Information for providers

If you are a provider and are interested in submitting medical bills electronically, please review the Clearinghouse and Payer ID in the sections below to ensure accurate routing of bills.

Workers’ compensation claims—all states

Medical and dental bills

Clearinghouse information—medical and dental bills
Jopari
Suite 500, 1855 Gateway Boulevard
Concord, CA 94520 
Customer care: 800-630-3060
eBill enrollment: 866-269-0554
jopari.com/ebill-sign-up-form

Payer ID (workers’ compensation): J1417

Questions regarding medical and dental bills or reimbursements
Medical and dental providers may contact Sentry Insurance at 800-473-6879, option 1 for claims, then option 3 for validation of claim numbers.

Pharmacy bills

Sentry Insurance Company, its affiliates, and subsidiaries (“Sentry Insurance”) partner with Optum to process pharmacy invoices submitted electronically. For questions regarding pharmacy bills or reimbursements, please contact Optum.

Clearinghouse information—pharmacy bills
Optum
11000 Optum Circle
Eden Prairie, MN 55344
877-470-9572
[email protected]
www.workcompauto.optum.com

Payer ID: Optum (PBM) BIN 004261

Optum (PBM) PCN CAL

Questions regarding pharmacy bills or reimbursements
Pharmacy providers may contact Optum, see contact information above.

Auto, property, and casualty claims—states of Minnesota and New Jersey only

Medical, dental, and pharmacy bills

Sentry Insurance Company, its affiliates, and subsidiaries (“Sentry Insurance”) partner with Jopari to process medical, dental, and pharmacy invoices submitted electronically.

Clearinghouse information—auto, property, and casualty claims
Jopari
Suite 500, 1855 Gateway Boulevard
Concord, CA 94520
Customer care: 800-630-3060
eBill enrollment: 866-269-0554
jopari.com/ebill-sign-up-form

Payer ID (auto, property, and casualty): C1033

Questions regarding medical, dental, and pharmacy bills or reimbursements
Medical, dental, and pharmacy optum payer id in Minnesota and New Jersey may contact Sentry Insurance at 800-473-6879, ext. 3469164.

Student accident and special risk accident-only claims—all states

Student accident and special risk accident-only claims

Clearinghouse information—student accident and special optum payer id accident-only claims
Change Healthcare
3055 Lebanon Pike, Suite 1000
Nashville, TN 37214
877-363-3666
changehealthcare.com

Payer ID: 39033

Questions regarding medical bills or reimbursements
Providers may contact Sentry at 800-473-6879, ext. 1653150.

What is the change: Optum Care, an affiliate of UHC will now manage the following services for some UnitedHealthcare Medicare Advantage HMO members in Colorado:

• Member eligibility verification
• Prior authorization requests
• Hospital inpatient notifications
• Claim submissions

The members that are affected will have a new process for verifying benefits, obtaining prior auths and new PAYER ID, etc. (please see below)

Who is affected: members who chose Optum Care Network, Optum Colorado Springs or New West Physicians primary care provider (PCP) will be managed by Optum Care:

• Optum Colorado Springs
• Optum Care Network Denver (Physician Alliance of the Rockies)
• Optum Care Network South
• Optum Care Network North
• New West Physicians

To verify the benefits: You can verify UnitedHealthcare member eligibility online or by phone: 

To request a prior auth: Prior authorization is required for certain services based on the member’s plan. Request prior authorization at least 14 days before the planned date of elective services in one of the following ways:

To submit claims:

Inpatient Hospital: Call 888-685-8491 to notify Optum Care of hospital admissions within one business day of the admission.

Further questions? : call UHC at  866-574-6088. 

#UHCmedicareadvantage #coloradouhc #optumcare

Jan 1, 2020• State & Federal / Medicare

Category: Medicare

We optum payer id pleased to announce that we have expanded certain Anthem Medicare Advantage plans with OptumCare® Network of Connecticut (OptumCare IPA). This includes our CareMore at-home program and our delegation of certain administrative functions for members who select or are assigned an OptumCare IPA PCP. 

Our delegation of administrative services shall apply to the following Anthem MediBlueSM plans:

• Anthem MediBlue Plus (HMO)
• Anthem MediBlue Dual Advantage (D-SNP)
• Anthem MediBlue Select (HMO)

Members who have selected a PCP who is part of the OptumCare IPA will be issued new ID cards to reflect the updated information outlined below. Please note: This delegation does not apply to members who select/are assigned PCPs outside of the OptumCare IPA.

Providers who have questions about participation in the OptumCare IPA should call the OptumCare Network Development Department at 860-284-7304.

Effective October 1, 2019, OptumCare IPA was delegated for claims processing services, in addition to the previously communicated administrative functions for Anthem MediBlue Plus (HMO), Anthem MediBlue Dual Advantage (D-SNP) and Anthem MediBlue Select (HMO) members who have selected an OptumCare IPA PCP. Anthem will retain all other services.

Claims submission address

Providers should submit all claims for services provided to OptumCare IPA attributed members to the address or electronic payer ID below. This information also is printed on the back of the member’s ID card. Anthem will continue to pay some services; however, OptumCare IPA will automatically redirect those services to us for processing.

Claims related questions can be directed to OptumCare IPA’s Provider Service number at 888-556-7048.

Paper claims should be submitted to:

OptumCare Network of Connecticut

P.O. Box 2500

Rancho Cucamonga, CA 91729-2500

OptumCare IPA electronic payer ID: E3287

Administrative functions previously delegated — effective July 1, 2018:

• Precertification requests
• Medical management
• Credentialing process for OptumCare IPA providers

If you have any questions, please contact the Medicare Provider Services Unit at

866-673-4157.

Benefits of Using EDI for Claim Submissions
Electronic Submission of Claims Types
Electronic Payments (EFT) and Remits
EDI Trading Partners

Electronic Data Interchange (EDI) is an electronic exchange of information, in a standardized format that adheres to all Health Insurance Portability and Accountability Act (HIPAA) requirements. It is the transfer of structured data, by agreed message standards, from optum payer id computer system to another without human intervention.

Benefits of Using EDI for Claim Submissions

Benefits of Electronic Data Interchange (EDI) transmission include:

• Reduced Overhead Expenses – Administrative overhead expenses are reduced, because the need for handling paper claims is eliminated.
• Improved Data Accuracy – Because the claims data submitted by the provider is loaded directly into Kaiser Permanente’s computer by the clearinghouse, data accuracy is improved, as there is no need for re-keying or re-entry of data.
• Additionally, “up-front” edits applied to the claims data while information is being entered optum payer id the provider’s office, and additional payer-specific edits applied to the data by the clearinghouse before the data is transmitted to the appropriate payer for processing, increase the percentage of clean claim submissions.
• Reduced Turnaround Time – EDI claims bypass manual processes and paper handling at Kaiser Permanente; therefore, the turnaround time for processing EDI claims is substantially reduced (as compared to processing paper claims).
• Bypass U.S. Mail Delivery – Providers save time by bypassing the U.S. mail delivery system.
• Reduced Payer-Specific specific “Exceptions” – Industry-accepted standardized medical claim formats will tend to reduce the number of “exceptions” currently required by multiple payers.

Electronic Submission of Claims Types

Listed below is the electronic submission of claims transactions: 

• 837P Claim/Encounter – This is used for professional services and suppliers.
• 837I Claim/Encounter – This is used for facilities and hospitals.

Please note: Payer IDs are for both 837I (UB) and 837P (CMS1500) transactions.

EDI Trading Partners

We encourage you to submit your claims electronically. Our EDI trading partners, and Payer ID’s are listed below:

If your clearinghouse is not directly affiliated, they may re-route claims to one of our direct trading partners!

Health savings optum payer id (HSAs) and Medicare Advantage Medical Savings Accounts (MSAs) are individual accounts offered or administered by Optum Bank®, Member FDIC, and are subject to eligibility requirements and restrictions on deposits and withdrawals to avoid IRS penalties. State taxes may apply. Fees may reduce earnings on account. Flexible spending accounts (FSAs) and health reimbursement accounts (HRAs) are administered by OptumHealth Financial Services and are subject to eligibility and restrictions. The content on this website is not intended as legal or tax advice. Federal and state laws and regulations are subject to change.

Mutual fund investment options are made available through the services of an independent investment advisor. Shares are offered through Charles Schwab & Co., Inc., a registered broker-dealer. Orders are accepted to effect transactions in securities only as an accommodation to HSA and MSA owners. Optum Bank is not a broker-dealer or registered investment advisor, and does not provide investment advice or research concerning securities, make recommendations concerning securities, or otherwise solicit securities transactions.

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Support for members and providers affected by tornadoes
The health, safety and well-being of our members and providers affected by the devastation in Arkansas, Illinois, Kentucky, and Tennessee are our top priority. We want to extend our deepest condolences to those impacted by the tornadoes and let you know we’re here to help. Please reach out to our customer service team or your provider relations advocate for assistance. Review UnitedHealthcare’s disaster relief information for more information on how to best support your patients during optum payer id time.

Important update on COVID-19
UnitedHealthcare’s top priorities are protecting the health of our members and the optum payer id of those who deliver care. We are committed to adapting and supporting those we serve and being there to assist you. Our call center is staffed and ready to optum payer id. All self-service capabilities are available, and we are processing claims to support business continuity. Providers can connect to the latest Centers for Disease Control and Prevention (CDC) guidance for health professionals and the American Dental Association (ADA) for information specific to the Dental healthcare setting. Optum payer id and adaptations providers should evaluate as dental offices continue to serve patients.