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Claims

Claim Issues

To resolve a claim issue the following options are available:

• Call the Customer Service number on the back of the member's insurance card or on the Explanation of Benefits (EOB) / Provider Remittance Advice (PRA).
• If the claim was not processed correctly, in-network clinicians and groups can log in and file a Claim Adjustment Request via the Claim Inquiry transaction. The Claim Inquiry training module can be accessed on the Training page for instructions.
  
• If the claim was submitted with inaccurate information, in-network clinicians and groups can log in and file a Corrected claim (or Void a claim) via the Claim Entry transaction. You can locate an overview of this on our Training page.
  
• Access the Claim Inquiry/Adjustment Request Form and mail it to the address listed on the EOB/PRA form.
• Contact a claims representative via Provider Express's Live Chat (for registered users) by logging in and going to Claim Inquiry (or My Submitted Claims, if the claim was submitted online). Locate the claim and towards the upper right on either "detail" page (above the member's ID #), click the link "Have questions about claim status?" to access Claims Live Chat. If you cannot locate the claim, then click the "Cannot locate claim status?" link on any of the claim pages.

Electronic Data Interchange (EDI)

Optum strongly advocates the use of electronic claim transactions. For more information on electronic claims submission, please check out EDI Claims.

Electronic Payments and Statements (EPS)

EPS allows health care providers to receive direct deposit claim payments and remittance information electronically.

Appeals and Provider Dispute Resolution

Please refer to the Optum Network Manual section, "Appeals and Provider Dispute Resolution" to find directions on how to submit your request. For California, please refer to the OHBSC Network Manual section on "Appeals and Disputes."

Join Our Network

For more information on joining our network, please click here.

Provider Record Maintenance - Demographic and Tax Identification Number (TIN) Changes and Updates

To submit a demographic change request online, log in by using your Provider Express registered user name and password, and then select "My Practice Info". Please allow up to 5 business days for your request to be completed. For more information or to get a User ID, click the "First-time User" link at the top of this page.

To change tax identification information or add another practice location with a different TIN, access the  Add / Update / Inactivate Tax ID online form.

If you are a TennCare Provider, please use the Clinician Add/Change Application  paper form and fax the completed form to Network Management for your state (see "Network Management Contact Information" below).

Network Management Contact Information

To submit your Clinician Add/Change Form or forms from the Join Our Network section, or for all other network questions, please contact Network Management by choosing your state below.

Alabama (AL)
Alaska (AK)
Arizona (AZ)
Arkansas (AR)
California (CA)
Colorado (CO)
Connecticut (CT)
Delaware (DE)
District of Colombia (DC)
Florida (FL)
Georgia (GA)
Hawaii (HI)
Idaho (ID)
Illinois (IL)

 

 

Indiana (IN)
Iowa (IA)
Kansas (KS)
Kentucky (KY)
Louisiana (LA)
Maine (ME)
Maryland (MD)
Massachusetts (MA)
Michigan (MI)
Minnesota (MN)
Mississippi (MS)
Missouri (MO)
Montana (MT)
Nebraska (NE)

Nevada (NV)
New Hampshire (NH)
New Jersey (NJ)
New Mexico (NM)
New York (NY)
North Carolina (NC)
North Dakota (ND)
Ohio (OH)
Oklahoma (OK)
Oregon (OR)
Pennsylvania (PA)
Puerto Rico (PR)
Rhode Island (RI)
South Carolina (SC)

South Dakota (SD)
Tennessee (TN)
Texas (TX)
Utah (UT)
Vermont (VT)
Virgin Islands (VI)
Virginia (VA)
Washington (WA)
West Virginia (WV)
Wisconsin (WI)
Wyoming (WY)