EDI AND CLEARINGHOUSE INFORMATION
Clearinghouse Options
Clearinghouses facilitate the transfer of electronic transactions between payers and
physicians, health care professionals or facilities. Many health care professionals
choose to submit electronic transactions to Optum™ through a clearinghouse.
Clearinghouses offer multi-payer solutions, batch transactions and direct data entry.
Most clearinghouse users also have a practice management or hospital information
system that may be maintained by a separate software vendor, but it’s not a
requirement before using the services of a clearinghouse.
Integrating and automating electronic transactions with your software system is a
service that many clearinghouses provide. The goal of these services is to eliminate
time spent keying information into multiple programs or requesting/submitting
transactions individually. Solutions or services that clearinghouses offer may be used
alongside your existing software system.
We recommend that you research clearinghouses and their capabilities to determine
which ones offer the services to help you meet your revenue cycle management
goals. Here are a few questions to help you determine the Electronic Data
Interchange (EDI) needs of your practice or facility:
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Do you need the capability to submit more claims electronically?
Are you requesting eligibility, claim status and notifications electronically?
Do you want an automated system for electronic eligibility, claim status and
notification transactions?
Would you like to file secondary claims electronically?
Would you like to have secondary electronic claim submissions automated?
Are you receiving electronic remittance statements and electronic funds
transfers?
Is your system automatically posting payments?
Some clearinghouses to consider*
Allscripts
Office Ally
Availity
OptumInsight™
Capario
Practice Insight
Emdeon
RealMed
Gateway EDI/TriZetto
RelayHealth
MD Online
SSI
MedAssets
ZirMed
Navicure
*This is a small sample of clearinghouses that interact with Optum. Optum does not
endorse any specific clearinghouse. OptumInsight is a UnitedHealth Group®
Company.
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EDI Options for Submitting Claims
Establishing an EDI connection for the submission of claims has never been easier! Optum
offers many solutions to support you in meeting the compliance standards and
requirements for the submission of your claims electronically. We encourage you to set up
an EDI connection today and begin enjoying the benefits of faster payment cycles and
increased claim processing accuracy.
CLAIM SUBMISSION TYPES
Physician Office Management Information System (POMIS): Offices typically use this
software to print or create batch claim files for electronic submission. Most offices, but not
all, have this software as it enables them to efficiently file claims, maintain appointment
schedule, store patient insurance information, etc.
Direct Data Entry (DDE): Usually for smaller practices, DDE solutions are ideal for those
without a POMIS wanting to submit claims electronically. DDE allows you to key
information into an online claim form for electronic submission.
Clearinghouse: A clearinghouse is the intermediary between the health care office and
payers. For a fee, the clearinghouse accepts claim submissions, validates and formats the
data, and transmits to all payers. Our preferred clearinghouse is Ingenix, but you may use
any clearinghouse to submit claims to UnitedHealthcare.
Direct Connect: UnitedHealthcare offers a free direct connect solution, Connectivity
Director. This web-based application allows you to submit real-time and batch transactions
electronically.
CLAIM SUBMISSION OPTIONS
Clearinghouse: Both participating and non-participating professional and institutional
claims are accepted electronically by Optum. Our preferred clearinghouse is OptumInsight,
but you may use any clearinghouse to submit claims to Optum.
ProviderExpress.com: Our website for network providers offers secure, electronic claim
submission of professional claims - free of charge! See ProviderExpress.com home page
for registration and login access.
Connectivity Director: Optum's direct connect solution, Connectivity Director provides a
means for professional providers, facilities and billing offices to file claims direct with no
"middle man" in the mix. In addition to claims submission, other electronic transactions are
available with this web-based solution. Best of all, it's available at no cost.
Connectivity Director
Connectivity Director provides physicians, health care professionals and facilities an
innovative, new way to transact with Optum. You can submit real-time and batch
transactions using a Web-based application accessed at UnitedHealthcareCD.com.
All Connectivity Director transactions take place through a secure Internet
connection using leading technology which accepts both HIPAA-compliant and nonHIPAA transactions. Connectivity Director is a self-service product that requires some
level of technological knowledge for set-up. You will need to register and test before
using Connectivity Director.
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Transactions available include:
HIPAA Transactions
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270 / 271 Eligibility
276 / 277 Claim Status Inquiry
837i and 837p Claim Submission
835 Electronic Remittance Advice (ERA)
If you need assistance setting up or using the Connectivity Director, call Customer
Support at (800) 445-8174, weekdays between 8 a.m. and 5 p.m. (Eastern).
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