Optum Claim Submission Requirements

April 2021

Please note the following to avoid claim rejections.  As of December 15, 2020, the following are required for all Optum claim submissions.

• Taxonomy numbers are required.

• Provider and/or Practice billing and rendering information continue as usual, but be sure to include the corresponding Taxonomy number for each NPI used, otherwise claims will reject.
• NPI and Taxonomy are required for both the billing provider and rendering provider fields.
  • For example;
    • If in the BILLING PROVIDER SEGEMENT of the claim form the practice currently bills group name and NPI, then group taxonomy must appear also on the claim form.
    • If in the RENDERING PROVIDER SEGMENT of the claim form the rendering is an individual provider, then the individual provider NPI and taxonomy must appear on the claim form, but in the rendering information field.
• Claims are rejected prior to entry in our claims system.  Provider must review rejection reports, correct claim information, and resubmit the claim.

Provider inquiries and concerns should be directed to the Neighborhood Behavioral Health Ombudsman, Donaldo O’Neil, at 1-401-427-8289 (direct line/fax).