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Electronic Data Interchange (EDI)

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?,open_in_new and EDI Connectivityopen_in_new and EDI Overview. open_in_new

Benefits of EDI

  • Exchange information with multiple payers
  • Increase productivity and lower administrative costs
  • Send and receive information faster
  • Identify submission errors immediately and avoid process delays

Want to see the average cost and savings opportunity per transaction? View the CAQH index for details (pg 51)open_in_new.

EDI transactions and code sets


Find detailed information and additional resources by transaction type.

View EDI transactions

UnitedHealthcare Payer Lists

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:

  • Claims Payer List:open_in_new Indicates Payer IDs for UnitedHealthcare, affiliates and strategic partners, including payers that accept secondary claims electronically and those that apply Smart Edits
  • ERA Payer List:open_in_new Indicates Payer IDs to use for EDI 835 ERA delivery directly to your PMS or HIS

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.

How to get connected

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:

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You can use any clearinghouse with a connection to UnitedHealthcare for EDI transactions. Before choosing a clearinghouse, review EDI Clearinghouse Options to:

  • Help determine the EDI needs of your practice or facility
  • Avoid clearinghouse fees if UnitedHealthcare is considered a non-participating payer

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).

  • DDE can be used for professional (CMS-1500) claims and institutional (UB04) claims, as well as other EDI transactions

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:

  1. If not signed in, click Sign In at the top-right corner to access the UnitedHealthcare Provider Portal
  2. Enter your One Healthcare ID
  3. Skip to step 2 if you already have a One Healthcare ID
  4. Request setupopen_in_new for iEDI to be added to your UnitedHealthcare Provider Portal dashboard
  5. Send an email to edisales@optum.com if you have issues with registration

*Excludes Harvard Pilgrim, The Alliance and NDC Home Infusion Specialty Pharmacy Claims

EDI support and resources

We have a variety of helpful pages and documents to help guide you through the EDI process.
 

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Optum Support: Call 866-678-8646 (866-OPTUM GO) for support with EDI solutions, sales, technical support and enrollment or Contact usopen_in_new.