UnitedHealthcare implements Smart Edits into the EDI claim process

June 06, 2018
Area(s) of Interest: Payor Issues and Reimbursement Practice Management 

In the April 2018 UnitedHealthcare (UHC) network bulletin, UHC notified physicians that it would implement Smart Edits, a new functionality introduced into the EDI workflow, allowing the payor to autodetect claims with potential errors in the claims pre-adjudication phase. Once a potential error has been identified, UHC will notify the physician (via the 277CA report) within 24 hours, returning the claim to the provider along with a suggested modification to overcome the problem. Providers will have five calendar days to correct the claim and resubmit it, reducing the potential for a denial. Claims that are not corrected and acted upon during the five calendar day grace period will be released for processing as originally submitted.

Smart Edits are currently being applied to a limited number of commercial, professional claims submitted electronically under Payer ID 87726. A complete list of UHC affiliates and products implementing Smart Edits can be found here.

The list of active and retired Smart Edits can be found on the UHCprovider.com website.

Physicians experiencing issues with Smart Edits should contact UHC EDI Support online via the EDI Transaction Support Form, at SupportEDI@uhc.com or (800) 842-1109.


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