EDI Benefits

Using EDI to exchange information with UnitedHealthcare and other payers may benefit your practice or facility in several ways.

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Care providers typically experience quicker turnaround times with EDI. For example, a payer can receive your claim the same day you send it. In addition, an eligibility inquiry can be received and responded to in seconds.

Electronic claims are automatically checked for HIPAA and payer-specific requirements at the vendor, clearinghouse and payer levels. This process decreases the number of reasons a claim may be rejected by the payer. This same level of automated data verification cannot be performed on paper claims.

EDI lets you execute various transactions for multiple payers at one time. Transactions can be set up to automatically generate as part of your daily workflow. For example, your system could perform a claim status inquiry at the same time as it sends eligibility inquiries to verify a member’s benefit coverage and copayment.

Payers receive electronic transactions in real time. This eliminates mail time and the cost of postage and envelopes. EDI is also good for the environment because it reduces the volume of paper you receive from UnitedHealthcare and other payers. Receiving electronic confirmation of claim submissions, electronic remittance advice (ERA/835), electronic funds transfer (EFT) and other EDI transactions can save trees and time.

Integrating EDI into your office workflow and software systems may have a positive impact on your bottom line. Automating electronic transactions such as eligibility enables you to have current coinsurance, deductible and benefit information readily available while the patient is present, and before filing the claim. All EDI transactions may help increase your cash flow due to the expediency and accuracy of information exchanged.

Whether you want to cut down on purchases (paper forms, supplies and postage) or save time phoning, faxing, printing, sorting and stuffing envelopes, EDI may increase productivity and lower costs.

The information returned by EDI comes from the same system used by our representatives to answer calls. Many of the calls we receive at UnitedHealthcare can be answered by performing one of the following EDI transactions:

  • Eligibility (270/271)
  • Claim status (276/277)
  • Notifications (278N)

CAQH, a nonprofit alliance, is the leader in creating shared initiatives to streamline the business of health care. The 2023 CAQH Index shows that the average cost to conduct transactions manually is consistently higher than the cost of electronic transactions for care providers and health plans. View the complete CAQH Index for more details. 

Below is Table 1 in the 2023 CAQH Index. This table shows the average cost and savings opportunity per transaction for health plans and providers, related to manual and electronic transactions.

  • If you have a practice management or hospital information system, please contact your software vendor to determine what electronic transactions are offered.
  • Contact clearinghouses to review which electronic transactions can interact with your software system. Read our Clearinghouse Options page for ideas.

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