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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.

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.

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.

Questions?

Do you have questions about HIPAA Claim Edits or Smart Edits?

First, contact your EDI vendor or clearinghouse for help answering questions about HIPAA or Smart Edit claims.

If you need assistance from UnitedHealthcare, see our EDI Contacts page.