New Type of Smart Edits

Catching billing errors within claims can be a daunting task. Smart Edits is a claims processing tool that can help you catch, and in some cases resolve, claims errors before a claim is processed. If the information within your claim triggers a Smart Edit, you will see an edit message on your 277CA clearinghouse rejection report within 24 hours of submitting a claim.

With over 200 Smart Edits, we’d like to make it easy to distinguish what the different types of Smart Edits are, and how you interact with them to help reduce denials. Here is some information to help with three main areas:

Return Edits

• These edits are sent when a claim you submitted that may be delayed or denied due to potential billing errors.
• What do I do with return edits?
  • You can resolve and resubmit the claim within five calendar days, before your claim is automatically processed as originally submitted.

NEW Rejection Edits

• Starting in August 2020, these edits will be sent when:
  • claims are automatically returned due to duplicate claims
    
  • or if the claim didn’t include a valid CLIA certification number
    
• What do I do with rejection edits?
  
  • If you have a duplicate claim, no action is needed.
    
  • If you receive the CLIA edit, you should submit a new claim with a valid CLIA certification number.
    
    • These CLIA edits were previously return edits and include the following Smart Edit mnemonics: uIBC, uISC, and uMCID
      

Informational Edits and Banners

• These are sent to provide you with additional information on upcoming reimbursement policy changes or other resources for more information.
• What do I do with informational edits/banners?
  
  • Please review the additional information provided to support our common goal of reducing claims errors.
    

For more information, please review the self-paced interactive guide or reach out to EDI Support at 800-842-1109 or SupportEDI@uhc.com.