January 2025

January Payer Processing Issues

Summary

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

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

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

VIEW ALL PAYER LISTS →

Update: Report Generation Delay for CPID 7074 UnitedHealthcare Ohio Medicaid

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

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

Original notify REF 16031610 sent Jan. 31, 2025:
A payer is experiencing issues affecting Institutional report generation for some claims submitted Jan. 24, 2025.

Payer impacted:

CPID 7074 UnitedHealthcare Ohio Medicaid

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09348590.

REF 16031610 1/31/2025 REF 16051758 2/3/2025

Remittance Reactivation for CPIDs 6857, 7638 APS Healthcare

Optum recently restored electronic remittance connectivity for the following payer:

Payer Name: APS Healthcare
Professional CPID: 6857
Institutional CPID: 7638
Industry Payer ID: 66056

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 16036710 1/31/2025

Remittance Reactivation for CPIDs 6857, 7638 APS Healthcare

Optum recently restored electronic remittance connectivity for the following payer:

Payer Name: APS Healthcare
Professional CPID: 6857
Institutional CPID: 7638
Industry Payer ID: 66056
Line of Business (LOB) Code: J3K

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 16036711 1/31/2025

Report Generation Delay for CPID 7074 UnitedHealthcare Ohio Medicaid

A payer is experiencing issues affecting Institutional report generation for some claims submitted on Jan. 24, 2025.

Payer impacted:

CPID 7074 UnitedHealthcare Ohio Medicaid

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09348590.

REF 16031610 1/31/2025

New Electronic Claims Connection Available

Optum has a new electronic claims connection available:

Payer Name: Ambetter of Delaware
Institutional CPID: 8536
Professional CPID: 3235
Payer-assigned Payer ID: 68069
Payer Enrollment Required: No
Secondary Claims Accepted: Yes
Payer Location: Delaware
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 16023493 1/30/2025

Reactivation and Electronic Routing Change for CPIDs 4241 and 6614 Bakersfield Family Medical Center

Effective January 31, 2025, Optum will be reactivating and changing electronic claims routing for the following payer:

Payer Name: Bakersfield Family Medical Center
Professional CPID: 4241
Current Edit Master: PE_O007
New Edit Master: PE_T007
Institutional CPID: 6614
Current Edit Master: HE9O007
New Edit Master: HE9T007
Payer-assigned Payer ID: BKRFM

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.

REF 16021481 1/30/2025

Reactivation and Electronic Routing Change for CPIDs 4241 and 6614 Bakersfield Family Medical Center

Effective January 31, 2025, Optum will be reactivating and changing electronic claims routing for the following payer:

Payer Name: Bakersfield Family Medical Center
Professional CPID: 4241
Institutional CPID: 6614
Payer-assigned Payer ID: BKRFM

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 16021408 1/30/2025

Report Generation Delay for CPIDs 6284 and 5658 Trillium Health Resources

A payer is experiencing issues affecting Professional and Institutional report generation for some claims submitted since Dec. 2, 2024.

Payer impacted:

CPID 6284 Trillium Health Resources
CPID 5658 Trillium Health Resources

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09347156.

REF 16015446 1/30/2025

Electronic Routing Change for CPIDs 3007 and 8255 Britton Benefit Services LLC

Effective January 30, 2025, Optum will be reactivating and changing electronic claims routing for the following payer:

Payer Name: Britton Benefit Services LLC
Professional CPID: 8255
Institutional CPID: 3007
Payer-assigned Payer ID: BBS19

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 16016758 1/30/2025

Electronic Routing Change for CPIDs 3007 and 8255 Britton Benefit Services LLC

Effective January 30, 2025, Optum will be reactivating and changing electronic claims routing for the following payer:

Payer Name: Britton Benefit Services LLC
Professional CPID: 8255
Edit Master: PE_T007
Institutional CPID: 3007
Edit Master: HE9T007
Payer-assigned Payer ID: BBS19

Enrollment Requirements:

Claims:

Payer enrollment for electronic claims is not required.

Report Changes:

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

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

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

REF 16016759 1/30/2025

Report Generation Delay for CPIDs 3658 and 5862 CorrectCare Integrated Health

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

Payer impacted:

CPID 3658 CorrectCare Integrated Health
CPID 5862 CorrectCare Integrated Health

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09347278.

REF 16016460 1/30/2025

Invalid Error Message for CPID 2116 Sanford Health

Due to a payer processing issue, Professional claims for the payer listed below may have received the following invalid error message 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):

A3:21 ACK,RETURND AS UNPRCESSBLE CLM- CLM,ENCNTER BEEN REJECTD AND NOT ENTERD INTO ADJUDICATION SYS.:MISSING OR INVALID INFORMATION
R THE SERVICE FACILITY LOCATION INFORMATION (LOOP 2310C) IS REQUIRED.

This issue began on January 8, 2025 and was resolved by the payer on January 27, 2025.

Payers Affected:

CPIID 2116 Sanford Health

Action Required: Please resubmit any impacted claims.

REF 16017158 1/30/2025

Update: Report Generation Delay for CPID 1209 Regence Group Administrators

Update: The payer intermediary has been unable to generate and deliver the reports for some claims submitted from Jan. 3, 2025-Jan. 13, 2025.

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

Original notify REF 15831431 sent Jan. 15, 2025:
A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted since Jan. 3, 2025.

Payer impacted:

CPID 1209 Regence Group Administrators

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09327438.

REF 16015158 1/30/2025

Report Generation Delay for CPID 2461 Virginia Medicare (Alexandria, Arlington, Fairfax)

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

Payer impacted:

CPID 2461 Virginia Medicare (Alexandria, Arlington, Fairfax)

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09346975.

REF 16014409 1/30/2025

Report Generation Delay for CPID 2464 Maryland Medicare (Montgomery,Prince George)

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

Payer impacted:

CPID 2464 Maryland Medicare (Montgomery,Prince George)

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09346969.

REF 16014408 1/30/2025

Electronic Routing and Payer ID Change for CPIDs 3909 and 1861 Covet Health

Effective January, 30, 2025, Optum will be changing electronic claims routing and Payer ID for the following payer:

Payer Name: Covet Health
Professional CPID: 1861
Edit Master: PE_T007
Institutional CPID: 3909
Edit Master: HE9T007
Previous Payer-assigned Payer ID: 98480
New Payer-assigned Payer ID: IHS21

Providers only need to include the CPID (not Payer ID) in the claim. Optum will manage the Payer ID changes for our customers.

Enrollment Requirements:

Claims:

Payer enrollment for electronic claims is not required.

Report Changes:

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

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

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

REF 16007460 1/29/2025

Electronic Routing and Payer ID Change for CPIDs 3909 and 1861 Covet Health

Effective January, 30, 2025, Optum will be changing electronic claims routing and Payer ID for the following payer:

Payer Name: Covet Health
Professional CPID: 1861
Institutional CPID: 3909
Previous Payer-assigned Payer ID: 98480
New Payer-assigned Payer ID: IHS21

Providers only need to include the CPID (not Payer ID) in the claim. Optum will manage the Payer ID changes for our customers.

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 16007459 1/29/2025

New Electronic Claim Connection Available

Optum has a new electronic claim connection available:

Payer Name: NeueHealth
Institutional CPID: 7035
Professional CPID: 9419
Payer-assigned Payer ID: NEUEH
Payer Enrollment Required: No
Secondary Claims Accepted: Yes
Payer Location: National
Claims Fee: N/A

Action Required:

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

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

REF 16007308 1/29/2025

Report Generation Delay for CPID 2004 Doctors HealthCare Plans

A payer intermediary is experiencing issues affecting Institutional report generation for some claims submitted on Dec. 17, 2024 and Dec. 18, 2024.

Payer impacted:

CPID 2004 Doctors HealthCare Plans

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.

If you have any questions, please contact Customer Support and refer to Case Number 09345214.

REF 16001758 1/29/2025

New Electronic Claims Connections Available

Optum has new electronic claims connections available:

Payer Name: National Association of Letter Carriers
Institutional CPID: 8640
Professional CPID: 7224
Payer-assigned Payer ID: 53011
Payer Enrollment Required: No
Secondary Claims Accepted: Yes
Payer Location: National
Claims Fee: N/A

Action Required:

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

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

REF 16000158 1/29/2025

Payer Change for CPID 4709 Sutter Connect – SIP, SMG, SWMG

Effective immediately, claims currently exchanged with the following payer must use different CPIDs.

Payer Name: Sutter Connect - SIP,SMG,SWMG
Professional CPID: 4709
Professional Edit Master: PE_T007
Payer-assigned Payer ID: 77306

Both Encounters and Fee For Service claims must use the following:

Previous Payer Name: Sutter Connect - SIP,SMG,SWMG encounters
New Payer Name: Sutter Connect - SIP,SMG,SWMG
Professional CPID: 4708
Professional Edit Master: PE_T007
Institutional CPID: 7956
Institutional Edit Master: HE9T007
Payer-assigned Payer ID: 77306

Enrollment Requirements:

Claims:

Payer enrollment for electronic claims is not required.

Action Required: Please make the following updates to accommodate these payer changes:

Modify related Payer Alias names to the new CPIDs.
To access the new enrollment forms, please visit Enrollment Central.

REF 15999109 1/29/2025

Payer Change for CPID 4709 Sutter Connect – SIP, SMG, SWMG

Effective immediately, claims currently exchanged with the following payer must use different CPIDs.

Payer Name: Sutter Connect - SIP,SMG,SWMG
Professional CPID: 4709
Remittance Available: No
Payer-assigned Payer ID: 77306

Both Encounters and Fee For Service claims must use the following:

Previous Payer Name: Sutter Connect - SIP,SMG,SWMG encounters
New Payer Name: Sutter Connect - SIP,SMG,SWMG
Professional CPID: 4708
Institutional CPID: 7956
Remittance Available: No
Payer-assigned Payer ID: 77306
Claim Fee: N/A

Enrollment Requirements:

Claims:

Payer enrollment for electronic claims is not required.

Action Required:

Please be aware of the changes above and make any necessary changes in your system.
To access the new enrollment forms, please visit Enrollment Central.

REF 15999108 1/29/2025

Enrollment Form Change for CPIDs 2415, 5555, 5561 Mississippi Blue Cross Blue Shield, Mississippi Blue Cross Blue Shield State Employees

The following payers have changed their Claims enrollment form:

CPID 2415 / Payer ID SB730 Mississippi Blue Cross Blue Shield
CPID 5555 / Payer ID SB730 Mississippi Blue Cross Blue Shield
CPID 5561 / Payer ID XSHEP Mississippi Blue Cross Blue Shield State Employees

Providers already approved to submit and receive transactions through 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 15995958 1/29/2025

CareFirst BlueCross BlueShield Community Health Plan Maryland Electronic Remittance Connection No Longer Available

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

Payer Name: CareFirst BlueCross BlueShield Community Health Plan Maryland
CPIDs: 6647, 6749
Remittance LOB: J78
Payer-assigned Payer ID: 45281
Reason: Electronic connection not available.

Action Required: None.

REF 15990061 1/28/2025

CareFirst BlueCross BlueShield Community Health Plan Maryland Electronic Remittance Connection No Longer Available

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

Payer Name: CareFirst BlueCross BlueShield Community Health Plan Maryland
Remittance CPIDs: 6647, 6749
Payer-assigned Payer ID: 45281
Reason: Electronic connection not available.

Action Required: None.

REF 15990058 1/28/2025

Electronic Routing Change for CPIDs 6624 and 7102 Scripps Coastal Medical Group

Effective Jan. 29, 2025, Optum is changing electronic claims and remittance routing for the following payer:

Payer Name: Scripps Coastal Medical Group
Professional CPID: 7102
Current Edit Master: PE_O007
New Edit Master: PE_T007
Institutional CPID: 6624
Current Edit Master: HE9O007
New Edit Master: HE9T007
Payer-assigned Payer ID: SHPS1
Line of Business Code (LOB): J8A

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 Change Healthcare 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 names and CPIDs are not changing.
When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.

REF 15985665 1/28/2025

Electronic Routing Change for CPIDs 6624 and 7102 Scripps Coastal Medical Group

Effective Jan. 29, 2025, Optum is changing electronic claims and remittance routing for the following payer:

Payer Name: Scripps Coastal Medical Group
Professional CPID: 7102
Institutional CPID: 6624
Payer-assigned Payer ID: SHPS1

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 Change Healthcare 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 15985664 1/28/2025

Update: Report Generation Delay for CPID 1116 Special Agents Mutual Benefit Association (SAMBA) Teledoc only

Update: The payer intermediary has been unable to generate and deliver the reports for some claims submitted Sept. 24, 2024-Jan. 8, 2025.

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

Original notify REF 793052 sent Oct. 7, 2024:

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.

If you have any questions, please contact Customer Support and refer to Case Number 09118866.

REF 15983610 1/28/2025

Report Generation Delay for CPID 1513 Minnesota Blue Cross Blue Shield

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

Payer impacted:

CPID 1513 Minnesota Blue Cross Blue Shield

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09343350.

REF 15983608 1/28/2025

Report Generation Delay for CPID 1120 Community Eye Care

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

If you have any questions, please contact Customer Support and refer to Case Number 09343245.

REF 15982808 1/28/2025

Electronic Routing Change for CPIDs 7133 and 8699 Alamitos IPA

Effective Jan. 28, 2025, Optum is changing electronic claims routing for the following payer:

Payer Name: Alamitos IPA
Professional CPID: 7133
Current Edit Master: PE_T007
Institutional CPID: 8699
Current Edit Master: HE9O007
New Edit Master: HE9T007
Payer-assigned Payer ID: AIPAZ

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 15984509 1/28/2025

Electronic Routing Change for CPIDs 7133 and 8699 Alamitos IPA

Effective Jan. 28, 2025, Optum is changing electronic claims routing for the following payer:

Payer Name: Alamitos IPA
Professional CPID: 7133
Institutional CPID: 8699
Payer-assigned Payer ID: AIPAZ
Claims Fee: $0.10

Enrollment Requirements:
Claims:

Payer enrollment for electronic claims is not required.

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

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

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

REF 15984508 1/28/2025

Electronic Routing Change for CPIDs 2531 and 5404 Insight Benefit Administrators

Effective January 28, 2025, Optum will be changing electronic claims routing for the following payer:

Payer Name: Insight Benefit Administrators
Professional CPID: 5404
Edit Master: PE_T007
Institutional CPID: 2531
Edit Master: HE9T007
Payer-assigned Payer ID: 38254

Enrollment Requirements:

Claims:

Payer enrollment for electronic claims is not required.

Report Changes:

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

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

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

REF 15976209 1/28/2025

Electronic Routing Change for CPIDs 2531 and 5404 Insight Benefit Administrators

Effective January 28, 2025, Optum will be changing electronic claims routing for the following payer:

Payer Name: Insight Benefit Administrators
Professional CPID: 5404
Institutional CPID: 2531
Payer-assigned Payer ID: 38254

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 15976208 1/28/2025

New Electronic Claims Connections Available

Optum has new electronic claims connections available:

Payer Name: Continuum Health Solutions Worker Comp
Institutional CPID: 7013
Professional CPID: 9295
Payer-assigned Payer ID: 59557
Payer Enrollment Required: No
Secondary Claims Accepted: Yes
Payer Location: National
Claims Fee: N/A

Action Required:

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

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

REF 15981658 1/28/2025

New Electronic Claims Connections Available

Optum has new electronic claims connections available:

Payer Name: U.S. Networks and Administrative Services

Institutional CPID: 4035

Professional CPID: 8763

Payer-assigned Payer ID: USN01

Payer Enrollment Required: No

Secondary Claims Accepted: Yes

Payer Location: National

Claims Fee: N/A

Action Required:

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

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 15976508 1/28/2025

Remittance Reactivation for CPIDs 8643, 7226 Sharp Health Plan

This message is intended for Assurance EDI customers.

Optum recently restored electronic remittance connectivity for the following payer:

Payer Name: Sharp Health Plan

Professional CPID: 7226

Institutional CPID: 8643

Industry Payer ID: SHP01

Remittance Enrollment Requirements:

Payer enrollment for electronic remittance is required:
- Providers currently receiving electronic remittance for this payer will need to complete a new enrollment form.
- Providers who moved their enrollment to another clearinghouse or have not received remittance will need to re-enroll to receive remittance for this payer from Optum (Change Healthcare).
- New providers must complete a new enrollment form.

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

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

REF 15976210 1/28/2025

Electronic Claims Connection Reactivated

Effective immediately, the payer listed below has been reactivated at Optum for claims processing and will be added back to the payer list. The Trading Partner confirmed there was an issue with this payer which caused invalid rejections and has now been corrected.

Rejected claims received from the date the invalid rejections started, through the date the CPID was suspended: Nov. 15, 2024 – Dec. 3, 2024, will be resubmitted by Optum.

Payer Name: Peak Pace Solutions

CPIDs: 5663

Payer ID: 27034

Action Required: Providers will need to submit all other claims within this timeframe that were not originally submitted and rejected during the period of time that the connection was suspended.

REF 15975758 1/28/2025

New Electronic Claims Connections Available

Payer Name: Provider Partners Health Plan of Indiana

Institutional CPID: 8533

Professional CPID: 3223

Payer-assigned Payer ID: 31407

Payer Enrollment Required: No

Secondary Claims Accepted: No

Payer Location: Indiana

Claims Fee: N/A

Action Required:

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

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

REF 15967858 1/28/2025

HealthSCOPE Benefits Electronic Claims and Remittance Connections No Longer Available

This message is intended for Assurance EDI customers.

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

Payer Name: HealthSCOPE Benefits
Claim and Remittance CPIDs: 4598, 8413
Payer-assigned Payer ID: 71063
Reason: Payer no longer in business.

Payer will no longer accept paper claims.

Action Required: None

REF15970558 1/27/2025

New Electronic Claims Connections Available

This message is intended for Assurance Reimbursement Management and Assurance EDI customers.

Optum has new electronic claims connections available:

Payer Name: Sidecare Health
Institutional CPID: 8535
Professional CPID: 2139
Payer-assigned Payer ID: SDCAR
Payer Enrollment Required: No
Secondary Claims Accepted: No
Payer Locations: California, Alabama, Arizona, Florida, Georgia, Indiana, Kentucky, Maryland, Mississippi, North Carolina, Ohi, Oklahoma, South Carolina, Tennessee, Texas
Claims Fee: N/A

Action Required:

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

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

REF 15963213 1/27/2025

Electronic Routing Change for CPIDs 2966 and 3847 Shasta Administrative Services

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

Payer Name: Shasta Administrative Services
Professional CPID: 3847
Current Edit Master: PE_T007
New Edit Master: PE_B800
Institutional CPID: 2966
Current Edit Master: HE9T007
New Edit Master: HE9B801
Payer-assigned Payer ID: 75280

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 15967016 1/27/2025

Electronic routing change for CPIDs 4593 and 6465 UnitedHealthcare Student Resources - Assurance EDI

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

Payer Name: UnitedHealthcare Student Resources

Professional CPID: 6465

Institutional CPID: 4593

Payer-assigned Payer ID: 74227

Enrollment requirements:

Remittance:

Payer enrollment for electronic remittance is required.
- Providers currently receiving electronic remittance through Change Healthcare do not need to complete a new enrollment form.
- Providers currently not receiving electronic remittance through Change Healthcare must complete a new enrollment form.
- New providers must complete a new enrollment form.

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

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

REF 15963212 1/27/2025

New Payer Name

This message is intended for Assurance EDI customers.

Previous Payer Name: Midlands Choice

New Payer Name: Point C

Professional CPID: 1742

Institutional CPID: 6588

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

REF 15959160 1/27/2025

Remittance Reactivation for CPIDs 4553, 1236 IU Health Plans

This message is intended for Assurance Reimbursement Management customers.

Optum recently restored electronic remittance connectivity for the following payer:

Payer Name: IU Health Plans
Professional CPID: 1236
Institutional CPID: 4553
Industry Payer ID: 26212
Line of Business (LOB) Code: U69

Remittance Enrollment Requirements:

Payer enrollment for electronic remittance is required:
- Providers currently receiving electronic remittance for this payer will need to complete a new enrollment form.
- Providers who moved their enrollment to another clearinghouse or have not received remittance will need to re-enroll to receive remittance for this payer from Optum (Change Healthcare).
- New providers must complete a new enrollment form.

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

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

REF 15948559 1/24/2024

Remittance Reactivation for CPIDs 4553, 1236 IU Health Plans

This message is intended for Assurance EDI customers.

Optum recently restored electronic remittance connectivity for the following payer:

Payer Name: IU Health Plans
Professional CPID: 1236
Institutional CPID: 4553
Industry Payer ID: 26212

Remittance Enrollment Requirements:

Payer enrollment for electronic remittance is required:
- Providers currently receiving electronic remittance for this payer will need to complete a new enrollment form.
- Providers who moved their enrollment to another clearinghouse or have not received remittance will need to re-enroll to receive remittance for this payer from Optum (Change Healthcare).
- New providers must complete a new enrollment form.

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

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

REF 15952308 1/24/2025

Payer Change for CPIDs 2106, 8963 AmeriHealth Caritas Florida

This message is intended for Assurance Reimbursement Management customers.

Please be advised that effective Feb. 1, 2025, AmeriHealth Caritas Florida will no longer provide Statewide Medicaid Managed Care (SMMC) program coverage for Medicaid enrollees in Indian River, Martin, Miami-Dade, Monroe, Okeechobee, Palm Beach, and St. Lucie counties. The last date of coverage for Medicaid enrollees will be Jan. 31, 2025.

Payer Name: AmeriHealth Caritas Florida
Professional CPID: 2106
Professional Edit Master: PE_E049
Institutional CPID: 8963
Institutional Edit Master: HE9E049
Payer-assigned Payer ID: 77003

Claim Processing:
• Claims containing only Dates of Service on or after 2/1/25 will be rejected.
• Claims containing at least one Service Line Date on or before 1/31/25 will be accepted and forwarded to payer for processing.
• Claims containing a date range on or before 1/31/25 through 2/1/25 or after will be accepted and forwarded to payer for processing.

The Agency for Health Care Administration (AHCA) has information on the SMMC program available online at: https://ahca.myflorida.com/medicaid/statewide-medicaid-managed-care. This website provides information about the SMMC program, the plans that are available by region and information on provider training, upcoming webinars, and plan provider relations contacts. Providers may call the Florida Statewide Medicaid Managed Care toll-free helpline at 1-877-711-3662 with questions or concerns.

Action Required: Please review changes and make necessary updates for claims processing based on the member’s ID card.

REF 15943908 1/24/2025

New Electronic Real Time Connections Available on RPA

This message is intended for Revenue Performance Advisor (RPA) customers.

Eligibility transactions have recently been added for the following payers:

46045 – Avera Health Plans

55413 – Ucare Individual and Family Plans

GAIMS – Great American Medicare Supplement

RP128 – Promise Health Plan

RP129 – Wellstar Health Plan

Claim Status Inquiry transactions have recently been added for the following payers:

CGIMS – Continental General Insurance (Medicare Supplement)

CRLMS – Central Reserve Life Medicare Supplement

GAIMS – Great American Medicare Supplement

SKAL0 – University of Michigan Health Plan

SKMN0 – Minnesota Medicaid

REF 15952308 1/24/2025

New Electronic Remittance Advice (ERA) Connections Available on RPA

Electronic Remittance (ERA) transactions have recently been added for the following payers:

26080 – MemorialCare Medical Foundation
BHOMD – Carelon Behavioral Health Maryland
JVHJB – JVHL HAP (CareSource)
JVHJG – JVHL - Health Alliance Plan (Capitated Contracts)
JVHJH – JVHL - Health Alliance Plan (Fee for Service)
JVHJQ – JVHL - Blue Care Network (Reimbursable Labs)
JVHJR – JVHL - United Healthcare Community Plan (GLHP)
JVHJW – JVHL - Community Care Associates (Healthchoice)
JVHJZ – JVHL - McLaren Health Plan
JVHJ5 – JVHL - United Healthcare (Non-Golden Rule)
JVHKQ – JVHL - CIGNA (Health Partners)
JVHKR – JVHL - United Healthcare (Golden Rule)
JVHK7 – JVHL - McLaren Health Plan
JVHMB – JVHL - Genesee County Health Plan
JVHMD – JVHL - AmeriHealth Caritas VIP Care Plus
JVHMJ – JVHL - Blue Care Network (Critical Access/Small Volume)
JVHMN – JVHL - Physicians Health Plan
RP107 – JVHL - VA Community Care Network
RP108 – JVHL - Provider Network of America

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

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

REF 15950135 1/24/2025

New electronic claims connections available

Optum has new electronic claims connections available:

Payer Name: Healthy Blue Kansas

Institutional CPID: 8514

Professional CPID: 3224

Payer-assigned Payer ID: 00047

Payer Enrollment Required: No

Secondary Claims Accepted: No

Payer Location: Kansas

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 15948959 1/24/2025

New electronic claims connections available

Optum has new electronic claims connections available:

Payer Name: Community Care Associates

Institutional CPID: 8525

Payer-assigned Payer ID: 17902

Payer Enrollment Required: No

Secondary Claims Accepted: No

Payer Location: Michigan

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 15945808 1/24/2025

Reactivation for CPIDs 7297, 9620 MemorialCare Select Health Plan

This message is intended for Assurance Reimbursement Management customers.

Optum recently restored electronic remittance connectivity for the following payer:

Payer Name: MemorialCare Select Health Plan

Professional CPID: 7297

Institutional CPID: 9620

Industry Payer ID: 46187

Line of Business (LOB) Code: J4P

Remittance Enrollment Requirements:

Payer enrollment for electronic remittance is required:
- Providers who moved their enrollment to another clearinghouse or have not received remittance will need to re-enroll to receive remittance for this payer from Optum (Change Healthcare).
- New providers must complete a new enrollment form.

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

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

REF 15944980 1/24/2025

Reactivation for CPIDs 7297, 9620 MemorialCare Select Health Plan

This message is intended for Assurance EDI customers.

Optum recently restored electronic remittance connectivity for the following payer:

Payer Name: MemorialCare Select Health Plan

Professional CPID: 7297

Institutional CPID: 9620

Industry Payer ID: 46187

Remittance Enrollment Requirements:

Payer enrollment for electronic remittance is required:
- Providers who moved their enrollment to another clearinghouse or have not received remittance will need to re-enroll to receive remittance for this payer from Optum (Change Healthcare).
- New providers must complete a new enrollment form.

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

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

REF 15944979 1/24/2025

Payer Change for CPIDs 2106, 8963 AmeriHealth Caritas Florida

This message is intended for Assurance EDI customers.

Payer Name: AmeriHealth Caritas Florida

Professional CPID: 2106

Institutional CPID: 8963

Payer-assigned Payer ID: 77003

Claim Processing:

Claims containing only Dates of Service on or after Feb. 1, 2025 will be rejected.
Claims containing at least one Service Line Date on or before Jan. 31, 2025, will be accepted and forwarded to payer for processing.
Claims containing a date range on or before Jan. 31, 2025, through Feb. 1, 2025 or after will be accepted and forwarded to payer for processing.

Action Required: Please review changes and make necessary updates for claims processing based on the member’s ID card.

REF 15943909 1/24/2025

Report generation delay for CPIDs 1913 and 2287 Medicare Plus Blue of MI (MAP)

A payer intermediary is experiencing issues affecting institutional and professional report generation for some claims submitted since Jan. 14, 2025.

Payer impacted:

CPID 1913 Medicare Plus Blue of MI (MAP)
CPID 2287 Medicare Plus Blue of MI (MAP)

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

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

If you have any questions, please contact customer support and refer to Case Number 09339386.

REF 15942309 1/24/2025

Report Generation Delay for CPID 5428 QualChoice of Arkansas

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted on Jan. 16, 2025.

Payer impacted:

CPID 5428 QualChoice of Arkansas

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09339452.

REF 15943158 1/24/2025

999 Payer Batch Rejections for CPID 8551 Wellcare Health Plans

Institutional claims transmitted to the payer listed below from Optum on Jan. 23, 2025, were not processed by the payer due to a 999 Batch Rejection.

CPID 8551 Wellcare Health Plans

A resolution has been implemented and the claims were retransmitted to the payer on Jan. 24, 2025.

Action Required: None.

If you have any questions, please contact Customer Support and refer to Case Number 09339314.

REF 15942308 1/24/2025

Processing Issue for Electronic Remittance Advice (ERA) for CPID 3507 Ohio Medicare

Due to a payer processing issue, there has been a processing issue for Institutional Electronic Remittance Advice (ERA) for the following payers for check dates of January 3, 2025 through January 8, 2025.

CPID 3507 Ohio Medicare

This could result in:

Discrepancies between the deposit amount and the ERA amount

Additional updates will be forwarded as more information becomes available.

Action Required: Please be aware of a processing issue for ERA for the check dates above.

If you have any questions, feel free to contact your Customer Support Team and refer to Case Number INC-000002181.

REF 15933158 1/23/2025

Payer Deactivation Notice - Cofinity - Group Resources

Effective immediately, Institutional and Professional Claims for the following payer has been deactivated on the Revenue Performance Advisor system:

Payer Name: Cofinity - Group Resources
RPA Payer ID: 42049
Reason: Payer no longer contracted.

Action Required:

Please discontinue use of the above Payer ID. Providers should review the patient's current insurance ID card for claim filing information.

REF 15933108 1/23/2025

Electronic Routing Reactivation and Change for CPIDs 3070 and 8480 Northwest Community Health Partners

Effective January 24, 2025, Optum will be reactivating and changing electronic claims routing for the following payer:

Payer Name: Northwest Community Health Partners
Professional CPID: 8480
Current Edit Master: PE_B800
New Edit Master: PE_T007
Institutional CPID: 3070
Current Edit Master: HE9B801
New Edit Master: HE9T007
Payer-assigned Payer ID: NWCHP

Enrollment Requirements:

Claims:

Payer enrollment for electronic clams 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(s) and CPID(s) are not changing.
When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.

REF 15929109 1/23/2025

Electronic Routing Reactivation and Change for CPIDs 3070 and 8480 Northwest Community Health Partners

Effective January 24, 2025, Optum will be reactivating and changing electronic claims routing for the following payer:

Payer Name: Northwest Community Health Partners
Professional CPID: 8480
Institutional CPID: 3070
Payer-assigned Payer ID: NWCHP
Claims Fee: $0.10

Enrollment Requirements:

Claims:

Payer enrollment for electronic claims is not required.

Report Changes:

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

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

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

REF 15929108 1/23/2025

New Electronic Remittance Connections Available

Optum has new electronic remittance connections available:

Payer Name: Pace Central Iowa

Institutional CPID: 2527

Professional CPID: 1171

Payer-assigned Payer ID: 72436

Line of Business (LOB) Code: K4T

Payer Enrollment Required: Yes

Remittance Fee: N/A

Payer Location: Iowa

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 15921459 1/23/2025

New Electronic Remittance Connections Available

Optum has new electronic remittance connections available:

Payer Name: Pace Central Iowa

Institutional CPID: 2527

Professional CPID: 1171

Payer-assigned Payer ID: 72436

Payer Enrollment Required: Yes

Remittance Fee: N/A

Payer Location: Iowa

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 15921458 1/23/2025

Resolved: Assurance Reimbursement Management Performance Issue

This message is intended for Assurance Reimbursement Management customers.

Resolved: The issue has been resolved. All affected attachments have been updated and sent.

Action Required: none

Original Message sent Jan. 20, 2025:

Assurance Attach Assist is experiencing an issue with intermittent performance.

This may result in:

Missing PWK information returning to claim
Claims not releasing

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

We apologize for any inconvenience.

Action Required: None.

REF 15904858 1/22/2025

Highmark BCBS DE Health Options electronic remittance connection no longer available

Effective immediately, the payer listed below is currently not available at Optum for remittance processing.

Payer Name: Highmark BCBS DE Health Options
Claim CPIDs: 7693, 7148
Remittance LOB: J1V
Payer-assigned Payer ID: 47181
Reason: The electronic remittance connection is not yet available. Remit was inadvertently processing out under payer ID 54771 which is associated with the Pennsylvania Highmark Blue Cross Blue Shield plans.

Providers that were actively receiving remit for CPIDs 7693, 7148 Highmark BCBS DE Health Options will need to re-enroll for one of the following CPIDs if not already enrolled.

CPID 2413 Pennsylvania Highmark Blue Cross Blue Shield
- Payer-assigned Payer ID: 54771
- Remittance LOB: S17
CPID 3587 Pennsylvania Highmark Blue Cross Blue Shield Central
- Payer-assigned Payer ID: 54771C
- Remittance LOB: X17
CPID 3619 Pennsylvania Highmark Blue Cross Blue Shield Southeastern
- Payer-assigned Payer ID: 54771S
- Remittance LOB: X17
CPID 2534 Pennsylvania Highmark Blue Cross Blue Shield Western
- Payer-assigned Payer ID: 54771W
- Remittance LOB: X17

Action Required: Re-enroll if applicable. Please watch for further notifications on the availability of remittance for payer ID 47181.

REF 15916359 1/22/2025

Highmark BCBS DE Health Options electronic remittance connection no longer available

Effective immediately, the payer listed below is currently not available at Optum for remittance processing.

Payer Name: Highmark BCBS DE Health Options
Remittance CPIDs: 7693, 7148
Payer-assigned Payer ID: 47181
Reason: The electronic remittance connection is not yet available. Remit was inadvertently processing out under payer ID 54771 which is associated with the Pennsylvania Highmark Blue Cross Blue Shield plans.

Providers that were actively receiving remit for CPIDs 7693, 7148 Highmark BCBS DE Health Options will need to re-enroll for one of the following CPIDs if not already enrolled.

CPID 2413 Pennsylvania Highmark Blue Cross Blue Shield
- Payer-assigned Payer ID: 54771
CPID 3587 Pennsylvania Highmark Blue Cross Blue Shield Central
- Payer-assigned Payer ID: 54771C
CPID 3619 Pennsylvania Highmark Blue Cross Blue Shield Southeastern
- Payer-assigned Payer ID: 54771S
CPID 2534 Pennsylvania Highmark Blue Cross Blue Shield Western
- Payer-assigned Payer ID: 54771W

Action Required: Re-enroll if applicable. Please watch for further notifications on the availability of remittance for payer ID 47181.

REF 15916358 1/22/2025

Payer Processing Issue for multiple CPIDs

Due to a payer intermediary processing issue, some Professional claims transmitted to the payers listed below Jan. 21, 2025, were not processed by the payers.

Payers impacted:

8454 Align Senior Care of Michigan
4101 AllCare Advantage
2113 Allcare Health Plan
1764 Ambetter From Absolute Total Care
1765 Ambetter From Louisiana Healthcare Connections
9278 Ambetter from Nebraska Total Care
9431 Ambetter from WellCare of Kentucky
9433 Ambetter of Oklahoma
9429 American Health Advantage of Idaho & Utah
9142 American Health Advantage of Mississippi
9218 American Health Advantage of Tennessee
4468 Americas Choice Healthplan
1741 Amerigroup
4437 Anthem Blue Cross Blue Shield New York
8749 Anthem MaineHealth
6220 Arizona Priority Care Plus
7272 Axminster Medical Group
3845 Banner Health Network
1407 Blue Cross Blue Shield of Georgia
1169 Blue Cross Blue Shield of Western New York Medicaid/CHP
1243 Blue Cross Community Centennial
1167 Blue Cross Medicare Advantage PPO/HMO
6165 Bridgeview
4246 Capital Health Plan
2810 Capitol Administrators
8146 Care N Care Insurance Co.
9759 Care1st Health Plan of Arizona Medicaid DOS before 12/01/2022
2830 CarePlus Health Plans
9226 CareSource PASSE of Arkansas
1194 CareSource of Georgia
7143 CareSource of Indiana
3826 CareSource of Ohio
4743 Carelon Behavioral Health
2164 Carelon Behavioral Health Maryland
6127 Carelon Behavioral Health, MBHP
3293 Carelon Health
6777 Centers Plan for Healthy Living
9765 Central Valley Medical Providers
8123 Clear Health Alliance
1415 Colorado Anthem Blue Cross Blue Shield
7416 Colorado Anthem Blue Cross Blue Shield HMO
7763 Columbine Health Plan
6778 Common Ground Healthcare Cooperative
8834 Commonwealth Care Alliance DOS after 3/31/2023
8477 Community Care Plan
2160 Community Care Plan (Commercial)
6865 Community Care Plan (Medicaid)
1420 Connecticut Anthem Blue Cross Blue Shield
3420 Connecticut Medicare Blue (Risk)
6795 Contra Costa Health Plan
7738 CountyCare Health Plan
9747 Delaware First Health
2433 Denver Health and Hospital Authority
8135 Doctors HealthCare Plans
1733 Doctors Professional Services Consultants (DPSC)
1119 Easy Choice Health Plan of California
9745 El Paso Health Advantage Dual SNP
4289 El Paso Health-CHIP
5483 Employee Benefit Management Services (EBMS)
1834 Employee Plans
1795 Envolve Benefit Options
5238 Evolent Specialty Cardiology
7121 Evolent Specialty Oncology
3792 Fidelis Care
2875 First Health Network (Coventry Health Care National Network)
7435 FirstCare Health Plans
1414 Florida Blue Cross Blue Shield
3417 Florida Blue Cross Blue Shield Health Options HMO
9417 Florida Complete Care
2150 Florida Health Care Plans
5440 Fox Valley Medicine
8189 Gemcare IPA
2720 GlobalCare
9766 Gold Kidney Health Plan
1772 HAP CareSource
1797 HAP CareSource Michigan Dual Medicare/Medicaid
1723 HealthCare Partners IPA
4448 HealthLink PPO
5243 Healthcare Management Administrators
7760 Healthy Blue Louisiana
8867 Healthy Blue Missouri
9133 Healthy Blue North Carolina
7715 Hopkins Health Advantage
6259 Humana - CareSource of Kentucky
3757 IMAGINE360 ADMINISTRATORS (GPA)
5479 IU Health Plan Medicare Advantage
7426 Idaho Regence Blue Shield
1405 Illinois Blue Cross Blue Shield
5865 Indian Health Services
1412 Indiana Anthem Blue Cross Blue Shield
4116 IntegraNet Health
8814 Integrated Homecare Services
1404 Iowa Wellmark Blue Cross Blue Shield
6733 Iowa Wellmark Blue Cross Blue Shield Crossover
5432 Johns Hopkins Healthcare / Priority Partners
7782 Kansas Health Advantage
2421 Kentucky Anthem Blue Cross Blue Shield
9412 Leon Health Plans
6273 Lifepath Hospice
8723 MN BCBS Health Care Programs Non Emergent Transportation
7446 Maine Anthem Blue Cross Blue Shield
8812 Maryland Physicians Care
8860 Medica Government Programs
7859 Medica Health Plan Solutions
6799 Medica Individual and Family (IFB)
2287 Medicare Plus Blue of MI(MAP)
3475 Memorial Hermann Health Solutions
9102 Meridian Medicare Medicaid Plan
9118 MeridianComplete Michigan
2426 Michigan Blue Care Network
1421 Michigan Blue Cross Blue Shield
1402 Minnesota Blue Cross Blue Shield
1410 Minnesota Blue Cross Blue Shield CC Systems
7892 Minnesota Blue Cross Blue Shield Health Care Programs
1408 Missouri Anthem Blue Cross Blue Shield
7450 Montana Blue Cross Blue Shield
7496 Nevada Anthem Blue Cross Blue Shield
7422 New Hampshire Anthem Blue Cross Blue Shield
7403 New Mexico Blue Cross Blue Shield
8864 NextBlue of North Dakota
2411 North Dakota Blue Cross Blue Shield
2418 Ohio Anthem 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
7168 Premier Healthcare Exchange (PHX)
4252 Presbyterian Salud
8468 Procare Advantage of TX
4253 Prominence Administrative Services
7281 PruittHealth Premier Medicare Advantage
5428 QualChoice of Arkansas
7264 Quartz
1209 Regence Group Administrators
3257 ResourceOne Administrators
6423 RevClaims
4464 SCAN Health Plan
8708 SOMOS Anthem
8816 SOMOS Emblem
2254 Scott & White Health Plan
9438 Shared Health Mississippi
7225 Sharp Community Medical Group
8124 Simply Healthcare Plans, Inc.
1740 Sonder Health Plans
2490 South Dakota Blue Cross Blue Shield
8134 Summit Community Care
6195 Superior Vision Services
1406 Texas Blue Cross Blue Shield
1729 Texas Childrens Health Plan (CHIP)
2483 Texas Childrens Health Plan (STAR Medicaid)
4278 The Boon Group
8473 Unicare
2412 Utah Regence Blue Cross Blue Shield
2788 Utah Regence Blue Cross Blue Shield Federal Employee Program
4258 VNS Health
7493 Vermont Blue Cross Blue Shield
1413 Virginia Anthem Blue Cross Blue Shield
7451 Washington Regence Blue Shield
1844 Wellcare Health Plans
9430 Wellcare by Allwell of Oklahoma
1775 Wellpoint
1401 Wisconsin Anthem Blue Cross Blue Shield
7489 Wyoming Blue Cross Blue Shield
6731 ZELIS

A resolution has been implemented and the claims were retransmitted to the payer intermediary Jan. 22, 2025.

This delay affected claims released to Optum Jan. 21, 2025, 2:00 p.m.-6:00 p.m. CT.

Action Required: Be aware of the processing issue above.

If you have any questions, please contact Customer Support and refer to Case Number 09334953.

REF 15914408 1/22/2025

Payer Name Change from Flume Health, Inc to Vitori Health

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

Previous Payer Name: FLUME HEALTH, INC
New Payer Name: VITORI HEALTH
Professional CPID: 3024
Institutional CPID: 8273
IMN Real Time Payer ID: FH105
Real Time Exchange Payer ID: FLMHI
IEDI Real Time Payer ID: FH105

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

REF 15915608 1/22/2025

Physicians Care Network/The Polyclinic Electronic Claims Connection No Longer Available

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

Payer Name: Physicians Care Network/The Polyclinic

Claim CPIDs: 4698, 6224

Payer-assigned Payer ID: PCN12

Reason: This connection is for claims with DOS <= Dec. 31, 2020. Claims with DOS >= Jan. 1, 2021, should be sent to payer ID LIFE1, CPIDs 4608 & 6101, Optum Medical Network.

Action Required: None.

REF 15912359 1/22/2025

Payer change for CPID 1292 OSU SoonerCare Secondary - Assurance EDI

Effective immediately, claims currently exchanged with the following payer must use different CPIDs.

Payer Name: OSU SoonerCare Secondary

Professional CPID: 1292

Remittance Available: No

Payer-assigned Payer ID: 7661S

Claims sent on or after Jan. 22, 2025, must begin using the following:

Payer Name: OSU SoonerCare

Professional CPID: 6763

Remittance Available: No

Payer-assigned Payer ID: 76619

Claim Fee: $0.10

Enrollment Requirements:

Payer enrollment for electronic claims is required.
- Providers currently sending electronic claims through Optum for CPID 6763 OSU SoonerCare do not need to 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 15902784 1/22/2025

Payer change for CPID 1292 OSU SoonerCare secondary - Assurance Reimbursement Management

Effective immediately, claims currently exchanged with the following payer must use different CPIDs.

Payer Name: OSU SoonerCare secondary

Professional CPID: 1292

Professional Edit Master: PE_T007

Payer-assigned Payer ID: 7661S

Line of Business Code (LOB): N/A

Claims sent on or after Jan. 22, 2025, must begin using the following:

Payer Name: OSU SoonerCare

Professional CPID: 6763

Professional Edit Master: PE_T007

Payer-assigned Payer ID: 76619

Line of Business Code (LOB): N/A

Enrollment Requirements:

Payer enrollment for electronic claims is required.
- Providers currently sending electronic claims through Optum for CPID 6763 OSU SoonerCare do not need to 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:

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 15902785 1/22/2025

Report generation delay for CPID 1283 HealthScope Benefits

A payer intermediary is experiencing issues affecting professional report generation for some claims submitted since Jan. 9, 2025.

Payer impacted:

CPID 1283 HealthScope Benefits

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09335162.

REF 15904508 1/22/2025

Report Generation Delay for CPID 3741 and 2532 Upper Peninsula Health Plan

A payer intermediary is experiencing issues affecting Professional and Institutional report generation for some claims submitted on Dec. 29, 2024 and Dec. 30, 2024.

Payer impacted:

CPID 2532 Upper Peninsula Health Plan
CPID 3741 Upper Peninsula 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.

If you have any questions, please contact Customer Support and refer to Case Number 09320644.

REF 15904509 1/22/2025

New Payer Availability

Optum Intelligent EDI is pleased to announce new claim payer connectivity for the following payer and transaction types. Please incorporate claims into existing files you submit to Optum today.

CONTINUUM HEALTH SOLUTIONS WORKER COMP (Payer ID 59557)

Transactions: 837 Professional and Institutional

Effective Date: January 22, 2025

Please direct any questions to the Support Team at 1-866-OptumGo. Please do not reply to this email directly.

REF 15901008 1/22/2025

New Electronic Remittance Connections Available

This message is intended for Assurance EDI customers.

Optum has new electronic remittance connections available:

Payer Name: Meridian PACE Solutions
Institutional CPID: 8077
Professional CPID: 2867
Payer-assigned Payer ID: MPSAB
Payer Enrollment Required: Yes
Remittance Fee: N/A
Payer Location: National

REF 15894417 1/21/2025

New Electronic Remittance Connections Available

This message is intended for Assurance EDI and Assurance Reimbursement Management customers.

Optum has new electronic remittance connections available:

Payer Name: Cinqcare Connect
Professional CPID: 2879
Payer-assigned Payer ID: CINQ1
Line of Business (LOB) Code: N49
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 15886362 1/21/2025

Electronic Routing Change for CPIDs 7264 and 8677 Quartz ASO

This message is intended for Assurance Reimbursement Management customers.

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

Old Payer Name: Quartz ASO
New Payer Name: Quartz
Professional CPID: 7264
Institutional CPID: 8677
Line of Business (LOB) Code: U51
Payer-assigned Payer ID: 39180

Enrollment Requirements:

Remittance:

Payer enrollment for electronic remittance is required.
- Providers currently receiving electronic remittance through Change Healthcare must complete a new enrollment form.
- New providers must complete a new enrollment form.

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

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

REF 15885162 1/21/2025

Electronic Routing Change for CPIDs 7264 and 8677 Quartz ASO

This message is intended for Assurance EDI customers.

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

Old Payer Name: Quartz ASO
New Payer Name: Quartz
Professional CPID: 7264
Institutional CPID: 8677
Payer-assigned Payer ID: 39180

Enrollment Requirements:

Remittance:

Payer enrollment for electronic remittance is required.
- Providers currently receiving electronic remittance through Change Healthcare must complete a new enrollment form.
- New providers must complete a new enrollment form.

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

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

REF 15885161 1/21/2025

New Electronic Remittance Connections Available - Assurance Reimbursement Management

Optum has new electronic remittance connections available:

Payer Name: Meridian PACE Solutions

Institutional CPID: 8077

Professional CPID: 2867

Payer-assigned Payer ID: MPSAB

Line of Business (LOB) Code: N51

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 15894416 1/21/2025

Optum Alert: Payer processing issue for multiple CPIDs

Due to a Optum processing issue, some professional and institutional claims transmitted to the payers listed below on Jan. 14, 2025 and Jan. 15, 2025 were not processed by the payers.

Payers impacted:

CPID 3786 Capital District Physicians Health Plan
CPID 1521 Nebraska Blue Cross Blue Shield
CPID 1467 Wisconsin Medicaid
CPID 3505 Ohio Anthem Blue Cross Blue Shield

A resolution has been implemented and the claims were retransmitted to the payers on Jan. 21, 2025.

This delay affected some claims released to Optum between 10 p.m. CT on Jan. 14, 2025 and 10 a.m. CT on Jan. 15, 2025.

Action Required: Be aware of the processing issue above.

REF15890808 1/21/2025

UPDATE: Report Generation Delay for CPID 7426 Idaho Regence Blue Shield

The payer intermediary has been unable to generate and deliver the reports for some claims submitted on Dec. 18, 2024, and Dec. 19, 2024.

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

Original message sent Jan. 3, 2025:

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted on Dec. 18, 2024, and Dec. 19, 2024.

Payer impacted:

CPID 7426 Idaho Regence Blue Shield

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09313050.

REF 15886133 1/21/2025

Update: Report Generation Delay for CPID 2830 CarePlus Health Plans

The payer intermediary has been unable to generate and deliver the reports for some claims submitted on Dec. 19, 2024.

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

Original message sent Jan. 3, 2025:

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted on Dec. 19, 2024.

Payer impacted:

CPID 2830 CarePlus Health Plans

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09313207.

REF 15887309 1/21/2025

Electronic Routing Change for CPID 1795 Envolve Benefit Options

Effective January 21, 2025, Optum will be changing electronic claims routing for the following payer:

Payer Name: Envolve Benefit Options
Professional CPID: 1795
Edit Master: PE_T007
Payer-assigned Payer ID: 56190

Enrollment Requirements:

Claims:

Payer enrollment for electronic claims is not required.

Report Changes:

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

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

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

REF 15886309 1/21/2025

Electronic Routing Change for CPID 1795 Envolve Benefit Options

Effective January 21, 2025, Optum will be changing electronic claims routing for the following payer:

Payer Name: Envolve Benefit Options
Professional CPID: 1795
Payer-assigned Payer ID: 56190

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 15886308 1/21/2025

Update: Report Generation Delay for CPID 1844 Wellcare Health Plans

The payer intermediary has been unable to generate and deliver the reports for some claims submitted on Dec. 19, 2024.

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

Original message sent Jan. 3, 2025:

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted on Dec. 19, 2024.

Payer impacted:

CPID 1844 Wellcare Health Plans

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

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

REF 15886482 1/21/2025

New Payer Edit for CPID 3089

The payer listed below has informed Optum of a new edit requirement effective immediately. In order to meet the new requirement, we will add the following edit Jan. 27, 2025:

IHI-01B058: MISSING OCCURRENCE DATE - The Occurrence Code 01-06 or 11 is required on all claims. Note: If this requirement does not apply to your billing situation, you can override the edit in the Error Text. LOOP 2300 HI
IHI-01A284: INVALID OCCURRENCE DATE - When the associated Occurrence Code 01-06 or 11 is present, the Occurrence Date must be on or before the Statement From Date. Exception: When the CPID is 5555 and Occurrence Code 11 is present, this requirement does not apply. LOOP 2300 HI

Edit applies to:

CPID 3089 ALLSTATE - EXCEPT NEW JERSEY

Action Required: Please be aware of updated edit requirements.

REF 15888158 1/21/2025

Payer Processing Issue for multiple CPIDs

Due to a payer intermediary processing issue, some Professional claims transmitted to the payers listed below on Jan. 15, 2025, were not processed by the payers.

Payers impacted:

8454	Align Senior Care of Michigan
2113	Allcare Health Plan
1764	Ambetter From Absolute Total Care
1765	Ambetter From Louisiana Healthcare Connections
9278	Ambetter from Nebraska Total Care
9431	Ambetter from WellCare of Kentucky
9432	Ambetter from WellCare of New Jersey
9775	Ambetter of Alabama
9433	Ambetter of Oklahoma
2138	American Family Insurance
9429	American Health Advantage of Idaho & Utah
9142	American Health Advantage of Mississippi
7280	American Health Advantage of Missouri
9117	American Health Advantage of Texas
4468	Americas Choice Healthplan
1741	Amerigroup
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
1407	Blue Cross Blue Shield of Georgia
1169	Blue Cross Blue Shield of Western New York Medicaid/CHP
1243	Blue Cross Community Centennial
1167	Blue Cross Medicare Advantage PPO/HMO
6165	Bridgeview
4246	Capital Health Plan
2810	Capitol Administrators
8146	Care N Care Insurance Co.
9759	Care1st Health Plan of Arizona Medicaid DOS before 12/01/2022
2830	CarePlus Health Plans
9226	CareSource PASSE of Arkansas
1194	CareSource of Georgia
7143	CareSource of Indiana
3826	CareSource of Ohio
7263	CareSource of West Virginia
4743	Carelon Behavioral Health
2164	Carelon Behavioral Health Maryland
6127	Carelon Behavioral Health, MBHP
3293	Carelon Health
6777	Centers Plan for Healthy Living
9765	Central Valley Medical Providers
8123	Clear Health Alliance
1415	Colorado Anthem Blue Cross Blue Shield
6778	Common Ground Healthcare Cooperative
8834	Commonwealth Care Alliance DOS after 3/31/2023
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
5862	CorrectCare Integrated Health
7738	CountyCare Health Plan
9747	Delaware First Health
1232	Denver Health Medical Plan, Inc. - Medicare Choice
2433	Denver Health and Hospital Authority
8135	Doctors HealthCare Plans
1733	Doctors Professional Services Consultants (DPSC)
3477	Early Intervention Central Billing
1119	Easy Choice Health Plan of California
4279	El Paso Health-STAR
5483	Employee Benefit Management Services (EBMS)
1834	Employee Plans
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
9417	Florida Complete Care
2150	Florida Health Care Plans
2720	GlobalCare
1772	HAP CareSource
1723	HealthCare Partners IPA
4448	HealthLink PPO
5243	Healthcare Management Administrators
7760	Healthy Blue Louisiana
8867	Healthy Blue Missouri
9133	Healthy Blue North Carolina
7715	Hopkins Health Advantage
6259	Humana - CareSource of Kentucky
3757	IMAGINE360 ADMINISTRATORS (GPA)
5479	IU Health Plan Medicare Advantage
7426	Idaho Regence Blue Shield
1405	Illinois Blue Cross Blue Shield
1412	Indiana Anthem Blue Cross Blue Shield
4445	Insurance Management Services TX
4116	IntegraNet Health
1107	Integrated Health Partners (IHP)
8814	Integrated Homecare Services
4876	International Medical Group
1404	Iowa Wellmark Blue Cross Blue Shield
6733	Iowa Wellmark Blue Cross Blue Shield Crossover
5432	Johns Hopkins Healthcare / Priority Partners
7782	Kansas Health Advantage
2421	Kentucky Anthem Blue Cross Blue Shield
9412	Leon Health Plans
6273	Lifepath Hospice
8723	MN BCBS Health Care Programs Non Emergent Transportation
7446	Maine Anthem Blue Cross Blue Shield
8812	Maryland Physicians Care
8860	Medica Government Programs
7859	Medica Health Plan Solutions
6799	Medica Individual and Family (IFB)
2287	Medicare Plus Blue of MI(MAP)
3475	Memorial Hermann Health Solutions
9102	Meridian Medicare Medicaid Plan
9118	MeridianComplete Michigan
2426	Michigan Blue Care Network
1421	Michigan Blue Cross Blue Shield
1402	Minnesota Blue Cross Blue Shield
1410	Minnesota Blue Cross Blue Shield CC Systems
7892	Minnesota Blue Cross Blue Shield Health Care Programs
1408	Missouri Anthem Blue Cross Blue Shield
7450	Montana Blue Cross Blue Shield
7496	Nevada Anthem Blue Cross Blue Shield
7422	New Hampshire Anthem Blue Cross Blue Shield
7403	New Mexico Blue Cross Blue Shield
8864	NextBlue of North Dakota
2411	North Dakota Blue Cross Blue Shield
2881	Northwell Direct
2418	Ohio Anthem Blue Cross Blue Shield
1403	Oklahoma Blue Cross Blue Shield
2404	Oregon Regence Blue Cross Blue Shield
7829	Passport Advantage
7168	Premier Healthcare Exchange (PHX)
4252	Presbyterian Salud
8468	Procare Advantage of TX
4253	Prominence Administrative Services
8182	PruittHealth Premier NC/SC
5428	QualChoice of Arkansas
7264	Quartz
1209	Regence Group Administrators
3257	ResourceOne Administrators
6246	Riverside Medical Clinic
4464	SCAN Health Plan
8708	SOMOS Anthem
8816	SOMOS Emblem
2254	Scott & White Health Plan
9438	Shared Health Mississippi
7225	Sharp Community Medical Group
8124	Simply Healthcare Plans, Inc.
2490	South Dakota Blue Cross Blue Shield
8134	Summit Community Care
6195	Superior Vision Services
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
2412	Utah Regence Blue Cross Blue Shield
2788	Utah Regence Blue Cross Blue Shield Federal Employee Program
4258	VNS Health
7493	Vermont Blue Cross Blue Shield
1413	Virginia Anthem Blue Cross Blue Shield
7451	Washington Regence Blue Shield
1844	Wellcare Health Plans
3211	Wellcare Health Plans (Encounters)
1775	Wellpoint
1401	Wisconsin Anthem Blue Cross Blue Shield
7489	Wyoming Blue Cross Blue Shield
6731	ZELIS

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

This delay affected claims released to Optum between 3 p.m. and 7 p.m. ET on Jan. 17, 2025.

Action Required: Be aware of the processing issue above.

If you have any questions, please contact Customer Support and refer to Case Number 09333262.

REF 15882659 1/21/2025

Optum Alert: Update: Report generation delay for CPID 1402 Minnesota Blue Cross Blue Shield

Update: The payer intermediary has been unable to generate and deliver the reports for some claims submitted on Dec. 19, 2024.

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

Original notify sent Jan. 6, 2025:

A payer intermediary is experiencing issues affecting professional report generation for some claims submitted on Dec. 19, 2024.

Payer impacted:

CPID 1402 Minnesota Blue Cross Blue Shield

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

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

If you have any questions, please contact customer support and refer to case number 09314870.

REF 15886481 1/21/2025

Optum Alert: Update: Report Generation Delay for CPID 1729 Texas Childrens Health Plan (CHIP)

Update: The payer intermediary has been unable to generate and deliver the reports for some claims submitted on Dec. 18, 2024 and Dec. 19, 2024.

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

Original notify sent Jan. 3, 2025:

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted on Dec. 18, 2024 and Dec. 19, 2024.

Payer impacted:

CPID 1729 Texas Childrens Health Plan (CHIP)

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09312990.

REF 15887308 1/21/2025

Remittance Reactivation for CPIDs 6750, 9662 MemorialCare Medical Foundation - Assurance EDI

Optum recently restored electronic remittance connectivity for the following payers:

Payer Name: MemorialCare Medical Foundation

Professional CPID: 6750

Institutional CPID: 9662

Industry Payer ID: MMFMC

Remittance Enrollment Requirements:

Payer enrollment for electronic remittance is required:
- Providers who moved their enrollment to another clearinghouse or have not received remittance will need to re-enroll to receive remittance for this payer from Optum (Change Healthcare).
- New providers must complete a new enrollment form.

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

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

REF 15883258 1/21/2025

Remittance reactivation for CPIDs 6750, 9662 MemorialCare Medical Foundation - Assurance Reimbursement Management

Optum recently restored electronic remittance connectivity for the following payer:

Payer Name: MemorialCare Medical Foundation

Professional CPID: 6750

Institutional CPID: 9662

Industry Payer ID: MMFMC

Line of Business (LOB) Code: J2J

Remittance enrollment requirements:

Payer enrollment for electronic remittance is required:
- Providers who moved their enrollment to another clearinghouse or have not received remittance will need to re-enroll to receive remittance for this payer from Optum (Change Healthcare).
- New providers must complete a new enrollment form.

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

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

REF 15883260 1/21/2025

Report Generation Delay for CPID 2404 Oregon Regence Blue Cross Blue Shield

Update: The payer intermediary has been unable to generate and deliver the reports for some claims submitted Dec. 18, 2024 and Dec. 20, 2024.

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

Original notify REF 15728585 sent Jan. 3, 2025:
A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted Dec. 18, 2024 and Dec. 20, 2024.

Payer impacted:

CPID 2404 Oregon Regence Blue Cross Blue Shield

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

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

REF 15728585 1/3/2025 15884358 1/21/2025

Resolved: Some transactions unavailable

This message is intended for Optum customers who process transactions with a select few payers, listed below.

Update: 1/21/2025: All transaction types mentioned below have been restored. This issue is resolved.

Update: 1/18/2025: The real-time issue (eligibility and claims status) below has been resolved. We will update you again when claims and remits are resolved.

Update: 1/17/2025: Please note the corrected Industry Payer ID for St. Vincent Catholic Medical Center – USFHP is 13407. All payers listed below are impacted for the transactions noted in the table:

Payer Name	Industry Payer ID	CPID (I)	CPID (P)	Claims	ERAs
New Hampshire Medicaid	12K90	2575	7423	X	X
Montana Medicaid	SKMT0	5586	4427	X	X
Alaska Medicaid	77200	5524	4489	X	X
District of Columbia Medicaid	77033	5550	4425	X	X
New Mexico Medicaid	12K22, NMMCD	5562	1492	X	X
St. Vincent Catholic Medical Center - USFHP	13407	7542	2845	X	X
Gold Coast Health Plan	77160	4616	6128		X

Action required: Please note the correct Industry Payer ID, and review which transactions are unavailable by payer.

Original message sent on Jan. 16, 2025:

Optum is aware of interruptions in transactions, including eligibility and claims, for the payers listed below.

Currently, there is not a restoration date or time. We will continue to keep you updated as we learn more. Please find a list of impacted Payer IDs below:

Eligibility and claims status:

Payer Name	Real Time Payer IDs
AETNA LTC	00225, 225, AETLC, AETLTC
AMERICO	AMRCO
AUTOMATED BENEFIT SERVICES	38259, ABSERV
BANKERS LIFE AND CASUALTY COMPANY	36066, BNKLIF
BOON CHAPMAN ADMINISTRATORS	74238, BNCHAP
BRAVEN HEALTH	84367, BRAVEN
CAPROCK HEALTH PLANS	CAPHP, CAPROK
CAREFIRST ADMINISTRATORS/NCAS	75190, CFSAD, NCAS
CAREMORE HEALTH PLAN	CARMO, CRMRE
CBA BLUE	03036, CBABLU
CENTRAL CALIFORNIA ALLIANCE FOR HEALTH	CCA01, CCALLH
CENTRAL STATES INDEMNITY	CTLST, CTLSTI
COLONIAL PENN LIFE INSURANCE COMPANY	37077, CPLIC
COMMUNITY HEALTH FIRST MEDICARE ADVANTAGE	CHFMA, CHFMAP
COMMUNITY HEALTH GROUP	66170, COMHGR
COOK CHILDRENS STAR PLAN	CCHP9, COOKCH
COVENANT ADMINISTRATORS	58102, COVENT
COX HEALTH PLAN	00019, COXHP
DISTRICT OF COLUMBIA MEDICAID	12001, AID52, DC, DCCAID, SKDC0
FIRSTCARE HEALTH PLANS	94999, FRTCR
HEALTH NEW ENGLAND	04286, HLTNE
HEALTH PLAN OF SAN JOAQUIN	00349, 68035, SJHP, SPSJH
HEALTH PLANS, INC.	44273, HLPLNS
HOMETOWN HEALTH	88023, HMETH, HOMTWN
INDEPENDENCE ADMINISTRATORS	INDADM, TA720
INTEGRATED MENTAL HEALTH SERVICES	CBHTX, INTMHS
JAI MEDICAL SYSTEMS	JAI01, JAIMED
KENTUCKY MEDICAID	12K11, AID31, CKKY1, KY, KYCAID, SKKY0
LINCOLN HERITAGE LIFE INSURANCE COMPANY	LCNHG
MASS GENERAL BRIGHAM HEALTH PLAN	04293, NGHBHP
MEDCOST BENEFIT SERVICES	56205, MEDCST
MERCY CARE PLAN	86052, AZMCP, AEMED
MISSISSIPPI STATE EMPLOYEES AND TEACHERS HEALTH PLAN	SEHP, XSEHP, MSSEHP
MONTANA MEDICAID	12K77, AID57, CKMT1, MT, MTCAID, SKMT0
NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	RINHP
NEW HAMPSHIRE MEDICAID	NH, SKNH0, NHCAID
NEW MEXICO MEDICAID	12K22, AID27, CKNM1, NM, NMCAID, SKNM0
NOVA HEALTHCARE ADMINISTRATORS NY	16644, NOVAHC
PARTNERSHIP HEALTHPLAN OF CALIFORNIA	00343, PRTHP, SPPHP, SX140
PROFESSIONAL BENEFIT ADMINISTRATORS (OAKBROOK, IL)	36331, ILPBA
ROYAL NEIGHBORS OF AMERICA	RYLNB
SHARP HEALTH PLAN	SHARP, SHP01
SISCO	SISCO

Claims and ERAs

Payer Name	Industry Payer ID	CPID (I)	CPID (P)
ALASKA MEDICAID	77200	5524	4489
DISTRICT OF COLUMBIA MEDICAID	77033	5550	4425
GOLD COAST HEALTH PLAN	77160	4616	6128
MONTANA MEDICAID	SKMT0	5586	4427
NEW HAMPSHIRE MEDICAID	12K90	2575	7423
NEW MEXICO MEDICAID	12K22, NMMCD	5562	1492
ST. VINCENT CATHOLIC MEDICAL CENTER - USFHP	SKVA0	7542	2845

Action required: Please halt all transaction processing through the affected payers until more information is available.

REF 15860559 15863658 1/21/2025

Update: Some transactions unavailable

This message is intended for Optum customers who process transactions with a select few payers, listed below.

Update: 1/18/2025: The real-time issue (eligibility and claims status) below has been resolved. We will update you again when claims and remits are resolved.

Update 1/17/2025: Please note the corrected Industry Payer ID for St. Vincent Catholic Medical Center – USFHP is 13407. All payers listed below are impacted for the transactions noted in the table:

Payer Name	Industry Payer ID	CPID (I)	CPID (P)	Claims	ERAs
New Hampshire Medicaid	12K90	2575	7423	X	X
Montana Medicaid	SKMT0	5586	4427	X	X
Alaska Medicaid	77200	5524	4489	X	X
District of Columbia Medicaid	77033	5550	4425	X	X
New Mexico Medicaid	12K22, NMMCD	5562	1492	X	X
St. Vincent Catholic Medical Center - USFHP	13407	7542	2845	X	X
Gold Coast Health Plan	77160	4616	6128		X

Action required: Please note the correct Industry Payer ID, and review which transactions are unavailable by payer.

Original message sent on Jan. 16, 2025:

Optum is aware of interruptions in transactions, including eligibility and claims, for the payers listed below.

Currently, there is not a restoration date or time. We will continue to keep you updated as we learn more. Please find a list of impacted Payer IDs below:

Eligibility and claims status:

Payer Name	Real Time Payer IDs
AETNA LTC	00225, 225, AETLC, AETLTC
AMERICO	AMRCO
AUTOMATED BENEFIT SERVICES	38259, ABSERV
BANKERS LIFE AND CASUALTY COMPANY	36066, BNKLIF
BOON CHAPMAN ADMINISTRATORS	74238, BNCHAP
BRAVEN HEALTH	84367, BRAVEN
CAPROCK HEALTH PLANS	CAPHP, CAPROK
CAREFIRST ADMINISTRATORS/NCAS	75190, CFSAD, NCAS
CAREMORE HEALTH PLAN	CARMO, CRMRE
CBA BLUE	03036, CBABLU
CENTRAL CALIFORNIA ALLIANCE FOR HEALTH	CCA01, CCALLH
CENTRAL STATES INDEMNITY	CTLST, CTLSTI
COLONIAL PENN LIFE INSURANCE COMPANY	37077, CPLIC
COMMUNITY HEALTH FIRST MEDICARE ADVANTAGE	CHFMA, CHFMAP
COMMUNITY HEALTH GROUP	66170, COMHGR
COOK CHILDRENS STAR PLAN	CCHP9, COOKCH
COVENANT ADMINISTRATORS	58102, COVENT
COX HEALTH PLAN	00019, COXHP
DISTRICT OF COLUMBIA MEDICAID	12001, AID52, DC, DCCAID, SKDC0
FIRSTCARE HEALTH PLANS	94999, FRTCR
HEALTH NEW ENGLAND	04286, HLTNE
HEALTH PLAN OF SAN JOAQUIN	00349, 68035, SJHP, SPSJH
HEALTH PLANS, INC.	44273, HLPLNS
HOMETOWN HEALTH	88023, HMETH, HOMTWN
INDEPENDENCE ADMINISTRATORS	INDADM, TA720
INTEGRATED MENTAL HEALTH SERVICES	CBHTX, INTMHS
JAI MEDICAL SYSTEMS	JAI01, JAIMED
KENTUCKY MEDICAID	12K11, AID31, CKKY1, KY, KYCAID, SKKY0
LINCOLN HERITAGE LIFE INSURANCE COMPANY	LCNHG
MASS GENERAL BRIGHAM HEALTH PLAN	04293, NGHBHP
MEDCOST BENEFIT SERVICES	56205, MEDCST
MERCY CARE PLAN	86052, AZMCP, AEMED
MISSISSIPPI STATE EMPLOYEES AND TEACHERS HEALTH PLAN	SEHP, XSEHP, MSSEHP
MONTANA MEDICAID	12K77, AID57, CKMT1, MT, MTCAID, SKMT0
NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	RINHP
NEW HAMPSHIRE MEDICAID	NH, SKNH0, NHCAID
NEW MEXICO MEDICAID	12K22, AID27, CKNM1, NM, NMCAID, SKNM0
NOVA HEALTHCARE ADMINISTRATORS NY	16644, NOVAHC
PARTNERSHIP HEALTHPLAN OF CALIFORNIA	00343, PRTHP, SPPHP, SX140
PROFESSIONAL BENEFIT ADMINISTRATORS (OAKBROOK, IL)	36331, ILPBA
ROYAL NEIGHBORS OF AMERICA	RYLNB
SHARP HEALTH PLAN	SHARP, SHP01
SISCO	SISCO

Claims and ERAs

Payer Name	Industry Payer ID	CPID (I)	CPID (P)
ALASKA MEDICAID	77200	5524	4489
DISTRICT OF COLUMBIA MEDICAID	77033	5550	4425
GOLD COAST HEALTH PLAN	77160	4616	6128
MONTANA MEDICAID	SKMT0	5586	4427
NEW HAMPSHIRE MEDICAID	12K90	2575	7423
NEW MEXICO MEDICAID	12K22, NMMCD	5562	1492
ST. VINCENT CATHOLIC MEDICAL CENTER - USFHP	SKVA0	7542	2845

Action required: Please halt all transaction processing through the affected payers until more information is available.

REF 15860559 15863658 1/18/2025

Duplicate Electronic Remittance Advice (ERA) Transmission for multiple CPIDs - Assurance EDI

Due to a processing issue, institutional and professional Electronic Remittance Advice (ERA) for the payers listed below may have been resent on Jan. 17, 2025 to customers who previously received the ERAs on Jan. 7, 2025. The check date for the duplicate ERAs is Jan. 7, 2025.

Payer Name	XREF ID
21st Century Insurance and Financial Services	2170
Berkley Risk Administrators Company, LLC	1858
Surest	2007
Surest	8139
Boilermakers National Health	2591
Boilermakers National Health	6425
Medicare DME MAC Jurisdiction B	7476
Medicare DME MAC Jurisdiction B	2211
Medicare DME MAC Jurisdiction C	7477
Medicare DME MAC Jurisdiction C	2213
District of Columbia CareFirst Blue Cross Blue Shield	1509
District of Columbia CareFirst Blue Cross Blue Shield	2425
Maryland CareFirst Blue Cross Blue Shield	7518
Maryland CareFirst Blue Cross Blue Shield	2419
Cedars Sinai Medical Network	8651
Cedars Sinai Medical Network	3295
TRICARE West Region	5648
TRICARE West Region	6286
Christus Health Plan	4646
Christus Health Plan	6167
Clover Health	5666
Clover Health	6433
CommunityCare MHP of Oklahoma	8560
CommunityCare MHP of Oklahoma	1874
Curative	8055
Curative	9774
Dignity Health Medical Foundation for Mercy Medical Group or Woodland Clinic Medical Group	8555
Dignity Health Medical Foundation for Mercy Medical Group or Woodland Clinic Medical Group	7796
EMI Health	8654
EMI Health	4410
ElderPlan	1999
ElderPlan	1853
Element Care	6977
Element Care	6811
Essence	8993
Essence	2274
Landmark Healthcare	3294
NorthShore Physician Associates	4659
NorthShore Physician Associates	6187
Farm Bureau Health Plans	3096
Farm Bureau Health Plans	1151
Florida Medicare	3518
Florida Medicare	4951
Puerto Rico Medicare	3544
Virgin Islands Medicare	5094
Virgin Islands Medicare	4961
Virgin Islands Medicare	4963
Florida Medicare	2216
Florida Medicare	1448
Puerto Rico Medicare	2785
Puerto Rico Medicare	2220
Virgin Islands Medicare	2221
Virgin Islands Medicare	4487
Luminare Health AZ, IL, IN, MD, MN, NC, PA	2587
Luminare Health AZ, IL, IN, MD, MN, NC, PA	3791
Luminare Health Detroit	8522
Luminare Health Detroit	1773
Luminare Health KC	4568
Luminare Health KC	5492
Luminare Health Little Rock	1983
Luminare Health Little Rock	3806
StandardHealth with Health Choice (HCS)	7595
StandardHealth with Health Choice (HCS)	2708
Health Choice Utah	7623
Health Choice Utah	6775
Health Plan of San Mateo	5678
Health Plan of San Mateo	4292
HealthSCOPE	8011
HealthSCOPE	9725
Health Services for Children with Special Needs	1920
Health Services for Children with Special Needs	2297
New Jersey Horizon Blue Cross Blue Shield	5526
New Jersey Horizon Blue Cross Blue Shield	2414
Braven Health	5000
Braven Health	8844
Horizon New Jersey Health	6534
Horizon New Jersey Health	1709
Iowa Medicaid	2571
Iowa Medicaid	1469
Mary Washington Health Plan	3045
Mary Washington Health Plan	8294
University of Michigan Health Medicare	3044
University of Michigan Health Medicare	8293
MDsave	3046
MDsave	8295
MDwise Healthy Indiana Plan	1086
MDwise Healthy Indiana Plan	8113
MDwise Hoosier Healthwise	1085
MDwise Hoosier Healthwise	8112
McLaren Advantage SNP	6637
McLaren Advantage SNP	6739
McLaren Health Advantage	6634
McLaren Health Advantage	6735
McLaren Health Plan Medicaid	6631
McLaren Health Plan Medicaid	6732
McLaren Health Plans	2592
McLaren Health Plans	3794
Medical Benefit Administration	4945
Medical Benefit Administration	3231
Sage Breast and Cervical Cancer Screening	5653
Sage Breast and Cervical Cancer Screening	6294
Mississippi Blue Cross Blue Shield	5555
Mississippi Blue Cross Blue Shield	2415
Mississippi Blue Cross Blue Shield State Employees	5561
Optum Care Network - Monarch	6606
Optum Care Network - Monarch	2475
North American Medical Management (NAMM - N. CA)	2931
North American Medical Management (NAMM - N. CA)	1782
New York State Dept of Health Uncompensated Care Program	3665
New York State Dept of Health Uncompensated Care Program	5863
Connecticut Medicare	3533
Connecticut Medicare	4966
Connecticut Medicare	1452
Connecticut Medicare	2223
Illinois Medicare	5506
Illinois Medicare	4971
Illinois Medicare	2224
Illinois Medicare	1437
Maine Medicare	5504
Maine Medicare	3547
Maine Medicare	2225
Maine Medicare	2472
Massachusetts Medicare	5527
Massachusetts Medicare	5592
Massachusetts Medicare	2229
Massachusetts Medicare	2469
Minnesota Medicare	5641
Minnesota Medicare	3521
Minnesota Medicare	1435
Minnesota Medicare	2230
New Hampshire Medicare	5644
New Hampshire Medicare	2528
New Hampshire Medicare	2237
New Hampshire Medicare	2470
New York Medicare Empire	3519
New York Medicare Empire	5902
New York Medicare Empire	2244
New York Medicare Empire	4442
New York Medicare GHI	7401
New York Medicare GHI	2260
New York Medicare Upstate	2261
New York Medicare Upstate	1463
RHHI Home Health Medicare NHIC	5918
RHHI Home Health Medicare NHIC	1640
RHHI Home Health Medicare Region V - Service Area 7	5919
RHHI Home Health Medicare Region V - Service Area 7	1947
Rhode Island Medicare	5578
Rhode Island Medicare	5941
Rhode Island Medicare	7419
Rhode Island Medicare	2268
Vermont Medicare	5963
Vermont Medicare	5954
Vermont Medicare	2278
Vermont Medicare	2471
Wisconsin Medicare	5512
Wisconsin Medicare	5966
Wisconsin Medicare	2288
Wisconsin Medicare	1434
Nippon Life Insurance Company of America	6539
Nippon Life Insurance Company of America	6443
Medicare DME MAC Jurisdiction A	2209
Medicare DME MAC Jurisdiction A	7475
Medicare DME MAC Jurisdiction D	7478
Medicare DME MAC Jurisdiction D	2215
Arizona Medicare	5546
California Medicare	3508
Hawaii Medicare	5567
Idaho Medicare	5581
JE Mutual of Omaha CA, HI, NV	2676
Montana Medicare	5584
Nevada Medicare	5907
North Dakota Medicare	1523
Oregon Medicare	5515
South Dakota Medicare	5589
Utah Medicare	1527
Washington/Alaska Medicare	5521
Wyoming Medicare	3583
Alaska Medicare	1455
Arizona Medicare	1456
Hawaii / Guam Medicare	2467
Idaho Medicare	2465
Montana Medicare	7400
Nevada Medicare	1446
North Dakota Medicare	2453
Northern California Medicare	1436
Oregon Medicare	1459
South Dakota Medicare	2454
Southern California Medicare	1444
Utah Medicare	2458
Washington Medicare	1462
Wyoming Medicare	2466
Arkansas Medicare	1526
Arkansas Medicare	4904
Colorado Medicare	1547
Colorado Medicare	4917
Delaware Medicare	4920
Delaware Medicare	5912
District of Columbia Medicare	4921
District of Columbia Medicare	1522
JH Mutual of Omaha CO, NM, OK, TX	4903
JH Mutual of Omaha CO, NM, OK, TX	3650
JL Mutual of Omaha DC, DE, MD, NJ, PA	3677
JL Mutual of Omaha DC, DE, MD, NJ, PA	4950
Louisiana Medicare	3579
Louisiana Medicare	4922
Maryland Medicare	4930
Maryland Medicare	5554
Mississippi Medicare	5556
Mississippi Medicare	4934
New Jersey Medicare	5503
New Jersey Medicare	4938
New Mexico Medicare	4937
New Mexico Medicare	5566
Oklahoma Medicare	1558
Oklahoma Medicare	4942
Pennsylvania Medicare	4944
Pennsylvania Medicare	5598
Texas Medicare	4946
Texas Medicare	5502
Arkansas Medicare	2455
Arkansas Medicare	2161
Colorado Medicare	1449
Colorado Medicare	2162
Delaware Medicare	2456
Delaware Medicare	2163
District of Columbia Metropolitan Area (DCMA) Medicare	2459
District of Columbia Metropolitan Area (DCMA) Medicare	2165
Louisiana Medicare	1460
Louisiana Medicare	2171
Maryland Medicare	2201
Maryland Medicare	7402
Maryland Medicare (Montgomery,Prince George)	2464
Mississippi Medicare	2203
Mississippi Medicare	2451
New Jersey Medicare	1465
New Jersey Medicare	2205
New Mexico Medicare	1457
New Mexico Medicare	2204
Oklahoma Medicare	2206
Oklahoma Medicare	1458
Pennsylvania Medicare	2207
Pennsylvania Medicare	2457
Texas Medicare	1440
Texas Medicare	2208
Virginia Medicare (Alexandria,Arlington,Fairfax)	2461
Optum Care Network	2940
Optum Care Network	4730
OhioHealthy	3652
OhioHealthy	1838
OptumCare Network of Connecticut	1068
OptumCare Network of Connecticut	7895
Oscar Health	9638
Oscar Health	7468
Physicians Medical Group of San Jose	2098
Physicians Medical Group of San Jose	3430
Care To Care	7671
Care To Care	7114
Sante Health System	1917
Sante Health System	2281
SelectHealth	1532
SelectHealth	4480
Sharp Rees-Stealy Medical Group	8644
Sharp Rees-Stealy Medical Group	7227
Special Agents Mutual Benefit Association (SAMBA)	5005
Special Agents Mutual Benefit Association (SAMBA) Teledoc only	1116
State Farm Insurance (Health)	6573
State Farm Insurance (Health)	5419
The Health Plan of West Virginia, Inc	7551
The Health Plan of West Virginia, Inc	2824
TakeCare Insurance Company	4085
TakeCare Insurance Company	8827
Kentucky Medicare	5533
Kentucky Medicare	2462
Ohio Medicare	3507
Ohio Medicare	1447
RHHI Home Health Medicare CIGNA	1987
RHHI Home Health Medicare CIGNA	IAHH_MCR
Alabama Medicare	5559
Georgia Medicare	3536
North Carolina Medicare	3563
RHHI Home Health Medicare (SW/SE)	5544
RHHI Home Health Medicare Region IV (Gulf Coast/Midwest)	3597
Rural Health Medicare	1506
South Carolina Medicare	1560
Tennessee Medicare	5525
Virginia Medicare	5536
West Virginia Medicare	5530
Alabama Medicare	2468
Georgia Medicare	1466
North Carolina Medicare	1464
Railroad Medicare	1443
South Carolina Medicare	2452
Tennessee Medicare	1453
Virginia Medicare	1442
West Virginia Medicare	1450
Touchstone Health PSO	2919
Touchstone Health PSO	4737
Transamerica Life Insurance Co	1946
Transamerica Life Insurance Co	2892
Transamerica Life Insurance Company IA, MD, PA	1014
Transamerica Life Insurance Company IA, MD, PA	7837
CHAMPVA - HAC	1503
CHAMPVA - HAC	3807
TriWest Region 4 CCN	6022
TriWest Region 4 CCN	9170
TriWest Region 5 CCN	6015
TriWest Region 5 CCN	9169
TriWest Region 6 CCN	6028
TriWest Region 6 CCN	9176
UC Davis Medical Group	7647
UC Davis Medical Group	6877
Aspirus Medicare Advantage	4097
Aspirus Medicare Advantage	8840
UCare Plans	1038
UCare Plans	7867
Unified Health Services	7576
Unified Health Services	5420
AARP	8940
AARP	5271
Care Improvement Plus CIP XLHealth	1998
Care Improvement Plus CIP XLHealth	3435
Golden Rule	4515
Golden Rule	6483
Medica Health Plan	8598
Medica Health Plan	1431
Medica HealthCare Plan of Florida	7641
Medica HealthCare Plan of Florida	4243
Neighborhood Health Partnership of Florida	1567
Neighborhood Health Partnership of Florida	7630
Neighborhood Health Partnership of Florida	6847
Neighborhood Health Partnership of Florida	2721
Optum Physical Health	3784
OptumHealth Care Solutions	9513
OptumHealth Care Solutions	3824
Oxford Health Plans	6549
Oxford Health Plans	6485
Peoples Health Network	2923
Peoples Health Network	8455
Preferred Care Partners	3929
Preferred Care Partners	2240
United Medical Resources	4590
United Medical Resources	5402
UnitedHealthcare	3550
UnitedHealthcare	3429
UnitedHealthcare Arizona Physicians IPA	1585
UnitedHealthcare Arizona Physicians IPA	3432
UnitedHealthcare Community Plan Tenncare	4523
UnitedHealthcare Community Plan Tenncare	6442
UnitedHealthcare Community Plan of CA,DC,DE,FL,GA,HI,KY,LA,MA,MD,NC,NM,OH,OK,PA,RI,VA,WA	6893
UnitedHealthcare Community Plan of Iowa	7734
UnitedHealthcare Community Plan of Kansas	5646
UnitedHealthcare Community Plan of Kansas	6283
UnitedHealthcare Community Plan of Michigan	8577
UnitedHealthcare Community Plan of Michigan	1886
UnitedHealthcare Community Plan of Missouri	4527
UnitedHealthcare Community Plan of Missouri	1227
UnitedHealthcare Community Plan of Nebraska	6892
UnitedHealthcare Community Plan of New Jersey Medicaid	7510
UnitedHealthcare Community Plan of New Jersey Medicaid	2806
UnitedHealthcare Community Plan of New York Medicaid	2541
UnitedHealthcare Community Plan of New York Medicaid	2815
UnitedHealthcare Community Plan of New York and Upstate	6889
UnitedHealthcare Community Plan of Ohio	7531
UnitedHealthcare Community Plan of Ohio	2809
UnitedHealthcare Community Plan of Texas	6891
UnitedHealthcare Community Plan of Wisconsin	6890
UnitedHealthcare Life Insurance Company	1941
UnitedHealthcare Life Insurance Company	7481
UnitedHealthcare Vision	5891
UnitedHealthcare West (fka Pacificare)	6895
Veterans Affairs Community Care Network Region 1, 2, 3	3009
Veterans Affairs Community Care Network Region 1, 2, 3	8257
University Health Care Advantage	8634
University Health Care Advantage	7217
University of Utah Health Plan	5920
University of Utah Health Plan	4779
ICARE Health Options TPA	5299
Veterans Administration Fee Basis Programs	1507
Veterans Administration Fee Basis Programs	3887

Action Required: Please be aware of this processing error and disregard the duplicate ERAs received for the file date above. If you have any questions, please contact Customer Support. We apologize for any inconvenience.

REF 15873569 1/17/2025

Optum Alert: Payer processing issue for multiple CPIDs

Due to a payer intermediary processing issue, some Professional claims transmitted to the payers listed below on Jan. 16, 2025 were not processed by the payers.

Payers impacted:

CPID	Payer Name
1214	AgeRight Advantage Health Plan
2842	Alexian PACE
9409	Align Senior Care of California
8454	Align Senior Care of Michigan
4101	AllCare Advantage
2113	Allcare Health Plan
9278	Ambetter from Nebraska Total Care
9431	Ambetter from WellCare of Kentucky
9775	Ambetter of Alabama
9433	Ambetter of Oklahoma
9142	American Health Advantage of Mississippi
1741	Amerigroup
1412	Anthem Blue Cross and Blue Shield - Indiana
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
7794	Associated Hispanic Physicians IPA
4881	Asuris Northwest Regence
7272	Axminster Medical Group
3845	Banner Health Network
1415	Blue Cross Blue Shield of Colorado
1407	Blue Cross Blue Shield of Georgia
7496	Blue Cross Blue Shield of Nevada
1243	Blue Cross Community Centennial
1167	Blue Cross Medicare Advantage PPO/HMO
9162	Blue Medicare Advantage
6779	Bridgespan Regence
4246	Capital Health Plan
2810	Capitol Administrators
8146	Care N Care Insurance Co.
4743	Carelon Behavioral Health
2164	Carelon Behavioral Health Maryland
6127	Carelon Behavioral Health, MBHP
3293	Carelon Health
2830	CarePlus Health Plans
9722	CareSource North Carolina
1194	CareSource of Georgia
7143	CareSource of Indiana
3826	CareSource of Ohio
9297	Cenpatico Behavioral Health - Nebraska
6777	Centers Plan for Healthy Living
9765	Central Valley Medical Providers
7275	Citrus Valley Physicians Group
8123	Clear Health Alliance
7416	Colorado Anthem Blue Cross Blue Shield HMO
7763	Columbine Health Plan
8834	Commonwealth Care Alliance DOS after 3/31/2023
6865	Community Care Plan (Medicaid)
8147	Community Care Plan (Palm Beach Health District)
1420	Connecticut Anthem Blue Cross Blue Shield
6795	Contra Costa Health Plan
7738	CountyCare Health Plan
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
7294	Eberle Vivian
4279	El Paso Health-STAR
5483	Employee Benefit Management Services (EBMS)
8137	Empower Healthcare Solutions
1795	Envolve Benefit Options
3792	Fidelis Care
2875	First Health Network (Coventry Health Care National Network)
7435	FirstCare Health Plans
1414	Florida Blue Cross Blue Shield
3417	Florida Blue Cross Blue Shield Health Options HMO
9128	Florida Blue Medicare
2150	Florida Health Care Plans
5440	Fox Valley Medicine
2720	GlobalCare
1772	HAP CareSource
1797	HAP CareSource Michigan Dual Medicare/Medicaid
5243	Healthcare Management Administrators
1723	HealthCare Partners IPA
4448	HealthLink PPO
4740	Healthways WholeHealth Networks
7760	Healthy Blue Louisiana
8867	Healthy Blue Missouri
9133	Healthy Blue North Carolina
7715	Hopkins Health Advantage
6259	Humana - CareSource of Kentucky
7426	Idaho Regence Blue Shield
1405	Illinois Blue Cross Blue Shield
3757	IMAGINE360 ADMINISTRATORS (GPA)
4445	Insurance Management Services TX
4116	IntegraNet Health
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
2421	Kentucky Anthem Blue Cross Blue Shield
9412	Leon Health Plans
6273	Lifepath Hospice
7446	Maine Anthem Blue Cross Blue Shield
8812	Maryland Physicians Care
8860	Medica Government Programs
7859	Medica Health Plan Solutions
6799	Medica Individual and Family (IFB)
2287	Medicare Plus Blue of MI(MAP)
3475	Memorial Hermann Health Solutions
9102	Meridian Medicare Medicaid Plan
9118	MeridianComplete Michigan
2426	Michigan Blue Care Network
1421	Michigan Blue Cross Blue Shield
1402	Minnesota Blue Cross Blue Shield
1410	Minnesota Blue Cross Blue Shield CC Systems
7892	Minnesota Blue Cross Blue Shield Health Care Programs
1429	Minnesota Blue Cross Blue Shield HMO
1408	Missouri Anthem Blue Cross Blue Shield
7450	Montana Blue Cross Blue Shield
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
5838	Preferred Administrators
4252	Presbyterian Salud
2807	Professional Benefit Administrators (Oakbrook, Illinois)
4253	Prominence Administrative Services
5428	QualChoice of Arkansas
7264	Quartz ASO
1209	Regence Group Administrators
4270	Resurrection Physicians Provider Group
4464	SCAN Health Plan
2254	Scott & White Health Plan
7225	Sharp Community Medical Group
8124	Simply Healthcare Plans, Inc.
8816	SOMOS Emblem
2490	South Dakota Blue Cross Blue Shield
6195	Superior Vision Services
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
2412	Utah Regence Blue Cross Blue Shield
2788	Utah Regence Blue Cross Blue Shield Federal Employee Program
7493	Vermont Blue Cross Blue Shield
4258	VNS Health
7451	Washington Regence Blue Shield
1844	Wellcare Health Plans
3211	Wellcare Health Plans (Encounters)
1775	Wellpoint
1401	Wisconsin Anthem Blue Cross Blue Shield
7489	Wyoming Blue Cross Blue Shield

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

This delay affected claims released to Optum between 6 p.m. and 10 p.m. CT on Jan. 16, 2025.

Action Required: Be aware of the processing issue above.

If you have any questions, please contact Customer Support and refer to Case Number 09330816.

REF 15865358 1/17/2025

Electronic connection no longer available

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

Payer Name: Rocky Mountain HMO

Industry Payer ID: SX141

IMN Real Time ID: SX141

Reason: Payer ID SX141 is being discontinued.

Action Required: For Eligibility inquiries, please use Payer ID 87726.

REF 15868058 1/17/2025

Report Generation Delay for CPID 1485 Kansas Medicaid

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

Payer impacted:

CPID 1485 Kansas Medicaid

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09330883.

REF 15865598 1/17/2025

Change Healthcare Accident Claims Solution Electronic Claims Connection No Longer Available

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

Payer Name: Change Healthcare Accident Claims Solution

Claim CPIDs: 7818, 9516

Payer-assigned Payer ID: 88446

Reason: Payer no longer offers an electronic connection.

Payer will no longer accept paper claims.

Action Required: None.

REF 15860810 1/17/2025

Report Generation Delay for CPIDs 3061 and 8454 Align Senior Care of Michigan

This message is intended for Assurance Reimbursement Management and Assurance EDI customers.

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

Payer impacted:

CPID 3061 Align Senior Care of Michigan
CPID 8454 Align Senior Care of Michigan

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 15851461 1/16/2025

Report Generation Delay for CPIDs 3937 and 1214 AgeRight Advantage Health Plan

This message is intended for Assurance Reimbursement Management and Assurance EDI customers.

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

Payer impacted:

CPID 3937 AgeRight Advantage Health Plan
CPID 1214 AgeRight Advantage Health Plan

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 15852987 1/16/2025

CORRECTION: Some transactions unavailable

This message is intended for Optum customers who process transactions with a select few payers, listed below.

Update: Please note the corrected Industry Payer ID for St. Vincent Catholic Medical Center – USFHP is 13407. All payers listed below are impacted for the transactions noted in the table:

Payer Name	Industry Payer ID	CPID (I)	CPID (P)	Claims	ERAs
New Hampshire Medicaid	12K90	2575	7423	X	X
Montana Medicaid	SKMT0	5586	4427	X	X
Alaska Medicaid	77200	5524	4489	X	X
District of Columbia Medicaid	77033	5550	4425	X	X
New Mexico Medicaid	12K22, NMMCD	5562	1492	X	X
St. Vincent Catholic Medical Center - USFHP	13407	7542	2845	X	X
Gold Coast Health Plan	77160	4616	6128		X

Action required: Please note the correct Industry Payer ID, and review which transactions are unavailable by payer.

Original message sent on Jan. 16, 2025:

Optum is aware of interruptions in transactions, including eligibility and claims, for the payers listed below.

Currently, there is not a restoration date or time. We will continue to keep you updated as we learn more. Please find a list of impacted Payer IDs below:

Eligibility and claims status:

Payer Name	Real Time Payer IDs
AETNA LTC	00225, 225, AETLC, AETLTC
AMERICO	AMRCO
AUTOMATED BENEFIT SERVICES	38259, ABSERV
BANKERS LIFE AND CASUALTY COMPANY	36066, BNKLIF
BOON CHAPMAN ADMINISTRATORS	74238, BNCHAP
BRAVEN HEALTH	84367, BRAVEN
CAPROCK HEALTH PLANS	CAPHP, CAPROK
CAREFIRST ADMINISTRATORS/NCAS	75190, CFSAD, NCAS
CAREMORE HEALTH PLAN	CARMO, CRMRE
CBA BLUE	03036, CBABLU
CENTRAL CALIFORNIA ALLIANCE FOR HEALTH	CCA01, CCALLH
CENTRAL STATES INDEMNITY	CTLST, CTLSTI
COLONIAL PENN LIFE INSURANCE COMPANY	37077, CPLIC
COMMUNITY HEALTH FIRST MEDICARE ADVANTAGE	CHFMA, CHFMAP
COMMUNITY HEALTH GROUP	66170, COMHGR
COOK CHILDRENS STAR PLAN	CCHP9, COOKCH
COVENANT ADMINISTRATORS	58102, COVENT
COX HEALTH PLAN	00019, COXHP
DISTRICT OF COLUMBIA MEDICAID	12001, AID52, DC, DCCAID, SKDC0
FIRSTCARE HEALTH PLANS	94999, FRTCR
HEALTH NEW ENGLAND	04286, HLTNE
HEALTH PLAN OF SAN JOAQUIN	00349, 68035, SJHP, SPSJH
HEALTH PLANS, INC.	44273, HLPLNS
HOMETOWN HEALTH	88023, HMETH, HOMTWN
INDEPENDENCE ADMINISTRATORS	INDADM, TA720
INTEGRATED MENTAL HEALTH SERVICES	CBHTX, INTMHS
JAI MEDICAL SYSTEMS	JAI01, JAIMED
KENTUCKY MEDICAID	12K11, AID31, CKKY1, KY, KYCAID, SKKY0
LINCOLN HERITAGE LIFE INSURANCE COMPANY	LCNHG
MASS GENERAL BRIGHAM HEALTH PLAN	04293, NGHBHP
MEDCOST BENEFIT SERVICES	56205, MEDCST
MERCY CARE PLAN	86052, AZMCP, AEMED
MISSISSIPPI STATE EMPLOYEES AND TEACHERS HEALTH PLAN	SEHP, XSEHP, MSSEHP
MONTANA MEDICAID	12K77, AID57, CKMT1, MT, MTCAID, SKMT0
NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	RINHP
NEW HAMPSHIRE MEDICAID	NH, SKNH0, NHCAID
NEW MEXICO MEDICAID	12K22, AID27, CKNM1, NM, NMCAID, SKNM0
NOVA HEALTHCARE ADMINISTRATORS NY	16644, NOVAHC
PARTNERSHIP HEALTHPLAN OF CALIFORNIA	00343, PRTHP, SPPHP, SX140
PROFESSIONAL BENEFIT ADMINISTRATORS (OAKBROOK, IL)	36331, ILPBA
ROYAL NEIGHBORS OF AMERICA	RYLNB
SHARP HEALTH PLAN	SHARP, SHP01
SISCO	SISCO

Claims and ERAs

Payer Name	Industry Payer ID	CPID (I)	CPID (P)
ALASKA MEDICAID	77200	5524	4489
DISTRICT OF COLUMBIA MEDICAID	77033	5550	4425
GOLD COAST HEALTH PLAN	77160	4616	6128
MONTANA MEDICAID	SKMT0	5586	4427
NEW HAMPSHIRE MEDICAID	12K90	2575	7423
NEW MEXICO MEDICAID	12K22, NMMCD	5562	1492
ST. VINCENT CATHOLIC MEDICAL CENTER - USFHP	SKVA0	7542	2845

Action required: Please halt all transaction processing through the affected payers until more information is available.

REF 15860559 15863658 1/17/2025

New Electronic Claims Connections Available

This message is intended for Assurance EDI and Assurance Reimbursement Management customers.

Optum has new electronic claims connections available:

Payer Name: Palo Alto Medical Foundation
Institutional CPID: 8097
Professional CPID: 3203
Payer-assigned Payer ID: 87158
Payer Enrollment Required: No
Secondary Claims Accepted: Yes
Payer Location: California
Claims Fee: N/A

Action Required:

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

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 15856610 1/16/2025

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 on Dec. 20, 2024.

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

Original notify sent Dec. 31, 2024:

A payer intermediary is experiencing issues affecting professional and institutional report generation for some claims submitted on Dec. 20, 2024.

Payers impacted:

CPID 2786 Prime West
CPID 1942 IMCare
CPID 3764 IMCare
CPID 1039 South Country Health Alliance
CPID 7868 South Country Health Alliance

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

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

If you have any questions, please contact cusomer support and refer to case number 09310523.

REF 15854913 1/16/2025

Report Generation Delay for CPID 4248 Community Care BHO

The payer listed below is experiencing issues affecting Professional report generation for some claims submitted Jan. 1, 2025.

Payer impacted:

CPID 4248 Community Care BHO

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

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

If you have any questions, please contact Customer Support and refer to Case Number 09330183.

REF 15854914 1/16/2025

Report Generation Delay for CPID 9710 Firefly Health

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

Payer impacted:

CPID 9710 Firefly Health

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

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

If you have any questions, please contact Customer Support and refer to case number 09330053.

REF 15855403 1/16/2025

Report Generation Delay for CPID 3066 Procare Advantage of TX

A payer intermediary is experiencing issues affecting Institutional report generation for some claims submitted on Jan. 9, 2025.

Payer impacted:

CPID 3066 Procare Advantage of TX

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 15853347 1/16/2025

Payer Processing Issue for multiple CPIDs

Due to a payer intermediary processing issue, some Professional claims transmitted to the payers listed below on Jan. 15, 2025, were not processed by the payers.

Payers impacted:

1214	AgeRight Advantage Health Plan
8454	Align Senior Care of Michigan
4101	AllCare Advantage
2113	Allcare Health Plan
9278	Ambetter from Nebraska Total Care
9431	Ambetter from WellCare of Kentucky
9433	Ambetter of Oklahoma
2138	American Family Insurance
9429	American Health Advantage of Idaho & Utah
9142	American Health Advantage of Mississippi
7854	American Health Advantage of Oklahoma
9117	American Health Advantage of Texas
1741	Amerigroup
4437	Anthem Blue Cross Blue Shield New York
8749	Anthem MaineHealth
6220	Arizona Priority Care Plus
4881	Asuris Northwest Regence
7272	Axminster Medical Group
3845	Banner Health Network
8482	Benefit Plan Administrators - Roanoke, VA
1407	Blue Cross Blue Shield of Georgia
1243	Blue Cross Community Centennial
1167	Blue Cross Medicare Advantage PPO/HMO
9162	Blue Medicare Advantage
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
2830	CarePlus Health Plans
9722	CareSource North Carolina
1194	CareSource of Georgia
7143	CareSource of Indiana
3826	CareSource of Ohio
7263	CareSource of West Virginia
4743	Carelon Behavioral Health
2164	Carelon Behavioral Health Maryland
6127	Carelon Behavioral Health, MBHP
3293	Carelon Health
9297	Cenpatico Behavioral Health - Nebraska
6777	Centers Plan for Healthy Living
9765	Central Valley Medical Providers
8123	Clear Health Alliance
1415	Colorado Anthem Blue Cross Blue Shield
7416	Colorado Anthem Blue Cross Blue Shield HMO
6778	Common Ground Healthcare Cooperative
8834	Commonwealth Care Alliance DOS after 3/31/2023
2160	Community Care Plan (Commercial)
8147	Community Care Plan (Palm Beach Health District)
1420	Connecticut Anthem Blue Cross Blue Shield
6795	Contra Costa Health Plan
7738	CountyCare Health Plan
1232	Denver Health Medical Plan, Inc. - Medicare Choice
2433	Denver Health and Hospital Authority
8135	Doctors HealthCare Plans
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
3792	Fidelis Care
2875	First Health Network (Coventry Health Care National Network)
7435	FirstCare Health Plans
1414	Florida Blue Cross Blue Shield
3417	Florida Blue Cross Blue Shield Health Options HMO
9417	Florida Complete Care
2150	Florida Health Care Plans
2720	GlobalCare
9766	Gold Kidney Health Plan
1772	HAP CareSource
1723	HealthCare Partners IPA
4448	HealthLink PPO
5243	Healthcare Management Administrators
4740	Healthways WholeHealth Networks
7760	Healthy Blue Louisiana
8867	Healthy Blue Missouri
9133	Healthy Blue North Carolina
6259	Humana - CareSource of Kentucky
3757	IMAGINE360 ADMINISTRATORS (GPA)
5479	IU Health Plan Medicare Advantage
7426	Idaho Regence Blue Shield
1405	Illinois Blue Cross Blue Shield
5865	Indian Health Services
1412	Indiana Anthem Blue Cross Blue Shield
4445	Insurance Management Services TX
4116	IntegraNet Health
8814	Integrated Homecare Services
1404	Iowa Wellmark Blue Cross Blue Shield
6733	Iowa Wellmark Blue Cross Blue Shield Crossover
5432	Johns Hopkins Healthcare / Priority Partners
5882	Kane County IPA
2421	Kentucky Anthem Blue Cross Blue Shield
9412	Leon Health Plans
6273	Lifepath Hospice
7446	Maine Anthem Blue Cross Blue Shield
8812	Maryland Physicians Care
8860	Medica Government Programs
7859	Medica Health Plan Solutions
6799	Medica Individual and Family (IFB)
2287	Medicare Plus Blue of MI(MAP)
3475	Memorial Hermann Health Solutions
9102	Meridian Medicare Medicaid Plan
9118	MeridianComplete Michigan
2426	Michigan Blue Care Network
1421	Michigan Blue Cross Blue Shield
1402	Minnesota Blue Cross Blue Shield
1429	Minnesota Blue Cross Blue Shield HMO
7892	Minnesota Blue Cross Blue Shield Health Care Programs
1408	Missouri Anthem Blue Cross Blue Shield
7450	Montana Blue Cross Blue Shield
7496	Nevada Anthem Blue Cross Blue Shield
7422	New Hampshire Anthem Blue Cross Blue Shield
7403	New Mexico Blue Cross Blue Shield
8864	NextBlue of North Dakota
2411	North Dakota Blue Cross Blue Shield
9406	Ochsner Health Plan
2418	Ohio Anthem Blue Cross Blue Shield
1403	Oklahoma Blue Cross Blue Shield
8165	Oncology Physicians Network
2404	Oregon Regence Blue Cross Blue Shield
7829	Passport Advantage
9199	Piedmont Community Health Plan
7168	Premier Healthcare Exchange (PHX)
4252	Presbyterian Salud
8468	Procare Advantage of TX
2807	Professional Benefit Administrators (Oakbrook, Illinois)
4253	Prominence Administrative Services
5428	QualChoice of Arkansas
7264	Quartz ASO
1776	RIS Rx
1209	Regence Group Administrators
3257	ResourceOne Administrators
6246	Riverside Medical Clinic
4464	SCAN Health Plan
8708	SOMOS Anthem
8816	SOMOS Emblem
2254	Scott & White Health Plan
9438	Shared Health Mississippi
8124	Simply Healthcare Plans, Inc.
1740	Sonder Health Plans
2490	South Dakota Blue Cross Blue Shield
6195	Superior Vision Services
1406	Texas Blue Cross Blue Shield
1729	Texas Childrens Health Plan (CHIP)
2483	Texas Childrens Health Plan (STAR Medicaid)
4278	The Boon Group
8820	Tribute/SelectCare of Oklahoma
8763	U.S. Networks and Administrative Services
8473	Unicare
2412	Utah Regence Blue Cross Blue Shield
2788	Utah Regence Blue Cross Blue Shield Federal Employee Program
4258	VNS Health
7493	Vermont Blue Cross Blue Shield
1413	Virginia Anthem Blue Cross Blue Shield
7451	Washington Regence Blue Shield
1844	Wellcare Health Plans
3211	Wellcare Health Plans (Encounters)
9430	Wellcare by Allwell of Oklahoma
1775	Wellpoint
1401	Wisconsin Anthem Blue Cross Blue Shield
7489	Wyoming Blue Cross Blue Shield

A resolution has been implemented and the claims were retransmitted to the payer intermediary on Jan. 16, 2025.

This delay affected claims released to Optum between 7 a.m. and 11 p.m. ET on Jan. 15, 2025.

Action Required: Be aware of the processing issue above.

REF 15854908 1/16/2025

Report Generation Delay for CPID 3935 NHC Advantage

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

Payer impacted:

CPID 3935 NHC Advantage

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 15851463 1/16/2025

New electronic remittance connections available for CPIDs 1071 and 7899 Elderwood Health - Assurance EDI

Optum has new electronic remittance connections available:

Payer Name: Elderwood Health

Institutional CPID: 1071

Professional CPID: 7899

Payer-assigned Payer ID: 03964

Payer Enrollment Required: Yes

Remittance Fee: N/A

Payer Location: New York

Action Required:

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

REF 15850958 1/16/2025

Remittance Reactivation for CPIDs 6110, 4910 Family Care Milwaukee, Wisconsin

This message is intended for Assurance EDI customers.

Optum recently restored electronic remittance connectivity for the following payer:

Payer Name: Family Care Milwaukee, Wisconsin

Professional CPID: 6110

Institutional CPID: 4910

Industry Payer ID: 60995

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 15851012 1/16/2025

Report Generation Delay for multiple CPIDs

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

Payers impacted:

CPID 7281 PruittHealth Premier Medicare Advantage
CPID 8182 PruittHealth Premier NC/SC

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

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

REF 15851462 1/16/2025

Payer Change for CPIDs 1632, 6118, Benefit Management of Kansas; CPIDs 4514, 1219 Benefit Management LLC/VBA

Effective immediately, claims currently exchanged with the following payers must use different CPIDs. Electronic remittance will no longer be available.

Payer Name: Benefit Management of Kansas

Professional CPID: 6118

Institutional CPID: 1632

Remittance Previously Available: Yes

Payer-assigned Payer ID: 48611

Payer Name: Benefit Management LLC/VBA

Professional CPID: 1219

Institutional CPID: 4514

Remittance Previously Available: No

Payer-assigned Payer ID: 88092

Effective immediately, claims must begin using the following:

Payer Name: Midlands Choice

Professional CPID: 1742

Institutional CPID: 6588

Remittance Available: No

Payer-assigned Payer ID: 47080

Claim Fee: N/A

Enrollment Requirements:

Claims:

Payer enrollment for electronic claims is not required.

Action Required:

Please be aware of the changes above and make any necessary changes in your system.

REF 15849412 1/16/2025

New Electronic Claims Connections Available - HAP Caresource Michigan Marketplace

This message is intended for Assurance EDI and Assurance Reimbursement Management customers.

Optum has new electronic claims connections available:

Payer Name: HAP Caresource Michigan Marketplace

Institutional CPID: 8095

Professional CPID: 2891

Payer-assigned Payer ID: MICS1

Payer Enrollment Required: No

Secondary Claims Accepted: Yes

Payer Location: Michigan

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 15836582 1/15/2025

New Electronic Claims Connections Available - PACE Your Life

This message is intended for Assurance EDI and Assurance Reimbursement Management customers.

Optum has new electronic claims connections available:

Payer Name: PACE Your Life
Institutional CPID: 8099
Professional CPID: 3204
Payer-assigned Payer ID: 98472
Payer Enrollment Required: No
Secondary Claims Accepted: No
Payer Location: Delaware
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 15835466 1/15/2025

Payer processing issue for multiple CPIDs

Due to a payer intermediary processing issue, some professional claims transmitted to the payers listed below on Jan. 13, 2025 were not processed by the payers.

Payers impacted:

CPID Payer Name

9409 Align Senior Care of California

9267 Align Senior Care of Florida

2113 Allcare Health Plan

1764 Ambetter From Absolute Total Care

1765 Ambetter From Louisiana Healthcare Connections

9278 Ambetter from Nebraska Total Care

9431 Ambetter from WellCare of Kentucky

9432 Ambetter from WellCare of New Jersey

9775 Ambetter of Alabama

9433 Ambetter of Oklahoma

9429 American Health Advantage of Idaho & Utah

9117 American Health Advantage of Texas

1741 Amerigroup

1412 Anthem Blue Cross and Blue Shield - Indiana

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

7272 Axminster Medical Group

3845 Banner Health Network

7798 Bay Bridge Administrators LLC

1415 Blue Cross Blue Shield of Colorado

1407 Blue Cross Blue Shield of Georgia

7496 Blue Cross Blue Shield of Nevada

1169 Blue Cross Blue Shield of Western New York Medicaid/CHP

1243 Blue Cross Community Centennial

1167 Blue Cross Medicare Advantage PPO/HMO

4110 Bollinger Inc

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

2164 Carelon Behavioral Health Maryland

6127 Carelon Behavioral Health, MBHP

3293 Carelon Health

2830 CarePlus Health Plans

1194 CareSource of Georgia

7143 CareSource of Indiana

3826 CareSource of Ohio

7263 CareSource of West Virginia

9226 CareSource PASSE of Arkansas

6777 Centers Plan for Healthy Living

9765 Central Valley Medical Providers

8123 Clear Health Alliance

7416 Colorado Anthem Blue Cross Blue Shield HMO

6778 Common Ground Healthcare Cooperative

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

6795 Contra Costa Health Plan

6241 Correctional Health Partners

7738 CountyCare Health Plan

9747 Delaware First Health

2433 Denver Health and Hospital Authority

8135 Doctors HealthCare Plans

1119 Easy Choice Health Plan of California

7787 El Paso First Health Plans - Health Care Options (HCO)

5483 Employee Benefit Management Services (EBMS)

1834 Employee Plans

8137 Empower Healthcare Solutions

1795 Envolve Benefit Options

5238 Evolent Specialty Cardiology

7121 Evolent Specialty Oncology

3792 Fidelis Care

2875 First Health Network (Coventry Health Care National Network)

7435 FirstCare Health Plans

1414 Florida Blue Cross Blue Shield

3417 Florida Blue Cross Blue Shield Health Options HMO

9417 Florida Complete Care

2150 Florida Health Care Plans

5440 Fox Valley Medicine

8189 Gemcare IPA

2720 GlobalCare

5853 GMS Insurance

9766 Gold Kidney Health Plan

1772 HAP CareSource

1797 HAP CareSource Michigan Dual Medicare/Medicaid

5243 Healthcare Management Administrators

1723 HealthCare Partners IPA

4448 HealthLink PPO

8750 Healthy Blue Dual Advantage Louisiana

7760 Healthy Blue Louisiana

8867 Healthy Blue Missouri

9133 Healthy Blue North Carolina

7715 Hopkins Health Advantage

6259 Humana - CareSource of Kentucky

7426 Idaho Regence Blue Shield

1405 Illinois Blue Cross Blue Shield

3757 IMAGINE360 ADMINISTRATORS (GPA)

5865 Indian Health Services

4445 Insurance Management Services TX

4116 IntegraNet Health

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

2421 Kentucky Anthem Blue Cross Blue Shield

9412 Leon Health Plans

7446 Maine Anthem Blue Cross Blue Shield

8812 Maryland Physicians Care

8860 Medica Government Programs

7859 Medica Health Plan Solutions

6799 Medica Individual and Family (IFB)

2287 Medicare Plus Blue of MI(MAP)

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

8723 MN BCBS Health Care Programs Non Emergent Transportation

7450 Montana Blue Cross Blue Shield

7496 Nevada Anthem 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

4252 Presbyterian Salud

8182 PruittHealth Premier NC/SC

5428 QualChoice of Arkansas

7264 Quartz ASO

1209 Regence Group Administrators

4464 SCAN Health Plan

2254 Scott & White Health Plan

9438 Shared Health Mississippi

7225 Sharp Community Medical Group

8124 Simply Healthcare Plans, Inc.

8708 SOMOS Anthem

8816 SOMOS Emblem

1740 Sonder Health Plans

2490 South Dakota Blue Cross Blue Shield

6195 Superior Vision Services

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

2412 Utah Regence Blue Cross Blue Shield

2788 Utah Regence Blue Cross Blue Shield Federal Employee Program

7493 Vermont Blue Cross Blue Shield

4258 VNS Health

7451 Washington Regence Blue Shield

9430 Wellcare by Allwell of Oklahoma

1844 Wellcare Health Plans

3211 Wellcare Health Plans (Encounters)

1775 Wellpoint

1401 Wisconsin Anthem Blue Cross Blue Shield

7489 Wyoming Blue Cross Blue Shield

6731 ZELIS

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

This delay affected claims released to Optum between 2 p.m. and 6 p.m. CT on Jan. 13, 2025.

Action Required: Be aware of the processing issue above.

REF 15835150 1/15/2025

New Electronic Remittance Connections Available

This message is intended for Assurance EDI customers.

Optum has new electronic remittance connections available:

Payer Name: Kalos Health

Institutional CPID: 9665

Professional CPID: 7720

Payer-assigned Payer ID: 40137

Payer Enrollment Required: Yes

Remittance Fee: N/A

Payer Location: New York

Action Required:

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

REF 15836581 1/15/2025

Leisure World Managed Care Electronic Claims Connection No Longer Available

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

Payer Name: Leisure World Managed Care
Claim CPID: 1153
Payer-assigned Payer ID: LWMC1
Reason: Payer no longer contracted.

Action Required: Claims must be submitted to Optum on paper.

REF 15836425 1/15/2025

New Electronic Claims Connections Available

Optum has new electronic claims connections available:

Payer Name: Carolina SeniorCare
Institutional CPID: 8096
Professional CPID: 2896
Payer-assigned Payer ID: 71499
Payer Enrollment Required: No
Secondary Claims Accepted: No
Payer Location: North Carolina
Claims Fee: N/A

Action Required:

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

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

REF 15835473 1/15/2025

Leisure World Managed Care Electronic Claims Connection No Longer Available

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

Payer Name: Leisure World Managed Care
Claim CPID: 1153
Payer-assigned Payer ID: LWMC1
Reason: Payer no longer contracted.

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 15836426 1/15/2025

Report generation delay for CPID 1209 Regence Group Administrators

A payer intermediary is experiencing issues affecting professional report generation for some claims submitted since Jan. 3, 2025.

Payer impacted:

CPID 1209 Regence Group Administrators

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

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

REF 15835143 1/15/2024

New Electronic Claims Connections Available

Optum has new electronic claims connections available:

Payer Name: Starlife Holdings

Institutional CPID: 8094

Professional CPID: 2889

Payer-assigned Payer ID: STARH

Payer Enrollment Required: No

Secondary Claims Accepted: No

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 15835465 1/15/2025

Payer Processing Issue for multiple CPIDs

Due to a payer processing issue, Professional and Institutional claims transmitted to the payers listed below on Jan. 13, 2025, were not processed by the payers.

Payers impacted:

1473 California Medi-cal
1648 California Medi-cal SNF/Hospice
2436 California Medi-cal
3510 California Medi-cal
5023 California Medi-cal CA009
5024 California Medi-cal CAA7P
5025 California Medi-cal CAEP1
5987 California Medi-cal
8613 California Medi-cal (Restricted)
8871 California Medi-cal CA009
8872 California Medi-cal CA2E5
8873 California Medi-cal CAA7P

A resolution has been implemented and the claims were retransmitted to the payers on Jan. 14, 2025.

This delay affected claims released to Optum between 3 p.m. ET on Jan. 12, 2025, and 3 p.m. ET on Jan. 13, 2025.

Action Required: Be aware of the processing issue above.

REF 15835558 1/15/2025

New Payer Availability 837D claims Payer ID 83028

Jan. 15, 2025 - Important Announcement from Optum - Intelligent EDI - Claims for PID 83028

New Payer Announcement - The following items are covered in this announcement:

Optum Intelligent EDI is pleased to announce new claim payer connectivity for the following transaction types. Please incorporate claims into existing files you submit to Optum today.

MBA Benefit Administrators (Payer ID 83028)

Transactions: 837 Dental

Effective Date: Jan. 15, 2025

Please direct any questions to the Support Team at 1-866-OptumGo. Please do not reply to this email directly.

REF 15823711 1/14/2025

Report Generation Delay for CPID 1592 Johns Hopkins Healthcare / Priority Partners

This message is intended for Assurance Reimbursement Management and Assurance EDI customers.

A payer intermediary is experiencing issues affecting Institutional report generation for some claims submitted on Jan. 2, 2025.

Payer impacted:

CPID 1592 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 15826913 1/14/2025

Report Generation Delay for CPID 2414 New Jersey Horizon Blue Cross Blue Shield

This message is intended for Assurance Reimbursement Management and Assurance EDI customers.

The payer listed below experienced an issue affecting Professional report generation for some claims submitted on Nov. 11, 2024.

Payer impacted:

CPID 2414 New Jersey Horizon Blue Cross Blue Shield

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

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

REF 15824319 1/14/2025

Multiple Payers Electronic Claims Connections No Longer Available

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

Payer Name: Cofinity - Group Resources
Claim CPIDs: 3035 & 8286
Payer-assigned Payer ID: 42049
Reason: Payer no longer contracted.

Payer Name: Employee Benefit Concepts Michigan
Claim CPIDs: 7561 & 3705
Payer-assigned Payer ID: 38241
Reason: Payer no longer contracted.

Action Required: Claims must be submitted to Optum on paper.

REF 15822392 1/14/2025

Multiple Payers Electronic Claims Connections No Longer Available

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

Payer Name: Cofinity - Group Resources
Claim CPIDs: 3035 & 8286
Payer-assigned Payer ID: 42049
Reason: Payer no longer contracted.

Payer Name: Employee Benefit Concepts Michigan
Claim CPIDs: 7561 & 3705
Payer-assigned Payer ID: 38241
Reason: Payer no longer contracted.

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 15822393 1/14/2025

Electronic Routing Change for CPIDs 7620 and 6834, VillageCareMax - Assurance Reimbursement Management

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

Payer Name: VillageCareMax

Professional CPID: 6834

Institutional CPID: 7620

Payer-assigned Payer ID: 26545

LOB Code: H2H

Enrollment Requirements:

Remittance:

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

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

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

REF 15821414 1/14/2025

Electronic Routing Change for CPIDs 7620 and 6834, VillageCareMax - Assurance EDI

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

Payer Name: VillageCareMax

Professional CPID: 6834

Institutional CPID: 7620

Payer-assigned Payer ID: 26545

Enrollment Requirements:

Remittance:

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

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

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

REF 15821413 1/14/2025

Report Generation Delay for CPID 8113 MDwise Healthy Indiana Plan

The payer listed below experienced an issue affecting Professional report generation for some claims submitted on Nov. 22, 2024 and Nov. 28, 2024.

Payer impacted:

CPID 8113 MDwise Healthy Indiana Plan

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

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

REF 15824320 1/14/2025

Electronic Remittance Advice (ERA) Delay for California Medi-Cal

This message is intended for Revenue Performance Advisor (RPA) customers.

Due to a payer processing issue, there has been a delay in Professional and Institutional Electronic Remittance Advice (ERA) for the following payer for check date of January 6, 2025:

SKCA3 California Medi-Cal
SKCA0 California Medi-Cal

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.

REF 15825626 1/14/2025

Electronic Routing Reactivation and Change for CPIDs 3046 and 8295 MDsave

Effective January 15, 2025, Optum will be reactivating and changing electronic remittance routing for the following payer:

Payer Name: MDsave
Professional CPID: 8295
Institutional CPID: 3046
Payer-assigned Payer ID: MDSV

Enrollment Requirements:

Remittance:

Payer enrollment for electronic remittance is required.
- Providers currently receiving electronic remittance through Change Healthcare do not need to complete a new enrollment form.
- New providers must complete a new enrollment form.

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

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

REF 15822367 1/14/2025

Report Generation Delay for CPIDs 1913 and 2287 Medicare Plus Blue of MI(MAP)

A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted on Jan. 1, 2025, and Jan. 3, 2025.

Payer impacted:

CPID 1913 Medicare Plus Blue of MI(MAP)
CPID 2287 Medicare Plus Blue of MI(MAP)

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 15825308 1/14/2025

Electronic Routing Change for CPIDs 5279 and 7000 Santa Clara County IPA HMO

Effective Jan. 14, 2025, Optum is changing electronic claims routing for the following payer:

Payer Name: Santa Clara County IPA HMO
Professional CPID: 5279
Current Edit Master: PE_O007
New Edit Master: PE_T007
Institutional CPID: 7000
Current Edit Master: HE9O007
New Edit Master: HE9T007
Payer-assigned Payer ID: 10378

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(s) and CPID(s) are not changing.
When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.

REF 15823710 1/14/2025

Electronic Routing Change for CPIDs 5279 and 7000 Santa Clara County IPA HMO

Effective Jan. 14, 2025, Optum is changing electronic claims routing for the following payer:

Payer Name: Santa Clara County IPA HMO
Professional CPID: 5279
Institutional CPID: 7000
Payer-assigned Payer ID: 10378
Claims Fee: $0.10

Enrollment Requirements:
Claims:

Payer enrollment for electronic claims is not required.

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

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

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

REF 15823709 1/14/2025

Update: Report Generation Delay for CPID 2455 Arkansas Medicare

The payer has been unable to generate and deliver the reports for some claims submitted between Dec. 13, 2024 and Dec. 16, 2024.

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

Original message sent Jan. 6, 2025:

A payer is experiencing issues affecting Professional report generation for some claims submitted since Dec. 13, 2024.

Payer impacted:

CPID 2455 Arkansas 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 15821758 1/14/2025

Update: Report generation delay for CPID 1449 Colorado Medicare

Update: The payer has been unable to generate and deliver the reports for some claims submitted on Dec. 18, 2024 and Dec. 19, 2024.

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

Original notify sent Jan. 6, 2025:

A payer is experiencing issues affecting Professional report generation for some claims submitted since Dec. 18, 2024.

Payer impacted:

CPID 1449 Colorado 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 15821759 1/14/2025

New Payer Edit for CPID 8714

The payer below has informed Optum of a new edit requirement effective immediately. In order to meet the new requirement, we will add the following edit on January 15, 2025:

PDTP03A118: MISSING ACCIDENT DATE: The Accident Date is required. LOOP 2300 DTP03

Edit applies to:

CPID 8714 ALLSTATE – EXCEPT NEW JERSEY

Action Required: Please be aware of updated edit requirements.

REF 15812864 1/13/2025

HealthSCOPE Benefits 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: HealthSCOPE Benefits
Claim CPIDs: 4643, 6162
Payer-assigned Payer ID: 52429
Reason: Payer no longer offers 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 15810509 1/13/2025

HealthSCOPE Benefits 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: HealthSCOPE Benefits
Claim CPIDs: 4643, 6162
Payer-assigned Payer ID: 52429
Reason: Payer no longer offers an electronic connection.

Action Required: Claims must be submitted to Optum on paper

REF 15810508 1/13/2025

New Electronic Claims Connections Available

This message is intended for Assurance EDI and Assurance Reimbursement Management customers.

Optum has new electronic claims connections available:

Payer Name: Alternative Insurance Resources
Institutional CPID: 5061
Professional CPID: 9106
Payer-assigned Payer ID: IHS06
Payer Enrollment Required: No
Secondary Claims Accepted: No
Payer Location: National
Claims Fee: N/A

Action Required:

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

REF 15814714 1/13/2025

New Electronic Claims Connections Available

Optum has new electronic claims connections available:

Payer Name: NueHealth

Institutional CPID: 8083

Professional CPID: 2880

Payer-assigned Payer ID: RP138

Payer Enrollment Required: No

Secondary Claims Accepted: No

Payer Location: National

Claims Fee: N/A

Action Required:

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

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

REF 15814187 1/13/2025

Electronic Routing Change for CPIDs 6674 and 6778 Common Ground Healthcare Cooperative - Assurance Reimbursement Management

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

Payer Name: Common Ground Healthcare Cooperative

Professional CPID: 6778

Current Edit Master: PE_T007

New Edit Master: PE_B800

Institutional CPID: 6674

Current Edit Master: HE9T007

New Edit Master: HE9B801

Payer-assigned Payer ID: 77170

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 15810593 1/13/2025

Electronic Routing Change for CPIDs 6674 and 6778 Common Ground Healthcare Cooperative - Assurance EDI

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

Payer Name: Common Ground Healthcare Cooperative

Professional CPID: 6778

Institutional CPID: 6674

Payer-assigned Payer ID: 77170

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 15807642 1/13/2025

New Electronic Claims Connections Available

Optum has new electronic claims connections available:

Payer Name: Innermark TPA

Institutional CPID: 8093

Professional CPID: 2888

Payer-assigned Payer ID: 98481

Payer Enrollment Required: No

Secondary Claims Accepted: Yes

Payer Location: National

Claims Fee: N/A

Plans accepted with this connection:

Bluegrass Care Navigators
Lutheran Senior Life

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 15808118 1/13/2025

New Electronic Claims Connections Available

Optum has new electronic claims connections available:

Payer Name: UFCW Local 1000

Institutional CPID: 8090

Professional CPID: 2886

Payer-assigned Payer ID: 99843

Payer Enrollment Required: No

Secondary Claims Accepted: No

Payer Location: National

Claims Fee: N/A

Plans accepted with this connection:

UFCW Local 1000 and Kroger Dallas Health and Welfare Plan

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 15811408 1/13/2025

Payer Processing Issue for multiple CPIDs

Due to a payer intermediary processing issue, some Professional claims transmitted to the payers listed below on Jan. 10, 2025, were not processed by the payers.

Payers impacted:

1214 AgeRight Advantage Health Plan

2842 Alexian PACE

9409 Align Senior Care of California

8454 Align Senior Care of Michigan

4101 AllCare Advantage

2113 Allcare Health Plan

9278 Ambetter from Nebraska Total Care

9431 Ambetter from WellCare of Kentucky

9775 Ambetter of Alabama

9433 Ambetter of Oklahoma

9142 American Health Advantage of Mississippi

1741 Amerigroup

1412 Anthem Blue Cross and Blue Shield - Indiana

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

7794 Associated Hispanic Physicians IPA

4881 Asuris Northwest Regence

7272 Axminster Medical Group

3845 Banner Health Network

1415 Blue Cross Blue Shield of Colorado

1407 Blue Cross Blue Shield of Georgia

7496 Blue Cross Blue Shield of Nevada

1243 Blue Cross Community Centennial

1167 Blue Cross Medicare Advantage PPO/HMO

9162 Blue Medicare Advantage

6779 Bridgespan Regence

4246 Capital Health Plan

2810 Capitol Administrators

8146 Care N Care Insurance Co.

4743 Carelon Behavioral Health

2164 Carelon Behavioral Health Maryland

6127 Carelon Behavioral Health, MBHP

3293 Carelon Health

2830 CarePlus Health Plans

9722 CareSource North Carolina

1194 CareSource of Georgia

7143 CareSource of Indiana

3826 CareSource of Ohio

9297 Cenpatico Behavioral Health - Nebraska

6777 Centers Plan for Healthy Living

9765 Central Valley Medical Providers

7275 Citrus Valley Physicians Group

8123 Clear Health Alliance

7416 Colorado Anthem Blue Cross Blue Shield HMO

7763 Columbine Health Plan

8834 Commonwealth Care Alliance DOS after 3/31/2023

6865 Community Care Plan (Medicaid)

8147 Community Care Plan (Palm Beach Health District)

1420 Connecticut Anthem Blue Cross Blue Shield

6795 Contra Costa Health Plan

7738 CountyCare Health Plan

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

7294 Eberle Vivian

4279 El Paso Health-STAR

5483 Employee Benefit Management Services (EBMS)

8137 Empower Healthcare Solutions

1795 Envolve Benefit Options

3792 Fidelis Care

2875 First Health Network (Coventry Health Care National Network)

7435 FirstCare Health Plans

1414 Florida Blue Cross Blue Shield

3417 Florida Blue Cross Blue Shield Health Options HMO

9128 Florida Blue Medicare

2150 Florida Health Care Plans

5440 Fox Valley Medicine

2720 GlobalCare

1772 HAP CareSource

1797 HAP CareSource Michigan Dual Medicare/Medicaid

5243 Healthcare Management Administrators

1723 HealthCare Partners IPA

4448 HealthLink PPO

4740 Healthways WholeHealth Networks

7760 Healthy Blue Louisiana

8867 Healthy Blue Missouri

9133 Healthy Blue North Carolina

7715 Hopkins Health Advantage

6259 Humana - CareSource of Kentucky

7426 Idaho Regence Blue Shield

1405 Illinois Blue Cross Blue Shield

3757 IMAGINE360 ADMINISTRATORS (GPA)

4445 Insurance Management Services TX

4116 IntegraNet Health

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

2421 Kentucky Anthem Blue Cross Blue Shield

9412 Leon Health Plans

6273 Lifepath Hospice

7446 Maine Anthem Blue Cross Blue Shield

8812 Maryland Physicians Care

8860 Medica Government Programs

7859 Medica Health Plan Solutions

6799 Medica Individual and Family (IFB)

2287 Medicare Plus Blue of MI(MAP)

3475 Memorial Hermann Health Solutions

9102 Meridian Medicare Medicaid Plan

9118 MeridianComplete Michigan

2426 Michigan Blue Care Network

1421 Michigan Blue Cross Blue Shield

1402 Minnesota Blue Cross Blue Shield

1410 Minnesota Blue Cross Blue Shield CC Systems

7892 Minnesota Blue Cross Blue Shield Health Care Programs

1429 Minnesota Blue Cross Blue Shield HMO

1408 Missouri Anthem Blue Cross Blue Shield

7450 Montana Blue Cross Blue Shield

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

5838 Preferred Administrators

4252 Presbyterian Salud

2807 Professional Benefit Administrators (Oakbrook, Illinois)

4253 Prominence Administrative Services

5428 QualChoice of Arkansas

7264 Quartz ASO

1209 Regence Group Administrators

4270 Resurrection Physicians Provider Group

4464 SCAN Health Plan

2254 Scott & White Health Plan

7225 Sharp Community Medical Group

8124 Simply Healthcare Plans, Inc.

8816 SOMOS Emblem

2490 South Dakota Blue Cross Blue Shield

6195 Superior Vision Services

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

2412 Utah Regence Blue Cross Blue Shield

2788 Utah Regence Blue Cross Blue Shield Federal Employee Program

7493 Vermont Blue Cross Blue Shield

4258 VNS Health

7451 Washington Regence Blue Shield

1844 Wellcare Health Plans

3211 Wellcare Health Plans (Encounters)

1775 Wellpoint

1401 Wisconsin Anthem Blue Cross Blue Shield

7489 Wyoming Blue Cross Blue Shield

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

This delay affected claims released to Optum between 7 p.m. and 11 p.m. ET on Jan. 10, 2025.

REF 15805639 1/13/2025

Action Required: Be aware of the processing issue above.

Delay in Electronic Remittance Advice (ERA) for California Medi-Cal

Due to a payer processing issue, there has been a delay in Professional and Institutional Electronic Remittance Advice (ERA) for the following payers for check date of January 6, 2025:

CPID 1473 California Medi-Cal
CPID 1648 California Medi-Cal
CPID 3510 California Medi-Cal
CPID 5023 California Medi-Cal
CPID 5024 California Medi-Cal
CPID 5025 California Medi-Cal
CPID 5026 California Medi-Cal
CPID 5987 California Medi-Cal
CPID 8613 California Medi-Cal

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 09312305.

REF 15806982 1/13/2025

District of Columbia Real Time Rejections 270/271

District of Columbia Medicaid has been receiving 270 transactions with missing fields in Loop 2100C REF segment. These transactions are being rejected by the payer. Please note that District of Columbia Medicaid has the following requirement:

When data is populated in the 2100C Loop (Subscriber Additional ID), and REF*01=SY, REF*02 must = Nine Digits, Minimum 9, Maximum 9. It must be a valid 9-digit ID. The payer will reject any transactions that do not meet these requirements. Please update your system to send the correct required elements else do not send the REF Segment. The REF segment in 2100C is an optional field and not required in the 270 but when sent, must adhere to this payer’s requirements.

REF 15804222 1/13/2025

Remittance Processing Suspended for CPIDs 1928, 2772 Medical Associates Health Plans

This message is intended for Assurance EDI and Assurance Reimbursement Management customers.

Effective immediately, the payer listed below has been temporarily suspended for remittance processing and removed from the payer list.

Payer Name: Medical Associates Health Plans
CPIDs: 1928, 2772
Payer ID: MAHC1
Reason: Payer unavailable electronically

Action Required: None

REF 15794258 1/10/2025

Payer Processing Issue for multiple CPIDs

This message is intended for Assurance EDI and Assurance Reimbursement Management customers.

Due to a payer intermediary processing issue, some Professional claims transmitted to the payers listed below on Jan. 9, 2025, were not processed by the payers.

Payers impacted:

9267 Align Senior Care of Florida
8454 Align Senior Care of Michigan
2113 Allcare Health Plan
1764 Ambetter From Absolute Total Care
9278 Ambetter from Nebraska Total Care
9431 Ambetter from WellCare of Kentucky
9432 Ambetter from WellCare of New Jersey
9775 Ambetter of Alabama
9433 Ambetter of Oklahoma
2138 American Family Insurance
9712 American Health Advantage of Florida
9142 American Health Advantage of Mississippi
9117 American Health Advantage of Texas
4468 Americas Choice Healthplan
1741 Amerigroup
1412 Anthem Blue Cross and Blue Shield - Indiana
1413 Anthem Blue Cross and Blue Shield (Virginia)
2418 Anthem Blue Cross and Blue Shield of Ohio
4437 Anthem Blue Cross Blue Shield New York
8749 Anthem MaineHealth
6220 Arizona Priority Care Plus
2859 Ascension Living Hope PACE
4477 Asuris Northwest Medadvantage Regence
4881 Asuris Northwest Regence
7272 Axminster Medical Group
3845 Banner Health Network
1415 Blue Cross Blue Shield of Colorado
1407 Blue Cross Blue Shield of Georgia
7496 Blue Cross Blue Shield of Nevada
1243 Blue Cross Community Centennial
1167 Blue Cross Medicare Advantage PPO/HMO
9162 Blue Medicare Advantage
6165 Bridgeview
4246 Capital Health Plan
2810 Capitol Administrators
8146 Care N Care Insurance Co.
9759 Care1st Health Plan of Arizona Medicaid DOS before 12/01/2022
4743 Carelon Behavioral Health
2164 Carelon Behavioral Health Maryland
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
8123 Clear Health Alliance
7416 Colorado Anthem Blue Cross Blue Shield HMO
8834 Commonwealth Care Alliance DOS after 3/31/2023
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
3420 Connecticut Medicare Blue (Risk)
6795 Contra Costa Health Plan
6241 Correctional Health Partners
7738 CountyCare Health Plan
9747 Delaware First Health
2433 Denver Health and Hospital Authority
1232 Denver Health Medical Plan, Inc. - Medicare Choice
8135 Doctors HealthCare Plans
1119 Easy Choice Health Plan of California
5483 Employee Benefit Management Services (EBMS)
1834 Employee Plans
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
8189 Gemcare IPA
2720 GlobalCare
9766 Gold Kidney Health Plan
1772 HAP CareSource
1797 HAP CareSource Michigan Dual Medicare/Medicaid
5243 Healthcare Management Administrators
1723 HealthCare Partners IPA
4448 HealthLink PPO
4740 Healthways WholeHealth Networks
7760 Healthy Blue Louisiana
8867 Healthy Blue Missouri
9133 Healthy Blue North Carolina
7715 Hopkins Health Advantage
6259 Humana - CareSource of Kentucky
7426 Idaho Regence Blue Shield
1405 Illinois Blue Cross Blue Shield
3757 IMAGINE360 ADMINISTRATORS (GPA)
5865 Indian Health Services
4445 Insurance Management Services TX
4116 IntegraNet Health
1107 Integrated Health Partners (IHP)
9713 Iowa Health Advantage
1404 Iowa Wellmark Blue Cross Blue Shield
6733 Iowa Wellmark Blue Cross Blue Shield Crossover
5479 IU Health Plan Medicare Advantage
5432 Johns Hopkins Healthcare / Priority Partners
7782 Kansas Health Advantage
2421 Kentucky Anthem Blue Cross Blue Shield
9412 Leon Health Plans
7446 Maine Anthem Blue Cross Blue Shield
8812 Maryland Physicians Care
8860 Medica Government Programs
7859 Medica Health Plan Solutions
6799 Medica Individual and Family (IFB)
2287 Medicare Plus Blue of MI(MAP)
3475 Memorial Hermann Health Solutions
9102 Meridian Medicare Medicaid Plan
9118 MeridianComplete Michigan
2426 Michigan Blue Care Network
1421 Michigan Blue Cross Blue Shield
1402 Minnesota Blue Cross Blue Shield
1410 Minnesota Blue Cross Blue Shield CC Systems
7892 Minnesota Blue Cross Blue Shield Health Care Programs
1429 Minnesota Blue Cross Blue Shield HMO
1408 Missouri Anthem Blue Cross Blue Shield
8723 MN BCBS Health Care Programs Non Emergent Transportation
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
2411 North Dakota Blue Cross Blue Shield
1403 Oklahoma Blue Cross Blue Shield
2404 Oregon Regence Blue Cross Blue Shield
7829 Passport Advantage
4252 Presbyterian Salud
8468 Procare Advantage of TX
2807 Professional Benefit Administrators (Oakbrook, Illinois)
4253 Prominence Administrative Services
7281 PruittHealth Premier Medicare Advantage
5428 QualChoice of Arkansas
7264 Quartz ASO
1209 Regence Group Administrators
1776 RIS Rx
4464 SCAN Health Plan
2254 Scott & White Health Plan
8124 Simply Healthcare Plans, Inc.
8708 SOMOS Anthem
8816 SOMOS Emblem
1740 Sonder Health Plans
2490 South Dakota Blue Cross Blue Shield
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
2412 Utah Regence Blue Cross Blue Shield
2788 Utah Regence Blue Cross Blue Shield Federal Employee Program
7493 Vermont Blue Cross Blue Shield
4258 VNS Health
7451 Washington Regence Blue Shield
9430 Wellcare by Allwell of Oklahoma
1844 Wellcare Health Plans
3211 Wellcare Health Plans (Encounters)
1775 Wellpoint
2448 Wellpoint Encounters
1401 Wisconsin Anthem Blue Cross Blue Shield
7489 Wyoming Blue Cross Blue Shield

A resolution has been implemented and the claims were retransmitted to the payer intermediary on Jan. 10, 2025.

This delay affected claims released to Optum between 3 p.m. and 7 p.m. ET on Jan. 9, 2025.

Action Required: Be aware of the processing issue above.

REF 15798278 1/10/2025

ERA and Reports Delay for VA Fee Basis Programs & CHAMPVA - HAC

This message is intended for Revenue Performance Advisor (RPA) customers.

Due to Payer scheduled maintenance, there will been a delay in Professional and Institutional Electronic Remittance Advice (ERA) and 277CAs for the below mentioned payers. The delay is expected to last two weeks from Dec. 31, 2024, to Jan. 14, 2025.

12115 - Veterans Administration Fee Basis Programs

84146 - CHAMPVA - HAC

Action Required:

Please be aware of a delay in the delivery of ERA and 277CAs.

REF 15799179 1/10/2025

New Electronic Remittance Connections Available on RPA

This message is intended for Revenue Performance Advisor (RPA) customers.

ERA (Remittance) transactions have recently been added for the following payers:

88058 – Med Pay

ACN90 – Altais Care Network

RP129 – Wellstar Health Plan

RP130 – NLIA (Ningen Dock)

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 15794112 1/10/2025

New Electronic Claim Connections Available on Revenue Performance Advisor (RPA)

Institutional claim transactions have recently been added for the following payers:

00C63 – BlueCross BlueShield of South Carolina Medicare Advantage
36423 – Zurich American Insurance Company
77306 – Sutter Connect - SIP,SMG,SWMG
82347 – DH Cook
87347 – US Family Health Plan - NW Region
88057 – Zelis
99727 – TRICARE East Region
ABH02 – Access Behavioral Health
ALLCA – AllCare Family Medical Group
AUX01 – Auxiant
EHI01 – Empire Healthcare IPA
EXC01 – Physicians Medical Group of San Jose
HMLIC – Horace Mann
IP082 – Key Medical Group
JVHMQ – JVHL - Physicians Health Plan (Medicare Advantage) **enrollment required
JVHMT – JVHL - HAP CareSource - FFS **enrollment required
LCO01 – Longevity Health Plan of Colorado
MAI60 – Millette Administrators
MMFUC – UC Irvine Health
MPM38 – AHP Provider Network
MPSAB – Meridian PACE Solutions
OSUAE – OSU Aetna Better Health
PRC01 – Utah Navajo Health System Inc
R3459 – Ascension Living St Vincent PACE
R3470 – Ascension Living Hope PACE
R3471 – Alexian PACE

Professional claim transactions have recently been added for the following payers:

00C63 – BlueCross BlueShield of South Carolina Medicare Advantage
36423 – Zurich American Insurance Company
82347 – DH Cook
87347 – US Family Health Plan - NW Region
88057 – Zelis
99727 – TRICARE East Region
ABH02 – Access Behavioral Health
ALLCA – AllCare Family Medical Group
AUDIO – Audionet - National Elevator
AUX01 – Auxiant
EHI01 – Empire Healthcare IPA
HMLIC – Horace Mann
JVHMQ – JVHL - Physicians Health Plan (Medicare Advantage) **enrollment required
JVHMT – JVHL - HAP CareSource - FFS **enrollment required
LCO01 – Longevity Health Plan of Colorado
MAI60 – Millette Administrators
MMFUC – UC Irvine Health
MPM38 – AHP Provider Network
MPSAB – Meridian PACE Solutions
OSUAE – OSU Aetna Better Health
PRC01 – Utah Navajo Health System Inc
R3459 – Ascension Living St Vincent PACE
R3470 – Ascension Living Hope PACE
R3471 – Alexian PACE
UC002 – Brand New Day Encounters

REF 15794114 1/10/2025

New Payer Name

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

Previous Payer Name: Professional Health Care Network (PHCN)
New Payer Name: tango
Professional CPID: 9217
Institutional CPID: 6062

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

REF 15789498 1/10/2025

New Payer Name

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

Previous Payer Name: Professional Health Care Network (PHCN)
New Payer Name: tango
Professional CPID: 9217
Institutional CPID: 6062
Edit Masters: PE_T007 and HE9T007
Remit Line of Business (LOB) Code: H5E

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 15789499 1/10/2025

Update: Report Generation Delay for CPID 4252 Presbyterian Salud

Update: The payer intermediary has been unable to generate and deliver the reports for some claims submitted on Dec. 17, 2024, and Dec. 18, 2024.

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

Original notification sent Jan. 2, 2025:

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted since Dec. 16, 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 15792997 1/10/2025

New Electronic Claims Connections Available

Optum has new electronic claims connections available:

Payer Name: Elderhaus

Institutional CPID: 8092

Professional CPID: 2887

Payer-assigned Payer ID: 64192

Payer Enrollment Required: No

Secondary Claims Accepted: No

Payer Location: North Carolina

Claims Fee: N/A

Action Required:

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

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

REF 15793723 1/10/2025

Payer Change for TRICARE East Region

This message is intended for Revenue Performance Advisor (RPA) customers.

UPDATE: 99727 is now live for claims and ERA on RPA. Please ensure that any needed enrollments have been done.

Original message posted Dec. 30, 2024:

Optum has been informed that PGBA will begin administering electronic claims and remittances for the payer identified below effective Jan. 1, 2025. We are currently working to add this payer to the Revenue Performance Advisor (RPA) system. Please watch for an announcement when payer is live before sending claim transactions to avoid rejections.

Optum would like to inform providers that while a claim enrollment form is not needed for submitting claims electronically, an Electronic Data Interchange (EDI) Provider Trading Partner Agreement is required to be on file with PGBA. Please see Enrollment instructions below. Providers may now begin completing the necessary enrollment forms for payer ID 99727 claims or electronic remittance.

Effective Jan. 1, 2025, claims and remittance currently exchanged with the following payer must use different payer IDs based on your new TRICARE contract (**For 99727, once available on RPA):

Claims and Remittance containing Dates of Service on or prior to Dec. 31, 2024, must continue to use the following through April 30, 2025:

Payer Name: TRICARE East Region DOS before 1/1/25

RPA Payer ID: 68299

Payer-assigned Payer ID: TREST

Claims and Remittance containing Dates of Service on or after Jan. 1, 2025 must begin using the following based on your TRICARE contract:

Payer Name: TRICARE East Region

RPA Payer ID: 99727

Payer-assigned Payer ID: 99727

NOTES:

Beginning May 1, 2025, submit 2024 claims to 99727 TRICARE East Region.
The following states are moving to the TRICARE West Region: Arkansas, Illinois, Louisiana, Oklahoma, Texas, and Wisconsin. TRICARE West providers should use RPA IDs 12C01 for institutional and SCWI0 for professional transactions.
For additional information regarding this change please see Humana Military’s Provider Update page - Provider Updates.

Enrollment Requirements for TRICARE East Region ID 99727:

Claims:

Payer enrollment for electronic claims is not required. However, PGBA requires an Electronic Data Interchange (EDI) Provider Trading Partner Agreement to be on file.
- If the provider is credentialed with PGBA and has an Electronic Data Interchange (EDI) Provider Trading Partner Agreement on file with PGBA the Optum Enrollment is not required.
- If the provider is not credentialed with PGBA, please complete the Optum Enrollment form process prior to sending claims.

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.

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 15788903 1/9/2025

Payer Processing Issue for multiple CPIDs

This message is intended for Assurance Reimbursement Management and Assurance EDI customers.

Due to a payer intermediary processing issue, some Professional claims transmitted to the payers listed below on Jan. 8, 2025, were not processed by the payers.

Payers impacted:
8454 Align Senior Care of Michigan
2113 Allcare Health Plan
8714 Allstate - Except New Jersey
1764 Ambetter From Absolute Total Care
1765 Ambetter From Louisiana Healthcare Connections
9278 Ambetter from Nebraska Total Care
9431 Ambetter from WellCare of Kentucky
9432 Ambetter from WellCare of New Jersey
9775 Ambetter of Alabama
9433 Ambetter of Oklahoma
9429 American Health Advantage of Idaho & Utah
9142 American Health Advantage of Mississippi
1741 Amerigroup
1412 Anthem Blue Cross and Blue Shield - Indiana
1413 Anthem Blue Cross and Blue Shield (Virginia)
2418 Anthem Blue Cross and Blue Shield of Ohio
4437 Anthem Blue Cross Blue Shield New York
8749 Anthem MaineHealth
6220 Arizona Priority Care Plus
4881 Asuris Northwest Regence
7272 Axminster Medical Group
3845 Banner Health Network
7798 Bay Bridge Administrators LLC
1415 Blue Cross Blue Shield of Colorado
1407 Blue Cross Blue Shield of Georgia
7496 Blue Cross Blue Shield of Nevada
1243 Blue Cross Community Centennial
1167 Blue Cross Medicare Advantage PPO/HMO
9162 Blue Medicare Advantage
4246 Capital Health Plan
2810 Capitol Administrators
8146 Care N Care Insurance Co.
9759 Care1st Health Plan of Arizona Medicaid DOS before 12/01/2022
4743 Carelon Behavioral Health
2164 Carelon Behavioral Health Maryland
6127 Carelon Behavioral Health, MBHP
3293 Carelon Health
2830 CarePlus Health Plans
1194 CareSource of Georgia
7143 CareSource of Indiana
3826 CareSource of Ohio
6777 Centers Plan for Healthy Living
9765 Central Valley Medical Providers
6700 Centurion Managed Care
7275 Citrus Valley Physicians Group
8123 Clear Health Alliance
7763 Columbine Health Plan
8834 Commonwealth Care Alliance DOS after 3/31/2023
8477 Community Care Plan
2160 Community Care Plan (Commercial)
6865 Community Care Plan (Medicaid)
8147 Community Care Plan (Palm Beach Health District)
1420 Connecticut Anthem Blue Cross Blue Shield
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
8135 Doctors HealthCare Plans
1119 Easy Choice Health Plan of California
5483 Employee Benefit Management Services (EBMS)
1834 Employee Plans
1795 Envolve Benefit Options
9215 Everpointe
5238 Evolent Specialty Cardiology
3792 Fidelis Care
2875 First Health Network (Coventry Health Care National Network)
7435 FirstCare Health Plans
1414 Florida Blue Cross Blue Shield
3417 Florida Blue Cross Blue Shield Health Options HMO
9417 Florida Complete Care
2150 Florida Health Care Plans
8189 Gemcare IPA
2720 GlobalCare
1772 HAP CareSource
1797 HAP CareSource Michigan Dual Medicare/Medicaid
5243 Healthcare Management Administrators
1723 HealthCare Partners IPA
4448 HealthLink PPO
7760 Healthy Blue Louisiana
8867 Healthy Blue Missouri
9133 Healthy Blue North Carolina
7715 Hopkins Health Advantage
6259 Humana - CareSource of Kentucky
7426 Idaho Regence Blue Shield
1405 Illinois Blue Cross Blue Shield
3757 IMAGINE360 ADMINISTRATORS (GPA)
5865 Indian Health Services
4445 Insurance Management Services TX
4116 IntegraNet Health
1107 Integrated Health Partners (IHP)
4876 International Medical Group
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
2421 Kentucky Anthem Blue Cross Blue Shield
9412 Leon Health Plans
6273 Lifepath Hospice
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
8723 MN BCBS Health Care Programs Non Emergent Transportation
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
2411 North Dakota Blue Cross Blue Shield
2881 Northwell Direct
1403 Oklahoma Blue Cross Blue Shield
2404 Oregon Regence Blue Cross Blue Shield
7829 Passport Advantage
4252 Presbyterian Salud
8468 Procare Advantage of TX
7281 PruittHealth Premier Medicare Advantage
5428 QualChoice of Arkansas
7264 Quartz ASO
1209 Regence Group Administrators
3257 ResourceOne Administrators
1776 RIS Rx
4464 SCAN Health Plan
2254 Scott & White Health Plan
7225 Sharp Community Medical Group
8124 Simply Healthcare Plans, Inc.
8708 SOMOS Anthem
8816 SOMOS Emblem
1740 Sonder Health Plans
2490 South Dakota Blue Cross Blue Shield
6195 Superior Vision Services
1203 TCC Basic Plus
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
2412 Utah Regence Blue Cross Blue Shield
2788 Utah Regence Blue Cross Blue Shield Federal Employee Program
7493 Vermont Blue Cross Blue Shield
4258 VNS Health
7451 Washington Regence Blue Shield
1844 Wellcare Health Plans
3211 Wellcare Health Plans (Encounters)
1775 Wellpoint
2448 Wellpoint Encounters
1401 Wisconsin Anthem Blue Cross Blue Shield
7489 Wyoming Blue Cross Blue Shield
6731 ZELIS

A resolution has been implemented and the claims were retransmitted to the payer intermediary on Jan. 9, 2025.

This delay affected claims released to Optum between 3 p.m. and 7 p.m. ET on Jan. 8, 2025.

Action Required: Be aware of the processing issue above.

REF 15782458 1/9/2025

Report Generation Delay for multiple CPIDs

This message is intended for Assurance EDI and Assurance Reimbursement Management customers.

A payer intermediary is experiencing issues affecting Professional and Institutional report generation for some claims submitted since Jan. 3, 2025.

Payers impacted:

CPID 2216 Florida Medicare
CPID 3650 JH Mutual of Omaha CO, NM, OK, TX
CPID 1460 Louisiana Medicare
CPID 3579 Louisiana Medicare
CPID 7402 Maryland Medicare
CPID 2451 Mississippi Medicare
CPID 5556 Mississippi Medicare
CPID 1457 New Mexico Medicare
CPID 5566 New Mexico Medicare
CPID 1558 Oklahoma Medicare
CPID 1440 Texas Medicare
CPID 5502 Texas 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 15784936 1/9/2025

Optum Notice: Electronic Routing Change for CPIDs 7030 and 9414 Evry Health - Assurance Reimbursement Management

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

Payer Name: Evry Health

Professional CPID: 9414

Institutional CPID: 7030

Remittance LOB Code: K1Z

Payer-assigned Payer ID: EH001

Enrollment Requirements:

Remittance:

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

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

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

REF 15783368 1/9/2025

Optum Notice: Electronic Routing Change for CPIDs 7030 and 9414 Evry Health - Assurance EDI

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

Payer Name: Evry Health

Professional CPID: 9414

Institutional CPID: 7030

Payer-assigned Payer ID: EH001

Enrollment Requirements:

Remittance:

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

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

Make any necessary system changes.

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

REF 15783366 1/9/2025

Electronic Routing Change for CPIDs 7794 and 8554, Associated Hispanic Physicians IPA

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

Payer Name: Associated Hispanic Physicians IPA

Professional CPID: 7794

Institutional CPID: 8554

Old Payer-assigned Payer ID: MPM44

New Payer-assigned Payer ID: AHPSC

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 15783510 1/9/2025

Electronic Routing Change for CPIDs 7794 and 8554, Associated Hispanic Physicians IPA

Effective immediately, Optum is changing electronic claims routing for the following payer:

Payer Name: Associated Hispanic Physicians IPA
Professional CPID: 7794
Current Edit Master: PE_O007
New Edit Master: PE_B800
Institutional CPID: 8554
Current Edit Master: HE9O007
New Edit Master: HE9B801
Old Payer-assigned Payer ID: MPM44
New Payer-assigned Payer ID: AHPSC

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(s) and CPID(s) are not changing.
When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.

REF 15783511 1/9/2025

Report Generation Delay for CPID 2481 Ohio Medicaid

A payer is experiencing issues affecting Professional report generation for some claims submitted Jan. 1, 2025.

Payer impacted:

CPID 2481 Ohio Medicaid

The payer has been unable to generate and deliver the reports for some claims submitted Jan. 1, 2025.

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

REF 15782708 1/9/2025

New Eligibility and Claims Status Connection Available for Luminare Health KC

Effective Jan., 9 2025 Optum is pleased to announce the availability of Real-time Eligibility Inquiry and Response 270/271 for the below payer:

Payer Name: Luminare Health KC

Industry Payer ID: 48117

IMN Real Time ID: 48117

Exchange Real Time ID: 48117

CPID(s): 4568,5492

Payer Enrollment Required: No

Connection Type: X12

Search options:

Subscriber

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

Dependent

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

For Claim Status 276/277

Search Options:

Subscriber

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

Dependent

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

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

REF 15782359 1/9/2025

Electronic Claims Connection Suspended

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

Payer Name: Healthy Blue Nebraska

CPIDs: 5502 and 8870

Payer ID: 00544

Payer Name: Healthy Blue South Carolina

CPIDs: 5953 and 2121

Payer ID: 00403

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

REF 15772674 1/9/2025

Payer Change for CPIDs 4545, 1231 - Imagine Health - Assurance Reimbursement Management

This message is intended for Assurance Reimbursement Management customers.

Effective immediately, claims currently exchanged with the following payer must use different CPIDs.

Payer Name: Imagine Health
Professional CPID: 1231
Professional Edit Master: PE_T007
Institutional CPID: 4545
Institutional Edit Master: HE9T007
Payer-assigned Payer ID: 43123

Claims must begin using the following:

Payer Name: Imagine360 Administrators
Professional CPID: 3757
Professional Edit Master: PE_B800
Institutional CPID: 2936
Institutional Edit Master: HE9B801
Payer-assigned Payer ID: 48143
Line of Business Code (LOB): J23

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 3757 and 2936 Imagine360 Administrators do not need to complete a new enrollment form.
- Providers not receiving electronic remittance through Optum for CPIDs 3757, 2936 Imagine360 Administrators 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 15769970 1/8/2025

Payer Change for CPIDs 4545, 1231 - Imagine Health - Assurance EDI

This message is intended for Assurance EDI customers.

Effective immediately, claims currently exchanged with the following payer must use different CPIDs.

Payer Name: Imagine Health
Professional CPID: 1231
Institutional CPID: 4545
Payer-assigned Payer ID: 43123

Claims must begin using the following:

Payer Name: Imagine360 Administrators
Professional CPID: 3757
Institutional CPID: 2936
Remittance Available: Yes
Payer-assigned Payer ID: 48143
Claim Fee: $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 for CPIDs 3757, 2936 Imagine360 Administrators do not need to complete a new enrollment form.
- Providers not receiving electronic remittance through Optum for CPIDs 3757, 2936 Imagine360 Administrators 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 15769969 1/8/2025

Payer Processing Issue for multiple CPIDs

This message is intended for Assurance Reimbursement Management and Assurance EDI customers.

Due to a payer intermediary processing issue, some Professional claims transmitted to the payers listed below on Jan. 7, 2025, were not processed by the payers.

Payers impacted:
9267 Align Senior Care of Florida
8454 Align Senior Care of Michigan
4101 AllCare Advantage
2113 Allcare Health Plan
8714 Allstate - Except New Jersey
1764 Ambetter From Absolute Total Care
9278 Ambetter from Nebraska Total Care
9431 Ambetter from WellCare of Kentucky
9775 Ambetter of Alabama
9433 Ambetter of Oklahoma
2138 American Family Insurance
9142 American Health Advantage of Mississippi
7854 American Health Advantage of Oklahoma
9117 American Health Advantage of Texas
4468 Americas Choice Healthplan
1741 Amerigroup
1412 Anthem Blue Cross and Blue Shield - Indiana
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
4881 Asuris Northwest Regence
7272 Axminster Medical Group
3845 Banner Health Network
1415 Blue Cross Blue Shield of Colorado
1407 Blue Cross Blue Shield of Georgia
7496 Blue Cross Blue Shield of Nevada
1243 Blue Cross Community Centennial
1167 Blue Cross Medicare Advantage PPO/HMO
9162 Blue Medicare Advantage
2857 BlueCross BlueShield of South Carolina Medicare Advantage
4110 Bollinger Inc
6779 Bridgespan Regence
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
2164 Carelon Behavioral Health Maryland
6127 Carelon Behavioral Health, MBHP
3293 Carelon Health
2830 CarePlus Health Plans
1194 CareSource of Georgia
7143 CareSource of Indiana
3826 CareSource of Ohio
6777 Centers Plan for Healthy Living
9765 Central Valley Medical Providers
7275 Citrus Valley Physicians Group
8123 Clear Health Alliance
8834 Commonwealth Care Alliance DOS after 3/31/2023
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
3420 Connecticut Medicare Blue (Risk)
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)
3477 Early Intervention Central Billing
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
7761 Esurance Insurance Company
5238 Evolent Specialty Cardiology
3792 Fidelis Care
2875 First Health Network (Coventry Health Care National Network)
7435 FirstCare Health Plans
1414 Florida Blue Cross Blue Shield
3417 Florida Blue Cross Blue Shield Health Options HMO
9128 Florida Blue Medicare
9417 Florida Complete Care
2150 Florida Health Care Plans
5440 Fox Valley Medicine
6851 Friday Health Plans
8189 Gemcare IPA
8879 Georgia Health Advantage
2720 GlobalCare
9766 Gold Kidney Health Plan
1772 HAP CareSource
1797 HAP CareSource Michigan Dual Medicare/Medicaid
5243 Healthcare Management Administrators
1723 HealthCare Partners IPA
4448 HealthLink PPO
8750 Healthy Blue Dual Advantage Louisiana
7760 Healthy Blue Louisiana
8867 Healthy Blue Missouri
8870 Healthy Blue Nebraska
9133 Healthy Blue North Carolina
6272 Hispanic Physicians IPA (Encounters Only)
7715 Hopkins Health Advantage
6259 Humana - CareSource of Kentucky
7426 Idaho Regence Blue Shield
1405 Illinois Blue Cross Blue Shield
2234 Illinois Health Partners
3757 IMAGINE360 ADMINISTRATORS (GPA)
5865 Indian Health Services
4445 Insurance Management Services TX
4116 IntegraNet Health
1107 Integrated Health Partners (IHP)
8814 Integrated Homecare Services
1404 Iowa Wellmark Blue Cross Blue Shield
6733 Iowa Wellmark Blue Cross Blue Shield Crossover
5479 IU Health Plan Medicare Advantage
5432 Johns Hopkins Healthcare / Priority Partners
7782 Kansas Health Advantage
2421 Kentucky Anthem Blue Cross Blue Shield
9412 Leon Health Plans
6273 Lifepath Hospice
1205 Lifeworks Advantage (ISNP Plan)
2863 Longevity Health Plan of Colorado
7446 Maine Anthem Blue Cross Blue Shield
8812 Maryland Physicians Care
8860 Medica Government Programs
7859 Medica Health Plan Solutions
6799 Medica Individual and Family (IFB)
2287 Medicare Plus Blue of MI(MAP)
9102 Meridian Medicare Medicaid Plan
9118 MeridianComplete Michigan
2426 Michigan Blue Care Network
1421 Michigan Blue Cross Blue Shield
1402 Minnesota Blue Cross Blue Shield
1410 Minnesota Blue Cross Blue Shield CC Systems
7892 Minnesota Blue Cross Blue Shield Health Care Programs
1429 Minnesota Blue Cross Blue Shield HMO
5871 Mission Community IPA Medical Group
1408 Missouri Anthem Blue Cross Blue Shield
7450 Montana Blue Cross Blue Shield
7422 New Hampshire Anthem Blue Cross Blue Shield
7403 New Mexico Blue Cross Blue Shield
8864 NextBlue of North Dakota
2411 North Dakota Blue Cross Blue Shield
1403 Oklahoma Blue Cross Blue Shield
2404 Oregon Regence Blue Cross Blue Shield
7829 Passport Advantage
9123 Perennial Advantage
8128 Pool Administrators, Inc.
5838 Preferred Administrators
7168 Premier Healthcare Exchange (PHX)
4252 Presbyterian Salud
8468 Procare Advantage of TX
4253 Prominence Administrative Services
7281 PruittHealth Premier Medicare Advantage
5428 QualChoice of Arkansas
8828 Qualexa Healthcare
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
9438 Shared Health Mississippi
7225 Sharp Community Medical Group
8124 Simply Healthcare Plans, Inc.
8816 SOMOS Emblem
1740 Sonder Health Plans
2490 South Dakota Blue Cross Blue Shield
1406 Texas Blue Cross Blue Shield
1729 Texas Childrens Health Plan (CHIP)
2483 Texas Childrens Health Plan (STAR Medicaid)
4278 The Boon Group
8763 U.S. Networks and Administrative Services
7810 UMass Medical School Health and Criminal Justice Program
8473 Unicare
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
9293 Wellcare by Allwell from Nebraska Total Care
9430 Wellcare by Allwell of Oklahoma
1844 Wellcare Health Plans
3211 Wellcare Health Plans (Encounters)
1775 Wellpoint
9441 Wellspace NEXUS LLC
1401 Wisconsin Anthem Blue Cross Blue Shield
7489 Wyoming Blue Cross Blue Shield
6731 ZELIS

A resolution has been implemented and the claims were retransmitted to the payer intermediary on Jan. 8, 2025.

This delay affected claims released to Optum between 11 a.m. and 3 p.m. ET on Jan. 7, 2025.

Action Required: Be aware of the processing issue above.

REF 15771661 1/8/2025

Electronic Routing Change for CPID 5676 Alliance Behavioral Health

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

Payer Name: Alliance Behavioral Health
Institutional CPID: 5676
Payer-assigned Payer ID: 23071

Enrollment Requirements:
Claims:

Payer enrollment for electronic claims is required.
- Providers who previously sent 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 15778310 1/8/2025

Electronic Routing Change for CPID 5676 Alliance Behavioral Health

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

Payer Name: Alliance Behavioral Healthcare
Institutional CPID: 5676
Current Edit Master: HE9O007
New Edit Master: HE9T007
Payer-assigned Payer ID: 23071

Enrollment Requirements:
Claims:

Payer enrollment for electronic claims is required.
- Providers who previously sent 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 15778311 1/8/2025

Update: VA payer delay of 277CA and 835 responses

The Department of Veterans Affairs (VA) payer is migrating to an updated system and due to this migration has paused all processing.

The latest update from the payer is as follows: The VA payer has stated that they have resumed processing of claims for 12115 and 12116. Optum has started to receive 277CA, 835s and 999s for those two payer IDs as of today, Jan. 8, 2025. The VA has also pushed 835s for claims that completed processing at the VA for payer IDs 84146, 84147, and 80214, but they continue to hold the new claim files that Optum delivered to them starting 12/31. They continue to work on data migration and validation of new system which now only impacts 84146, 84147, and 80214.

No new ETA has been provided, but updates will be published as they are made available.

Original message sent Dec. 31, 2024 (REF 15699577): The VA payer has stated that there will be a delay in the delivery of 277CAs and 835 electronic remittance advice transactions. This delay is expected to be a minimum of two weeks and into the New Year. The cause of the delay is due to a scheduled migration of a critical system from a legacy process to a cloud-based process.

REF 15774052 1/8/2025

Report Generation Delay for CPIDs 9615 and 7292 CorrectCare Integrated Health- Louisiana

A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted since Dec. 23, 2024.

Payer impacted:

CPID 9615 CorrectCare Integrated Health- Louisiana
CPID 7292 CorrectCare Integrated Health- Louisiana

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 15771673 1/8/2025

Enrollment Form Change for CPIDs 4967, 7493 / Payer IDs BCBSVT / Payer Name-Vermont Blue Cross Blue Shield

The following payers have changed their Remittance enrollment form:

CPID 4967 / Payer ID BCBSVT - Vermont Blue Cross Blue Shield
CPID 7493 / Payer ID BCBSVT - Vermont Blue Cross Blue Shield

Providers already approved to submit and receive transactions through Change Healthcare 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 15769749 1/8/2025

Enrollment Form Change for CPIDs 1481,5517/Payer ID SKOR0/Payer Name Oregon Medicaid

The following payers have changed their Remittance enrollment form:

CPID 1481 / Payer ID SKOR0 Oregon Medicaid
CPID 5517 / Payer ID SKOR0 Oregon Medicaid

Providers already approved to submit and receive transactions through 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 15769963 1/8/2025

New Electronic Claims Connections Available

Optum has new electronic claims connections available:

Payer Name: Carelon Health of Pennsylvania

Institutional CPID: 8089

Professional CPID: 2885

Payer-assigned Payer ID: BHOPA

Payer Enrollment Required: No

Secondary Claims Accepted: No

Payer Location: Pennsylvania

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 15762360 1/8/2025

Updated Electronic Eligibility Connection Available

Effective immediately, Optum is pleased to announce an update of Real-time Eligibility Inquiry and Response 270/271 for the below payer:

Payer Name: Group Administrators LTD

Industry Payer ID: 36338

IMN Real Time ID: 36338

Exchange Real Time ID: N/A

CPID(s): 8501/1770

Payer Enrollment Required: No

Connection Type: X12

Eligibility Inquiries are currently only accepted for members of the following Group IDs:

CCL

CHE24

DFF

DMOS

EIQC

EJEI

EXMP

GSTC

HSS

HUNT

HYVE

NSH

NWI

OPL

REC

RSNF

SYNC

TBG

TDC

Search Options:

Subscriber: Member ID, First Name, Last Name, Date of Birth

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

Action Required by customer:

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

REF 15764140 1/8/2025

New Electronic Claims Connections Available

This message is intended for Assurance EDI and Assurance Reimbursement Management customers.

Optum has new electronic claims connections available:

Payer Name: Wellspace NEXUS LLC
Institutional CPID: 8088
Payer-assigned Payer ID: NEXUS
Payer Enrollment Required: No
Secondary Claims Accepted: No
Payer Location: California
Claims Fee: N/A

Action Required:

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

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 15762361 1/7/2025

UPDATE: Optum Notice: Electronic Routing Change for 9518 Pioneer Provider Network

There is a Claim Fee associated for this routing change.

Current Claim Fee: N/A

New Claim Fee: $0.10

Original sent on Jan. 7, 2025:

Effective Jan. 7, 2025, Optum will be changing electronic claims routing for the following payer:

Payer Name: Pioneer Provider Network

Institutional CPID: 9518

Payer-assigned Payer ID: PPNZZ

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 15746887 1/7/2025

Delay in NGS Electronic Remittance Advice (ERA)

There were issues that impacted clearinghouse delivery of remits from NGS (various payer IDs – see below) beginning Feb. 19, 2024-April 19, 2024. NGS completed reprocessing remits for this period as of Dec. 20, 2024. If you are missing any remits from NGS for the above period, contact the payer to post the remits manually.

Payers Affected:

12M35 - New York Medicare Empire
SMCT0 - Connecticut Medicare
12M13 - Maine Medicare
12M74 - Rhode Island Medicare
12M08 - Illinois Medicare

Action Required: Please be aware of a delay in the delivery of ERA for the dates above and contact the payer to post the remits manually as needed.

REF 15762363 1/7/2025

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 Dec. 31, 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 15753208 1/7/2025

Payer ID Update for Selman & Company - Revenue Performance Advisor

Effective immediately, Selman & Company (ID SLMTC) Eligibility and Claim Status Inquiry have been deactivated on the Revenue Performance Advisor system.

Providers should now be using:

Payer Name: Selman & Company

Payer ID: 52214

Action Required: Please update the above payer within your medical billing software or contact your software vendor for assistance, as needed.

REF 15754595 1/7/2025

Associated Hispanic Physicians IPA Electronic Remittance Connection No Longer Available

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

Payer Name: Associated Hispanic Physicians IPA
Remittance LOB: H9Q
Payer-assigned Payer ID: MPM44

Reason: Payer no longer contracted with Medpoint Management. Electronic remittance can be obtained directly from the payer’s portal https://provider.astranahealth.com/login?ipa=AHISP or through nmm.epayment.center.

Action Required: None.

REF 15754598 1/7/2025

Claim Processing Suspended for CPIDs 7224, 8640 National Association of Letter Carriers

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

Payer Name: National Association of Letter Carriers

CPIDs: 7224, 8640

Payer ID: 53011

Reason: Payer unavailable electronically

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

REF 15755324 1/7/2025

New Electronic Claims Connections Available

This message is intended for Assurance Reimbursement Management customers.

Optum has new electronic claims connections available:

Payer Name: Champion Health Plans

Institutional CPID: 8085

Professional CPID: 2883

Payer-assigned Payer ID: CPS01

Payer Enrollment Required: No

Secondary Claims Accepted: No

Payer Location: California, Nevada

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 15745595 1/7/2025

Associated Hispanic Physicians IPA Electronic Remittance Connection No Longer Available

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

Payer Name: Associated Hispanic Physicians IPA
Remittance CPIDs: 8554, 7794
Payer-assigned Payer ID:MPM44

Action Required: None.

REF 15754597 1/7/2025

New Electronic Claims Connections Available

This message is intended for Assurance EDI customers.

Optum has new electronic claims connections available:

Payer Name: Champion Health Plans

Institutional CPID: 8085

Professional CPID: 2883

Payer-assigned Payer ID: CPS01

Payer Enrollment Required: No

Secondary Claims Accepted: No

Payer Location: California, Nevada

Claims Fee: $0.10

Action Required: 

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

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

REF 15745594 1/7/2025

Report Generation Delay for CPID 5976 Carelon Behavioral Health Maryland

A payer intermediary is experiencing issues affecting Institutional report generation for some claims submitted on Dec. 24, 2024.

Payer impacted:

CPID 5976 Carelon Behavioral Health Maryland

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 15751408 1/7/2025

Electronic Routing Change for 9518 Pioneer Provider Network

This message intended for Assurance Reimbursement Management customers.

Effective January 7, 2025, Optum will be changing electronic claims routing for the following payer:

Payer Name: Pioneer Provider Network

Institutional CPID: 9518

Current Edit Master: HE9O007

New Edit Master: HE9C051

Payer-assigned Payer ID: PPNZZ

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 are not changing.
When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.

REF 15739443 1/7/2025

Electronic Routing Change for 9518 Pioneer Provider Network

This message intended for Assurance EDI customers.

Effective January 7, 2025, Optum will be changing electronic claims routing for the following payer:

Payer Name: Pioneer Provider Network

Institutional CPID: 9518

Payer-assigned Payer ID: PPNZZ

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 15739442 1/7/2025

Update: Report Generation Delay for Multiple CPIDs

The payers have been unable to generate and deliver the reports.

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

Original message sent Dec. 17, 2024:

The payers listed below are experiencing issues affecting Institutional and Professional report generation for some claims submitted on Nov. 27, 2024, and Dec. 4, 2024.

Payers impacted:

CPID 1411 North Carolina Blue Cross Blue Shield
CPID 3562 North Carolina Blue Cross Blue Shield
CPID 7514 Blue Medicare PPO/HMO of North Carolina

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

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

REF 15751516 1/7/2025

Payer Deactivation Notice - Peoples Health Network

Effective immediately, the payer listed below will no longer be available at Optum for claims processing. ERA/remittance will be terminated once run out is completed.

Payer Name: Peoples Health Network
Payer ID: 72126

Claims with dates of service Jan. 1, 2024 and forward should be sent to Payer ID 87726.

Action Required:
Please discontinue use of the above Payer ID. Providers should review the patient's current insurance ID card for claim filing information.

REF 15749912 1/7/2025

Electronic claims connection no longer available for Combined Health Administrators

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

Payer Name: Combined Health Administrators

Claim CPIDs: 5004, 8807

Payer-assigned Payer ID: 88059

Reason: Payer no longer contracted.

Action Required: Claims must be submitted to Optum on paper.

REF 15749319 1/7/2025

Payer Deactivation Notice - Rocky Mountain HMO

This message is intended for Revenue Performance Advisor (RPA) customers.

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

Payer Name: Rocky Mountain HMO

Payer ID: RMHMO, SX141, 84065

Claims should be sent to Payer ID 87726.

ERA/remittances will now come under UnitedHealthcare Community Plan, Payer ID 04567.

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 15745299 1/7/2025

Report Generation Delay for CPID 1514 Oklahoma Blue Cross Blue Shield

This message is intended for Assurance EDI and Assurance Reimbursement Management customers.

A payer intermediary is experiencing issues affecting Institutional report generation for some claims submitted on Dec. 20, 2024.

Payer impacted:

CPID 1514 Oklahoma 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 15739358 1/6/2025

Payer Processing Issue for multiple CPIDs

This message is intended for Assurance EDI and Assurance Reimbursement Management customers.

Due to a payer intermediary processing issue, some Professional claims transmitted to the payers listed below on Jan. 3, 2025, were not processed by the payers.

Payers impacted:
1214 AgeRight Advantage Health Plan
4101 AllCare Advantage
2113 Allcare Health Plan
1764 Ambetter From Absolute Total Care
1765 Ambetter From Louisiana Healthcare Connections
9278 Ambetter from Nebraska Total Care
9433 Ambetter of Oklahoma
2138 American Family Insurance
7854 American Health Advantage of Oklahoma
1741 Amerigroup
1412 Anthem Blue Cross and Blue Shield - Indiana
2421 Anthem Blue Cross and Blue Shield - Kentucky
1413 Anthem Blue Cross and Blue Shield (Virginia)
2418 Anthem Blue Cross and Blue Shield of Ohio
4437 Anthem Blue Cross Blue Shield New York
8749 Anthem MaineHealth
6220 Arizona Priority Care Plus
4881 Asuris Northwest Regence
7272 Axminster Medical Group
3845 Banner Health Network
1415 Blue Cross Blue Shield of Colorado
1407 Blue Cross Blue Shield of Georgia
7496 Blue Cross Blue Shield of Nevada
1401 Blue Cross Blue Shield of Wisconsin
1243 Blue Cross Community Centennial
1167 Blue Cross Medicare Advantage PPO/HMO
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
2164 Carelon Behavioral Health Maryland
3293 Carelon Health
2830 CarePlus Health Plans
1194 CareSource of Georgia
7143 CareSource of Indiana
3826 CareSource of Ohio
7263 CareSource of West Virginia
9226 CareSource PASSE of Arkansas
6777 Centers Plan for Healthy Living
9765 Central Valley Medical Providers
8123 Clear Health Alliance
7763 Columbine Health Plan
8834 Commonwealth Care Alliance DOS after 3/31/2023
2160 Community Care Plan (Commercial)
6865 Community Care Plan (Medicaid)
1420 Connecticut Anthem Blue Cross Blue Shield
3420 Connecticut Medicare Blue (Risk)
6795 Contra Costa Health Plan
7292 CorrectCare Integrated Health- Louisiana
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
1119 Easy Choice Health Plan of California
7787 El Paso First Health Plans - Health Care Options (HCO)
4289 El Paso Health-CHIP
4279 El Paso Health-STAR
5483 Employee Benefit Management Services (EBMS)
8137 Empower Healthcare Solutions
1795 Envolve Benefit Options
5238 Evolent Specialty Cardiology
3792 Fidelis Care
2875 First Health Network (Coventry Health Care National Network)
7435 FirstCare Health Plans
1414 Florida Blue Cross Blue Shield
3417 Florida Blue Cross Blue Shield Health Options HMO
9128 Florida Blue Medicare
9417 Florida Complete Care
2150 Florida Health Care Plans
5440 Fox Valley Medicine
8189 Gemcare IPA
2720 GlobalCare
9766 Gold Kidney Health Plan
1772 HAP CareSource
1797 HAP CareSource Michigan Dual Medicare/Medicaid
5243 Healthcare Management Administrators
1723 HealthCare Partners IPA
4448 HealthLink PPO
4740 Healthways WholeHealth Networks
7760 Healthy Blue Louisiana
8867 Healthy Blue Missouri
9133 Healthy Blue North Carolina
6272 Hispanic Physicians IPA (Encounters Only)
7715 Hopkins Health Advantage
6259 Humana - CareSource of Kentucky
7426 Idaho Regence Blue Shield
1405 Illinois Blue Cross Blue Shield
2234 Illinois Health Partners
3757 IMAGINE360 ADMINISTRATORS (GPA)
5865 Indian Health Services
4116 IntegraNet Health
1107 Integrated Health Partners (IHP)
9713 Iowa Health Advantage
1404 Iowa Wellmark Blue Cross Blue Shield
6733 Iowa Wellmark Blue Cross Blue Shield Crossover
5479 IU Health Plan Medicare Advantage
5432 Johns Hopkins Healthcare / Priority Partners
9412 Leon Health Plans
6273 Lifepath Hospice
2863 Longevity Health Plan of Colorado
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
7892 Minnesota Blue Cross Blue Shield Health Care Programs
1429 Minnesota Blue Cross Blue Shield HMO
5871 Mission Community IPA Medical Group
1408 Missouri Anthem Blue Cross Blue Shield
7450 Montana Blue Cross Blue Shield
7422 New Hampshire Anthem Blue Cross Blue Shield
7403 New Mexico Blue Cross Blue Shield
8864 NextBlue of North Dakota
1213 NHC Advantage
2411 North Dakota Blue Cross Blue Shield
1403 Oklahoma Blue Cross Blue Shield
2404 Oregon Regence Blue Cross Blue Shield
7829 Passport Advantage
8128 Pool Administrators, Inc.
4252 Presbyterian Salud
2807 Professional Benefit Administrators (Oakbrook, Illinois)
8182 PruittHealth Premier NC/SC
5428 QualChoice of Arkansas
7264 Quartz ASO
1209 Regence Group Administrators
6246 Riverside Medical Clinic
4464 SCAN Health Plan
2254 Scott & White Health Plan
9438 Shared Health Mississippi
7225 Sharp Community Medical Group
8124 Simply Healthcare Plans, Inc.
8708 SOMOS Anthem
8816 SOMOS Emblem
2490 South Dakota Blue Cross Blue Shield
8134 Summit Community Care
1406 Texas Blue Cross Blue Shield
1729 Texas Childrens Health Plan (CHIP)
2483 Texas Childrens Health Plan (STAR Medicaid)
4278 The Boon Group
8763 U.S. Networks and Administrative Services
8473 Unicare
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
9293 Wellcare by Allwell from Nebraska Total Care
9430 Wellcare by Allwell of Oklahoma
1844 Wellcare Health Plans
3211 Wellcare Health Plans (Encounters)
1775 Wellpoint
9441 Wellspace NEXUS LLC
7489 Wyoming Blue Cross Blue Shield
6731 ZELIS

A resolution has been implemented and the claims were retransmitted to the payer intermediary on Jan. 6, 2025.

This delay affected claims released to Optum between 11 a.m. and 3 p.m. ET on Jan. 3, 2025.

Action Required: Be aware of the processing issue above.

REF 15739378 1/6/2025

Report Generation Delay for CPID 6987 Veterans Affairs Financial Services Center

This message is intended for Assurance EDI and Assurance Reimbursement Management customers.

A payer intermediary is experiencing issues affecting Institutional report generation for some claims submitted on Dec. 30, 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 15743708 1/6/2025

Atypical Provider ID Issuance from iEDI

This message is intended for Assurance Reimbursement Management and Revenue Performance Advisor customers.

Due to a processing issue, some atypical provider’s claims have received the error below in error.

TO BE CONSIDERED FOR REIMBURSEMENT, SERVICES MUST BE SUBMITTED EITHER WITH A BILLING PROVIDER NPI OR WITH BOTH A BILLING PROVIDER MEDICAID ID AND A G2 INDICATOR.

Payer: Humana
Payer ID: 61101 (CPID: 2449)

Payer: Iowa Medicaid
Payer ID: SKIA0 (CPID: 1469)

This issue has been corrected and impacted claims can be resubmitted for processing.

Action Required: Resubmit any impacted claims

REF 15747353 1/6/2025

Electronic Routing Change for CPID 6195 Superior Vision Services - Assurance Reimbursement Management

Effective Jan. 6, 2025, Optum will be changing electronic claims routing for the following payer:

Payer Name: Superior Vision Services

Professional CPID: 6195

Current Edit Master: PE_T007

New Edit Master: PE_B800

Current Payer-assigned Payer ID: 41352

New Payer-assigned Payer ID: 13305

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 are not changing.
When a payer requires enrollment, forms must be submitted and approved from Enrollment Central.

REF 15739445 1/6/2025

Electronic routing change for CPID 6195 Superior Vision Services - Assurance EDI

Effective Jan. 6, 2025, Optum will be changing electronic claims routing for the following payer:

Payer Name: Superior Vision Services

Professional CPID: 6195

Current Payer-assigned Payer ID: 41352

New Payer-assigned Payer ID: 13305

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 15739444 1/6/2024

Real Time update for Eligibility and Claim Status

Effective Jan. 1, 2025, Unicare became Wellpoint and effective immediately payer ID 80314 will no longer be active for 270/271 and 276/277 transactions. Unicare has advised that the payer ID to use moving forward is WLPNT.

Terminated payer details:
Payer ID: 80314
Payer Name: Unicare
Transaction: Eligibility Inquiry and Response 270/271 and Claim Status 276/277

New payer details:
Payer ID: WLPNT
Payer Name: Wellpoint
Transaction: Eligibility Inquiry and Response 270/271 and Claim Status 276/277

Action Required by Customer: Please update your system to the new payer id effective immediately. For assistance with submitting real-time transactions, please contact your Practice Management System Vendor.

REF 15742505 1/6/2025

Report Generation Delay for CPID 1449 Colorado Medicare

A payer is experiencing issues affecting Professional report generation for some claims submitted since Dec. 18, 2024.

Payer impacted:

CPID 1449 Colorado 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 15738389 1/6/2025

Report Generation Delay for CPID 2455 Arkansas Medicare

A payer is experiencing issues affecting Professional report generation for some claims submitted since Dec. 13, 2024.

Payer impacted:

CPID 2455 Arkansas 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 15738388 1/6/2025

Payer Processing Issue for CPID 6400 Aetna

Due to a payer processing issue, some Professional claims transmitted to the payer listed below on Jan. 3, 2025 were not processed by the payer.

Payer impacted:

CPID 6400 Aetna

A resolution has been implemented and the claims were retransmitted to the payer on Jan. 6, 2025.

This delay affected claims released to Optum between 1:00 a.m. and 7:00 a.m. ET on Jan. 3, 2025.

Action Required: Be aware of the processing issue above.

REF 15738377 1/6/2025

Report Generation Delay for CPID 1402 Minnesota Blue Cross Blue Shield

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted on Dec. 19, 2024.

Payer impacted:

CPID 1402 Minnesota Blue Cross Blue Shield

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

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

REF15739110 1/6/2025

Report Generation Delay for CPID 4246 Capital Health Plan

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted Dec. 25, 2024.

Payer impacted:

CPID 4246 Capital Health Plan

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

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

REF 15739374 1/6/2025

Report Generation Delay for CPIDs 7892 and 1064 Minnesota Blue Cross Blue Shield Health Care Programs

A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted on Dec. 19, 2024.

Payer impacted:

CPID 7892 Minnesota Blue Cross Blue Shield Health Care Programs
CPID 1064 Minnesota Blue Cross Blue Shield Health Care Programs

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

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

REF 15739108 1/6/2025

Report Generation Delay for CPID 7403 New Mexico Blue Cross Blue Shield

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted on Dec. 19, 2024.

Payer impacted:

CPID 7403 New Mexico 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 15739109 1/6/2025

New Electronic Remittance (ERA) Connections Available on RPA

This message is intended for Revenue Performance Advisor (RPA) customers.

ERA (Remittance) transactions have recently been added for the following payers:

77052 – Coastal TPA
85729 – HealthComp
99727 – TRICARE East Region
JVHMQ – JVHL - Physicians Health Plan (Medicare Advantage)
JVHMT – JVHL - HAP CareSource – FFS

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 15736634 1/3/2025

Report Generation Delay for CPID 4070 Integrated Homecare Services

This message is intended for Assurance EDI and Assurance Reimbursement Management customers.

A payer intermediary is experiencing issues affecting Institutional report generation for some claims submitted on Dec. 19, 2024.

Payer impacted:

CPID 4070 Integrated Homecare 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 15728592 1/3/2025

Report Generation Delay for CPID 1782 North American Medical Management

This message is intended for Assurance EDI and Assurance Reimbursement Management customers.

A payer experienced issues affecting Professional report generation for some claims submitted on Dec. 03, 2024.

Payer impacted:

CPID 1782 North American Medical Management

The payer is unable to generate and deliver the reports.

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

REF 15719552 1/3/2025

Report Generation Delay for CPID 7426 Idaho Regence Blue Shield

This message is intended for Assurance EDI and Assurance Reimbursement Management customers.

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted on Dec. 18, 2024, and Dec. 19, 2024.

Payer impacted:

CPID 7426 Idaho Regence Blue Shield

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

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

REF 15728586 1/3/2025

New Electronic Real Time Connections Available on Revenue Performance Advisor

Eligibility transactions have recently been added for the following payers:

75190 – CareFirst Administrators/NCAS
XMEDX – CMS Medicare (RT)

Claim Status Inquiry transactions have recently been added for the following payers:

22384 – Administrative Concepts
37330 – University of Michigan Health Plan
SB590 – Florida Blue Cross Blue Shield

Submitter Action: Add the payers to your system to begin using the new payer connection.

REF 15736633 1/3/2025

Report Generation Delay for CPIDs 3658 and 5862 CorrectCare Integrated Health

A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted since Dec. 20, 2024.

Payer impacted:

CPID 3658 CorrectCare Integrated Health
CPID 5862 CorrectCare Integrated 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 15728599 1/3/2025

Payer Transmit Delay for CPID 5979 Tricare East Region

Due to a payer system issue, a delay is occurring in the transmissions to the following payer since Dec. 31, 2024.

Payer impacted:

CPID 5979 Tricare East Region

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

This delay affects claims released to Optum since 3 p.m. CT on Dec. 31, 2024.

Action Required: Be aware of the transmit delay above.

REF 15731612 1/3/2025

Report Generation Delay for CPID 2050 Gemcare IPA

A payer intermediary is experiencing issues affecting Institutional report generation for some claims submitted on Dec. 19, 2024.

Payer impacted:

CPID 2050 Gemcare IPA

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 15728589 1/3/2025

Report Generation Delay for CPID 1844 Wellcare Health Plans

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted on Dec. 19, 2024.

Payer impacted:

CPID 1844 Wellcare Health Plans

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

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

REF 15728590 1/3/2025

New Payer Name

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

Previous Payer Name: One Call Equipment and Devices
New Payer Name: One Call Medical DME and Home Health
Professional CPID: 9238
Institutional CPID: 6079

Previous Payer Name: One Call Medical
New Payer Name: One Call Medical Diagnostics
Professional CPID: 4254
Institutional CPID: 3696

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

REF 15724388 1/3/2025

Report generation delay for CPID 2830 CarePlus Health Plans

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted on Dec. 19, 2024.

Payer impacted:

CPID 2830 CarePlus Health Plans

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

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

REF 15728588 1/3/2025

Report generation delay for CPID 1729 Texas Childrens Health Plan (CHIP)

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted on Dec. 18, 2024 and Dec. 19, 2024.

Payer impacted:

CPID 1729 Texas Childrens Health Plan (CHIP)

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 15728584 1/3/2025

Report generation delay for CPID 5432 Johns Hopkins Healthcare / Priority Partners

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted on Dec. 18, 2024.

Payer impacted:

CPID 5432 Johns Hopkins Healthcare / Priority Partners

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

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

REF 15728583 1/3/2025

New Payer Name

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

Previous Payer Name: One Call Equipment and Devices
New Payer Name: One Call Medical DME and Home Health
Professional CPID: 9238
Institutional CPID: 6079
Edit Master: PE_T007, HE9T007

Previous Payer Name: One Call Medical
New Payer Name: One Call Medical Diagnostics
Professional CPID: 4254
Institutional CPID: 3696
Edit Master: PE_T007, HE9T007
Remit Line of Business (LOB) Code: J6N

Action Required: You may choose to update the Payer Alias in your system to accommodate the new payer name.

REF 15724389 1/3/2025

Report Generation Delay for CPIDs 2400 and 5975 Utah Medicaid

A payer intermediary is experiencing issues affecting Professional and Institutional report generation for some claims submitted on Dec. 24, 2024.

Payer impacted:

CPID 2400 Utah Medicaid
CPID 5975 Utah Medicaid

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 15728086 1/3/2025

Report Generation Delay for CPID 2404 Oregon Regence Blue Cross Blue Shield

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted Dec. 18, 2024 and Dec. 20, 2024.

Payer impacted:

CPID 2404 Oregon Regence Blue Cross Blue Shield

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

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

REF 15728585 1/3/2025

Payer Processing Issue for multiple CPIDs

Due to a payer intermediary processing issue, some Professional claims transmitted to the payers listed below on Dec. 31, 2024 were not processed by the payers.

Payers impacted:

8454 Align Senior Care of Michigan
2113 Allcare Health Plan
8714 Allstate - Except New Jersey
1764 Ambetter From Absolute Total Care
9278 Ambetter from Nebraska Total Care
9433 Ambetter of Oklahoma
9270 American Benefit Corporation
2138 American Family Insurance
7854 American Health Advantage of Oklahoma
9218 American Health Advantage of Tennessee
9117 American Health Advantage of Texas
4468 Americas Choice Healthplan
1741 Amerigroup
1412 Anthem Blue Cross and Blue Shield - Indiana
2421 Anthem Blue Cross and Blue Shield - Kentucky
1413 Anthem Blue Cross and Blue Shield (Virginia)
2418 Anthem Blue Cross and Blue Shield of Ohio
4437 Anthem Blue Cross Blue Shield New York
8749 Anthem MaineHealth
6220 Arizona Priority Care Plus
4881 Asuris Northwest Regence
7272 Axminster Medical Group
3845 Banner Health Network
1415 Blue Cross Blue Shield of Colorado
1407 Blue Cross Blue Shield of Georgia
7496 Blue Cross Blue Shield of Nevada
1401 Blue Cross Blue Shield of Wisconsin
1243 Blue Cross Community Centennial
1167 Blue Cross Medicare Advantage PPO/HMO
9162 Blue Medicare Advantage
4110 Bollinger Inc
6165 Bridgeview
4246 Capital Health Plan
2810 Capitol Administrators
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
2164 Carelon Behavioral Health Maryland
6127 Carelon Behavioral Health, MBHP
3293 Carelon Health
2830 CarePlus Health Plans
1194 CareSource of Georgia
7143 CareSource of Indiana
3826 CareSource of Ohio
7263 CareSource of West Virginia
9226 CareSource PASSE of Arkansas
6777 Centers Plan for Healthy Living
9765 Central Valley Medical Providers
7275 Citrus Valley Physicians Group
8123 Clear Health Alliance
7763 Columbine Health Plan
8834 Commonwealth Care Alliance DOS after 3/31/2023
2160 Community Care Plan (Commercial)
6865 Community Care Plan (Medicaid)
8147 Community Care Plan (Palm Beach Health District)
1420 Connecticut Anthem Blue Cross Blue Shield
3419 Connecticut Federal Employee Health Benefits
3420 Connecticut Medicare Blue (Risk)
6795 Contra Costa Health Plan
4460 Cook Group Health Plan
7738 CountyCare Health Plan
6145 CSI Network Services
9747 Delaware First Health
2433 Denver Health and Hospital Authority
1232 Denver Health Medical Plan, Inc. - Medicare Choice
8135 Doctors HealthCare Plans
1119 Easy Choice Health Plan of California
4279 El Paso Health-STAR
5483 Employee Benefit Management Services (EBMS)
1834 Employee Plans
1795 Envolve Benefit Options
9215 Everpointe
5238 Evolent Specialty Cardiology
7121 Evolent Specialty Oncology
3792 Fidelis Care
2875 First Health Network (Coventry Health Care National Network)
7435 FirstCare Health Plans
1414 Florida Blue Cross Blue Shield
3417 Florida Blue Cross Blue Shield Health Options HMO
9128 Florida Blue Medicare
9417 Florida Complete Care
2150 Florida Health Care Plans
5440 Fox Valley Medicine
8189 Gemcare IPA
8879 Georgia Health Advantage
2720 GlobalCare
9766 Gold Kidney Health Plan
1772 HAP CareSource
5243 Healthcare Management Administrators
1723 HealthCare Partners IPA
4448 HealthLink PPO
7760 Healthy Blue Louisiana
8867 Healthy Blue Missouri
9133 Healthy Blue North Carolina
7715 Hopkins Health Advantage
6259 Humana - CareSource of Kentucky
7426 Idaho Regence Blue Shield
1405 Illinois Blue Cross Blue Shield
2234 Illinois Health Partners
3757 IMAGINE360 ADMINISTRATORS (GPA)
5865 Indian Health Services
4445 Insurance Management Services TX
4116 IntegraNet Health
1107 Integrated Health Partners (IHP)
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
9412 Leon Health Plans
6273 Lifepath Hospice
7446 Maine Anthem Blue Cross Blue Shield
8812 Maryland Physicians Care
8860 Medica Government Programs
7859 Medica Health Plan Solutions
6799 Medica Individual and Family (IFB)
2287 Medicare Plus Blue of MI(MAP)
3475 Memorial Hermann Health Solutions
9102 Meridian Medicare Medicaid Plan
9118 MeridianComplete Michigan
2426 Michigan Blue Care Network
1421 Michigan Blue Cross Blue Shield
1402 Minnesota Blue Cross Blue Shield
1410 Minnesota Blue Cross Blue Shield CC Systems
7892 Minnesota Blue Cross Blue Shield Health Care Programs
1429 Minnesota Blue Cross Blue Shield HMO
5871 Mission Community IPA Medical Group
1408 Missouri Anthem Blue Cross Blue Shield
7450 Montana Blue Cross Blue Shield
7422 New Hampshire Anthem Blue Cross Blue Shield
7403 New Mexico Blue Cross Blue Shield
8864 NextBlue of North Dakota
2411 North Dakota Blue Cross Blue Shield
9406 Ochsner Health Plan
1403 Oklahoma Blue Cross Blue Shield
8165 Oncology Physicians Network
2404 Oregon Regence Blue Cross Blue Shield
7829 Passport Advantage
9421 Perennial Advantage of Colorado
9199 Piedmont Community Health Plan
7168 Premier Healthcare Exchange (PHX)
4252 Presbyterian Salud
8468 Procare Advantage of TX
2807 Professional Benefit Administrators (Oakbrook, Illinois)
4253 Prominence Administrative Services
7281 PruittHealth Premier Medicare Advantage
5428 QualChoice of Arkansas
8828 Qualexa Healthcare
7264 Quartz ASO
1209 Regence Group Administrators
1776 RIS Rx
6246 Riverside Medical Clinic
8256 Saudi Health Mission
4464 SCAN Health Plan
2254 Scott & White Health Plan
9438 Shared Health Mississippi
7225 Sharp Community Medical Group
8124 Simply Healthcare Plans, Inc.
8816 SOMOS Emblem
1740 Sonder Health Plans
2490 South Dakota Blue Cross Blue Shield
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
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
9430 Wellcare by Allwell of Oklahoma
1844 Wellcare Health Plans
3211 Wellcare Health Plans (Encounters)
1775 Wellpoint
9441 Wellspace NEXUS LLC
7489 Wyoming Blue Cross Blue Shield
6731 ZELIS

A resolution has been implemented and the claims were retransmitted to the payer intermediary on Jan. 2, 2025.

This delay affected claims released to Optum between 10 a.m. and 2 p.m. CT on Dec. 31, 2024.

Action Required: Be aware of the processing issue above.

REF 15728580 1/3/2025

New Electronic Eligibility Connection Available

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

Payer Name: Promise Health

Industry Payer ID: RP128

IMN Real Time ID: RP128

Exchange Real Time ID: PROMS

CPID(s): 2751, 7928

Payer Enrollment Required: No

Connection Type: X12

Search Options:

270/271 Search options (Subscriber)

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

270/271 Search Options (Dependent)

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

Action Required:

REF 15721312 1/3/2025

New Electronic Eligibility Connections Available

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

Payer Name: Wellstar Health Plan

Industry Payer ID: RP129

IMN Real Time ID: RP129

Exchange Real Time ID: WELST

CPID(s): 2813, 7955

Payer Enrollment Required: No

Connection Type: X12

Search Options:

270/271 Search options (Subscriber)

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

270/271 Search Options (Dependent)

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

Action Required:

REF 15721313 1/3/2025

Electronic Connection No Longer Available - Aetna Better Health of California

Effective Jan. 2, 2025, the payer listed below will no longer be available at Optum for claim status and/or eligibility processing:

Payer Name: Aetna Better Health of California

Claim Status Payer ID: 128CA, ABHCA

Eligibility Payer ID: 128CA, ABHCA

Reason: Effective Jan 1, 2025, this plan terminated

REF 15723875 1/2/2025

Payer Processing issue for multiple CPIDs

Due to a payer intermediary processing issue, some professional claims transmitted to the payers listed below on Dec. 19, 2024 were not processed by the payers.

Payers impacted:

CPID Payer Name

8454 Align Senior Care of Michigan
4101 AllCare Advantage
2113 Allcare Health Plan
1764 Ambetter From Absolute Total Care
9278 Ambetter from Nebraska Total Care
9431 Ambetter from WellCare of Kentucky
9432 Ambetter from WellCare of New Jersey
9775 Ambetter of Alabama
9433 Ambetter of Oklahoma
9712 American Health Advantage of Florida
9429 American Health Advantage of Idaho & Utah
9142 American Health Advantage of Mississippi
7280 American Health Advantage of Missouri
7854 American Health Advantage of Oklahoma
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
1415 Blue Cross Blue Shield of Colorado
1407 Blue Cross Blue Shield of Georgia
7496 Blue Cross Blue Shield of Nevada
1169 Blue Cross Blue Shield of Western New York Medicaid/CHP
1401 Blue Cross Blue Shield of Wisconsin
1243 Blue Cross Community Centennial
1167 Blue Cross Medicare Advantage PPO/HMO
9162 Blue Medicare Advantage
4246 Capital Health Plan
2810 Capitol Administrators
8146 Care N Care Insurance Co.
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
9722 CareSource North Carolina
1194 CareSource of Georgia
7143 CareSource of Indiana
3826 CareSource of Ohio
7263 CareSource of West Virginia
6777 Centers Plan for Healthy Living
9765 Central Valley Medical Providers
7275 Citrus Valley Physicians Group
8123 Clear Health Alliance
7416 Colorado Anthem Blue Cross Blue Shield HMO
7763 Columbine Health Plan
8834 Commonwealth Care Alliance DOS after 3/31/2023
2160 Community Care Plan (Commercial)
6865 Community Care Plan (Medicaid)
8147 Community Care Plan (Palm Beach Health District)
1420 Connecticut Anthem Blue Cross Blue Shield
3419 Connecticut Federal Employee Health Benefits
3420 Connecticut Medicare Blue (Risk)
6795 Contra Costa Health Plan
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
4279 El Paso Health-STAR
5483 Employee Benefit Management Services (EBMS)
1834 Employee Plans
1795 Envolve Benefit Options
5238 Evolent Specialty Cardiology
7121 Evolent Specialty Oncology
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
8189 Gemcare IPA
2720 GlobalCare
9766 Gold Kidney Health Plan
1772 HAP CareSource
1797 HAP CareSource Michigan Dual Medicare/Medicaid
5243 Healthcare Management Administrators
1723 HealthCare Partners IPA
4448 HealthLink PPO
7760 Healthy Blue Louisiana
8867 Healthy Blue Missouri
9133 Healthy Blue North Carolina
7715 Hopkins Health Advantage
6259 Humana - CareSource of Kentucky
7426 Idaho Regence Blue Shield
1405 Illinois Blue Cross Blue Shield
3757 IMAGINE360 ADMINISTRATORS (GPA)
5865 Indian Health Services
4445 Insurance Management Services TX
4116 IntegraNet Health
1107 Integrated Health Partners (IHP)
8814 Integrated Homecare Services
9713 Iowa Health Advantage
1404 Iowa Wellmark Blue Cross Blue Shield
6733 Iowa Wellmark Blue Cross Blue Shield Crossover
5479 IU Health Plan Medicare Advantage
5432 Johns Hopkins Healthcare / Priority Partners
7782 Kansas Health Advantage
9412 Leon Health Plans
7446 Maine Anthem Blue Cross Blue Shield
8812 Maryland Physicians Care
8860 Medica Government Programs
7859 Medica Health Plan Solutions
6799 Medica Individual and Family (IFB)
2287 Medicare Plus Blue of MI(MAP)
3475 Memorial Hermann Health Solutions
9102 Meridian Medicare Medicaid Plan
9118 MeridianComplete Michigan
2426 Michigan Blue Care Network
1421 Michigan Blue Cross Blue Shield
1402 Minnesota Blue Cross Blue Shield
1410 Minnesota Blue Cross Blue Shield CC Systems
7892 Minnesota Blue Cross Blue Shield Health Care Programs
1429 Minnesota Blue Cross Blue Shield HMO
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
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
7168 Premier Healthcare Exchange (PHX)
4252 Presbyterian Salud
8468 Procare Advantage of TX
5428 QualChoice of Arkansas
7264 Quartz ASO
1209 Regence Group Administrators
8256 Saudi Health Mission
4464 SCAN Health Plan
2254 Scott & White Health Plan
9438 Shared Health Mississippi
8124 Simply Healthcare Plans, Inc.
8708 SOMOS Anthem
8816 SOMOS Emblem
1740 Sonder Health Plans
2490 South Dakota Blue Cross Blue Shield
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
2412 Utah Regence Blue Cross Blue Shield
2788 Utah Regence Blue Cross Blue Shield Federal Employee Program
7493 Vermont Blue Cross Blue Shield
4258 VNS Health
7451 Washington Regence Blue Shield
1844 Wellcare Health Plans
3211 Wellcare Health Plans (Encounters)
1775 Wellpoint
7489 Wyoming Blue Cross Blue Shield
6731 ZELIS

A resolution has been implemented and the claims were retransmitted to the payer intermediary on Jan. 2, 2025.

This delay affected claims released to Optum between 2 p.m. and 6 p.m. CT on Dec. 19, 2024.

Action Required: Be aware of the processing issue above.

REF15725714 1/2/2025

Report Generation Delay for CPID 7907 Scott & White Health Plan

A payer intermediary is experiencing issues affecting institutional report generation for some claims submitted on Dec. 18, 2024.

Payer impacted:

CPID 7907 Scott & White Health Plan

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

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

REF 15724025 1/2/2025

Report Generation Delay for CPID 4101 AllCare Advantage

A payer intermediary is experiencing issues affecting professional report generation for some claims submitted from Dec. 16, 2024 through Dec. 18, 2024.

Payer impacted:

CPID 4101 AllCare 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 15720902 1/2/2025

Payer Processing Issue for multiple CPIDs

Due to a payer intermediary processing issue, some Institutional claims transmitted to the payers listed below on Dec. 19, 2024 were not processed by the payers.

Payers impacted:

8549 Absolute Total Care
8526 Allwell from Absolute Total Care
7592 Allwell from Buckeye Health Plan
7591 Allwell from Home State Health
7588 Allwell from Louisiana Healthcare Connections
7582 Allwell from Managed Health Services
9587 Ambetter Illinicare Health
9588 Ambetter New Hampshire Healthy Families
6660 Ambetter from Buckeye Community Health Plan
8583 Ambetter from Health Net
8584 Ambetter from Homestate Health
6658 Ambetter from Magnolia Health
6656 Ambetter from Managed Health Services
6030 Ambetter from Meridian
6655 Ambetter from Peach State Health Plan
6654 Ambetter from Sunshine Health
6661 Ambetter from Superior HealthPlan
6652 Ambetter of Arkansas
2071 Ambetter of North Carolina Inc
4013 Ambetter of Tennessee
1045 Arizona Complete Health
1962 Buckeye Community Health
6027 Carolina Complete Health Care
7515 Health Net of CA, OR
4652 Home State Health
2026 Iowa Total Care
4639 Louisiana Health Connections
1611 Magnolia Health Plan
1562 Managed Health Services Indiana
3504 Managed Health Services Wisconsin
4560 Meridian Health Plan of Michigan
2508 Nebraska Total Care
5628 New Hampshire Healthy Families
7533 Oklahoma Complete Health Centene
6582 PA Health & Wellness
1921 Peach State Health Plan
5542 Silver Summit Health Plan
5613 Sunflower Health Plan
5947 Sunshine Health
3522 Superior Health Plan of Texas
9617 Trillium Community Health Plan
2029 Wellcare Complete a product of Wellcare By Allwell
1076 Western Sky Community Care

A resolution has been implemented and the claims were retransmitted to the payer intermediary on Jan. 2, 2025.

This delay affected claims released to Optum between 3:50 p.m. CT on Dec. 18, 2024 and 5 a.m. CT on Dec. 19, 2024.

Action Required: Be aware of the processing issue above.

REF 15724031 1/2/2024

Report Generation Delay for CPID 2234 Illinois Health Partners

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted on Dec. 18, 2024 and Dec. 19, 2024.

Payer impacted:

CPID 2234 Illinois Health Partners

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

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

REF 15724026 1/2/2025

Update: Report Generation Delay for CPID 5879 Erisa Administrative Services

This message is intended for Assurance EDI and Assurance Reimbursement Management customers.

Update: The payer intermediary has been unable to generate and deliver the reports for some claims submitted from Sept. 30, 2024, through Dec. 13, 2024.

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

Original notify sent Aug. 21, 2024:

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted since Aug. 7, 2024.

Payer impacted:

CPID 5879 Erisa 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 15717476 1/2/2025

Claims Delay for Rhode Island Medicaid

This message is intended for Revenue Performance Advisor (RPA) customers.

Due to a payer system issue, a delay occurred in the transmissions to the following payer since Dec. 14, 2024.

Payer Name: Rhode Island Medicaid

Institutional ID: 12K74

Professional ID: SKRI0

Optum was working with the payer to resolve this issue. A resolution has been implemented and the claims were transmitted to the payer on Jan. 2, 2025.

Submitter Action:

Be aware of the transmit delay above.

REF 15723461 1/2/2025

Report Generation Delay for CPID 4252 Presbyterian Salud

This message is intended for Assurance EDI and Assurance Reimbursement Management customers.

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted since Dec. 16, 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 15720900 1/2/2025

Electronic Routing Change for CPIDs 3824, 9513 - OptumHealth Care Solutions

This message is intended for Assurance EDI and Assurance Reimbursement Management customers.

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

Payer Name: OptumHealth Care Solutions
Professional CPID: 3824
Institutional CPID: 9513
Payer-assigned Payer ID: 41194

Enrollment Requirements:
Remittance:

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

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

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

REF 15718038 1/2/2025

Electronic Routing Change for CPIDs 6132 and 8698 Family Care Specialist IPA

Effective Jan. 2, 2025, Optum will be changing electronic claims routing for the following payer:

Payer Name: Family Care Specialist IPA
Professional CPID: 6132
Current Edit Master: PE_O007
New Edit Master: PE_T007
Institutional CPID: 8698
Current Edit Master: HE9O007
New Edit Master: HE9T007
Current Payer-assigned Payer ID: MPM40
New Payer-assigned Payer ID: FCS01

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 15723871 1/2/25

Electronic Routing Change for CPIDs 6132 and 8698 Family Care Specialist IPA

Effective Jan. 2, 2025, Optum will be changing electronic claims routing for the following payer:

Payer Name: Family Care Specialist IPA
Professional CPID: 6132
Institutional CPID: 8698
Current Payer-assigned Payer ID: MPM40
New Payer-assigned Payer ID: FCS01

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 15723870 1/2/25

Report Generation Delay for CPIDs 8900 and 2113 Allcare Health Plan

A payer intermediary is experiencing issues affecting Institutional and Professional report generation for some claims submitted from Dec. 16, 2024, through Dec. 18, 2024.

Payer impacted:

CPID 8900 Allcare Health Plan
CPID 2113 Allcare Health Plan

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

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

REF 15720901 1/2/2025

Report Generation Delay for CPID 2404 Oregon Regence Blue Cross Blue Shield

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted on Dec. 13, 2024.

Payer impacted:

CPID 2404 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 15717479 1/2/2025

Report Generation Delay for multiple CPIDs

A payer intermediary is experiencing issues affecting Professional report generation for some claims submitted Dec. 13, 2024.

Payers impacted:

CPID 2412 Utah Regence Blue Cross Blue Shield
CPID 2788 Utah Regence Blue Cross Blue Shield Federal Employee Program

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

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

REF 15717478 1/2/25

Report Generation Delay for CPID 2593 QualChoice of Arkansas

A payer intermediary is experiencing issues affecting institutional report generation for some claims submitted on Dec. 13, 2024.

Payer impacted:

CPID 2593 QualChoice of Arkansas

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 15720821 1/2/2025

Update: Payer Transmit Delay for Rhode Island Medicaid - Multiple CPIDs

Update: A resolution has been implemented and the claims were transmitted to the payer on Jan. 2, 2025.

Action Required: Please be aware of the transmit delay.

Original Notify sent Dec. 18, 2024: Due to a payer system issue, a delay is occurring in the transmissions to the following payer since Dec. 14, 2024.

Payer impacted:

CPID 7421 Rhode Island Medicaid
CPID 3647 Rhode Island Medicaid
CPID 2405 Rhode Island Medicaid

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

This delay affects claims released to Optum since 2 p.m. CT on Dec. 13, 2024.

Action Required: Be aware of the transmit delay above.

REF15719430 1/2/2025

Update: Payer Change for CPIDs 1253, 4585 TRICARE East Region - Assurance Reimbursement Management

This message is intended for Assurance Reimbursement Management customers.

Update:
Optum would like to clarify the Payer Alias Names associated with the TRICARE East Region payer changes.

For claims containing Dates of Service on or prior to Dec. 31, 2024 must continue to use the following entry:

Payer Name: TRICARE East Region
Professional CPID: 1253
Professional Edit Master: PE_B026
Institutional CPID: 4585
Institutional Edit Master: HE9B023
Payer-assigned Payer ID: TREST
Line of Business Code (LOB): M08

Claims containing Dates of Service on or after Jan. 1, 2025 must use the following entry:

Payer Name: TRICARE East Reg
Professional CPID: 2872
Professional Edit Master: PE_B026
Institutional CPID: 5979
Institutional Edit Master: HE9B023
Payer-assigned Payer ID: 99727
Line of Business Code (LOB): M08

NOTES:

Beginning May 1, 2025, submit 2024 claims to CPIDs 2872 and 5979 TRICARE East Reg.

Reminder:
Effective Jan. 1, 2025, providers must use the appropriate TRICARE East Region CPIDs based on Dates of Service for electronic claim submissions to Optum. Providers must also complete the necessary claims or electronic remittance enrollment forms prior to exchanging transactions. Steps to complete the appropriate enrollment can be completed immediately.

Update:
Optum would like to inform providers that while a claim enrollment form is not needed for submitting claims electronically, an Electronic Data Interchange (EDI) Provider Trading Partner Agreement is required to be on file with PGBA. Please see updated Enrollment instructions. Providers may now begin completing the necessary enrollment forms for payer ID 99727 claims or electronic remittance.

Original:
Optum has been informed that PGBA will begin administering electronic claims and remittances for the payer identified below effective Jan. 1, 2025. We are currently working to obtain transition details and will send additional information regarding electronic remittance enrollment as soon as it becomes available.

Effective Jan. 1, 2025, claims and remittance currently exchanged with the following payer must use different CPIDs based on your new TRICARE contract:

Claims and Remittance containing Dates of Service on or prior to Dec. 31, 2024 must continue to use the following through April 30, 2025:

Payer Name: TRICARE East Region DOS before 1/1/25
Professional CPID: 1253
Professional Edit Master: PE_B026
Institutional CPID: 4585
Institutional Edit Master: HE9B023
Payer-assigned Payer ID: TREST
Line of Business Code (LOB): M08

Claims and Remittance containing Dates of Service on or after Jan. 1, 2025, must begin using the following based on your TRICARE contract:

Payer Name: TRICARE East Region
Professional CPID: 2872
Professional Edit Master: PE_B026
Institutional CPID: 5979
Institutional Edit Master: HE9B023
Payer-assigned Payer ID: 99727
Line of Business Code (LOB): M08

NOTES:

Beginning May 1, 2025, submit 2024 claims to CPIDs 2872 and 5979 TRICARE East Region.
The following states are moving to the TRICARE West Region: Arkansas, Illinois, Louisiana, Oklahoma, Texas, and Wisconsin. TRICARE West providers should use CPIDs 5648 for institutional and 6286 for professional transactions. Enrollment forms can be accessed through Enrollment Central.
For additional information regarding this change please see Humana Military’s Provider Update page - Provider Updates.

Enrollment Requirements for TRICARE East Region CPIDs 2872 and 5979:
Claims:

Payer enrollment for electronic claims is not required. However, PGBA requires an Electronic Data Interchange (EDI) Provider Trading Partner Agreement to be on file.
- If the provider is credentialed with PGBA and has an Electronic Data Interchange (EDI) Provider Trading Partner Agreement on file with PGBA the Optum Enrollment is not required.
- If the provider is not credentialed with PGBA, please complete the Optum Enrollment form process prior to sending claims.
- Providers may now complete the EDI Provider Trading Partner Agreement, if not already on file with PGBA, for CPIDs 2872 and 5979.

Remittance:

Payer enrollment for electronic remittance is required.
- Providers currently receiving electronic remittance through Optum must complete a new enrollment form for CPIDs 2872 and 5979.
- New providers must complete a new enrollment form.
- Providers may now enroll for electronic remittance for CPIDs 2872 and 5979.

Action Required: Please make the following updates to accommodate these payer changes:

Please be aware of the changes above and make necessary updates.
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 15698975 / 15719559 1/2/2025

JP Farley Electronic Eligibility Connection No Longer Available

This message intended for Clearance Patient Access Suite customers.

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

Payer Name: JP Farley

Connection Type: Portal

Reason: Payer no longer offers an electronic connection

Action Required: None

REF 15715360 1/2/2025

JP Farley Electronic Eligibility Connection No Longer Available

This message is intended for Assurance EDI and Assurance Reimbursement Management customers.

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

Payer Name: JP Farley

Real Time ID: JPFAR1

CPIDs: 2578, 3771

Industry Payer ID: 34136

Connection Type: Portal

Reason: Payer no longer offers an electronic connection

Action Required: None

REF 15715359 1/2/2025

Older Payer Updates

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

GET OLDER UPDATES

CHC Payer Updates (January 2025)

January 2025

January Payer Processing Issues

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