Optum Intelligent EDI Clearinghouse - Channel Partner Data Collection for SFTP Setup

**STOP!** Revenue Performance Advisor (RPA) client, go to this Optum RPA SFTP - Data for Setup form: https://app.smartsheet.com/b/form/39ae10c671e149a1968476bc0275c855

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If you are an OKC direct Channel Partner client, please proceed with filling out the form below. Provide the following data points so the Optum team can expedite setup of your IEDI SFTP accounts for Claims processing. Clients will be processed on a first-come, first-served basis. We will send an acknowledgement email within a few hours of receiving and you will get an assigned project manager to assist with the implementation.

**Prerequisite for form completion!**

  1. Enter your OneHealthcare ID (OHID) below.
  2. Create OHID if you do not have an account: https://identity.onehealthcareid.com/oneapp/index.html#/login
  3. Verify if you have an OHID account already created:
  • URL: https://optumprovider.optum.com/
  • Click on “Manage My One Healthcare ID”
  • Enter your email address or OHID
  • Enter your password
  • Click continue
  • If will show the user their information if account previously created

First and Last Name entered during OHID account creation.

Email address used during OHID account creation.

Please provide your submitter ID used on Change Healthcare clearinghouse previously. If you do not know your submitter ID, please provide the reason why.

Please provide your billing ID used on Change Healthcare clearinghouse previously. If you do not know your billing ID, please provide the reason why.

Which Platform are you currently using?*
Channel Partner Type*
  • Aggregator: Channel Partner (parent) will submit the 837 I/P claim files on behalf of their providers (child) directly to iEDI via SFTP.
  • Non-Aggregator: The providers (child) of the Channel Partner (parent) will submit their 837i/p claim files individually directly to iEDI via SFTP. Note: If Non-Aggregator model we start with establishing the Channel Partner (parent) account and then provider (child) records via template and bulk load process. Your assigned project manager will provide the details on this process.

What is the Parent Name for your organization?

Please enter your organizations EHR/HIS. Select from the list or enter a value if not on the list.

Select or enter value
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Provide one (1) external/public, static IP addresses you will use to submit files via SFTP as the primary (parent) Channel Partner account. Note: If considered a non-aggregator model, your project manager will contact you with a template to fill out for your submitters to be provisioned for SFTP.

Please enter a single (1) TIN to be used to create the primary Channel Partner (parent) account. Note: if considered a non-aggregator model, your project manager will contact you with a template to fill out for your submitters to be provisioned for SFTP.

Please enter all applicable NPIs. Note: Not required!

Select
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Phone
Will you submit Institutional Claims to iEDI?*

Indicate estimated monthly Institutional Claim volume

Will you submit Professional Claims to iEDI?*

Indicate estimated monthly Professional Claim volume

Phone

Add any additional comments or special considerations here: