Beginning Aug. 1, 2026, Optum, on behalf of ConnectiCare, will begin performing prepayment claim reviews. As a result, Optum may ask providers for medical records and billing documents that support the charges billed.
Providers will receive detailed instructions by mail on how and when to submit requested documentation. Providers who do not submit the requested documentation may receive a technical denial.
This will result in a claim denial until Optum receives all information necessary to process the claim. If it is determined that a coding and/or payment adjustment is applicable, providers will receive the appropriate claim adjudication.
For more information, review Optum Pause and Pay in ConnectiCare’s Billing and Reimbursement Policies and these Frequently Asked Questions.
