Optum Pinnacle Medical Group
Optum Pinnacle Medical Group is a payer organization operating in California. For an ASC, what matters isn't the logo. It's how Optum Pinnacle Medical Group pays: where it runs rich, where it runs thin, and how its reimbursement compares with peer plans for the same procedures.
Pilot Analysis
Get the complete Optum Pinnacle Medical Group analysis
Tell us where to send it. Our team will prepare an analysis of Optum Pinnacle Medical Group covering rates by code, market position, and underpaid areas, and email it to you within 5-10 business days. Need it faster? Book a demo.
What Insights reveals
How Optum Pinnacle Medical Group pays
See how Optum Pinnacle Medical Group reimburses across procedures and markets, benchmarked against the peer plans competing for the same cases. Not a raw rate sheet, a read on where it sits.
Geographic footprint
Optum Pinnacle Medical Group's presence spans California. See where it concentrates and how that shapes the markets you compete in.
Peer position
Put your own position next to the benchmark for Optum Pinnacle Medical Group and bring the gap to your next contract conversation.
Specialty mix
Understand which procedures and specialties drive Optum Pinnacle Medical Group's volume, so you know where a rate change moves the needle.
Whether you're an ASC benchmarking a contract or a provider team looking Optum Pinnacle Medical Group up, DataLily AI maps how it reimburses across procedures and markets, and where your own rates sit against the peer benchmark.
Reference
Working with Optum Pinnacle Medical Group
- Payer ID
- 95271 is the EDI identifier used to route electronic eligibility checks (270/271), claim-status inquiries (276/277), and claims to Optum Pinnacle Medical Group through a clearinghouse.
- Eligibility verification
- Coverage and benefits for Optum Pinnacle Medical Group members are verified before the date of service, through a clearinghouse using payer ID 95271or through the payer's provider portal.
- Prior authorization
- Requirements are set per plan and per procedure. Confirm whether an authorization is required with Optum Pinnacle Medical Group directly before the date of service.
Book a demo: pick a time
A 15-minute walkthrough of Optum Pinnacle Medical Group the way it pays.
- What is Optum Pinnacle Medical Group's payer ID?
- Optum Pinnacle Medical Group's electronic payer ID is 95271. ASC billing teams use it to route eligibility checks (270/271), claim-status inquiries (276/277), and electronic claims to Optum Pinnacle Medical Group through a clearinghouse.
- How do ASCs verify eligibility for Optum Pinnacle Medical Group members?
- Eligibility and benefits for Optum Pinnacle Medical Group members are verified before the date of service, either electronically through a clearinghouse (a 270/271 transaction using payer ID 95271) or through the payer's provider portal.
- Does Optum Pinnacle Medical Group require prior authorization for ASC procedures?
- Prior-authorization requirements for Optum Pinnacle Medical Group are set per plan and per procedure. Confirm whether an authorization is required with Optum Pinnacle Medical Group directly before the date of service.
- What type of payer is Optum Pinnacle Medical Group?
- Optum Pinnacle Medical Group is a payer organization operating in California.
- How does Optum Pinnacle Medical Group compare with other payers for ASC procedures?
- Ask Rose and you get a plain-language read on where Optum Pinnacle Medical Group pays above or below peer plans for your top procedures, charted, and ending in a recommendation you can take into a contract conversation.
- Is Optum Pinnacle Medical Group paying my ASC below market?
- Put your own Optum Pinnacle Medical Group contract next to the peer benchmark in DataLily AI and you'll see the gap by procedure and market, the fastest way to know whether you're leaving money on the table.