Smart Edits
This is a claims optimization tool that identifies claim billing errors and provides the opportunity to review and repair problematic claims. Smart Edits are reported within 24 hours of claim submission so timely adjustments can be made to avoid claim denials.
Smart Edits Updates
Frequently asked questions
What are Smart Edits?
Smart Edits detect claims with potential errors within electronic claims and send a message back within 24 hours explaining why. Smart Edits also provide direction on how to resolve for resubmission via the 277CA clearinghouse rejection report.
What do they communicate?
A message on your 277CA clearinghouse rejection report will explain why the claim was flagged and provide direction on how to resolve and resubmit the claim.
The message will always begin with P4999, followed by the edit mnemonic, which is a short combination of letters that identifies a unique edit.
Smart Edits are designed to identify the specific error that triggered the edit. An example Smart Edit message is:
- P4999mPI SmartEdit (mPI): Per the Medicare Physician Fee Schedule, Procedure Code [XXXXX] describes a physician interpretation for this service and is inappropriate in Place of Service [XX].
What are the EDI codes?
The status codes found on your 277CA are a way for you to identify the different types of Smart Edits. Each type of Smart Edit has a unique status code to help you organize your workflow.
- A3:21 will indicate a Return Edit
- A7:21 will indicate a Rejection Edit
- A3:54 will indicate a duplicate claim rejection
- A7:85 will indicate a COB claim rejection
- A1:19 will indicate an Informational Edit
- R1:294 will indicate a Documentation Edit
How many are there?
There are 4 types of Smart Edits that define what specific action is needed from you: Return Edits, Rejection Edits, Documentation Edits and Informational Edits. The message will always begin with P4999, followed by a short combination of letters that identifies the required edit.
Where will they appear?
A message on your 277CA clearinghouse rejection report will explain why a claim was flagged and provide direction on how to resolve and resubmit the claim.
If you have questions, contact your EDI vendor or clearinghouse for help.
If you need further assistance from UnitedHealthcare, visit our EDI page.
