Optum OKC Clearinghouse Status

SB580 | SB690 | 12000 | 12011 CareFirst BCBS : Claim Filing Indicator Code

Identified - CareFirst BCBS has implemented professional edits, and will be adding Institutional edits in March, to accept only the following values for Claim Filing Indicator Codes on Secondary claims where CareFirst is not the Primary Payer.

Institutional Claims:
- When Loop 2320 Other Subscriber Information. If SBR01 = P,
Loop 2320 Claim Filing Indicator Code: SBR09 must be MA, 12, BL, CI or ZZ

Professional Claims:
- When Loop 2320 Other Subscriber Information. If SBR01 = P,
Loop 2320 Claim Filing Indicator Code: SBR09 must be MB, 12, BL, CI or ZZ

Please include the valid Claim Filing Indicator Codes to avoid any claim rejections from the Payer.

Ref#676000
Feb 19, 2024 - 15:49 EST

CB186 | BRIGHT HEALTH PLAN - Reports Delivery Delay

Identified - Optum identified an interruption to normal claim status report processing and delivery from the payer primarily related to claims processed at Optum from Jan. 18, 2024, to Feb 15, 2024. This results in some delivery delays for the impacted reports and delayed claim status updates because the 999 reporting from the payer is not being received.

Optum has been notified that the payer continues efforts to resolve this issue, and updates concerning client impact will be provided as they become available.

Efforts to resolve this issue continue. It is currently open and in progress.

REF 674450
Feb 16, 2024 - 17:39 EST

22099, 84367 - Horizon BCBSNJ, Braven Health - Claims - Transactions – Rejection

Monitoring - Horizon BCBSNJ and Braven Health (Payer IDs 22099, 84367)

Due to a processing issue, 837I and 837P claims submitted Feb. 2 through Feb. 12, 2024 have rejected at the payer due to the following error:

• "Clinical Coding Error"

Horizon EDI has identified the issue and taken necessary steps for correction.

We will work with the payer to resubmit impacted claims once the payer provides a list.

An update will be provided with additional information.

CSA#672900
Feb 14, 2024 - 12:04 EST

SB580, SB690 - CareFirst BCBS MD, CareFirst BCBS DC - Claims - Transactions - Rejection

Identified - CareFirst BCBS requires that Sequestration Adjustment be included on Professional Medicare Crossover Claims.

CareFirst BCBS will reject Professional Medicare Crossover Claims when there is a Medicare Payment indicated with no related CAS (Claim Level Adjustment) information included.

In addition, CareFirst requires this adjustment to appear at the line level of every claim where the Medicare payment is more the .50. Medicare reports the payment reduction as a CAS*CO*253.

There must be an instance of either CAS02, CAS05, CAS08, CAS11, CAS14, or CAS17 that equals(=) 253 when Loop 2320, segment SBR01 = P and SBR09 = MB; Loop 2430 SVD02 is greater than .50 and CAS01 =PR.

Please include Sequestration Adjustment to avoid any claim rejections from the Payer.

REF 670152
Feb 09, 2024 - 13:00 EST

59331 | 59298 | Ascension Benefits (Stuart, Florida) - Claims - Transactions - Payer Deactivation

Identified - Effective immediately, Ascension Benefits (Stuart, Florida), Payer IDs 59331 & 59298, has deactivated the below services with Optum:

• 837I
• 837P

Please discontinue use of the above Payer IDs for these transactions.

Going forward, all claims for Ascension Benefits should be processed under Payer ID 75261.

Updated Payer Lists may be obtained from your software vendor or Optum. Optum removed this payer from the Payer List and any transactions sent using the above Payer ID will be rejected.

REF 668250
Feb 07, 2024 - 17:03 EST

33373 | MOLINA HEALTHCARE OF CA ENCOUNTERS - 999 Reports Delivery Delay

Identified - Optum identified an interruption to normal claim status report processing and delivery from MOLINA HEALTHCARE OF CA ENCOUNTERS, Payer ID 33373, primarily related to claims processed at Optum from Jan. 23, 2024, to Feb. 6, 2024. This results in some delivery delays for the impacted reports and delayed claim status updates because the 999 reporting from the payer is not being received.

REF: 666450
Feb 06, 2024 - 12:38 EST

00403 - Healthy Blue South Carolina - Claims Denials

Investigating - As of Jan. 1, 2024, claims submitted to Healthy Blue South Carolina, Payer ID 00403, with a Date of Service (DOS) of 2024 may have denials returned via ERAs.

Optum/Change Healthcare is aware of this issue and efforts are ongoing to resolve.

Action Required: At this time, no actions are needed.

REF 664800
Feb 02, 2024 - 14:23 EST

20934 | Molina Healthcare of Illinois - Rendering Provider Loops on Claims

Identified - Rendering Provider Loops on Claims for Molina Healthcare of Illinois (Payer ID 20934)

Optum and Molina would like to remind submitters that Molina Healthcare of Illinois (Payer ID 20934) allows for the Rendering Provider loop (2310B) even when the NPI matches the Billing Provider Loop (2010AA).

Submitters should not suppress the Rendering Loop if sent on the claims to avoid any processing delays at the payer.

REF 660602
Feb 02, 2024 - 11:17 EST

Update: Ohio Medicaid One Front Door, new reporting starting Sept. 18, 2023

Monitoring - When Optum implemented the unique ODM (Ohio Department of Medicaid) “ODM one front door” claims routing configuration in Feb. 1, 2023, the payer changed the way that they report claim level rejections. ODM reports claim level rejections on a 999 Functional Acknowledgement instead of a 277CA Claims Acknowledgement. Starting on September 18, 2023, Optum will be passing pertinent rejection information from these 999 files to our submitters via the following reporting methods:

• SR (Human Readable Standardized Payer Report)
• SF (Data File Standardized Payer Report)
• FX (Recreate Notification Report)

As a reminder, providers need to access the Provider Network Management link to add NPI affiliations. Failure to complete this step will result in claim rejections.

• The messages returned to the provider for not completing this step are as follows:
o 7 - INVALID CODE VALUE|REF ELEMENT 2 – xxxxxxxxx
 Where xxxxxxxxx represents the NPI that has not been registered
o 8 - SEGMENT HAS DATA ELEMENT ERRORS|2010 REF|

Ref#572800
Sep 15, 2023 - 12:47 EDT

81079 - BayCare Plus Medicare Advantage - Claim Status Inquiry Issues

Investigating - Currently, there are Claim Status transactions processing issues with:

Payer Name: BayCare Plus Medicare Advantage
Payer ID: 81079

Claim Status Inquiry Transactions for Baycare Select Health Plans, Incorporated (Payer 81079) are currently experiencing intermittent issues.
Availity is actively working to resolve the intermittent issues. Please contact Availity with any questions or issues you have with these transactions.

Change Healthcare will update you as soon as service is restored or we receive additional information.

Action Required: Be aware of the processing issue above.

REF 672154
Feb 14, 2024 - 14:00 EST

81079: BayCare Plus Medicare Advantage - Real-Time 270/271 and 276/277, Hosted to Direct Conversion and Re-routing to Availity

Identified - Currently, there are Eligibility transaction processing issues with:

Payer Name: BayCare Plus Medicare Advantage

Change Healthcare Payer ID: 81079

Eligibility and Benefit Inquiry Transactions for Baycare Select Health Plans Incorporated (Payer 81079) are currently experiencing intermittent issues. To avoid potential transaction processing fees, we recommend that you hold all Eligibility and Claim Status transactions for this payer until this issue is resolved.

Change Healthcare will update you as soon as service is restored or we receive additional information.

Action Required: Be aware of the processing issue above.

REF 646900
Jan 11, 2024 - 12:47 EST

AETNX Aetna: Unavailability of Boon Claim Status Inquiry

Identified - Boon Claim Status Inquiry Transactions through Aetna

Transaction: Claim Status Inquiry (276)

Payer: Aetna (AETNX)

Topic: Unavailability of Boon Claim Status Inquiry through Aetna Payer ID AETNX.

Please be aware that requests for Claim Status sent to Aetna Payer ID AETNX for Boon claims will return an error beginning Dec. 29, 2023 through March 1, 2024, while connectivity upgrades are made. Provider submitters can use Payer ID BOONA instead of AETNX to access Boon Claim Status Inquiry transactions.

Action Required by Customer:
Please use Payer ID BOONA to access Claim Status Inquiry beginning Dec. 29, 2023.

Ref# 635550
Dec 20, 2023 - 16:19 EST

SKMA0 12K14 | MA Medicaid - File Delivery Delay

Monitoring - This is an update on an issue previously reported by Optum.

Optum has worked with MassHealth and have been able to resolve the issue with delivering claim files and receiving 999 responses.
All files that were previously backlogged due to this issue have now been successfully delivered to the payer.

The resolution to the ERA delivery issue is still being reviewed. Optum will be able to confirm that change worked after the next release of ERA by the payer.

Once that is completed, another communication will be sent out.
Feb 07, 2024 - 16:34 EST

Identified - Optum identified an interruption to normal claims delivery with MassHealth, Payer IDs 12K14 and SKMA0, related to claims processed at Optum after Jan. 14, 2024. This resulted in some processing delays for the impacted claims.

Optum is working closely with the payer to resolve this issue as soon as possible.

REF 658651
Jan 26, 2024 - 17:35 EST

75191 | CAREFIRST ADMINISTRATORS Reports Delivery Delay

Identified - Optum identified an interruption to normal claim status report processing and delivery from CAREFIRST ADMINISTRATORS, Payer ID 75191, primarily related to claims processed at Optum from Jan. 16, 2024, to Jan. 29, 2024. This results in some delivery delays for the impacted reports and delayed claim status updates because the 999 reporting from the payer is not being received.

Please be aware of these delays. No action is required.

REF: 664504
Feb 05, 2024 - 09:11 EST

Payer Processing Issue for Multiple Payers

Identified - Optum discovered a processing issue with claims with Date of Service starting January 1, 2024, forward for Payers referenced below.

ARA01-Ageright Advantage Health Plan
ASFL1-Align Senior Care of Florida
ASMI1-Align Senior Care of Michigan, Align Senior Health of Michigan
ASVA1-Align Senior Care of Virginia
KCMD1-Keycare
LWA01-Lifeworks Advantage
PACO1-Perennial Advantage of Colorado
PAOH1-Perennial Advantage Ohio
PH001-Pruitthealth Premier
PHPC1-PruittHealth Premier NC/SC
PTX01-ProCare Advantage of TX
NHC01-National Healthcare Corporation Advantage (NHC Advantage)

Optum is actively working to resolve this issue. Once the issue is resolved, Optum will reprocess the impacted claims.

REF: 662700
Jan 31, 2024 - 17:04 EST

38343 | INGHAM HEALTH PLAN- PLAN MANAGEMENT SERVICES - Reports Delivery Delay

Identified - Optum identified an interruption to normal claim status report processing and delivery from the payer primarily related to claims processed at Optum from Jan. 11, 2024, to Jan. 12, 2024. This results in some delivery delays for the impacted reports and delayed claim status updates because the 999 reporting from the payer is not being received.

Optum has been notified that the payer continues efforts to resolve this issue, and updates concerning client impact will be provided as they become available.

Efforts to resolve this issue continue. It is currently open and in progress.

REF 660850
Jan 30, 2024 - 16:13 EST

84133 | DENVER HEALTH AND HOSPITAL AUTHORITY - Reports Delivery Delay

Identified - Optum identified an interruption to normal claim status report processing and delivery from the payer primarily related to claims processed at Optum on Jan. 10, 2024. This results in some delivery delays for the impacted reports and delayed claim status updates because the 999 reporting from the payer is not being received.

Optum has been notified that the payer continues efforts to resolve this issue, and updates concerning client impact will be provided as they become available.

Efforts to resolve this issue continue. It is currently open and in progress.

REF 658053
Jan 29, 2024 - 16:50 EST

22285 | ATLANTIC MEDICAL INSURANCE - Reports Delivery Delay

Identified - Optum identified an interruption to normal claim status report processing and delivery from the payer primarily related to claims processed at Optum on Jan. 12, 2024. This results in some delivery delays for the impacted reports and delayed claim status updates because the 999 reporting from the payer is not being received.

Optum has been notified that the payer continues efforts to resolve this issue, and updates concerning client impact will be provided as they become available.

Efforts to resolve this issue continue. It is currently open and in progress.

REF 658052
Jan 26, 2024 - 17:43 EST

62308 | Cigna Health Plans - Delay in Electronic Remittance Advice (ERA)

Identified - Due to a payer processing issue, there is a delay in some Professional and Institutional Electronic Remittance Advice (ERA) for the following payer for check dates of Jan. 3, 2024, through present:

• Payer ID 62308 Cigna Health Plans

Additional updates will be forwarded as more information becomes available.

Action Required: Please be aware of a delay in the delivery of ERAs for check dates above.

REF 652402
Jan 19, 2024 - 16:07 EST

47181 | Highmark BCBS DE Health Options - Delay in Professional and Institutional Electronic Remittance Advice (ERA)

Identified - Delay in Electronic Remittance Advice (ERA) for Payer ID 47181 Highmark BCBS DE Health Options

Due to a payer processing issue, there has been a delay in Professional and Institutional Electronic Remittance Advice (ERA) for the following payers for check date of January 10, 2024 through present:

• Payer ID 47181 Highmark BCBS DE Health Options

Additional updates will be forwarded as more information becomes available.

Action Required: Please be aware of a delay in the delivery of ERA for check dates above.

REF651650
Jan 18, 2024 - 15:17 EST

Delay in Some Claim Status Reports for Molina Healthcare CA (Payer ID 33373, 38333)

Identified - Optum has been advised that due to a processing delay at the payer, Claim Status Reports are currently delayed for some claims submitted to Molina Healthcare of California (Payer ID 33373, 38333) starting on Jan. 1, 2024. The reports are expected to be received at the clearinghouse for processing by Jan. 22, 2024.

An updated notification will be sent as additional information becomes available.

REF: 650851
Jan 17, 2024 - 16:31 EST

84146 | 84147 CHAMPVA HAC - Avoid Claim Rejections for Veterans Administration

Update - It has been determined that the most common clearinghouse rejection for claims submitted to the CHAMPVA program is invalid Member ID format. The *only* acceptable Member ID format for claims submitted to CHAMPVA, Payer IDs 84146 (institutional/professional) and 84147 (dental), is a 9-digit numeric Social Security Number (SSN) or Individual Taxpayer Identification Number (ITIN).

The second most common clearinghouse rejection reason is invalid Patient’s Relationship to Insured: the *only* valid relationship code is “self”. The patient is always the member, there are no sponsors.

It has also been determined that the most common rejections from the payer CHAMPVA are mismatches on Member ID, Date of Birth, or the First/Last Name of the Patient/Insured identified on the claim. The VA requires that the Patient/Insured name on the claim, including hyphenated last names, be an exact match to the name it has on file. Strict matching requirements on claims make it especially important that providers submit an eligibility check and update their systems prior to submitting a claim to CHAMPVA.

CHAMPVA is a health benefits program in which the department of Veterans Affairs shares the cost of certain health care services and supplies with eligible beneficiaries. CHAMPVA provides coverage to the spouse or widow(er) and to the children of veterans who meet very specific criteria which are further defined on the VA’s website:

https://www.va.gov/COMMUNITYCARE/programs/dependents/champva/champva-eligibility.asp

PLEASE NOTE: *CHAMPVA does not provide coverage to the veteran.*

Providers should always check the Member ID card to establish if the patient is enrolled with CHAMPVA: Insurance Cards for CHAMPVA will have "Department of Veterans Affairs Health Administration Center" in the top left corner. Please also note that in order to be eligible for CHAMPVA a member cannot be eligible for TRICARE.

To avoid claims being rejected for invalid Member ID format or the VA’s inability to identify the member/patient please check the ID card to be sure you are submitting to the correct program. If your patient is a veteran, submit an eligibility inquiry to the VHA Office of Integrated Veteran Care (IVC), Payer ID VAFEE, to verify active benefits and correct demographics prior to submitting a claim. If your patient is a spouse/widow(er) or dependent of a veteran AND has a CHAMPVA insurance card please send an eligibility inquiry to CHAMPVA, Payer ID VAHAC, to verify active benefits and correct demographics prior to submitting a claim. Once you have confirmed that your patient is enrolled with the CHAMPVA program, then submit your claims to Payer IDs 84146 or 84147 as appropriate.

REF 633752
Jan 19, 2024 - 13:14 EST

Update - Reminder:
It has been determined that the most common clearinghouse rejection for claims submitted to the CHAMPVA program is invalid Member ID format. The *only* acceptable Member ID format for claims submitted to CHAMPVA, Payer IDs 84146 (institutional/professional) and 84147 (dental), is a 9-digit numeric Social Security Number (SSN) or Individual Taxpayer Identification Number (ITIN).

The second most common clearinghouse rejection reason is invalid Patient’s Relationship to Insured: the *only* valid relationship code is “self”. The patient is always the member, there are no sponsors.

It has also been determined that the most common rejections from the payer CHAMPVA are mismatches on Member ID, Date of Birth, or the First/Last Name of the Patient/Insured identified on the claim. The VA requires that the Patient/Insured name on the claim, including hyphenated last names, be an exact match to the name it has on file. Strict matching requirements on claims make it especially important that providers submit an eligibility check and update their systems prior to submitting a claim to CHAMPVA.

CHAMPVA is a health benefits program in which the department of Veterans Affairs shares the cost of certain health care services and supplies with eligible beneficiaries. CHAMPVA provides coverage to the spouse or widow(er) and to the children of veterans who meet very specific criteria which are further defined on the VA’s website:

https://www.va.gov/COMMUNITYCARE/programs/dependents/champva/champva-eligibility.asp

PLEASE NOTE: *CHAMPVA does not provide coverage to the veteran.*

Providers should always check the Member ID card to establish if the patient is enrolled with CHAMPVA: Insurance Cards for CHAMPVA will have "Department of Veterans Affairs Health Administration Center" in the top left corner. Please also note that in order to be eligible for CHAMPVA a member cannot be eligible for TRICARE.

To avoid claims being rejected for invalid Member ID format or the VA’s inability to identify the member/patient please check the ID card to be sure you are submitting to the correct program. If your patient is a veteran, submit an eligibility inquiry to the VHA Office of Integrated Veteran Care (IVC), Payer ID VAFEE, to verify active benefits and correct demographics prior to submitting a claim. If your patient is a spouse/widow(er) or dependent of a veteran AND has a CHAMPVA insurance card please send an eligibility inquiry to CHAMPVA, Payer ID VAHAC, to verify active benefits and correct demographics prior to submitting a claim. Once you have confirmed that your patient is enrolled with the CHAMPVA program, then submit your claims to Payer IDs 84146 or 84147 as appropriate.

REF 633752
Jan 02, 2024 - 15:31 EST

Identified - It has been determined that the most common clearinghouse rejection for claims submitted to the CHAMPVA program is invalid Member ID format. The *only* acceptable Member ID format for claims submitted to CHAMPVA, Payer IDs 84146 (institutional/professional) and 84147 (dental), is a 9-digit numeric Social Security Number (SSN) or Individual Taxpayer Identification Number (ITIN).

The second most common clearinghouse rejection reason is invalid Patient’s Relationship to Insured: the *only* valid relationship code is “self”. The patient is always the member, there are no sponsors.

It has also been determined that the most common rejections from the payer CHAMPVA are mismatches on Member ID, Date of Birth, or the First/Last Name of the Patient/Insured identified on the claim. The VA requires that the Patient/Insured name on the claim, including hyphenated last names, be an exact match to the name it has on file. Strict matching requirements on claims make it especially important that providers submit an eligibility check and update their systems prior to submitting a claim to CHAMPVA.

CHAMPVA is a health benefits program in which the department of Veterans Affairs shares the cost of certain health care services and supplies with eligible beneficiaries. CHAMPVA provides coverage to the spouse or widow(er) and to the children of veterans who meet very specific criteria which are further defined on the VA’s website:

https://www.va.gov/COMMUNITYCARE/programs/dependents/champva/champva-eligibility.asp

PLEASE NOTE: *CHAMPVA does not provide coverage to the veteran.*

Providers should always check the Member ID card to establish if the patient is enrolled with CHAMPVA: Insurance Cards for CHAMPVA will have "Department of Veterans Affairs Health Administration Center" in the top left corner. Please also note that in order to be eligible for CHAMPVA a member cannot be eligible for TRICARE.

To avoid claims being rejected for invalid Member ID format or the VA’s inability to identify the member/patient please check the ID card to be sure you are submitting to the correct program. If your patient is a veteran, submit an eligibility inquiry to the VHA Office of Integrated Veteran Care (IVC), Payer ID VAFEE, to verify active benefits and correct demographics prior to submitting a claim. If your patient is a spouse/widow(er) or dependent of a veteran AND has a CHAMPVA insurance card please send an eligibility inquiry to CHAMPVA, Payer ID VAHAC, to verify active benefits and correct demographics prior to submitting a claim. Once you have confirmed that your patient is enrolled with the CHAMPVA program, then submit your claims to Payer IDs 84146 or 84147 as appropriate.

REF 633752
Dec 20, 2023 - 11:27 EST

84146 | 80214 | Veterans Administration CHAMPVA | Reporting Delivery Delay 835 Transactions

Update - We continue to reach out to the payer Department of Veterans Administration (VA) CHAMPVA, as Intermittent delays continue. Currently, there is no update or estimated time of resolution. 835s are still being delivered, but some can take several days to be received at Optum.
The payers Electronic Data Interchange (EDI) group is reviewing the issue. Updates will be provided as more information is given by the VA.

Ref# 649304
Jan 17, 2024 - 10:44 EST

Update - We continue to reach out to the VA for a resolution, but no new update or ETA is available at this time. Updates will be provided as more information is given by the VA.
Dec 14, 2023 - 16:54 EST

Identified - The payer Veterans Administration CHAMPVA, Payer ID 84146 and 80214, has confirmed that they are currently experiencing delays in the delivery of 835 transactions due to a system issue that is still to be fully identified. The delays are sporadic in nature and the issue is being reviewed at this time by the payer's EDI group. 835s are still being delivered, but some can take several days to be received at Optum.

The payer apologizes for these longer than normal delays and is working diligently to resolve the issue. The delay on 835s will not prevent or delay the paper EOB from being generated and mailed, and providers still have the option of using that remittance to post payments. Updates will be provided as more information is given by the VA.

REF 608100
Nov 08, 2023 - 09:29 EST

12B17 | MS - BLUE CROSS - Reports Delivery Delay

Identified - Optum identified an interruption to normal claim status report processing and delivery from the payer primarily related to claims processed at Optum from Oct. 19, 2023, to Jan. 8, 2024. This results in some delivery delays for the impacted reports and delayed claim status updates because the 999 reporting from the payer is not being received.

Optum has been notified that the payer continues efforts to resolve this issue, and updates concerning client impact will be provided as they become available.

Efforts to resolve this issue continue. It is currently open and in progress.

REF 647700
Jan 11, 2024 - 17:11 EST

61325 | PASSPORT HEALTH PLAN BY MOLINA HEALTHCARE - Claim Rejection

Identified - Payer 61325 has identified an issue where claims are rejecting for "Type of Service" or "Invalid Claim" starting with dates of service of Jan. 4, 2024, to present.

The payer is currently reviewing this issue with claim rejections under their internal incident of INC3485820.

The payer has advised that once this is resolved, all impacted claims will be reprocessed.

Action required by customer: None at this time, as the payer is working on these claim rejections that started on Jan. 4, 2024.

REF 647401
Jan 11, 2024 - 17:00 EST

SKMA0 Massachusetts Medicaid - Electronic Remittance Advice (ERA) Transactions Delay

Identified - Some customers may be experiencing an interruption to normal electronic remittance advice (ERA) processing and delivery expected from the following payer from Dec. 11, 2023 to current.

Massachusetts Medicaid - SKMA0

Action Required: Please be aware of a delay in the delivery of ERA for check dates above.

Ref#641000
Jan 02, 2024 - 13:43 EST

95567 Healthnet: Electronic Remittance Advice (ERA) Transactions

Identified - Customers may be experiencing an interruption to normal electronic remittance advice (ERA) delivery from Healthnet payer ID 95567 from Dec. 5, 2023 to current.

Optum is working with the payer to resolve.

Ref# 634950
Dec 20, 2023 - 10:33 EST

71412 | Mutual of Omaha - Delay in Electronic Remittance Advice (ERA)

Identified - Due to a payer intermediary processing issue, there has been a delay in Professional and Institutional Electronic Remittance Advice (ERA) for the following payers for check dates of Dec. 6, 2023, through present:

Payer ID: 71412 Mutual of Omaha

Action Required: Please be aware of a delay in the delivery of ERA for check dates above.

REF 632354
Dec 15, 2023 - 17:22 EST

Multiple Payers - Reports Delivery Delay

Identified - Optum identified an interruption to normal claim status report processing and delivery from the payer primarily related to claims processed at Optum on Nov. 30, 2023. This results in some delivery delays for the impacted reports and delayed claim status updates because the 999 reporting from the payer is not being received.

Optum has been notified that the payer continues efforts to resolve this issue, and updates concerning client impact will be provided as they become available.

Efforts to resolve this issue continue. It is currently open and in progress.

REF 629600
Dec 13, 2023 - 17:04 EST

37287 | PLANNED ADMINISTRATORS, INC. - Reports Delivery Delay

Identified - Optum identified an interruption to normal claim status report processing and delivery from the payer primarily related to claims processed at Optum from Nov. 22, 2023, to Nov. 24, 2023. This results in some delivery delays for the impacted reports and delayed claim status updates because the 999 reporting from the payer is not being received.

Optum has been notified that the payer continues efforts to resolve this issue, and updates concerning client impact will be provided as they become available.

Efforts to resolve this issue continue. It is currently open and in progress.

REF 627251
Dec 08, 2023 - 15:16 EST

Transactions Status Changes - Multiple Payers/Payer IDs

Investigating - Please be advised of the status change for the following Payers/Transactions effective January 1, 2024:

Payer ID 31403, Texas Independence Health Plan, Claims (Prof/Inst), ERA change to Gateway
Payer ID 45529, Nascentia Health Plus, Claims (Prof/Inst), ERA change to PAR
Payer ID 71066, Kansas Health Advantage, Claims (Prof/Inst) change to Gateway
Payer ID 83247, Dignity Health Plan(DOS before Jan. 1, 2023) , Claims (Prof/Inst) change to Gateway
Payer ID MPCHA, Atrio Health Plans, Claims (Prof/Inst) change to PAR
Payer ID RP075, Iowa Health Advantage, Claims (Prof/Inst) change to Gateway
Payer ID RP088, Dignity Health Plan (DOS after Dec. 31, 2022) , Claims (Prof/Inst) change to Gateway
Payer ID SIM01, Simpra Advantage, Claims (Prof/Inst) change to Gateway
Payer ID SIM02, Simpra Advantage, Claims (Prof/Inst) change to Gateway

Action Required by Customers:
Update your records to reflect the change in transaction status for the above payer/transactions.

REF 623001
Dec 01, 2023 - 15:12 EST

88337 | UNITED HEALTHCARE OHIO MEDICAID - Reports Delivery Delay

Identified - Optum identified an interruption to normal claim status report processing and delivery from the payer primarily related to claims processed at Optum from Nov. 7, 2023, to Nov. 22, 2023. This results in some delivery delays for the impacted reports and delayed claim status updates because the 999 reporting from the payer is not being received.

Optum has been notified that the payer continues efforts to resolve this issue, and updates concerning client impact will be provided as they become available.

Efforts to resolve this issue continue. It is currently open and in progress.

REF 620253
Nov 28, 2023 - 15:27 EST

35605 | MMA - Reports Delivery Delay

Identified - Optum identified an interruption to normal claim status report processing and delivery from the payer primarily related to claims processed at Optum on Oct. 20, 2023. This results in some delivery delays for the impacted reports and delayed claim status updates because the 999 reporting from the payer is not being received.

Optum has been notified that the payer continues efforts to resolve this issue, and updates concerning client impact will be provided as they become available.

Efforts to resolve this issue continue. It is currently open and in progress.

REF 613752
Nov 16, 2023 - 14:01 EST

65093 | ADVOCATE HEALTH PARTNERS - Reports Delivery Delay

Identified - Optum identified an interruption to normal claim status report processing and delivery from the payer primarily related to claims processed at Optum from Oct. 27, 2023, to Nov. 10, 2023. This results in some delivery delays for the impacted reports and delayed claim status updates because the 999 reporting from the payer is not being received.

Optum has been notified that the payer continues efforts to resolve this issue, and updates concerning client impact will be provided as they become available.

Efforts to resolve this issue continue. It is currently open and in progress.

REF 613750
Nov 15, 2023 - 15:14 EST

PAYER DEACTIVATION CARELON AETNA HOME HEALTH & CARELON ANTHEM HOME HEALTH Payer ID 34009

Update - We are continuing to monitor for any further issues.
Nov 09, 2023 - 12:41 EST

Monitoring - Effective immediately, CARELON AETNA HOME HEALTH & CARELON ANTHEM HOME HEALTH, Payer ID 34009, has deactivated the below services with Change Healthcare:

*837P

Please discontinue use of the above Payer ID. Updated Payer Lists may be obtained from your software vendor or
Change Healthcare

Change Healthcare removed this payer from the Payer List and any transactions sent using the above Payer ID will be rejected.

REF: 609750
Nov 09, 2023 - 12:40 EST

73160 | MOLINA OHIO MEDICAID - Reports Delivery Delay

Identified - Change Healthcare identified an interruption to normal claim status report processing and delivery from the payer primarily related to claims processed at Change Healthcare from Oct. 19 - 27, 2023. This results in some delivery delays for the impacted reports and delayed claim status updates because the 999 reporting from the payer is not being received.

Change Healthcare has been notified that the payer continues efforts to resolve this issue, and updates concerning client impact will be provided as they become available.

Efforts to resolve this issue continue. It is currently open and in progress.

REF 604002
Nov 01, 2023 - 15:13 EDT

68036 | JOHN MUIR - MT. DIABLO HEALTH SYSTEM - Reports Delivery Delay

Identified - Change Healthcare identified an interruption to normal claim status report processing and delivery from the payer primarily related to claims processed at Change Healthcare from Oct. 16, 2023, to Oct. 26, 2023. This results in some delivery delays for the impacted reports and delayed claim status updates because the 999 reporting from the payer is not being received.

Change Healthcare has been notified that the payer continues efforts to resolve this issue, and updates concerning client impact will be provided as they become available.

Efforts to resolve this issue continue. It is currently open and in progress.

REF 600650
Oct 26, 2023 - 16:03 EDT

12K12 | LA - MEDICAID (MOLINA) - Reports Delivery Delay

Identified - Change Healthcare identified an interruption to normal claim status report processing and delivery from the payer primarily related to claims processed at Change Healthcare from Aug. 8, 2023, to Oct. 20, 2023. This results in some delivery delays for the impacted reports and delayed claim status updates because the 999 reporting from the payer is not being received.

Change Healthcare has been notified that the payer continues efforts to resolve this issue, and updates concerning client impact will be provided as they become available.

Efforts to resolve this issue continue. It is currently open and in progress.

REF 599200
Oct 24, 2023 - 14:02 EDT

Claims Processing Issue

Investigating - The Processor for Washington Labor is experiencing a processing issue.

This issue is currently being investigated. Optum team apologize for any inconvenience this may cause.

Status
Currently, there is no estimated time for the resolution of the processing issue. Presently working with Washington Labor to remedy this issue.

Thank you for your attention,

Optum

Ref: 596853
Oct 22, 2023 - 20:49 EDT

31478 | PREFERRED HEALTH PROF - Reports Delivery Delay

Identified - Change Healthcare identified an interruption to normal claim status report processing and delivery from the payer primarily related to claims processed at Change Healthcare from Sept. 28, 2023, to Sept. 29, 2023. This results in some delivery delays for the impacted reports and delayed claim status updates because the 999 reporting from the payer is not being received.

Change Healthcare has been notified that the payer continues efforts to resolve this issue, and updates concerning client impact will be provided as they become available.

Efforts to resolve this issue continue. It is currently open and in progress.

REF 590101
Oct 10, 2023 - 17:44 EDT

CAQH Payer Electronic Registration Provider Enrollment Delays

Identified - The following CAQH Electronic Registration Payers 58379, 20818, 29076, 34192, 22099, 81079, 82275, 83276 and 83269 have had an interruption since Wednesday, March 29, 2023 in sending the CAQH Payer files to Enroll providers. There is no current ETA for resolution however, the files for this timeframe will be pushed out to the payers once resolved. You may see delays in ERA or Approvals/Rejections.

REF 453600
Apr 05, 2023 - 10:22 EDT

Legacy Change Healthcare Eligibility Connectivity Issue

Update - Change Healthcare team members are continuing to work with CMS and other agencies to resolve the eligibility connectivity issue.
May 02, 2023 - 12:44 EDT

Identified - Change Healthcare is experiencing an issue with our eligibility connectivity to CMS. We are currently engaged with the vendor and will provide additional information as it becomes available.

REF 474150
IN 03979683
May 01, 2023 - 13:08 EDT

SB880 BCBS South Carolina 835 File Delivery Delay

Identified - BCBS South Carolina (Payer ID SB880) currently has an issue with 835 files being created for Medicare crossover claims.

The payer is actively reviewing in an attempt to resolve. There is not an ETA at this time.

REF 487250
May 16, 2023 - 10:21 EDT

Claims Rejections 71064 and 71065

Identified - There has been a delay in processing claims for payer IDs 71064, HealthChoice Oklahoma and 71065, Oklahoma DRS DOC for claims with Dates of Service 12/31/2022 and prior.
Claims are currently rejecting.

This impacts I and P claims.

We are working to resolve this in a timely manner.

We will update the audience once the issue is corrected.

REF: 508454
Jun 16, 2023 - 09:18 EDT

MFA Email Delays

Identified - Some customers are experiencing delays in receiving the emails with MFA when accessing the Customer Portal. Change Healthcare is aware of the delays in some of the emails and is working towards a resolution. We apologize for the inconvenience.

REF 554550
Aug 22, 2023 - 13:56 EDT

Florida Medicaid SKFL0 and 12K34 - ERA Enrollment Delay

Update - Update: Change Healthcare is pending changes at Florida Medicaid to allow Claims Enrollment and Electronic Remittance Advice (ERA) enrollments. An update will be provided once the issue is resolved.

Original message:

Change Healthcare has identified an issue that is preventing new ERA enrollments with Florida Medicaid for the below payer IDs:

• SKFL0 Florida Medicaid
• 12K34 - Florida Medicaid

Change Healthcare is working with the payer to resolve this issue.

Providers can download ERAs directly via their Florida Medicaid Web Portal account. If further assistance is required, please contact Florida Medicaid provider support team with your 9-digit Medicaid ID directly at FLEDITEAM@gainwelltechnologies.com.

Additional updates will be forwarded as more information becomes available.

Action Required: Please be aware of a delay in enrolling for ERA delivery through Change Healthcare for the above payer IDs.

If you have any questions, feel free to contact your Customer Support.

REF 554950, 567850
Sep 08, 2023 - 18:07 EDT

Identified - Correction: This situation is ongoing and was marked resolved in error.

Original Message:

Change Healthcare has identified an issue that is preventing new ERA enrollments with Florida Medicaid for the below payer IDs:

• SKFL0 Florida Medicaid
• 12K34 - Florida Medicaid

Change Healthcare is working with the payer to resolve this issue.

Providers can download ERAs directly via their Florida Medicaid Web Portal account. If further assistance is required, please contact Florida Medicaid provider support team with your 9-digit Medicaid ID directly at FLEDITEAM@gainwelltechnologies.com.

Additional updates will be forwarded as more information becomes available.

Action Required: Please be aware of a delay in enrolling for ERA delivery through Change Healthcare for the above payer IDs.

If you have any questions, feel free to contact your Customer Support

REF: 554950

As you may know, Change Healthcare is becoming part of Optum. Throughout the brand migration process, both brand identities may be visible in our markets.
Aug 23, 2023 - 15:59 EDT

MOKEDS Connection to Payer Down

Investigating - Claims Processing Issue

Dear Valued Customer,

The following is currently experiencing connection issues:

• Oklahoma Medicaid - BIN 010579 / PCN OKA01

The issue is currently being investigated by Oklahoma Medicaid. We apologize for any inconvenience this may cause.

Status
Currently, there is no estimated time for the resolution of the outage. We are working closely with Oklahoma Medicaid to remedy this issue.

Thank you for your attention,

Change Healthcare

REF: 582450
Sep 28, 2023 - 15:59 EDT

68035 | HEALTH PLAN OF SAN JOAQUIN - Reports Delivery Delay

Identified - Change Healthcare identified an interruption to normal claim status report processing and delivery from the payer primarily related to claims processed at Change Healthcare from Aug. 4, 2023, to Sept. 22, 2023. This results in some delivery delays for the impacted reports and delayed claim status updates because the 999 reporting from the payer is not being received.

Change Healthcare has been notified that the payer continues efforts to resolve this issue, and updates concerning client impact will be provided as they become available.

Efforts to resolve this issue continue. It is currently open and in progress.

REF 583904
Oct 02, 2023 - 16:24 EDT

About This Site

As you may know, Change Healthcare is becoming part of Optum. Throughout the brand migration process, both brand identities may be visible in our markets. Tell us how we're doing. For more information about the status of other Change Healthcare products and services, please visit our Solution Status page.

Uptime over the past 90 days. View historical uptime.

Institutional Operational

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100.0 % uptime

Today

Professional Operational

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Today

Dental Operational

90 days ago

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90 days ago

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Scheduled Maintenance

RP122 - HAP CareSource Michigan Dual Medicare/Medicaid - New Payer Availability Jan 18, 2024 15:45-15:55 EST

Effective Jan. 18, 2024, Change Healthcare is pleased to announce additional connectivity to the payer HAP CareSource Michigan Dual Medicare/Medicaid, Payer ID RP122, for Medical/Hospital Claims (837) transactions.

Payer Details:
Claim Status: Non Participating
Payer ID: RP122
Payer type: Commercial

Action Required: Please update your system to take advantage of this new payer transaction. Updated Payer Lists may be obtained from your software vendor or by Clicking here.

Action Taken by Change Healthcare: Change Healthcare worked closely with the payer to establish this additional connectivity for our customers. Thank you for your attention and cooperation.

REF 652200
Posted on Jan 18, 2024 - 15:40 EST

LV707 - Convergent Claims Services - New Payer Availability Jan 22, 2024 10:15-10:25 EST

Effective Jan. 22, 2024, Change Healthcare is pleased to announce additional connectivity to Convergent Claims Services, payer ID LV707, for Workers Comp Claims to include Medical/Hospital Lines of business transactions.

This payer accepts Workers Compensation claims for all States.

Payer Details:
Status: Non Participating
Payer ID: LV707
Payer type: Commercial

Action Required by Customer: Please update your system and procedures to take advantages of this new connection. For assistance with submitting claims electronically, please contact your Practice Management System Vendor or Change Healthcare Customer Support.

Action Taken by Change Healthcare: Change Healthcare worked closely with the payer to establish this additional connectivity for our customers.

REF 653853
Posted on Jan 22, 2024 - 10:05 EST

WC113 - GENEX CARE FOR OHIO - Claims, ERA - Transactions - Other Jan 22, 2024 12:00-13:00 EST

Effective Jan. 22, 2024, Optum is pleased to announce additional connectivity to GENEX CARE FOR OHIO, Payer ID- WC113 for Workers Comp Claims to include Medical/Hospital Lines of business, as well as ERA (835) transactions.

This payer accepts Workers Compensation claims for all States.

Payer Details:
Status- Non Participating
Payer ID-WC113
Payer type- Commercial.

Action Required by Customer:
Please update your system and procedures to take advantages of this new connection. For assistance with submitting claims electronically, please contact your Practice Management System Vendor or Optum Customer Support.

Action Taken by Optum:
Optum worked closely with the payer to establish this additional connectivity for our customers.

REF: 653854
Posted on Jan 22, 2024 - 11:33 EST

74095 - USAA (U.S. Automobile Association) - New Payer Availability Jan 31, 2024 17:15-18:15 EST

Effective Jan. 31, 2024, Please note the PAR status for payer, U.S. Automobile Association, (USAA) Payer ID- 74095, for Hospital and Professional Claims (837) transactions.

Payer Details:
Claim Status: Non-Participating
Payer ID: 74095
Payer Type: Commercial

Action Taken by Optum:
Optum worked closely with the Payer to establish this additional connectivity for our customers.

Action Required by Customer:
Please update your system and procedures to note the PAR status change to NON-PAR for this payer. For assistance with submitting claims electronically, please contact your Practice Management System Vendor or Customer Support.

Ref# 661902
Posted on Jan 31, 2024 - 17:05 EST

Multiple Payers | Payer Transaction Status Change Jan 31, 2024 23:45-23:50 EST

Please be advised of the status change for the following Payers/Transactions effective March 1, 2024.

Payer ID 83247, Dignity Health Plan, Claims (Medical and Hospital) status change to Par effective March 1, 2024

Payer ID 66008, Passport Advantage, Claim Status and Eligibility, status change to Non Par effective March 1, 2024

Payer ID 35182, Luminare Health AZ, IL, IN, MD, MN, NC, PA, ERA (Hospital and Professional) status change to Trans effective March 1, 2024

Payer ID 35189, MHCC/Luminare Health, ERA (Hospital and Professional) status change to Trans effective March 1, 2024

Payer ID 38225, Luminare Detroit, ERA (Hospital and Professional) status change to Trans effective March 1, 2024

Payer ID 48116, OhioHealthy, ERA (Hospital and Professional) status change to Trans effective March 1, 2024

Payer ID 48117, Luminare Health KC, ERA (Hospital and Professional) status change to Trans effective March 1, 2024

Payer ID 81264, Nippon Life Insurance Company of America, ERA (Hospital and Professional) status change to Trans effective March 1, 2024

Payer ID 75136, Luminare Health Little Rock, ERA & Claims (Hospital and Professional) status change to Trans effective March 1, 2024

Action Required by Customer:

Posted on Jan 31, 2024 - 13:53 EST

FH105 - FLUME HEALTH, INC. | REAL TIME NEW PAYER TRANSACTION-ALERT Feb 1, 2024 10:30-11:30 EST

Effective Jan. 29, 2024, Optum is pleased to announce the availability of Real-Time 270/271; 276/277 transactions for the below Payer.

Payer ID - FH105
Payer Name - FLUME HEALTH, INC.

Search Options supported for Eligibility:

•MEMBER ID, SUBSCRIBER LAST NAME, SUBSCRIBER FIRST NAME, SUBSCRIBER DATE OF BIRTH
•MEMBER ID, SUBSCRIBER LAST NAME, DEPENDENT LAST NAME, DEPENDENT FIRST NAME, DEPENDENT DATE OF BIRTH

Search Options supported for Claim Status :

•MEMBER ID, SUBSCRIBER LAST NAME, SUBSCRIBER FIRST NAME, SUBSCRIBER DATE OF BIRTH
•MEMBER ID, SUBSCRIBER LAST NAME, DEPENDENT LAST NAME, DEPENDENT FIRST NAME, DEPENDENT DATE OF BIRTH

Action Required: Please update your system to take advantage of this new payer transaction. For assistance with submitting Real-Time transactions, please contact your Practice Management System Vendor or Optum Customer Support. Refer to Optum's Payer Dictionaries/Guidelines for detailed descriptions.

Updated Payer Lists may be obtained from your software vendor or www.changehealthcare.com.

Action Taken by Optum: Optum worked closely with the payer to establish this additional connectivity for our customers.

REF: 662800
Posted on Feb 01, 2024 - 09:51 EST

FCC20 - Falling Colors (BHSD STAR) - New Payer Availability Feb 1, 2024 13:00-13:10 EST

Effective Feb. 1, 2024, Optum is pleased to announce additional connectivity to the payer Falling Colors (BHSD STAR), Payer ID FCC20, for Hospital and Professional claims (835) transactions.

Payer Details:
Claim Status: Non-Participating
Payer ID: FCC20
Payer type: Commercial

Action Required by Customer:
Please update your system and procedures to take advantage of this new connection. For assistance with submitting claims electronically, please contact your Practice Management System Vendor or Optum Customer Support.

Action Taken by Change Healthcare:
Optum worked closely with the Payer to establish this additional connectivity for our customers.

REF 663151
Posted on Feb 01, 2024 - 12:23 EST

Timely Filing Letter Requests: Payer Rejection or Denial Requirement Feb 1, 2024 15:30-15:40 EST

For claims submitted to Optum/Change Healthcare that require a Timely Filing Letter, the payer's rejection or the payer's denial for Timely Filing is required by the provider.

Please ensure a copy of the denial or rejection from the payer is provided when Timely Filing Letters are requested to avoid delay in processing the requests.

If proof of denial or rejection from the payer is not received, the request for Timely Filing Letter will not be accommodated.

REF 663700
Posted on Feb 01, 2024 - 15:05 EST

00562 - BCBS Minnesota Health Care Programs (MHCP) - Payer ID Changes Feb 1, 2024 17:00-18:00 EST

Optum/Change Healthcare is aware of the recent payer ID changes for BCBS Minnesota Health Care Programs (MHCP) EDI transactions.

Providers using Optum/Change Healthcare for claims processing do not need to update the payer ID at this time and should continue to use 00562 for BCBS Minnesota Health Care Programs (MHCP) transactions. Optum/Change Healthcare will be making the needed payer ID change so claims will be sent to the payer with the expected 00726 payer ID.

Action Required: Continue to use payer ID 00562 for BCBS Minnesota Health Care Programs (MHCP).

REF 663451
Posted on Feb 01, 2024 - 16:49 EST

48116 - OhioHealthy- Updated Payer Name and Claims Availability Feb 1, 2024 17:17-18:17 EST

Effective Feb. 1, 2024, Optum is pleased to announce additional connectivity to the payer OhioHealthy (Payer ID 48116) for Medical/Hospital claims (837) transactions.

Payer Details:
New Payer Name: OhioHealthy
Previous Payer Name: Florida Hospital Waterman
Claim Status: Participating
Payer ID: 48116
Payer type: Commercial

Action Required: Please update your system to take advantage of this new payer transaction. Updated Payer Lists may be obtained from your software vendor or by Clicking here.

Ref# 663503
Posted on Feb 01, 2024 - 17:16 EST

CRPHP - CLOVER HEALTH - Eligibility - Transactions Feb 7, 2024 11:00-12:00 EST

Scheduled - For Payer CRPHP (Clover Health), the Search Option for Member ID/ Last Name/ First Name, which does not require Member Date Of Birth, has been discontinued.

Remaining Search Option for this payer is specified below:

Member ID/ Last Name/ First Name/ Member Date of Birth

REF: 665850
Feb 07, 2024 - 09:49 EST

HCOMP - HEALTHCOMP-GILSBAR - Claims Status, Eligibility Feb 12, 2024 15:00-16:00 EST

Topic: Eligibility Inquiry and Response 270/271, Claim status Inquiry 276/277

For claims payer id 85279 please submit your Eligibility and claim status inquiries to payer id HCOMP.

Payer Name: HealthComp-Gilsbar
Payer id: HCOMP

Action Required by Customer:
Please update your system to take advantage of this Payer transaction. For assistance with submitting Real-Time transactions, please contact your Practice Management System Vendor or Change Healthcare Customer Support. Refer to Change Healthcare's Payer Dictionaries/Guidelines for detailed descriptions.

REF: 671551
Posted on Feb 12, 2024 - 14:34 EST

45282 - Carefirst Bluecross BlueShield Medicare Advantage - Claims Status - Transactions - Other Feb 13, 2024 17:00-18:00 EST

Claim status inquiry 276/277

Reminder for real time claim status inquiries 276/277 use the member id from the member's card, the format of the member id is MD followed by 8 numerals (MDnnnnnnnn).

Payer Name: CareFirst BlueCross BlueShield Medicare Advantage
Payer id: 45282

Action Required by Customer:
Please update your system to take advantage of this new Payer transaction. For assistance with submitting Real-Time transactions, please contact your Practice Management System Vendor or Optum Customer Support. Refer to Optum's Payer Dictionaries/Guidelines for detailed descriptions.

REF: 672551
Posted on Feb 13, 2024 - 16:32 EST

23250 - Significa Benefit Services, Inc. - Payer Deactivation Feb. 28, 2024 Feb 28, 2024 00:00-00:10 EST

Effective Feb. 28, 2024, Significa Benefit Services, Inc., payer ID 23250, will deactivate the below services with Optum:

- 837P
- 837I
- ERA

Please discontinue use of the above Payer ID for these transactions.

Updated Payer Lists may be obtained from your software vendor or Optum. Optum removed this payer from the Payer List and any transactions sent using the above Payer ID will be rejected.

REF 669150
Posted on Feb 08, 2024 - 13:39 EST

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