What's New?

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 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@optumhealth.com with any questions.

¹American Recovery and Reinvestment Act of 2009

CMC CLAIMS PORTAL 

In order to expedite payments to providers and to validate the receipt of claims, OptumHealth Complex Medical Conditions (CMC) has implemented a claims portal.  The CMC Claims Portal is a paperless claim process for our clients to receive re-priced claims.   

Benefits of the CMC Claims Portal include:

• Reduces claim processing timelines.
• Provides the ability to track all claims.
• Protects Personal Health Information (PHI) by providing our clients with a secure location to retrieve claims.
• Validates claims received.

If you would like to learn more about the CMC Claims Portal please click here.

Changes to Secure E-mail Process
OptumHealth is now using a new secure e-mail system. The first time you receive a secure (encrypted) e-mail from us, you will be asked to register and create a password with Cisco Registered Service. Once registration is complete, you will receive an e-mail with a link to view the encrypted e-mail. You will then be prompted to enter your password in order to view the message.

Secure e-mail will remain available for 30 days after the migration so you can continue to access existing encrypted e-mails.  Please contact OptumHealth Care Solutions at cmc.customer.service@optumhealth.com with any questions.

Claim Detail Report Now Available for External Claims
An enhancement has been made to our provider Web site which enable users to access the Client Claim Detail Report provided to our external payers.  This report provides an explanation of pricing and a summary page outlining the charges received for the case as of the date the report is pulled.  The summary page also breaks down the charges received by phase.  Please note, the data will change on reports for future claims received.

The report is located under Manage Claims- Patient List and is attached to each claim under the header Claim Detail Report via the link "View Report".

The Client Claim Detail Report is also available to our payers via the OptumHealth client Web site.  Please contact OptumHealth Care Solutions at cmc.customer.service@optumhealth.com with any questions. 

Complex Medical Conditions compliance with the California Language Assistance Regulation  California Department of Managed HealthCare (DMHC) Language Assistance Regulations (SB-853) mandate all Knox-Keene licensed  health plans in California provide language assistance services to members with limited English proficiency (LEP).

In accordance with this legislation, OptumHealth Complex Medical Conditions (CMC) will continue to provide verbal translation to any member contacting our call centers for assistance. 

For those members eligible under this legislation, the insured's health plan assumes responsibility for providing all translation and interpretation services outside of a member?s direct interaction with our call centers.  Please direct any questions or issues regarding any translation or interpretation services directly to the insured?s health plan as the responsible party.

For more information on the California Language Assistance legislation, please review the Department of Managed HealthCare's Web site for Frequently Asked Questions at http://www.dmhc.ca.gov/healthplans/gen/gen_laFAQ.aspx.

Claims Status Process and Payer Contact List Available Online.
OptumHealth Care Solutions' Providers can contact payers directly for claims payment status.  Please see the Claims Status Process Provider Letter, Claims Status Procedure and Client Claims Status Contact List for details.

Health Care Providers are required to contact our payers directly between 30 and 45 business days from the repricing date.  If payment has not been identified to the provider by the payer after 45 business days, OptumHealth will assist in obtaining payment information from the payer.