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Availity LLC supports the exchange of electronic remittances in the ASC X12 835 version 5010A1 format. 1755 Telstar Drive Ste 400 Colorado Springs CO 80920 www. optum.com NMBLS Thank you for choosing Electronic Network Systems Clearinghouse a division of Optum to submit your Claims/ERAs. This form is for Optum use only and will not be forwarded on to the payer with your Optum user ID Contact Name Group Name Group Billing TIN Group Legacy ID Please list all providers for this Payer below...
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