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Beginning Jan. 1, 2023, claims processing for HealthChoice, Department of Corrections (DOC) and Department of Rehabilitation Services (DRS) will move to UMR. Providers will not need to make any changes to electronic data interchange (EDI) payer IDs in their system.
The payer ID or EDI number is a unique ID assigned to each insurance company. It allows provider and payer systems to talk to one another to verify eligibility, benefits and submit claims.
Continue to use the same HealthChoice, DOC and DRS EDI payer IDs used today after Jan. 1, 2023:
- 71064 HealthChoice.
- 71065 DOC and DRS.
Optum – UMR’s clearinghouse for claim files – works with several clearinghouses to receive claims.
HealthChoice members will receive new ID cards for the 2023 plan year that will reflect the payer IDs listed above. The new ID cards will also have these UMR-assigned group numbers:
- 76415077 HealthChoice (member IDs will remain the same).
- 76415170 Oklahoma DOC (member IDs will continue to be the inmate ID).
- 76415171 Oklahoma DRS (UMR will issue new member IDs).
For questions regarding this update, call Customer Care at 800-323-4314. TTY users call 711.
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The Department of Corrections (DOC) is transitioning from its current third-party administrator, HealthSCOPE benefits, to UMR effective Jan. 1, 2023.
For dates of service on or after Jan. 1, 2023, DOC providers will need to:
- Bill with group number 76415170.
- Update the member ID to utilize a prefix of 3650 + the DOC inmate ID number.
- Enter the prefix 3650 + DOC inmate ID number when making a DOC inquiry using the IVR system or UMR Portal.
For questions, call the Customer Care team at toll-free 800-323-3710.
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UMR will be the new claims processor for HealthChoice, DOC and DRS processing claims with dates of service beginning Jan. 1, 2023. As a provider, you will be able to receive direct deposit of claim payments processed by UMR.
HealthChoice encourages you to enroll now with Optum Pay or by calling 877-620-6194.
You will need the following information to complete your enrollment online:
- The payment method for your organization.
- Direct deposit (ACH).
- Virtual card payments (VCP).
- Organization name, mailing information and tax identification number (TIN).
- Contact information for your designated Optum Pay contacts.
- Banking information for the ACH option.
- Your organization's W-9 form.
- A voided check or bank letter for each account where payments will be deposited for the ACH option.
- There will be an option to enroll for virtual card payments.
- This option is currently not available for payments made by HealthChoice.
- If you enroll for virtual cards in error, you will receive checks.
- Virtual cards will be available as a payment option in 2023.
What happens if I do not enroll?
- You will receive a paper check for dates of service after Jan. 1, 2023, if you are not enrolled in Optum Pay.
Benefits of electronic payments
- Payments arrive sooner than checks.
- No lost payments.
- Often see less administrative costs with receiving electronic payments.
- Payments viewable through the Optum Pay web portal.
- Free basic service or paid premium service available with more robust reporting options.
- Remittance advices and 835 transaction data is available.
For questions about EFT enrollment, call the Customer Care team at toll-free 800-323-4314. TTY users call 711.
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UMR will be the new claims processor for HealthChoice, DOC and DRS claims with dates of service beginning Jan. 1, 2023. The payment disbursement vendor will also change from ECHO Health to Optum. HealthSCOPE Benefits will continue to process claims received in 2023 with a 2022 date of service, and ECHO Health will continue to process those payments.
Providers
If you are currently enrolled under UMR payer ID 39026 with OptumInsight for 835 electronic remittance advices or Optum Pay for ERAs, you do not need to register.
If you are not currently enrolled for remittances under UMR payer ID 39026, you can enroll at any time. UMR will automatically transfer your enrollment from payer ID 39026 to HealthChoice payer ID 71064 and DOC\DRS payer ID 71065 effective Jan. 1, 2023.
To enroll for ERAs via OptumInsight, call 866-367-9778 and choose Option 1.
• If you contact OptumInsight prior to Jan. 1, 2023, ask to enroll for payer ID 39026.
• If you contact OptumInsight after Jan. 1, 2023, ask to enroll for payer IDs 71064 and 71065.
You can also enroll for Optum Pay ERAs. With this option, you can view and download remittance information. HealthChoice encourages you to enroll or confirm you are currently enrolled by calling 877-620-6194.
Clearinghouse connections
You can also enroll to receive ERAs through your current clearinghouse. Clearinghouses can enroll you using the Optum portal.
• If you request to enroll prior to Jan. 1, 2023, ask your clearinghouse to enroll you for payer ID 39026.
• If you request to enroll after Jan. 1, 2023, ask your clearinghouse to enroll you for payer IDs 71064 and 71065.
What happens if I do not enroll for ERAs by Jan. 1, 2023?
If you do not enroll for 835 remittances or ERAs, you will need to view claim information on the HealthChoice provider portal or request copies of remittances from Customer Care at 800-323-4314.
If you have any questions, please call Customer Care at 800-323-4314.
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Beginning Jan. 1, 2023, claims processing for HealthChoice, Department of Corrections (DOC) and Department of Rehabilitation Services (DRS) will move to UMR. For portal claim communications, UMR uses Optum Secure Messaging.
What changes will you experience for sending and receiving secure messages starting Jan. 1?
On the HealthChoice provider portal under Contact us, you will see a new feature that allows you to send and receive messages for claims with dates of service on or after Jan. 1, 2023.
Once signed into the website, select the Contact us icon at the top of the screen to initiate a conversation.
By selecting the Messages icon, you will be able to view sent and receive messages.
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