Unmatched services for comprehensive healthcare interoperability
At the core of the Optum Medical Network are its robust clearinghouse services. These services facilitate all standard healthcare administrative transactions, including 837P, 837I, 837D, 835, 275, 278, 270/271, 276/277 and 834, and acknowledgment transactions like 277CA and 999.
The Optum clearinghouse efficiently manages millions of medical and dental providers through SFTP, APIs and portals, while supporting thousands of payers via real-time and API connections. Harness a network that offers unparalleled connectivity, support, stability and security at scale.
Modernizing the claims process for everyone
Accelerate transaction processing with secure cloud-based solutions
- Enable swift, accurate and secure claims and remittance transmission via direct connections.
- Minimize delays with intelligent alerts and dashboards for proactive issue resolution.
- Help to improve first pass rates with behind-the-scenes edits and customizations.
Reduce processing cost-per-claim through automation
- Identify the most efficient path for claims to be delivered to the final claim adjudicator.
- Enhance accuracy by validating and normalizing data.
- Support supplemental data needs and facilitate PPO repricing.
- Automate workflows with personalized pre-adjudication rules.
Improve claims accuracy and help support timely, appropriate care
- Get real-time eligibility verification for providers, payers and administrators.
- Improve claim accuracy and streamline authorizations.
- Ensure regulatory compliance, including HIPAA and CORE, with our ENHAC-certified clearinghouse.
- Access our secure network of 2,400 payers.
Send and receive electronic claims attachments to drive efficiency
- Submit the correct documentation the first time by accessing payer-specific requirements.
- Help reduce customer-service calls with visibility into claim and attachment status.
- Lower the administrative burden and costs of paper workflows.
Key benefits
Our secure solutions are designed to drive claims accuracy, improve efficiency and reduce costs.
Built to support your business
Leverage multiple options to streamline eligibility verification and the submission, processing and tracking of claims and attachments.
Use APIs to access our network
Our productized APIs are easy to implement and scale, giving you fast access to advanced functionality available with our solutions.
Help ensure accuracy of eligibility and benefits
Our broad connectivity facilitates the secure exchange of information to drive time and cost efficiencies and support accelerated reimbursement.
Gain connectivity, flexibility and innovation
Our EDI Network offers smarter transaction processing and advanced interoperability with healthcare networks nationwide.
Let’s start a conversation
We’re here to help you find out how our services could benefit your organization.
Our experts will:
- Discuss your individual use case and business needs
- Explain our features, benefits and services
- Show how this solution can help achieve your goals
EDI Network FAQ
An EDI network describes the broader connectivity across many payers — often delivered by a clearinghouse to simplify scale and compliance. A clearinghouse validates, routes and acknowledges HIPAA transactions between providers and payers.
The Optum EDI Network emphasizes broad provider‑to‑payer connectivity for standard transactions. SmartEDI serves payers and third-party administrators (TPAs) with advanced edits, routing and analytics to reduce denials and streamline complex EDI operations.
The core sets that are often used the most are:
- 270/271 (eligibility)
- 837 (claims)
- 276/277 (claim status)
- 835 (remittance)
- 278 (prior auth)
Together they confirm coverage, submit clean claims, track progress and reconcile payments faster.
A payer ID is the electronic address your claims use to reach the right health plan. Some payer IDs are universal, while others vary by clearinghouse. Confirm the payer ID on the member card or the payer’s published list before submitting.
EDI onboarding depends on payer enrollments and transaction mix. Typical ranges include:
- Commercial ERA: 15–30 days
- Government claim enrollments: approximately 3–15 days
- ERAs: approximately 5–30 days
Many organizations can go live in weeks with a focused plan.
Use real‑time EDI for moments needing instant answers and eligibility or claim status during check‑in.
Use batch EDI for high‑volume jobs where a slight delay is acceptable.
A hybrid model pairs EDI for compliance with APIs when immediacy matters.
Practices, hospitals and dental groups of all sizes use EDI — often through a clearinghouse or portal — to:
- Submit claims
- Verify eligibility
- Receive remits
This saves time and cost versus paper or phone.
Optum offers productized APIs via the Optum AI Marketplace, including a sandbox to test real‑time, near real‑time and batch transactions before deployment.
Optum supports real‑time transactions and API connections alongside batch workflows and secure file transfer. Teams can mix immediate checks with high‑volume processing.
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