Optimum HealthCare provider portal, phone and payer ID quick facts
| Provider resource entry point | https://www.youroptimumhealthcare.com/provider/claims |
|---|---|
| Payer contact reference | 1-866-245-5360Provider Relations/network participation |
| Claims payer ID | No single all-product identifier established in this registry; see source findings and verify the member product and transaction separately |
| Eligibility payer ID | No single all-product identifier established in this registry; see source findings and verify the member product and transaction separately |
| ERA payer ID | No single all-product identifier established in this registry; see source findings and verify the member product and transaction separately. Clearinghouse-specific: This registry has not established one national ERA payer ID for Optimum HealthCare. ERA enrollment and 835 routing are clearinghouse- and product-specific; verify in the payer portal or clearinghouse payer list before enrollment. |
| Timely filing | 180 days (verify applicability) |
| Prior auth route | Verify the current product policy and delegated reviewer; X12 278 support is not established by a portal link |
| Last reviewed | 2026-04-23 |
- Provider Relations/network participation
- This registry has not established a payer-specific appeal ladder for Optimum HealthCare. Use the denial notice, plan document, provider agreement, or jurisdictional rule to assign the correct route and deadline. Missing registry evidence does not mean appeal rights are unavailable.
- This registry has not established one national ERA payer ID for Optimum HealthCare. ERA enrollment and 835 routing are clearinghouse- and product-specific; verify in the payer portal or clearinghouse payer list before enrollment.
Optimum HealthCare at a glance
| Legal name | Optimum HealthCare, Inc. |
|---|---|
| Also known as | Optimum HealthCare FL |
| Category | Medicare Advantage |
| Parent organization | Elevance Health |
| Claims payer ID | No single all-product identifier established in this registry; see source findings and verify the member product and transaction separately |
| Eligibility (270/271) payer ID | No single all-product identifier established in this registry; see source findings and verify the member product and transaction separately |
| ERA (835) payer ID | No single all-product identifier established in this registry; see source findings and verify the member product and transaction separately. Clearinghouse-specific: This registry has not established one national ERA payer ID for Optimum HealthCare. ERA enrollment and 835 routing are clearinghouse- and product-specific; verify in the payer portal or clearinghouse payer list before enrollment. |
| NAIC company code | Not established in this registry |
| States covered | Florida |
| Provider resource entry point | https://www.youroptimumhealthcare.com/provider/claims |
| Provider phone | 1-866-245-5360Provider Relations/network participation |
Always verify claims-routing details against the member ID card and the payer's current EDI companion guide before submission.
Timely filing & appeals for Optimum HealthCare
This registry lists 180 days as an initial-claim reference for Optimum HealthCare. Confirm the applicable product, provider agreement, start event and current payer instructions. Do not apply this value automatically to out-of-network, secondary, corrected or appealed claims.
| Submission type | Window |
|---|---|
| Initial claim reference | 180 days (verify applicability) |
| Out-of-network initial claim | Verify the member's plan and applicable out-of-network rules |
| Secondary / coordination of benefits | Verify the allowed window and start event; a primary EOB does not automatically restart filing |
| Corrected claim | Verify correction instructions; do not substitute an appeal deadline |
| Reconsideration / appeal | Use the applicable denial or decision notice and the process below |
This registry has not established a payer-specific appeal ladder for Optimum HealthCare. Use the denial notice, plan document, provider agreement, or jurisdictional rule to assign the correct route and deadline. Missing registry evidence does not mean appeal rights are unavailable.
Source: Optimum HealthCare provider policy. Always confirm before disputing a TFL denial — payer policies are versioned and product-specific.
Prior authorization with Optimum HealthCare
Decision deadlines depend on the product, service and urgency. CMS-0057-F generally starts its decision-timeframe requirements in 2026 for Medicare Advantage, Medicaid and CHIP payers subject to the rule: seven calendar days for standard requests and 72 hours for expedited requests. Those requirements exclude drug authorizations and QHP issuers on the federally facilitated exchanges. Other plans, state rules and permitted extensions can differ. Check the applicable policy; a decision deadline is not a guarantee of approval.
CMS-0057-F decision-timeframe requirements and exclusions
Verify Optimum HealthCare electronic claims (837), eligibility (270/271), remittance (835) and authorization (278) separately for the member product and clearinghouse. Registry flags and routing references are not current transaction-complete approval. Confirm the companion guide, enrollment and applicable source findings below. A blank or unverified field does not establish that the transaction is unavailable. Authorization requirements and submission channels depend on the product, service and delegated reviewer. Verify the applicable policy before scheduling; a portal listing is not proof of X12 278 connectivity.
This registry does not provide a current prior-authorization code list for Optimum HealthCare. Start with the provider resources or the policy documents below, then confirm the applicable product, service and effective date. A resource link does not establish that a live code-lookup tool is available.
Top denial reasons for Optimum HealthCare
Per-payer denial benchmarks publish here once the QuickIntell anonymized ETL pipeline ingests sufficient Optimum HealthCare volume. Until then, see the broader CARC reference for industry-wide remediation guides.
Electronic claims, eligibility & ERA
| Transaction | Registry indication — not verification | Routing reference |
|---|---|---|
| 837P / 837I claims | Listed in registry; verify current scope | No single all-product identifier established in this registry; see source findings and verify the member product and transaction separately |
| 270 / 271 eligibility | Listed in registry; verify current scope | No single all-product identifier established in this registry; see source findings and verify the member product and transaction separately |
| 278 prior authorization | Listed in registry; verify current scope | Verify X12 278 routing separately |
| 835 ERA | Verify support and enrollment separately | No single all-product identifier established in this registry; see source findings and verify the member product and transaction separately. Clearinghouse-specific: This registry has not established one national ERA payer ID for Optimum HealthCare. ERA enrollment and 835 routing are clearinghouse- and product-specific; verify in the payer portal or clearinghouse payer list before enrollment. |
Payer IDs vary by clearinghouse — confirm against your clearinghouse payer list (Availity, Change Healthcare/Optum, Waystar) before configuring submitter routing.
Source checks and remaining limits
The latest partial comparison is dated . Retained earlier findings keep their original dates below. This is a partial source check, not a whole-page, clinical or legal review. It does not refresh the legacy review date above.
portal_url
Source comparison: 2026-09-26
The actual public route is singular /provider/claims and supplies claims status and PaySpan EFT/ERA enrollment information. Stored plural /providers was not readable.
Primary source for portal_urlprovider_phone
Source comparison: 2026-09-26
Participating-provider page lists 866-245-5360 and 813-506-6000 for Provider Relations/network participation. This supports a specific contact purpose, not all claims support.
Primary source for provider_phone
Not checked in this pass: Whole-record approval, legal identity, ownership and complete product coverage; Authenticated transactions and QuickIntell integrations; timely_filing_days: Claims page gives 90 days from EOB denial for claim appeals, not an initial filing limit. It does not establish stored 180 days or justify substituting 90.; payer_ids.claims: No universal medical claims identifier established; preserve clearinghouse and product verification.; payer_ids.eligibility / payer_ids.era / era_payer_id: No transaction-specific universal eligibility/ERA identifier established; do not copy a claims ID.; electronic_claims_supported / supports_279_271 / supports_278: No blanket transaction-capability or QuickIntell connectivity certification; unauthenticated resources do not establish all stored flags.; appeal_levels / prior_auth_required_codes_sample / qi_module_coverage: No new approval of appeals, code-specific authorization or product integrations in this bounded pass..
Sources used for this guide
State coverage
Optimum HealthCare operates in the following states. Each link opens state-level Medicaid program details, dominant commercial payers, and state-specific RCM regulations.
Evaluate QuickIntell workflow fit for Optimum HealthCare
These module references are evaluation starting points, not evidence of a validated connection, supported transaction or customer deployment. Confirm the actual member plan, data access and product scope first.
- QuickRCM
Evaluate claim preparation, follow-up and denial worklists for Optimum HealthCare; verify the actual plan rules and available connections before implementation.
- QuickAuth
Assess authorization-packet and status workflows for Optimum HealthCare; confirm product, service, delegated reviewer and permitted submission channels.
- QuickERA
Verify the actual 835 files, posting exceptions and reconciliation requirements for Optimum HealthCare before evaluating automation. An ERA identifier alone does not establish supported ingestion or posting.
Frequently asked questions about Optimum HealthCare
Where is the Optimum HealthCare provider portal?
Use https://www.youroptimumhealthcare.com/provider/claims as a starting point for Optimum HealthCare provider resources. This link may open a directory or contact page rather than a transaction portal. Select the applicable product and administrator, then verify the available functions, enrollment and access requirements. QuickIntell is not the official payer portal.
What is the timely filing limit for Optimum HealthCare?
This registry lists 180 days as an initial-claim reference for Optimum HealthCare. Confirm the applicable product, provider agreement, start event and current payer instructions. Do not apply this value automatically to out-of-network, secondary, corrected or appealed claims.
Does Optimum HealthCare publish a single claims payer ID?
This registry has not established one all-product claims payer ID for Optimum HealthCare. See the source findings for transaction-specific references. Look up the correct ID for the member's plan and transaction in your clearinghouse directory and verify against the member ID card before submission.
Does Optimum HealthCare accept electronic claims?
Verify Optimum HealthCare electronic claims (837), eligibility (270/271), remittance (835) and authorization (278) separately for the member product and clearinghouse. Registry flags and routing references are not current transaction-complete approval. Confirm the companion guide, enrollment and applicable source findings below. A blank or unverified field does not establish that the transaction is unavailable.
How do I appeal a Optimum HealthCare denial?
This registry has not established a payer-specific appeal ladder for Optimum HealthCare. Use the denial notice, plan document, provider agreement, or jurisdictional rule to assign the correct route and deadline. Missing registry evidence does not mean appeal rights are unavailable.
How long do Optimum HealthCare prior authorization approvals take?
Decision deadlines depend on the product, service and urgency. CMS-0057-F generally starts its decision-timeframe requirements in 2026 for Medicare Advantage, Medicaid and CHIP payers subject to the rule: seven calendar days for standard requests and 72 hours for expedited requests. Those requirements exclude drug authorizations and QHP issuers on the federally facilitated exchanges. Other plans, state rules and permitted extensions can differ. Check the applicable policy; a decision deadline is not a guarantee of approval.
What is the Optimum HealthCare provider phone number?
This registry lists 1-866-245-5360 as a contact reference for Optimum HealthCare. Provider Relations/network participation
Automate workflows around Optimum HealthCare requirements
Connect eligibility, prior authorization, pre-submission claim checks, and remittance routing in one governed workflow. Payer and plan configuration is confirmed during implementation.
Disclaimer
This page is operational reference for medical-billing professionals. It is not legal, clinical, or contractual advice. Payer policies change without notice — always verify against Optimum HealthCare's current published documents before submission. CPT® is a registered trademark of the American Medical Association.