Billing and Claims

The Claims Department at Optima Health is committed to providing you with the highest level of service possible. Our mission is to pay claims correctly and quickly the first time. Doing it right the first time saves time and money for everyone. We want to help you improve the premier health outcomes of our members by reducing the time you spend on claims follow-up.

If you have questions for the Claims Department or suggestions on how we can improve our operations, please call us at 800-727-7536, press 4 for Claims. Our fax number is 804-819-5174.

Claims Forms

All of our forms can be found under documents and forms.

Claim Filing Addresses 

Below is a list of claim filing addresses for Optima Health Medallion 4.0 providers:

  • PCP Claims
    PO Box 5550
    Richmond, VA 23220-0550
  • Specialty Claims
    PO Box 5550
    Richmond, VA 23220-0550
  • Hospital Claims
    PO Box 5550
    Richmond, VA 23220-0550
  • Claim Appeals
    PO Box 5286
    Richmond, VA 23220-0286

Electronic Claims

EDI (Electronic) Claims Submission

Optima Health strongly encourages our providers to file their claims electronically. By filing claims electronically, you are able to aid in lowering claims processing timeframes, which in turn allows Optima Health to make payments more quickly.

EDI 837 Claims

Please refer to the first document below for instructions on how to send EDI 837 (electronic) claims to Optima Health. You will find answers to most of your questions here:

The EDI 837 (Electronic Claims Enrollment) form can be found under documents and forms.

EDI 835 ERA

Should you want to receive the EDI 835 ERA (Electronic Remittance Advice) from Optima Health, the process is exactly the same as the process to send electronic claims to Optima Health. Only the form is different. The EDI 835 (Electronic Remittance Advice) form can be found under documents and forms.

Other EDI Transactions

Optima Health also offers additional transactions in partnership with our clearinghouses. If interested in either of the following, please contact your clearinghouse.

  • 277 – Claim Acknowledgment
  • 997 – Functional Acknowledgment

E-Mail: vphp_edi@sentara.com

Technical Support: edi_support@sentara.com

EDI Clearinghouses

Clearinghouse Phone Email 837 Claims Professional 837 Claims Institutional 835 ERA
Availity 800-282-4548 support@availity.com YES YES YES
Change Healthcare 866-371-9066 https://www.changehealthcare.com/support/customer-resources/enrollment-services YES YES YES
RelayHealth 800-527-8133 DBQTSHInsuranceSupport@RelayHealth.com YES YES YES

If you have questions for the Claims Department or suggestions on how we can improve our operations, contact us:

  • by phone at 800-727-7536 (press 4 for Claims)
  • by fax at 804-819-5174

Optima Health Medallion 4.0 Providers

Below is a list of Optima Health claim filing addresses:

  • PCP Claims
    PO Box 5550
    Richmond, VA 23220-0550
  • Specialty Claims
    PO Box 5550
    Richmond, VA 23220-0550
  • Hospital Claims
    PO Box 5550
    Richmond, VA 23220-0550
  • Transportation Claims
    PO Box 5287
    Richmond, VA 23220-0287
  • Claim Appeals
    PO Box 5286
    Richmond, VA 23220-0286

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