August 03, 2018
Area(s) of Interest: Commercial Payors Payor Issues and Reimbursement Practice Management
UnitedHealthcare (UHC) will implement its Smart Edits program for professional claims for all of its commercial, Medicare Advantage and Community Plans effective August 16, 2018. UHC notified physicians in its 2018 United Healthcare network bulletin that it would implement Smart Edits, a new functionality introduced into the electronic data interchange (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 correction. Providers will have five calendar days to correct the claim and resubmit it, thereby 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.
Additionally, UHC will further expand the number of live Smart Edits on September 10, 2018. The list of “Active Smart Edits” and their descriptions are available under “Helpful Resources” at UHCprovider.com/ace.
Physicians experiencing issues with Smart Edits should contact UHC EDI Support online via the EDI Transaction Support Form, by email at SupportEDI@uhc.com or by calling (800) 842-1109.