Optum will be changing edit masters for the following payer:
Payer Name: Eversana Life Sciences Services LLC
Professional CPID: 7115
Current Edit Master: PE_E049
New Edit Master: PE_T007
Institutional CPID: 7690
Current Edit Master: HE9E049
New Edit Master: HE9T007
Payer-assigned Payer ID: 64300
Action Required: Please make the following changes to accommodate the edit master 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.
REF 793252 10/7/2024
Electronic Connection No Longer Available for Southwest Service Administrators
Effective immediately, the payer listed below will no longer be available at Optum for remittance processing.
Assurance EDI:
Payer Name: Southwest Service Administrators
Remittance CPIDs: 1184, 2555
Reason: Payer does not offer an electronic remittance connection.
Action Required: None
Assurance Reimbursement Management:
Payer Name: Southwest Service Administrators
Remittance CPIDs: 1184, 2555
Remittance LOB: K1E
Reason: Payer does not offer an electronic remittance connection.
Action Required: None.
REF 793150 10/07/2024
Report Generation Delay for CPID 7662 Community Care Plan (Medicaid)
A payer intermediary is experiencing issues affecting Institutional report generation for some claims submitted on Sept. 23, 2024.
Payer impacted:
- CPID 7662 Community Care Plan (Medicaid)
The payer intermediary is unable to generate and deliver the reports.
Action Required: Please resubmit claims if payment has not been received from the payer.
REF 793050 10/07/2024
Update: Report Generation Delay for CPID 5440 Fox Valley Medicine
The payer intermediary has been unable to generate and deliver the reports for some claims submitted on Sept. 6, 2024 and Sept. 7, 2024.
Action Required: Please resubmit claims if payment has not been received.
Original notification sent Aug. 27, 2024:
A payer intermediary is experiencing issues affecting professional report generation for some claims submitted since Aug. 16, 2024.
Payer impacted:
- CPID 5440 Fox Valley Medicine
Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.
Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.
REF 793054 10/7/2024
Report Generation Delay for CPID 1737 PodAmerica
A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted on Sept. 23, 2024.
Payer impacted:
- CPID 1737 PodAmerica
Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.
Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.
REF 793051 10/7/2024
Edit Master for CPIDs 9215, 6060 Everpointe, 9777, 8060 University Medical Center, 4253, 2979 Prominence Administrative Services
Effective immediately, Optum will be changing Edit Masters for the following payers:
Payer Name: Everpointe
Professional CPID: 9215
Current Edit Master: PE_T007
New Edit Master: PE_B800
Institutional CPID: 6060
Current Edit Master: HE9T007
New Edit Master: HE9B801
Payer-assigned Payer ID: 32052
Payer Name: University Medical Center
Professional CPID: 9777
Current Edit Master: PE_C054
New Edit Master: PE_B800
Institutional CPID: 8060
Current Edit Master: HE9C054
New Edit Master: HE9B801
Payer-assigned Payer ID: 11149
Payer Name: Prominence Administrative Services
Professional CPID: 4253
Current Edit Master: PE_T007
New Edit Master: PE_B800
Institutional CPID: 2979
Current Edit Master: HE9T007
New Edit Master: HE9B801
Payer-assigned Payer ID: 88022
Action Required: Please make the following changes to accommodate the routing change:
- Revalidate unreleased claims to edit correctly under new edit master.
- Modify any bridge routines based on the edit master.
No Payer Alias changes are required. Payer name(s) and CPID(s) are not changing.
REF 792605 10/4/2024
Claims Delay for Massachusetts Medicaid
This message is intended for Revenue Performance Advisor customers.
Due to a payer system issue, a delay occurred in the transmissions to Massachusetts Medicaid since Aug. 27, 2024.
Payer ID: 12K14 (Institutional) and SKMA0 (Professional)
Optum is working with the payer to resolve this issue. We will notify you as soon as additional information becomes available.
Action Required: Be aware of the transmit delay above.
REF 792351 10/04/2024
Remittance Reactivation for CPIDs 1015, 7838 Aetna Better Health of California
Optum recently restored electronic remittance connectivity for the following payer:
Payer Name: Aetna Better Health of California
Professional CPID: 7838
Institutional CPID: 1015
Industry Payer ID: 128CA
Remittance Enrollment Requirements:
- Payer enrollment for electronic remittance is required:
- Providers currently receiving electronic remittance for this payer do not need to complete a new enrollment form.
- Providers who moved their enrollment to another clearinghouse or have not received remittance will need to re-enroll to receive remittance for this payer from Optum (Change Healthcare).
- New providers must complete a new enrollment form.
Action Required: Please consider the following to allow transactions to process properly due to the above changes:
- Make any necessary system changes.
- When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.
REF 792604 10/04/2024
Electronic Routing Change - SCAN Health Plan
Effective Oct. 4, 2024, Optum will be changing electronic claims routing for the following payer:
New Payer Name: SCAN Health Plan
Professional CPID: 4464
Institutional CPID: 2983
Payer-assigned Payer ID: 72261
Enrollment Requirements:
Claims:
- Payer enrollment for electronic claims is not required.
Report Changes:
You may see some differences in the payer reports you are receiving.
Action Required: Please consider the following to allow transactions to process properly due to the above changes:
- Make any necessary system changes.
- When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.
REF 792800 10/4/2024
Electronic Claims Connection Suspended
Effective immediately, the payer listed below has been temporarily suspended at Optum for claims processing and removed from the payer list.
Payer Name: TDS/ATRIO
CPIDs: 6057, 9211
Payer ID: RP005
Action Required: Please refrain from submitting claims until further notice.
REF 792551 10/4/2024
Update for Paper Claim Payer ID SPRNT
This message is intended for Revenue Performance Advisor (RPA) customers.
Research found that paper-printed claims sent under an unpublished payer ID of SPRNT are being printed under a previous version of the HCFA 1500 form (08/05) since April 2024.
The published payer IDs for commercial paper-printed claims on RPA is either "PAPER" or "PRINT", and those claims are being printed on the correct HCFA form. We advise anyone using SPRNT, to update the payer ID to PAPER or PRINT.
The RPA system has been updated to route SPRNT claims to the current HCFA form, starting Oct. 5, 2024. Any claims previously sent with SPRNT, and not processed by payers due to incorrect form, can be resubmitted.
SPRNT can still be used at this time, but we strongly encourage providers to update the payer ID for paper printed claims to an RPA published payer ID.
Full list of RPA-specific payer IDs for paper-printed claims:
- PAPER – Commercial Professional claims (may convert to EDI, if payer address is on file on RPA) PRINT – Commercial Professional claims
- X4321 – Medicare Professional claims
- X4322 – Medicaid Professional claims
- X4323 – BCBS Professional claims
- PAPER – Commercial Institutional claims (may convert to EDI, if payer address is on file on RPA) PRINT – Commercial Institutional claims
- X4351 – Medicare Institutional claims
- X4352 – Medicaid Institutional claims
- X4353 – BCBS Institutional claims
Submitter Action: For providers using payer ID SPRNT, update the payer ID as noted above and resubmit any claims sent from April 2024 - to date, that have not been processed by the payer.
REF792350 10/4/2024
Update: Report Generation Delay for CPIDs 7543 and 2803 UPMC Health Plan
Update: The payer has been unable to generate and deliver the reports for some claims submitted from Sept. 23, 2024 through Sept. 25, 2024.
Action Required: Please resubmit claims if payment has not been received.
Update sent Sept. 27, 2024:
Update: The payer listed below is experiencing issues affecting Institutional and Professional report generation for some claims submitted since Sept. 23, 2024.
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.
Original notify sent Sept. 26, 2024:
The payer listed below is experiencing issues affecting Professional report generation for some claims submitted since Sept. 23, 2024.
Payer impacted:
- 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.
REF 787204 791050 10/3/2024
Remittance Reactivation
Optum recently restored and re-routed electronic remittance connectivity for the following payers:
Payer Name: Downey Select IPA (AppleCare Medical Management)
Professional CPID: 3071
Institutional CPID: 4152
Industry Payer ID: APP01
Payer Name: St. Joseph Heritage
Professional CPID: 9570
Institutional CPID: 3412
Industry Payer ID: STJOE
Remittance Enrollment Requirements:
- Payer enrollment for electronic remittance is required for all providers.
Action Required: Please consider the following to allow transactions to process properly due to the above changes:
- Make any necessary system changes.
- When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.
REF 790796 10/3/2024
New Electronic Remittance Connections Available
Optum has new electronic remittance connections available:
Exchange
Payer Name: Joplin Claims
Institutional CPID: 1659
Professional CPID: 3255
Payer-assigned Payer ID: 43178
Payer Enrollment Required: Yes
Remittance Fee: N/A
Payer Location: Missouri
Payer Name: New Era Employee Welfare Benefit Plan Trust
Institutional CPID: 9525
Professional CPID: 1115
Payer-assigned Payer ID: 76031
Payer Enrollment Required: Yes
Remittance Fee: N/A
Payer Location: National
Assurance Reimbursement Management:
Payer Name: Joplin Claims
Institutional CPID: 1659
Professional CPID: 3255
Payer-assigned Payer ID: 43178
Line of Business (LOB) Code: N01
Payer Enrollment Required: Yes
Remittance Fee: N/A
Payer Location: Missouri
Payer Name: New Era Employee Welfare Benefit Plan Trust
Institutional CPID: 9525
Professional CPID: 1115
Payer-assigned Payer ID: 76031
Line of Business (LOB) Code: N19
Payer Enrollment Required: Yes
Remittance Fee: N/A
Payer Location: National
Action Required:
- Add the payers to your system to begin using the new payer connection.
- Enrollment forms must be submitted and approved to begin receiving electronic remittance through Optum.
REF 790522 10/2/2024
Optum Payer ID Change Notice
Optum is changing the payer ID for the payer listed below. This change is effective immediately.
Payer Name: Partners Health Management
Old Payer ID: 52613
New Payer ID: 13141
CPIDs: 5682, 6701
Action required: Please adjust your transaction processing to accommodate the updated payer ID.
REF 789397 10/2/2024
Remittance Reactivation for Multiple Payers
Optum recently restored and re-routed electronic remittance connectivity for the following payers:
Payer Name: Medsolutions
Professional CPID: 1825
Institutional CPID: 8973
Industry Payer ID: 62160
Payer Name: Nascentia Health Options
Professional CPID: 6842
Institutional CPID: 7622
Industry Payer ID: 31626
Payer Name: Nascentia Health Plus
Professional CPID: 8780
Institutional CPID: 3086
Industry Payer ID: 45529
Remittance Enrollment Requirements:
- Payer enrollment for electronic remittance is required for all providers.
Action Required: Please consider the following to allow transactions to process properly due to the above changes:
- Make any necessary system changes.
- When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.
REF 790200 10/01/2024
Electronic Claims Connection Suspended
Effective immediately, the payer listed below has been temporarily suspended at Optum for claims processing and removed from the payer list.
Payer Name: CentraCare
CPIDs: 3091, 8715
Payer ID: 66698
Action Required: Please refrain from submitting claims until further notice.
REF 789151 10/1/2024
AgeWell New York Electronic Claims and Remittance Connections No Longer Available
Effective immediately, the payer listed below will no longer be available at Optum for claims or remittance processing.
Payer Name: AgeWell New York
Claim CPIDs: 7702, 9645
Remittance LOB: J35
Reason: Payer no longer in business.
Action Required: None.
REF 789450 10/01/2024
Update: Report Generation Delay for CPID 5432 Johns Hopkins Healthcare / Priority Partners
Update: The payer intermediary has been unable to generate and deliver the reports for some claims submitted on Sept. 16, 2024.
Action Required: Please resubmit claims if payment has not been received.
Original notify sent Sept. 30, 2024 (REF 787400):
A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted on Sept. 16, 2024.
Payer impacted:
- CPID 5432 Johns Hopkins Healthcare / Priority Partners
Optum is working diligently with the payer intermediary to resolve the issue and ensure reports are received.
Action Required: None. Please be aware of delays in the report generation for claims submitted during the time frame above.
REF 788901 10/01/2024
Report Generation Delay for CPIDs 4727 and 1673 Public Employee Health Plan
A payer intermediary experienced issues affecting Professional and Institutional report generation for some claims submitted from Aug. 26, 2024 to Sept. 23, 2024.
Payer impacted:
- CPID 1673 Public Employee Health Plan
- CPID 4727 Public Employee Health Plan
The payer intermediary is unable to generate and deliver the reports.
Action Required: None. Please resubmit claims if payment has not been received.
REF 789300 10/01/2024
United Medical Alliance Electronic Claims Connection No Longer Available - Assurance EDI
This message is intended for Assurance EDI customers.
Effective immediately, the payer listed below will no longer be available at Optum for claims processing.
Payer Name: United Medical Alliance
Claim CPIDs: 1802, 4564
Reason: Payer no longer offers an electronic connection to which Optum can connect.
Action Required: Claims must be submitted to Optum on paper.
REF 787453 10/01/2024
United Medical Alliance Electronic Claims Connection No Longer Available - Assurance Reimbursement Management
This message is intended for Assurance Reimbursement Management customers.
Effective immediately, the payer listed below will no longer be available at Optum for claims processing.
Payer Name: United Medical Alliance
Claim CPIDs: 1802, 4564
Reason: Payer no longer offers an electronic connection to which Optum can connect.
Action Required:
Please be aware the payer alias entries will be removed and claims for this payer must now be submitted on paper. Please make the following changes to accommodate the payer no longer offering an electronic connection.
After the edit release date above, revalidate unreleased claims to edit correctly to send paper claims.
Modify any bridge routines based on Edit Masters for paper claims.
REF 787453 10/01/2024
Electronic Connections No Longer Available
Effective Oct. 1, 2024, the payers listed below will no longer be available at Optum for Claims and Remittance processing.
Payer Name: Bright Healthcare
CPIDs: 6091, 9269
Payer ID: BRGHT
Reason: Payer went out of business
Payer Name: Bright Health – Medicare Advantage
CPIDs: 1078, 8105
Payer ID: BRT01
Reason: Payer went out of business
*Paper claims are no longer accepted.
REF 788451
Older Payer Updates
Click the link below to access payer updates prior to October 1st, 2024.