OptumHealth has EPS solutions for: Health Plans and Payers | Physicians and Other Health Care Providers

How It Works

A system infused with efficiency.

From an 835 file to claims payment and remittance advice – OptumHeath Electronic Payments and Statements claims settlement system removes paper, postage, and time from the claims settlement process:

1. The health plan sends a payer originated output file to OptumHealth Financial Services, where the file is validated against HIPAA 835 standard, splitting payments and remittance advices between compliant and non-compliant transactions.
2. On the payment side, the consolidation engine bundles payment transactions at the provider level to efficiently reduce the number of transactions.
3. OptumHealth Bank, Member FDIC, then creates a NACHA-compliant file and distributes payments to the provider-designated banks via electronic funds transfer (EFT), using a settlement account funded by the health plan. Paper payments, when necessary, are printed and mailed through OptumHealth Print*.
4. Electronic remittance advice (ERA) is available to the provider on the Electronic Payments and Statements portal. Paper remittances, when necessary, are printed and mailed to the provider through OptumHealth Print on behalf of the health plan.
5. Providers access payment and remittance advice information though the secure Electronic Payments and Statements user portal. Information for both electronic and paper transactions is presented online for viewing, querying, downloading and printing. EFT and ERA information is referenced together with a payment ID number for easy reconciliation

In addition, the user portal can be modified to incorporate health plan-specific branding, allowing the health plan to reinforce the relationship with the provider.   


*OptumHealth Print is offered by Duncan Printing Services LLC, an affiliate company of OptumHealth Financial Services


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