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Bundled codes for maternity are deleted January 1, 2027Get ready for the change >>
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Coverage profile

Work Optimum Healthcare across every published route

Use the current payer record to choose the right claim-status, eligibility, portal, phone, or appeals workflow. Substrate only marks routes that are published for this payer.

Eligibility

EDI 270/271

The Substrate Eligibility Agent can verify patient benefits, identify TPAs and carve-outs, and more with Optimum Healthcare.

Available

Other aliases

Also known as

  • 14460
  • 20133
  • 20133MA
  • 4227
  • 4680
  • Optimum Healthcare Incorporated
  • Optimum Healthcare, Incorporated
  • Wellpoint
  • OPTIMUM HEALTHCARE INC.

Payer intelligence

Observed adjudication timing

How long completed claims in Substrate’s aggregate network took from payer receipt to the 835 payment date.

Median time to payment

23 days
10% of adjudications by
21 days
90% of adjudications by
27 days
Applicable state coverage
FL
Current As Of
June 2026

Five-month median trend

Days to 835 payment

A trend needs at least two qualified service months.

View chart data as a table
Optimum Healthcare observed adjudication timing by service month
Service monthMedian10% of adjudications by90% of adjudications byCompleted claimsCoverage
AprNo qualified data
MayNo qualified data
Jun23 days21 days27 days101FL
JulNo qualified data
AugNo qualified data

Payer policies

Optimum Healthcare policies

The first 25 of 1,402 public policies Substrate tracks for Optimum Healthcare, by title. Links open the payer's own document; check its current version before relying on it.

Search all 1,402 Optimum Healthcare policies by CPT code, keyword or policy number →

Routing reference

Optimum Healthcare payer IDs and operating states

Use the payer ID listed for the transaction you are submitting. Verify current routing and enrollment requirements with your clearinghouse.

Optimum Healthcare payer name, operating states, and transaction-specific payer IDs
Payer nameOptimum HealthcareSource: Substrate payer directory · data last changed
Operating statesFLSource: Substrate payer directory · data last changed
837P professional claims payer IDStedi20133Source: Stedi payer catalog · catalog dated · matched by payer ID
837I institutional claims payer IDStedi20133Source: Stedi payer catalog · catalog dated · matched by payer ID
835 ERA payer IDStedi20133Enrollment requiredSource: Stedi payer catalog · catalog dated · matched by payer ID
270 eligibility payer IDStedi20133Source: Stedi payer catalog · catalog dated · matched by payer ID
270 eligibility payer IDAvailityAGPMEDICAIDOPT01Source: Availity payer catalog · catalog dated · matched by payer name
276 claim status payer IDAvailityAGPMEDICAIDSource: Availity payer catalog · catalog dated · matched by payer name

Routing sources and verification

  • Substrate payer directoryPayer identity, aliases, operating states, and vendor IDs. Data last changed ; checked .Open payer website ↗
  • Stedi payer catalogMatched by payer ID; matched record: Optimum Healthcare. Source dated .PrimaryPayerId is used as the transaction payer ID when the corresponding Stedi support flag is true.Open current Stedi reference ↗
  • Availity payer catalogMatched by payer name; matched records: OPTIMUM HEALTHCARE INCORPORATED, WELLPOINT. Source dated .The attached API workbook supplies 270 and 276 payer IDs only. It does not supply 837P, 837I, or 835 IDs.Open current Availity reference ↗
  • United Clearinghouse payer catalogMatched by payer name; matched record: Wellpoint. The source did not provide a publication date.The attachment supplies payer names and states only; it does not contain transaction-specific payer IDs.Open current United Clearinghouse reference ↗

Clearinghouse payer IDs are transaction-specific and can change. Confirm the current payer list and the member’s ID card before submission.

Not affiliated with Optimum Healthcare or BCBSA.

Confirm routing with your clearinghouse. Report an error

Disclaimer

The information provided on this page is for general informational purposes only and does not constitute billing, coding, or reimbursement advice. Nothing on this page should be relied upon as a substitute for clinician assessment, professional billing guidance, or as a definitive statement of any payor's billing requirements or policies.

Payor agreements, fee schedules, and billing policies vary and are subject to change. Before submitting any claims related to maternity care services, including claims affected by the 2027 CPT code revisions, please consult the applicable payor agreements, coverage policies, and billing guidelines to confirm current requirements for their specific payor contracts.

Substrate makes no representation or warranty regarding the accuracy, completeness, or timeliness of the payor-specific information presented here. Providers are solely responsible for ensuring that all claims are submitted in accordance with applicable payor requirements, and Substrate assumes no liability for claim denials, underpayments, or other adverse outcomes arising from reliance on this information.

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