Claim Entry through Provider Express

Yes. Claims for outpatient behavioral health services can be entered through the Claim Entry feature on Provider Express.

Facility claims can be submitted electronically using EDI. Click here for EDI/Electronic claims information.

If you have received a confirmation number through Provider Express, you can be assured that Optum has received your claim successfully. Claims entered through Provider Express must be passed electronically to one of Provider Express' host claim systems for adjudication. In most cases, you should be able to get status through the Claim Inquiry feature of Provider Express within 2 to 3 business days after entry. However, it sometimes takes longer. To see claims you have submitted through Provider Express, use the  My Submitted Claims feature under the claims menu. This feature will show the claims you submitted directly to Optum via Provider Express. 

We recommend you print the confirmation page in Claim Entry – Step 4 of 4 for your records. If you want more detail than that, we recommend you use your browser's print function to make a screen print of the completed form in Claim Entry – Step 2 of 4 (note: you may need to change settings on your browser to print on a single page).

No, only claims submitted on a CMS-1500 can be submited on Provider Express  See the Facility Claims section for details of how to submit a facility claim.

Please refer to the Claim Tips page through Provider Express for instructions on submitting a claim manually.

Generally, clean claims that contain all of the required information will be paid within 30 days after receipt of the claims. This may exclude claims which require an exception process, such as coordination of benefits (COB) and student status verification, which can delay this process. The procedure for processing claims will be modified as necessary to satisfy any applicable state laws.

Registered users of Provider Express can use the Claim Inquiry transaction or you can call the number on the back of the member’s ID card.