Inpatient Claims

Inpatient claims are bills submitted for program level (facility-based) services such as:

• Inpatient Services
• Residential Services
• Day Treatment Services (Partial Hospitalization Services)
• Structured/Intensive Outpatient Services (IOP)

    Additionally, facilities may submit bills for:

• Behavioral Health Assessment in the Emergency Room,
• Observation Services, and
• Crisis Services

Typically, these claims are submitted on a UB-04 claim form using industry-standard, contracted revenue codes. Each UB-04 must be accompanied by a complete itemization for all services. See a list of Optum preferred revenue codes below. If you are a participating provider, it is important that you utilize the codes reflected on your agreement, or risk denial of claim payment(s).

MD fees associated with facility-based services may or may not be included in your contracted reimbursement rate. If MD fees are not included in the negotiated facility program rate, Optum will create an individual authorization in the psychiatrist's name. In such cases, the MD fees must be billed separately using a CMS-1500 form, or by using the Claim Entry feature. If you have questions about an authorization for a specific member, please call the number on the back of the member's ID card for further information.

You can do a web search for information on ordering UB-04 Claim Forms.

Optum recognizes that some facilities may need to bill for certain contracted services on this "non-facility" claim form. Unfortunately, Optum has a limited capacity to accept facility-based claim information on the CMS-1500 form. If you are uncertain about which claim form to submit your facility-based claims with, or you need information on how to bill for facility-based services on a CMS-1500, contact your Optum Facility Contracting Manager for more information.

While Provider Express allows contracted hospitals/facilities secure access, it is not configured to allow access to hospitals/facilities to submit claims.

Notification  (dated 9/15/15)