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.
Claim Submissions Related to ICD-10
For more information or any ICD-10 related issues you may be having regarding submitting claims, please visit our ICD-10 Resource page. In addition, you may also want to review the following Knowledge Briefs:
- Three ICD-10 Claim Requirements for HIPAA Validation
- Claim Resubmission or Corrections
- ICD-CM Indicator/Qualifier Codes for Claim Submission
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 Claims Problem Resolution 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 Network Management 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.
To check eligibility and benefits, please log in and use the online search feature. Otherwise, you can call the number on the back of the member's ID card.
To check the status of an authorization, please log in and use the Auth Inquiry feature. Otherwise, you can call the number on the back of the member's ID card.