Claim Entry through Provider Express
Introduction
Optum's clinician website, Provider Express, supports entry of outpatient behavioral health claims by a registered user. This time-saving and secure transaction feature is designed to streamline the claim submission process with Provider Express.
Here are some advantages we think you will find:
- Faster claim payment and disposition
- Reduced mailing time and expense
- Faster claim form completion
- More accurate claim information
- Higher level of auto-adjudication
Claims Supported by Provider Express Claim Entry
- Claims for both traditional behavioral health and claims for EAP services are supported.
Claims Not Supported by Provider Express Claim Entry
- Claims from a non-participating clinician
- Claims from clinicians in some specialized arrangement status with Provider Express (e.g., clinicians who only see patients from a specific employer group, or Autism claims)
- Claims for services administered on external claims systems
- Claims for any facility-based behavioral health service (such as residential, inpatient, partial hospitalization, or intensive outpatient treatment)
Frequently Asked Questions About Claim Entry through Provider Express
Yes. Claims for outpatient behavioral health services can be entered through the Claim Entry feature on Provider Express. Click here for EDI/Electronic claims information.
Claims entered through Provider Express must be passed electronically to one of Provider Express's 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 Provider Express > My Submitted Claims feature. This feature will show the claims you submitted directly to Optum via Provider Express. If you received a confirmation number through Provider Express, you can be assured that Optum received your claim successfully.
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, this is not necessary and will result in a duplicate claim. If you want to check the status of the claim you submitted through Provider Express, you can query the Claim Inquiry transaction through beginning 2 or 3 business days after entry. However, it sometimes takes longer. To see claims you have submitted through Provider Express, use the My Provider Express > My Submitted Claims feature. This feature will show the claims you submitted directly to Optum via Provider Express. If you received a confirmation number through Provider Express, you can be assured that Optum received your claim successfully.
No. You must be an in-network clinician and have a registered Username and password for Provider Express.
No. See the Inpatient/Facility Claims section for details of how to submit a facility claim.
No. Provider Express functionality only supports clinicians who are fully contracted to provide services for Optum members.
Optum considers this a facility-based service and does not currently support it through Provider Express. 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 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 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.