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Optum - Complex Medical Conditions (CMC)

Optum - Complex Medical Conditions (CMC)

This page contains information you can use to exchange healthcare transactions with Optum - Complex Medical Conditions (CMC) using Stedi.
Use any of the following payer IDs to send transactions to Optum - Complex Medical Conditions (CMC) using Stedi APIs or SFTP. Read the docs
Primary Payer ID
41194
Stedi Payer ID
SXRHP
Payer ID aliases
3824, 41194, 41194MA, 9513, UNTDRN
Parent group
UnitedHealth Group
Coverage types
Medical

Supported transactions

Use Stedi to exchange the following transactions with Optum - Complex Medical Conditions (CMC) using APIs or SFTP. Send transactions as JSON or raw EDI files.
Eligibility & benefit verification
Not supported

Eligibility checks

(270/271)
Verify member coverage and benefits by sending real-time and batch eligibility checks to Optum - Complex Medical Conditions (CMC).
Not supported

Coordination of benefits checks

(COB)
Submit coordination of benefit checks to Optum - Complex Medical Conditions (CMC) to determine if a member has overlapping coverage with another plan and determine each payer's responsibility for paying claims.
Claims processing
Not supported

Real-time claim status

(276/277)
Check on the status of a claim previously submitted to Optum - Complex Medical Conditions (CMC) in real-time by sending a claim status check (276/277).
Supported

Professional claims

(837P)
Submit professional claims to Optum - Complex Medical Conditions (CMC) and receive 277 claim acknowledgments asynchronously.
Supported

Institutional claims

(837I)
Submit institutional claims to Optum - Complex Medical Conditions (CMC) and receive 277 claim acknowledgments asynchronously.
Supported, enrollment required

Claim payments

(835 ERA)
Receive electronic remittance advice (ERAs) from Optum - Complex Medical Conditions (CMC) to review full payment details.
Not supported

Dental claims

(837D)
Submit dental claims to Optum - Complex Medical Conditions (CMC) and receive 277 claim acknowledgments asynchronously.
Not supported

Unsolicited claim attachments

(275)
Receive unsolicited attachments for claims submitted to Optum - Complex Medical Conditions (CMC).
Get started
Use Stedi's APIs to get fast and reliable connectivity to Optum - Complex Medical Conditions (CMC) and start processing healthcare claims and eligibility checks within minutes.
Start processing healthcare claims and eligibility checks with Stedi and Optum - Complex Medical Conditions (CMC) today.
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Other names
Alternative known names, networks, or health plans for this payer that may appear on insurance cards, claims, or other correspondence.
  • OptumHealth Care Solutions
  • United Resource Networks
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