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Stop Loss?  We are here to help you!

Your Network Relations Representative will be notifying you of stop loss cases once we receive communication from our clients that a stop loss is in place.  OptumHealth will be monitoring each case to ensure our providers are submitting claims timely.  We appreciate your timely submission of claims as this ensures prompt claims payment.  Please remember to send all claims to us via EDI.  Our Payer ID is 41194.  If you have questions or concerns, please contact our customer service department at cmc.customer.service@optum.com.

Care Solutions is Migrating From Paper to Electronic Claim Processing
OptumHealth Care Solutions is migrating from paper to electronic claim processes. As OptumHealth focuses on the significance of electronic data, it is important to know that we are not alone.  Experts believe the wide use of patient health information systems combined with organizations that work together (interoperability) stand to improve heath care quality, reduce medical errors, enhance the physician-patient encounter, and lower health care costs.1

The benefits of submitting claims via Electronic Data Interchange (EDI) include:

  • allows for faster receipt of claims and payment cycles, resulting in quicker claims payment, fewer outstanding receivables, and increased cash flow.
  • provides you the ability to track the claims from the time they leave your facility until OptumHealth receives, accepts and prices them.
  • eliminates the administrative, paper and mailing costs that paper claims require.
  • claims are easily managed on the provider Web site, allowing you to search and validate the claims; review closed/rejected claims and manage the EDI claims inventory.
  • Bundle billing, cover sheets and/or itemizations are no longer necessary.

Due to the overwhelming benefit to you, our provider, it is OptumHealth's goal to work with you to ensure that claims are being submitted electronically. Please contact OptumHealth at cmc.customer.service@optum.com with any questions.

1American Recovery and Reinvestment Act of 2009

The OptumHealth Quick Reference Guide, Claims Status Process and Payer Contact List are Available Online. Please visit the News section of this site for more information.

Claims Status Contact List

The UnitedHealthcare Payment Link Available Online 
The UnitedHealthcare Payment Link is available to access OptumHealth/UnitedHealthcare cases.  UnitedHealthcare Payment Link

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