Feature

With Optima Health's IVR providers can call 1-800-229-8822 (toll free) or 757-552-7474 twenty-four hours a day to check on:

• Claim status information
• Member eligibility
• Referral status information
• Member effective or termination date
• PCP and specialist visit copay amounts 
• Member group number.

To check claim status, eligibility or authorizations choose Option 2 from the main menu and do the following:

Claim Status 

To check claim status press 1

1. To enter the claim number, press 1.
   a) Enter the numeric portion of the claim number.
2. To enter the vendor number, member number, date of service and billed amount, press 2.
   a) Enter the numeric vendor ID.
   b) Enter the 8 or 9 digit member number, omitting the asterisk.
   c) Enter the date of service by pressing 2 digits for the month, 2 digits for the day and 4 digits for the year.  Example:  mm/dd/yyyy.
   d) Enter the billed amount, including 2 digits for cents followed by the pound (#) sign.
     
   Note the following when checking claim status:

• The information supplied is “real-time."
• The Optima Health vendor number must be entered.  This is a Health Insurance Portability and Accountability Act (HIPAA) requirement and ensures confidentiality.
• When receiving information on claims, the claim number and additional payment information will be provided (check number, check date/remit date, copay amount and deductible payment amount).
• If a claim is denied or pending, the denial or suspension reason will be provided.
• Multiple claims can be checked for the same member.
• Users can bypass verification of data by pressing 1 instead of listening to the repeat of the data input.
• Numeric entries should be followed by pressing the pound sign (#).  This will eliminate the 3 to 7 second delay and notify the system of the completion of the numeric entry.

Verify Eligibility 

To verify eligibility check eligibility, press 2

1. To enter the member number, press 1.
2. To enter the Social Security Number (SSN), press 2.
3. To enter the Medicaid ID number, press 3.

Notes about Eligibility:

• If a SSN or Medicaid ID number is used to search for a member, the IVR will provide the member ID number.  It will also give the member ID number if the member is disenrolled.
• The IVR will provide the member’s “eligible as of” or “terminated as of” date (if applicable), the group number, PCP and specialist office visit copay amounts and the Primary Care Physician’s (PCP) name.  A PCP is not required for PPO members.

Confirm Authorizations 

To check authorizations, press 3

1. To enter the referral number, press 1.
   a) Enter the numeric portion of the referral number.
2. To enter the vendor or provider number, member number and beginning date of referral, press 2.
   a) Enter the vendor or provider number
   b) Enter the 8 or 9 digit member number, omitting the asterisk.
   c) Enter the beginning date of the referral by pressing 2 digits for the month and 4 digits for the year.  Example:  mm/yyyy.The member number, effective date of the referral, the expiration date of the referral, the liability, the number of visits authorized, the number of visits claimed and the referral number will be provided. Multiple referrals may be checked for multiple members.

Other

For other information, call during business hours and:

Choose Option 3 for pre-certification. If you call after hours or on weekends you may leave a message and a representative will return your you the next business day.

Choose Option 4 to speak to a Provider Service representative about other issues.