Outpatient Services Claims

Bill using ICD-CM codes associated with conditions defined in the current edition of the DSM. Valid (billable) ICD-10-CM codes may be 3-7 characters in length. Remember to bill using the full ICD-10-CM code (including up to a 7th digit when required).

Frequently Asked Questions

What are outpatient services?

To find out about outpatient services, refer to the Optum Network Manual.

Can outpatient claims be submitted electronically?

Yes, network providers and groups can enter outpatient behavioral health claims through the Claim Entry feature on Provider Express.

Or, find out about submitting EDI/Electronic claims.

What form should I use to submit paper claims?

All outpatient claims should be submitted on a red CMS-1500 claim form. More information is available about submitting claims on this form at the CMS site.

If you are participating provider, it is important to utilize the codes reflected on your agreement, or you may risk denial of claim(s) payment.

What fields on the 1500 form does Optum require?

View the listing of all 1500 Optum required fields.