Medical Mutual - Health Plans for Life

Claims Edit System

Disclaimer for Optum Claims Edit System

The information provided through the Optum Claims Edit System represents only the applicable edits as of the date viewed and is subject to change at any time. In addition, the information provided here is dependent upon the claim information entered by you, which may include, but is not limited to, claim type, type of bill, specialty type, patient gender, patient date of birth, dates of service, place of service (POS), procedure codes, modifiers, units, revenue codes, diagnosis codes, charges, and patient status. The information provided here does not represent the actual edits that will apply to any submitted claim, which are subject to change depending on the date the claim is processed and the actual claim information submitted, nor does it represent any actual reimbursement amount. The information provided is not to be construed in any way as a guarantee of payment for any particular service. Actual payments will vary not only based on edits applied, but also based on such factors as provider charge amounts, applicable member coverage and benefits, sequestration reductions (for payments under Medicare Advantage plans as applicable), quality adjustments and the administrative, medical and payment policies of Medical Mutual of Ohio and its Affiliates (collectively “Medical Mutual”). The provider is responsible for submission of accurate claims.

By accessing the Optum Claims Edit System through the link provided below, you acknowledge that you have read and agree to the foregoing. No part of this information may be reproduced, stored in a database or retrieval system, copied or transmitted, in any form or by any means, whether electronic, mechanical, photocopying or otherwise without the express written permission of Medical Mutual.

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