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Important claims submission information

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Did you know that the OptumCare® preferred method of claim submission is electronic, known as electronic data interchange (EDI)? EDI is the computer-to-computer transfer of data transactions and information between trading partners (payers and providers). 

EDI is a fast, inexpensive and safe method for automating the business practices that take place on a daily basis. There is no charge for submitting claims electronically to OptumCare.

Electronic claims submission allows you to eliminate the hassle and expense of printing, stuffing and mailing your claims to OptumCare.

It substantially reduces the delivery, processing and payment time of claims. There is no charge for submitting claims electronically. Providers are able to use any major clearinghouse.

Payer ID: LIFE1

Benefits of EDI

  • Reduces costs: No more handling, sorting, distributing or searching paper documents. It keeps health care affordable to the end customer.
  • Reduces errors: Improves accuracy of information exchanged between health care participants and the quality of health care delivery and its processes.
  • Reduces cycle time: Enhanced information is available more quickly and it ensures fast, reliable, accurate, secure and detailed information.

EDI format

EDI has a standardized format, which ensures that data can be sent quickly and is interpreted on both sides. EDI transactions adhere to HIPAA regulations and American National Standards Institution (ANSI) standards. 

The EDI specifications are like blueprints for the data that guide the data to make the transitions between different data trading partners as smooth as possible.

As of March 31, 2012, health care providers must be compliant with version 5010 of the HIPAA EDI standards. The current format that is used is 837, ANSI x12.

  • 837i — Institutional claims
  • 837p — Professional claims

Other transactions performed by OptumCare:

  • 997 — Functional acknowledgement (claim receipt acknowledgement via clearinghouse)

For paper submissions, please review the following to ensure that your claim is received and processed accordingly.

Paper submission:

  • Professional vendors must submit on a CMS 1500
  • Ambulatory surgery centers must submit with appropriate modifier SG or TC
  • Hospital and facility vendors must submit on a CMS 1450

Paper claim submission address:

OptumCare Claims
PO Box 30539
Salt Lake City, UT 84130