Our claims process - Oxford Level-Funded plans (NJ and CT) - 2021 Administrative Guide

Follow these steps for fast payment:

  1. Notify Oxford Level Funded.
  2. Prepare a complete and accurate claim form.
  3. For Oxford Level Funded members, submit electronic claims using payer ID number 06111. Submit paper claims to the address on the member’s ID card.
  4. For contracted care providers who submit electronic claims and would like to receive electronic payments and statements, call Optum Financial Services Customer Service line at 1-877-620-6194 or visit Optumbank.com > Partners > Providers

Claim reimbursement (adjustments)

If you think your claim was processed incorrectly, call the number on the member’s ID card. If you find a claim where you were overpaid, send us the overpayment within 30 calendar days. If we find a claim was overpaid, payment is due within 30 calendar days.

If you disagree with our decision regarding a claim adjustment, you may appeal.

Claim reconsideration, appeals and disputes

Claim reconsideration does not apply to some states based on applicable state legislation (e.g. Arizona, California, Colorado, New Jersey or Texas). For states with applicable legislation, any request for dispute will follow the state specific process.

There is a two-step process available for review of your concern. Step one is a claim reconsideration. If you disagree with the outcome of the claim reconsideration, you may request a claim appeal (step two).