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 traditional behavioral health services
- Claims for EAP services
- Claims from a participating clinician
- Claims from a non-participating clinician
Claims Not Supported by Provider Express Claim Entry
- Claims for any facility-based behavioral health service (such as residential, inpatient, partial hospitalization, or intensive outpatient treatment)
- Claims for members who's coverage has been expired more than 90 days
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.
Facility claims can be submitted electronically using EDI. Click here for EDI/Electronic claims information.
If you have received a confirmation number through Provider Express, you can be assured that Optum has received your claim successfully. Claims entered through Provider Express must be passed electronically to one of Provider Express' 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 Submitted Claims feature under the claims menu. This feature will show the claims you submitted directly to Optum via Provider Express.
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, only claims submitted on a CMS-1500 can be submited on Provider Express See the Facility Claims section for details of how to submit a facility claim.
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 30 days 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.