Frequently Asked Questions
The Basics of Optum Pay™ (formerly known as Electronic Payments & Statements - EPS)
Getting Started / Making the Decision to Enroll
General Questions
This is a standard transaction mandated by the Health Insurance Portability and Accountability Act (HIPAA) used to transfer payment and remittance information for adjudicated professional and institutional health care claims. All adjudicated claims are reported in an 835 transaction.
A consolidated 835 file is a HIPAA-format file that simply merges multiple individual 835 files sent on the same day into a consolidated file. This consolidated 835 file will tie to the automated clearinghouse (ACH) payment for that day's deposit to your bank account to ensure that your funds transfer and EPRAs match one for one. The total amount of the consolidated 835 will always equal the amount sent to your depository bank account that day. This will enable you to receive and track payment for multiple claims easily and effectively.
All 835 files are compliant with HIPAA requirements. However, some payers such as worker's compensation claims are not available in the 835 format.
ACH Addenda is the payment reference information sent to your bank account associated with the electronic claims payment. EPS Enrollment utilizes the Cash Concentration or Disbursement CCD ACH addenda format.
EPS ACH payments with the CCD addenda format include the detail from the Trace Number (TRN) segment of the corresponding consolidated 835 file. Key pieces of information in this segment are the Payer Identifier (TIN) and the electronic payment number. This number will match the Payment Number on the 'View Payments' page in EPS.
For most organizations, the CCD addenda format is sufficient. If you're not sure, check with your financial officer or a representative at your bank for guidance.
No, adjustments will appear on the consolidated 835 file or electronic EOB and future payments will be adjusted accordingly.
We cannot debit or deduct funds from your checking account for claim overpayments and/or refund requests unless we have obtained your permission. We can make adjusting/correction entries to correct deposit errors.
No. You may direct Optum electronic claims payments to any bank you wish.
The financial services offered through Optum are aimed exclusively at meeting the health care financial needs of consumers, employers, health plans and professionals. These products and services are transforming health care, to make it simpler, more efficient and more affordable. Optum Bank, Member FDIC, was chartered in 2002 to improve services offered by Optum. OptumHealth Bank is a state-chartered financial institution and its accounts are FDIC-insured. Electronic Payments and Statements payments and related services will be administered through OptumHealth Bank.
National Provider Identifier (NPI)
Yes. Electronic remittances (835s) and online Explanation of Benefits (EOBs) will be separated by NPI. From the EPS home page of Provider Express, the summary page will display the NPI number for each payment and will also allow the user to filter their search by TIN or NPI number. Remittance search can also be done by NPI number.
Not at this time. NPI numbers and subsequent changes must be submitted on paper to ensure payments are processed accurately. Initial NPI enrollment can be made using the NPI Addendum Form and faxed to (800) 765-6766.
It can also be mailed to:
OptumHealth Bank
Attn: EPS Processing Manager
PO Box 30777
Salt Lake City, UT 84130-0777
Providers and clinicians may contact the EPS Help Desk at 1-877-620-6194 with specific questions about enrolling their NPI numbers with the EPS product. Upon receipt of the NPI enrollment information, an EPS Enrollment Specialist will review the information for accuracy and contact you if necessary.
No. The only NPIs that must be reported to EPS on the EPS NPI Addendum Form are those that require deposit into a bank account other than the one associated with the TIN.
No. If the NPI is not on file with us then EPS will not recognize it or pay to it.
Yes, however, all providers and clinicians who use that specific TIN will be enrolled in EPS and any provider or clinician represented by that TIN will no longer receive paper remittances and EOBs.
Yes. Electronic remit consolidation can be done either at the TIN or NPI level. If done at the NPI level, each enrolled NPI will receive its own consolidated payment and remit.
No. If no NPI number is designated, payment will be made to the default bank account for the corporate organization.
No. At this time this information is not shared and will need to be submitted separately.
Post-Enrollment Questions
Information is available within the EPS Help section. Simply log on to Provider Express, click on "EPS" in the gray menu bar, and you will be taken to the "Welcome Page." From there, you can access the EPS FAQs and User Guide.
Yes, you can view, save and print your EOBs through Provider Express. The EOBs are formatted in an Adobe Acrobat® file which makes printing and/or saving EOBs easy! Use the Search Remit feature for EOBs going back a rolling 13 months.
Yes. You can download it for free from the EPS site or, if you want to receive it from your clearinghouse, please contact them and they will obtain it from OptumHealth.
You may upload it from the EPS site to your Practice Management System or you may contact a vendor such as Post N Track to have the 835 delivered to you.
There is no software required to download the 835 file. However, you may need additional software to translate the 835 into a format that is usable by your particular practice management system. Contact your practice management system vendor for more information about what you may need.
At this time, Electronic Payments and Statements does not offer this capability. Contact your clearinghouse and ask them to contact OptumHealth for connectivity options that support electronic delivery of the 835 file.
You will receive two or more 835 files when:
- Errors are detected during the HIPAA validation process for any claims paid that day. These are minor errors (such as "x" is not a valid Remark Code) that do not prevent the claim from being adjudicated or paid. Whenever this situation occurs, one 835 file received will contain claims that were 100% compliant, and the other file will contain claims that failed one or more of the standard HIPAA edits. Recognizing that these minor errors may complicate reconciliation, we identify them for you in this fashion prior to your reconciliation process. We continue to improve 835 processing to eliminate these errors.
- Claims are submitted under multiple "pay to provider" NPIs. Each of the "pay to provider" NPIs requires its own 835.
- Claims are submitted representing different sub-payers associated with our Payer ID (these are separate brands that are all tied to our Payer ID # 87726).
You will need to process all files in order to reconcile to your depository checking account deposit for that day.
No, typically you will receive the consolidated file one to three days prior to receipt of funds.
No, your selection of claim payment format does not affect how retroactive adjustments are processed. When it is determined that a claim was paid incorrectly, a retroactive adjustment will appear in future EOB information as before.
The claim adjustment remark codes in EPS are from the national code list, which is maintained by the Claim Adjustment Status Code Maintenance Committee, and are updated three times per year. The mailed paper statements reflect OptumHealth's proprietary remark codes. For a copy of a reference document that translates these codes to the national codes, please call us toll-free at 1-877-620-6194. For more information about the national codes and how they are maintained, go to wpc-edi.com, choose the HIPAA link from the main menu and select Code Lists.
Yes. EPS currently supports claims payments and remittance at the TIN level with an option to select the National Provider Identifier (NPI) level. Please see the list of questions within the NPI Section (above) or the EPS Resources found within the EPS Welcome Page for more information.
Yes. For quick reference, the "View Payment" screen will display payment information from the past 30, 60, or 90 days. From there, you can download the HIPAA 835, print the EPRA, and drill down to the remittance and claim detail for each payment.
From the "Search Remittance" screen, EPS offers the ability to search for claims paid electronically for a rolling 13 months. If you are not sure if a claim has been paid or are searching for claims you know have not been paid, please utilize the Claim Inquiry search feature on Provider Express.
Otherwise, you can search for paid claims based on:
- Date of Service
- Subscriber ID
- Payment Number
- Payment Date
- Patient Name
- Claim Number
To begin the search process:
- From the EPS Welcome page, click on the "Search Remittance" link.
- From the Search Remittance page, click on the button next to the search selection you wish to use and type the search criteria in the box that appears below it
- Once you have entered your search criteria, click on the Search Remittance button to obtain the results
- You can view your results online or print them. For further instructions, please select the Click Here link on the main search page. If you need further assistance, please call us at 1-877-620-6194.
EPS allows you to review claims payments one TIN at a time. To begin reviewing payments and claims for another TIN choose the other TIN from the drop-down menu on the EPS Welcome Page.
If you need further assistance, please call 1-877-620-6194.
An Electronic Payments number is provided on the remittance as well as the deposit amount. This number is often called the TRN or Trace Number. Your bank should be able to provide you with this number for a related deposit. You can use this number to locate the remittance advice or it also can be found within the 835 if you are receiving one. If you would like to locate the remittance online, you can follow these simple steps:
- From the View Payments page, find the payment that you need to reconcile to your practice management system.
- Select the payment by clicking on the Payment Number.
- The View Remittance Details page displays all the claims, service lines and adjustment data that are included in the payment.
- You may work directly from the View Remittance Details screen or print the EPRA by clicking on the Print EPRA button.
- To view a single claim, locate the desired claim and click on the Claim Number link.
- The View Claim page displays additional adjustment information (if applicable).
- Print the claim by clicking on the Print Claim Detail button.
- To return to the EPRA that contains this claim, click on the Return to View Remittance Details button.
- To quickly locate a particular claim, EPRA or payment, select Search Remittance and use the search functionality to find what you need.
All changes to banking information must be submitted in writing and will be processed within three business days. You may fax your change requests to an EPS Enrollment Specialist at 1-800-765-6766, or you may call our help line toll-free at 1-877-620-6194. There is an EPS Enrollment Form that may be used to request these changes available on the Provider Express EPS page or you may contact Customer Service to obtain a copy of the form. If you have additional questions on maintaining the EPS online information, please call our help desk as listed above.
Changes such as primary/secondary spelling of names, mailing or remit address, and phone numbers can be modified online under "maintain enrollment" and changes are immediately reflected.
More information is available within the Electronic Payments and Statements Help section. Simply log on to Provider Express, click on the EPS tab, and you will be taken to the Electronic Payments and Statements Welcome page. From there, you can access the EPS User Guide.
Individual EOBs for the past 32 calendar days are available using the Multiple EOB (MEOB) Printing feature online.
EPS can provide you with a Claim Mapping Report that is designed to assist you with locating the original EOB for the adjustments. You may also need to use the original EOB found online for posting adjustments. To request this report, please contact our Help Desk at 1-877-620-6194.
EPS is capable of locating and printing an individual EOB. To locate an EOB and print a copy, follow these instructions:
Accessing EOB
- From the EPS Welcome Page, select the link Multiple EOB printing.
- You may view and print up to 500 EOBs at a time.
- EOBs for the past 32 business days are available using the Multiple EOB printing feature.
Printing EOB
- Locate the desired payment date.
- Select the link segment to open the EOB files for that payment date (EOB files are available for the past 32 business days.
- Multiple EOB processing screen displays while EOBs are downloading from the server.
- Upon completion of download, Adobe Reader will launch, containing up to 500 EOBs.
EPS Notify is the mailbox used to send e-mails with information pertaining to EPS. Emails include information such as payment notifications, confirmations of changes to enrollment, etc. If your organization uses spam blocking software, please add this email address so it will not be blocked: eps_notify@optumhealthbank.com.
Yes, you will receive an e-mail notification on the day a remittance is processed. To ensure that the right contacts are notified, please select "email notification" next to the appropriate contact in the account maintenance section of EPS.