Optimum Healthcare
Part of Elevance Health
Summary
Optimum Healthcare is a Medicaid managed care organization, part of Elevance Health, offering medical coverage operating in 22 states. Claims route under payer ID 20133, with 3 alternate IDs in use across clearinghouses. Provider enrollment typically takes 60-120 days, with applications through Wellpoint Provider Portal, and CAQH is used for credentialing data. Through clearinghouses it supports eligibility checks, professional claims, institutional claims, and electronic remittance (ERA); ERA enrollment is required and takes several weeks.
At a glance
- Payer ID
20133Also seen as 14460, 20133MA, 4227- Also known as
- Optimum Healthcare Incorporated, Optimum Healthcare, Incorporated, Wellpoint
- Uses CAQH
- YesApplication route: Payer portal application
- Service area
- 22 states
Clearinghouse transaction setup
Which EDI transactions this payer supports, and how long clearinghouse enrollment typically takes when it is required.
| Transaction | Enrollment | Typical setup |
|---|---|---|
| Eligibility checks (270/271) | Not required | Immediate |
| Professional claims (837P) | Not required | Immediate |
| Institutional claims (837I) | Not required | Immediate |
| ERA / remittance (835) | Required | Several weeks |
Common questions
- What is the payer ID for Optimum Healthcare?
- The payer ID for Optimum Healthcare is 20133. Alternate IDs seen across clearinghouses include 14460, 20133MA, 4227.
- How long does Optimum Healthcare provider enrollment take?
- Optimum Healthcare provider enrollment typically takes 60-120 days from application to effective date. Timelines vary by state, plan, and how complete the application is.
- Does Optimum Healthcare require CAQH?
- Yes. Optimum Healthcare uses CAQH for credentialing data, so keep the provider's CAQH profile current and attested before applying.
- Does Optimum Healthcare require ERA enrollment?
- Yes. Optimum Healthcare requires a separate ERA (835) enrollment before electronic remittances flow, and setup typically takes several weeks.
- What states does Optimum Healthcare cover?
- Optimum Healthcare operates in 22 states. Coverage can differ by plan and product line, so confirm the specific plan before you file.
Related payers
Compiled from public payer resources and clearinghouse catalogs. Details change often, so confirm with the payer before relying on them. Spot something out of date? Tell us and we will fix it.