Claim Tips
Introduction
Optum supports multiple ways of submitting a claim for service. We encourage our clinicians to submit claims electronically or through the Claim Entry feature of Provider Express.
Optum processes claims for its members on multiple claims systems, depending on the member's benefit plan. As a result, Optum has multiple mailing addresses for paper claim submissions. In order to ensure prompt and accurate payment, please verify the mailing address prior to submitting your claim. For EDI and online claims, a claim mailing address is not required.
Frequently Asked Questions about Claim Submission
Yes. Claims for outpatient behavioral health and EAP services can be entered through the Claim Entry feature on Provider Express. You may also view our EDI/Electronic claims page for more information.
There are a number of different Optum mailing addresses depending upon the member's benefit plan. Find out where to submit your claim.
Please note: Claims submitted online or via EDI do not require a claim mailing address and typically result in faster processing.
Our customer service centers can help you with your claim questions. Check out the Contact Us page under the Claims and Appeals section, or call the telephone number listed on the explanation of benefits (EOB) or member ID card.
You can also visit our Claim Corrections and Resubmission page for additional information.
The Optum reimbursement rate depends on several factors and will vary by state, license type, and your network status. For further information, contact Provider Services at 877-614-0484.
Note: Registered users of Provider Express can also log in and submit a message through the Message Center.
The Optum payer ID is 87726.
Generally, clean claims that contain all of the required information will be paid within 4 weeks after receipt of the claims. This may exclude claims which require an exception process, such as coordination of benefits (COB) and student status verifications, which can delay this process. The procedure for processing claims will be modified as necessary to satisfy any applicable state laws.
If you are a registered user of Provider Express, log in and click Claim Inquiry. If you need to call Optum for assistance with claims status, check out the Contact Information page.
Here are some of the most common reasons why your claim inquiry on Provider Express did not find the results you expected:
There is a delay in processing your claim. Provider Express will not show a valid claim status until the claim is loaded into the claim system for processing. Most claims you submit should show a status within about 48 hours but it can take longer depending on how you submitted your claim.
You may be performing you search under the wrong record on Provider Express. Make sure you are using the same rendering and billing provider record in your search that you used to submit the claim.
Your claim may have been processed incorrectly. If your claim was processed as Out of Network and you are a contracted provider, you may not find it on Provider Express.
The member may have multiple eligibility records. Members can have different products through Optum and United Healthcare. In some cases, a claim may route for processing under a different eligibility record than you expected.
If you are not able to find a claim through Provider Express that you expect to find, please call the number listed on the member’s ID card for further assistance.