Many health care professionals choose to submit electronic transactions to UnitedHealthcare through a clearinghouse. Clearinghouses facilitate the transfer of electronic transactions between payers and physicians, health care professionals or facilities. They offer multi-payer solutions, batch transactions and direct data entry.
Clearinghouses often integrate with practice management or hospital information systems to eliminate time spent keying information into multiple programs or requesting/submitting transactions individually.
We recommend you research clearinghouses and their capabilities to determine which ones best meet your needs and can integrate with your existing software systems.
Some questions you may want to consider include:
UnitedHealthcare interacts with many clearinghouses and doesn't endorse a specific one. However, most of our EDI transactions go through Optum, an affiliate of UnitedHealthcare. Optum also interacts with many clearinghouses.
You may experience additional costs to submit UnitedHealthcare claims electronically if we are considered a non-participating payer with your clearinghouse. Although this isn’t common, we want to make sure you know how to avoid additional costs (or paper submissions) when you submit Electronic Data Interchange (EDI) 837 claims to us.
Submitting EDI Claims
If your clearinghouse classifies UnitedHealthcare as a non-participating payer and charges fees to submit claims electronically, please consider using the following options: