Spectera, formerly OptumHealth, is experiencing system problems in which the claim line items reimbursed as “Other Ophthalmic Lens Options” are not adjudicating. The patient out-of-pocket is calculating, however, the reimbursement is not.
Example of items that are reimburse as “Other Ophthalmic Lens Options” are high index 1.74, polarized lenses, etc.
Spectera is working on the problem but at this time they don’t have a resolution. Offices will be updated as soon as more information becomes available.
1. Please note that the OptumHealth discount plans (UnitedHealth One, Health Allies, and Exam Only/discounted Materials) have been rebranded to Spectera. Also, the Health Allies has been revised. The percentage off of professional fees has been reduced from 20% to 10%. All plans have been updated on eNetwork.
2. Don’t forget to update your office hours, email address and languages spoken in the office. In the near future, Spectera will begin to display your office hours on their online Provider Directory.
3. Spectera has established a connection with Optuminsight, which allows them to receive electronic claims from any clearinghouse (I.e. Emdeon, Gateway, EDI, McKeeson/Relay, CCapario, ViaTrack, MD Online an many more). If you are interested in submitting your claims electronically, contact your current clearinghouse or billing partner to transmit your claims to Spectera. Use Payer ID 00773 or contact Caroline Otterman at firstname.lastname@example.org or 630-499-9780.