The following tips cover topics that care providers frequently ask about. They may help you understand and resolve any issues that may occur with electronic claim submissions.
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For secondary professional or institutional claims to be paid electronically, the COB information must be submitted in the applicable loops and segments.
Loops IDs include:
To learn more about submitting secondary/COB claims electronically to UnitedHealthcare, please consult your vendor, 837P/837I Implementation Guide, or our Companion Guides page for eCOB specifications.
Secondary or tertiary professional and institutional claims can be submitted electronically. This process is commonly referred to as eCOB (electronic Coordination of Benefits).
If sending these types of claims correctly in an electronic format, the paper EOB is not needed by UnitedHealthcare.
Claims from participating and non-participating physicians and facilities are accepted electronically.
Primary, secondary, and tertiary claims can be submitted electronically to UnitedHealthcare.
For secondary/COB claims, this includes UnitedHealthcare as secondary payer for a commercial claim as well as secondary to Medicare. See the Secondary/COB or Tertiary Claims section for additional information.
Professional/Physician (CMS-1500) and Institutional/Hospital (UB-04) claims are accepted electronically by UnitedHealthcare.
All payers receiving electronic claims have one or more Payer ID numbers that indicate where claims are routed, similar to an electronic mailing address. A Payer ID must be indicated to file a claim electronically. Read more on Understanding Payer IDs.
View the Payer List for UnitedHealthcare, Affiliates and Strategic Alliances to learn more about which Payer IDs to use for various UnitedHealthcare plans.
Some software vendors or clearinghouses create their own list of Payer IDs to use for each payer.
If Payer IDs in your software system do not look similar to Payer IDs published by the payer, you should ask your vendor for their proprietary payer list indicating what Payer ID to use for claim submissions.
Submit anesthesia claims with minutes, not units.
The ASC X12 Version 5010 format for electronic claims includes specific address location requirements that apply to 837 claim transactions. The address field, required usage and transaction location are:
Submit on all institutional claims in order to facilitate claim adjudication.
Required on all claims. Can be a minimum of nine or maximum of 16 alphanumeric or numeric characters.
Include both the Tax ID and NPI number on claim to promote timely and accurate payments.
When adding new payers to your system, immediately determine the Payer ID and set up claims for electronic submission. Even if there is low volume for that payer, all claims submitted electronically are received by the payer quicker and will save you time and money.
For more information on identifying what Payer ID to use, refer to the Payer ID section on the Quick Tips home page.
When adding new members in your system, you will be also be including their insurance information. Immediately set the insurance carrier to receive claims electronically. Most member ID cards include the electronic Payer ID.
If payers are in your computer system several times due to multiple street addresses, verify all are routed to an electronic Payer ID. Payers may have multiple street addresses yet use the same Payer ID for electronic claim submissions.
If primarily filing claims electronically, it may only be necessary to keep track of Regional Mailing Offices (RMO) for payers instead of all individual street addresses. Street addresses are only necessary if filing a claim on paper.
Contact payers to determine if they have RMO addresses for claims that cannot be sent electronically and eliminate the number of times one payer may be listed in your system.
The spelling of payer names in software systems may vary to distinguish one payer from another or to identify specific plans, addresses or other information related to the same payer.
Please review these periodically to verify they are still necessary. Set all variances of payer names for electronic submission instead of paper.
Payer tables in your computer system should be set to generate electronic claims instead of paper claims.
Your software vendor or clearinghouse may need to be contacted for instructions or further information on making changes to your Practice Management System or Hospital Information System.
Do not delete information without making sure it doesn't affect another area within your system.
To search the status on a claim with UnitedHealthcare, the claim must pass all format requirements with no rejections. Once it enters our processing system for adjudication, we will return an acknowledgement that your claim has been accepted. It should then be available for query as a Claim Status search.
Customer Service can only find claims that have passed all electronic edits and accepted into UnitedHealthcare's claim payment system. Once UnitedHealthcare returns an acknowledgement that your claim has been accepted, it will be accessible to UnitedHealthcare Customer Service and Claim Status search.
If a claim filed electronically appears to be missing, this usually means that the claim was rejected either from your software vendor, clearinghouse or the payer. Rejected claims are:
To locate a missing or rejected claim, refer to the Rejection Reports section. If a claim has been rejected for any reason, it must be corrected and resubmitted electronically for acceptance into the payer's processing system for adjudication.
If you are submitting professional or institutional claims electronically through your vendor or clearinghouse, your vendor or clearinghouse should be returning two levels of rejection reports to track progress of electronic claims submissions:
Finding, correcting and resubmitting rejected claims is important to avoid timely filing delays or denials. If you are not receiving electronic claim reports, contact your vendor or clearinghouse.
Some services or procedures performed by providers might not have specific CPT or HCPCS codes. When submitting claims for these services or procedures that are not otherwise specified, unlisted codes are designated. Unlisted codes provide the means of reporting and tracking services and procedures until a more specific code is established.
If you’re submitting EDI claims with an unlisted service code, up to 80 characters of notes can be sent at the claim and service line level for the following loops and segments:
Consult your vendor or the 837 implementation guide for fields required in the loop and segment.
Professional and institutional claims with unlisted codes can be submitted electronically to UnitedHealthcare.
Reports from your clearinghouse and the payer should be delivered to your software system so you can track which claims were rejected and which were accepted. If you file claims electronically and are not receiving these reports both from the clearinghouse and the payer, please contact your software vendor.
Electronic claim reports should be received for all claim batches submitted. These reports identify claim rejections, which must be resolved and resubmitted with requested information before the payer ultimately accepts the claim for adjudication. This process allows the payer to receive a clean claim, resulting in timely processing and payment. Where you locate these reports and how to retrieve them should be specified by your vendor, clearinghouse or company that maintains the system you use to file claims electronically.
Some clearinghouses enable you to track all electronic claims through a website, rather than by monitoring individual reports that may be delivered to your system mailbox. Check with your clearinghouse to see if they offer this service.
Claims that are rejected do not enter the payer's claim processing system. Corrections are usually made in your computer system and the claim resubmitted electronically. To learn more about rejected claims, see the Missing Claims section.
Eligibility inquiries can reduce claim rejections, especially if run before the initial claim submission. See the Eligibility and Benefit Inquiry and Response page for more information.