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HIPAA Claim Edits

EDI Claim Edits

EDI Claim Edits EDI Claim Edits

UnitedHealthcare applies HIPAA edits to professional (837P) and institutional (837I) claims submitted electronically. These edits help you send a cleaner claim for faster processing.

New Payer Level (277CA) Edits

New edits will be applied to EDI 837 claim submissions that identify claims submitted with information that may be missing or doesn’t match data in our systems.

A detailed description is provided for each edit beyond the standard messaging noted on the 277CA (claims acknowledgment) rejection report. View the list for help with correcting the claim and resubmitting electronically.

HIPAA claim edits apply to all plans and Payer ID numbers on our Claims Payer List, except:

  • Harvard Pilgrim (04271)
  • The Alliance (88461)

We validate and apply HIPAA claim edits before the claim is processed. This means rejections that may occur will appear at a clearinghouse level so you can identify and correct rejected information before we accept and process the claim.

We periodically update the claim edit list and note changes, additions or deletions by date in the legend at the bottom of the last page.

Helpful Resources

  • Questions about Claim Edits or Smart Edits?  Contact your EDI vendor or clearinghouse for assistance.
  • For information on electronic claim reports, go to UHCprovider.com/ediclaimtips > Tracking your electronic claims 
  • View UHCprovider.com/edicontacts for EDI Support from UnitedHealthcare

Smart Edits: Let’s speed up claims processing, together.

Smart Edits is a claims optimization tool that identifies potential billing errors within a claim and allows care providers the opportunity to review and repair before the claim is processed.

Smart Edits are sent within 24 hours of a claim submission, so you can review identified claims in a matter of hours instead of potential claims denials days later.

Learn More