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Follow these tips to ensure timely and accurate claim payment

Optum encourages you to file your claim electronically for a fast, secure, and convenient experience.  We currently accept behavioral health and EAP claims electronically through the Claim Entry feature on Provider Express or as an EDI transaction.  It is quick and easy to file electronically – check out the other resources in this section to get started today!

Here are a few examples of common claim errors and how to prevent them:

  • Missing or incomplete information: Provider Express Claim Entry prevents the submission of a claim in the event that any required fields are left blank.  This helps to ensure that you don’t inadvertently submit a claim that is missing key information required for processing, such as the NPI number and a complete diagnosis code. 
  • Member demographic errors:  Member information is auto-populated into the claim form when you use the Claim Entry transaction on Provider Express.  This saves you time and also prevents errors or omissions in the member information that would otherwise delay or prevent the processing of your claim.
  • Unclear information:  Legibility can be a concern on paper claims. The Claim Entry transaction on Provider Express ensures legibility and auto-populates critical information, such as the rendering provider information.

Filing paper claims

Filing claims electronically is by far the fastest and most efficient method to submit claims and initiate payment processing. However, if you are not able to use an electronic filing method, we recommend you implement the following guidelines to ensure smooth claim processing:

  • Use an original 1500 Health Insurance Claim Form as supplied by a CMS recognized vendor;  do not photocopy the form as this reduces legibility

  • Type information into the form – illegible information will prevent or delay claim processing

  • Use an ICD-10 code for the primary diagnosis (Hint: the DSM-5 includes ICD codes along with the DSM diagnostic criteria and descriptor or label. Click here to access our ICD-10 resource center to learn more)

  • Complete all required fields, including the ICD indicator field and NPI numbers. (Hint: access the Helpful Hints for Claim Submission for a list of information that should be included on the claim form) 

Timely Filing

We recommend that you submit claims shortly after services are provided. Please be aware that all information necessary to process claims must be received by Optum no later than 90 calendar days from the date of service. Also, any corrections or additions to a claim should be made within 90 days of receipt of the initial claim. 

Check out the following resources for additional information on claims: