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: 

Frequently Asked Questions about Claim Submission

Can I submit my Optum claims electronically?

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.

Where should I mail my paper claim?

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.

What do I do if I have a claim problem?

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.

What is my reimbursement rate?

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.

What is the Optum payer ID for Electronic (EDI) claims submission?

The Optum payer ID is 87726.

How long will it take to get my check?

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.

How do I check the status of my claims?

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.