01/2020: Bringing You Smart Edits in the New Year

In an effort to continuously support care providers in our network, UnitedHealthcare offers a claims optimization tool called Smart Edits. The Smart Edits tool detects and flags errors within 24 hours of submitting a claim, prompting a Smart Edits message on your 277CA clearinghouse rejection report. You can correct the claim by responding to the Smart Edits message.

In 2020, you may receive a new type of Smart Edit called Documentation Edit, which alerts you when a submitted claim requires additional information before processing. The Documentation Edit will describe what supporting documentation is required and the appropriate format, which you can then submit using Claims (on Link). The claims process will be paused for five calendar days, allowing you to resolve the claim before it’s processed. If documentation is not submitted within these five days, the claim will be released into UnitedHealthcare’s claims processing system as originally submitted. If you receive a Documentation Edit, it will be indicated by status code R1:294 on your 277CA clearinghouse rejection report. Status codes are a quick way to navigate your clearinghouse rejection report to see what Smart Edits you have received.

In addition to our new Documentation Edit, here are the current types of Smart Edits you may see on your 277CA clearinghouse rejection report:

A Return Edit is sent when the claim in question is likely to result in a denial, potential medical record requests or potential future overpayment requests. The claims process will be paused for five calendar days, allowing you to resolve and resubmit the claim before it’s processed. If you receive a Return Edit, a status code of A3:21 will be displayed on your clearinghouse rejection report.

An Informational Edit notifies you of key information in the claim submission process or about upcoming changes that require your attention, such as a change in a reimbursement policy. Informational Edits do not pause the claims process, but are sent to provide you with important information. A status code of A1:19 will be displayed on your 277CA clearinghouse rejection report if you receive an Informational Edit.

An Informational Banner is intended to provide resources for further information on Smart Edits and the associated policies. Claims receiving Smart Edits will have an Informational Banner placed at the claim level. A status code of A1:19 will be displayed on your 277CA clearinghouse rejection report and will not pause the claims cycle.

For more information on how Smart Edits can speed up your claims cycle, visit UHCprovider.com/smartedits