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EDI 837: Electronic Claims

Establishing an EDI connection to submit claims has never been easier. UnitedHealthcare offers many solutions to support you in meeting the compliance standards and requirements for filing claims electronically. We encourage you to set up an EDI connection today and begin enjoying the benefits of faster payment cycles and increased claim processing accuracy.

Check our Claims Payer List to ensure you have the capability to file all UnitedHealthcare claims electronically through an EDI connection.

Claim Submission Methods

  • Practice Management System (PMS) and Hospital Information System (HIS): Software used by physicians or facilities for scheduling, registration, billing and account receivables management. Claim files can easily be created in batch or individually for electronic submission. Submit claims directly from the system or upload claim files to another source for transmission to payer(s).
  • Direct Data Entry (DDE): Usually used for smaller practices or facilities, Direct Data Entry solutions are ideal for those without a Practice Management System who want to submit claims electronically. Direct Data Entry lets you key information into an online claim form for electronic submission.
  • Clearinghouse: A clearinghouse functions as the intermediary who accepts electronic claims from care providers and forwards them to insurance payers. Claims received by clearinghouses are checked for errors, validating the information required both by HIPAA and the payer. This review process is called claim scrubbing and helps to prevent time-consuming processing errors.

Claim Submission Connections

  • Clearinghouse: UnitedHealthcare accepts both participating and non-participating professional (CMS-1500) and institutional (UB-04) claims electronically from clearinghouses, submitted as 837P and 837I transactions. You may use any clearinghouse with a connection to UnitedHealthcare for claim submissions. 
    • Before selecting a clearinghouse, review the Clearinghouse Options to help determine the EDI needs of your practice or facility.
  • Optum Intelligent EDI: A multi-payer web service and clearinghouse solution where you can submit UnitedHealthcare professional and institutional claims electronically at no cost. Enter claim information into an online claim form or upload claims from a practice management or hospital information system. Dashboard reporting provides real-time reports to manage claims quickly and easily. Learn more about Optum Intelligent EDI. 
    • To get started with Optum Intelligent EDI, call 866-367-9778, and select option 3. 
    • Excludes Harvard Pilgrim, The Alliance, TRICARE West and NDC Home Infusion Specialty Pharmacy Claims; charges apply for an all-payer solution.
  • Registered users of Link can securely submit professional (CMS-1500) claims by entering the information on our online claim form.