Beginning in 2026, Optum Behavioral Health will enforce new billing requirements for Commercial (employer-sponsored) behavioral health claims. Both the billing provider and the rendering provider must have their National Provider Identifier (NPI) and taxonomy code included on every claim—or risk rejection.
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What’s Changing
Optum is aligning its systems with federal regulations that already mandate NPI and taxonomy information on claim submissions. With recent upgrades to its claims platform, Optum can now automatically verify this data against the National Plan and Provider Enumeration System (NPPES).
Starting in 2026:
- All Commercial behavioral health claims must list both billing and rendering provider NPIs and taxonomy codes.
- Missing or incorrect information will result in claim rejections or denials.
- Taxonomy codes and NPIs will be validated against NPPES for accuracy.
When It’s Effective
The official effective date will be announced in Q1 2026. Optum is giving providers ample time to prepare, so your billing workflows can be updated well before enforcement begins.
October 2025: Informational Edits Begin
To help practices prepare, Optum will begin issuing informational edits in October 2025.
These edits will flag any missing or misplaced rendering provider NPI or taxonomy data, but won’t stop claims from being paid.
Think of this as a “soft launch” before full enforcement in 2026 — a chance to fix your systems and avoid future denials.
Where to Include NPI and Taxonomy Codes
Electronic Claims
- Form type: 837P (Professional) or 837I (Institutional)
- Loops: 2310 and 2420
- Payer ID: 87726
- ERA Payer ID: 86047
Paper Claims
- Professional claims: Boxes 24I and 24J
- Institutional claims: Boxes 76 and 81
Tip: Rendering provider information is required only if it differs from the billing provider.
Action Steps for Providers
- Verify your NPI and taxonomy in NPPES to ensure accuracy and correct primary designation.
- Update your EHR or billing software so both codes automatically populate in the required fields.
- Test your submission workflows during the October 2025 informational edit period.
- Stay alert for Q1 2026 updates announcing the exact enforcement date.
Why It Matters
Claims missing this information will soon be denied, leading to:
- Extra administrative work
- Delayed reimbursements
- Cash flow disruption
By preparing now, you’ll avoid rejections and keep your revenue cycle running smoothly.
Bottom Line
Optum Behavioral Health’s upcoming billing change is part of a broader shift toward standardized, federally compliant claim submissions. Starting in 2026, every Commercial behavioral health claim must include NPI and taxonomy codes for both billing and rendering providers.
Prepare early — test your systems during the October 2025 edit period to avoid denials next year.
Portia Software
Our Engineering Team is working on development to house taxonomy codes within provider profiles and populate on claims prior to the January 1, 2026 deadline that UnitedHealthcare has set forth.
For our Self Serve Billing Client, we recommend proactively requesting a business rule through the partnered Inovalon clearinghouse via the Help Center. It will be required for all providers to be listed under Settings > Entities with their applicable NPI and Taxonomy codes for a valid business rule to be applied to future claims.
For our Full Serve Billing Clients, no need to worry, the Portia Team has already taken care of this!
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