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EDI Clearinghouse Options

Many health care professionals choose to submit electronic transactions to UnitedHealthcare through a clearinghouse. Clearinghouses facilitate the transfer of electronic transactions between payers and physicians, health care professionals or facilities. They offer multi-payer solutions, batch transactions and direct data entry.

Clearinghouses often integrate with practice management or hospital information systems to eliminate time spent keying information into multiple programs or requesting/submitting transactions individually.

We recommend you research clearinghouses and their capabilities to determine which ones best meet your needs and can integrate with your existing software systems.

Some questions you may want to consider include:

  • Do you need the ability to submit more claim types electronically?
  • Do you want an automated system for electronic eligibility, claim status and notification transactions?
  • Would you like to file secondary claims electronically?
  • Would you like to have secondary electronic claims automated?
  • Are you receiving electronic remittance statements and electronic funds transfers?
  • Does your system automatically post payments?

UnitedHealthcare interacts with many clearinghouses and doesn't endorse a specific one. However, most of our transactions go through OptumInsight, a clearinghouse owned by Optum, an affiliate of UnitedHealthcare. Optum also
interacts with many clearinghouses.