OptumHealth Claims and Updates

Due to recent changes of the provider claims statement, many TSO offices are experiencing difficult reading, understanding and reconciling the statement or EOB.  In order to assist offices OptumHealth has released information on how to understand your OptumHealth Provider Claims Statement. Click here for a copy for the “Guide to Understanding Your Provider Claims Statement.” 

Claims Paid to Wrong TSO Doctor

This issue with OptumHealth is some that some claim payments are being paid to another TSO doctor.  The wrong doctor is being paid for another doctor’s claim.

OptumHealth believes that the authorizations on those claims were requested and paid to incorrect providers due to a keying error while using www.optumhealth.com.  The problem is that there are two different tax ID numbers involved and they can’t take money from one tax ID and apply to another tax ID without written authorization from both doctors.

The procedure for correcting the problem to recoup and repay a claim is with written request from both parties…email is acceptable.  

Send your emails directly to Cristine Anderson at Cristine_m_anderson@optumhealth.com  

The following data points must be included in the email in order to recoup and repay the doctor:

  • Authorization number
  • Patient name
  • Patient ID
  • Date of Service
  • OptumHealth ID of the party who received the payment (recoup)
  • OptumHealth ID of the party who should receive the payment (corrected payment)

OptumHealth is working on internal procedures to ensure that this issue is addressed and that moving forward this issue can be corrected quickly.  


Stuck in Forward Claims

Last week doctors received notice from the TSO Network office that OptumHealth Vision had identified a system problem affecting various providers across their provider network described as “Stuck in Forward” claims.  These claims have been received by OptumHealth and queued for payment; however, the amount paid out was zero. 

Earlier this week Ann Deen discussed the urgency of the situation with the Sr. Vice President of Vision Provider Networks.  Ann received notice yesterday that the situation has been resolved and all TSO doctors will receive payment on all the 2011 “Stuck in Forward” claims by the end of March and should include any appropriate interest.  Make sure you continually review and reconcile your EOB for future problems. 

Please direct your question or inquiries to Ann Deen at 214-704-1181 or cadeen@tso.com


OptumHealth Offers Online Training Sessions

OptumHealth is offering providers and staff online training sessions every other month.  The next session is scheduled in April.  To enroll in the next and future sessions see attachment. 

Topics Covered

  • Overview of the online services
  • New enhancements added to the site
  • Live online demonstration
  • Q&A