Optum EAP Claims: Payer ID 87726, HJ and Telehealth
By George Ruan • October 22, 2026
Public guidance reviewed October 22, 2026. US therapy-practice billing; documentation review, not a live claim submission.
Optum calls its EAP Emotional Wellbeing Solutions (EWS). It can share a claims route with ordinary behavioral health while requiring a different set of service codes and authorization information. Set up the EWS visit as its own billing configuration rather than copying every field from the client’s ongoing psychotherapy claim.
Sections
Where to send an Optum EAP claim
Provider Express supports outpatient EAP Claim Entry. Optum’s current Claim Tips page identifies 87726 as its EDI payer ID. Match the clearinghouse destination to the authorized Optum benefit before transmitting; the number alone does not establish coverage. Optum Claim Tips.
For direct entry, use the participating practice’s Provider Express account. For EDI, inspect the payer entry selected in your EHR or clearinghouse and retain the transaction reference. A payer search result is not the same as proof that your specific professional claim reached Optum.
Allowable CPT codes and special modifiers
The EWS page lists 90832, 90834, 90846, 90847 and 90853, each with HJ. It also calls for GT for virtual services and a supported diagnosis. 90837 and 90791 are not on that published EWS list. Do not substitute them merely because they are on your routine psychotherapy fee schedule. Optum EWS billing instructions.
Keep HJ and any applicable telehealth modifier in separate modifier fields; do not turn the entire code-and-modifier string into an invalid procedure-code field. Confirm the current place-of-service and modality instructions for the actual appointment, especially for audio-only care. Do not assume another payer’s use of 95 overrides Optum’s published EWS instructions.
Authorization and the first submission
Obtain the member’s EWS authorization and confirm dates, remaining visits and the clinician who will provide care. Members can request authorization through Live and Work Well or the program’s phone route.
Match the member and subscriber information to that authorization. Enter its reference in the supported authorization field; inspect the outbound claim rather than relying on the EHR’s service label.
Select an allowable EWS service supported by what you delivered, including the required modifiers and diagnosis. Confirm the billing TIN, rendering NPI, service location and charge.
Submit once, save the portal confirmation or EDI acknowledgment, and reconcile the resulting claim against the appointment. Use the contract’s filing deadline rather than assuming the authorization expiration is also the submission deadline.
How to check receipt and payment
Provider Express recommends saving the final confirmation page. Claim Inquiry normally shows directly entered claims within two to three business days, although it can take longer. Optum describes clean-claim payment generally within 30 days, subject to exceptions and applicable law; this is not a guarantee for a particular EAP claim. Provider Express Claim Entry FAQ.
If a visit is rejected, first compare the EWS code/modifier combination, authorization, member identifier and payer destination. If it is already accepted or pending, check its status before sending another original. A client balance appearing under ordinary insurance should prompt a benefit-routing review, rather than immediate collection for a visit intended to be EWS-covered.
Related EAP guides
Compare EAP networks or review authorization and session-limit checks.
Frequently Asked Questions
Does Optum EAP use 90837-HJ?
90837 is not listed on the current public EWS allowable-code list reviewed here. Use the published allowable services and verify any specific written exception with Optum.
Is HJ enough for an Optum virtual EAP visit?
The public EWS instructions also call for GT for virtual services. Verify the service, modality, place of service and current arrangement rather than copying another payer’s telehealth configuration.
Sources and scope
Use the cited program and transaction-specific instructions with your current referral and agreement. Clearinghouse listings establish connectivity, not authorization or a guarantee of payment.
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