Using Electronic Data Interchange (EDI) for all eligible UnitedHealthcare transactions can help your organization improve efficiency, reduce costs and increase cash flow. Not sure what EDI is or want to learn more about EDI connections? Check out our resources and guides: What is EDI?, and EDI Connectivity and EDI Overview.
Want to see the average cost and savings opportunity per transaction? View the CAQH index for details (pg 48).
EDI transactions are routed to payers using a Payer ID based on the transaction type. The member’s ID card will indicate the Payer ID to use for claims submissions. If applicable, medical Payer IDs refer to professional and institutional claim submissions; dental is listed separately.
You can find Payer IDs in the following payer lists:
Please note: Your clearinghouse will also have a payer list that may or may not exactly match with our payer list. Ours also contains former brand and plan names, as well as comments that may help you choose the correct Payer ID. Contact your clearinghouse if your current Payer IDs aren’t on their payer list.
EDI transactions can be submitted to multiple payers from your practice management system (PMS) or hospital information system (HIS) through a clearinghouse. Some clearinghouses offer online solutions that allow you to upload data from your software system or manually enter the information online to generate a transaction. We offer the following connectivity options:
You can use any clearinghouse with a connection to UnitedHealthcare for EDI transactions. Before choosing a clearinghouse, review EDI Clearinghouse Options to:
You can use this multi-payer web service and clearinghouse solution for all your EDI transactions. Submit transactions directly to Optum by using data from your PMS or HIS, or manually enter the data using Direct Data Entry (DDE).
Optum iEDI is free* for UnitedHealthcare transactions and simplifies the process from patient check-in to payment posting. It’s accessible through UnitedHealthcare Provider Portal, once registration is complete.
Follow steps below to sign up for iEDI:
*Excludes Harvard Pilgrim, The Alliance and NDC Home Infusion Specialty Pharmacy Claims
We have a variety of helpful pages and documents to help guide you through the EDI process.
Optum Support: Call 866-678-8646 (866-OPTUM GO) for support with EDI solutions, sales, technical support and enrollment or Contact us.