August 08, 2022

New Smart Edit for commercial plans

Effective Aug. 25, 2022, a new Smart Edit will be available for commercial plans to help with coordination of benefits when you submit a claim.

How the new Smart Edit works
When you submit a claim for a member who has a commercial plan and primary health insurance with another carrier, you’ll receive 1 of the following 3 messages on your 277 Claims Acknowledgement report within 24 hours of submission:

  1. REJECT – This patient has primary insurance coverage with <other insurance name>, <effective Date>. Please resubmit as electronic secondary once adjudicated by the primary payor.
    a. You’ll receive this message if we have the primary health insurer’s name and effective date, but don’t have the other carrier’s EOB.
  2. REJECT – This patient has primary insurance coverage with another carrier with <effective date>. Please resubmit as electronic secondary once adjudicated by the primary payor.
    a. You’ll receive this message if we have the effective date, but don’t have the other carrier’s name or EOB.
  3. REJECT – This patient has primary insurance coverage with another carrier. Please resubmit as electronic secondary once adjudicated by the primary payor.
    a. You’ll receive this message if we’re missing the carrier’s name, effective date and EOB.

What is the Smart Edits tool?
We developed the Smart Edits tool to identify billing errors within a claim so you can quickly review and repair problematic claims. We send these messages within 24 hours of a claim submission so you can review identified claims in a matter of hours instead of potential claims denials days later.

Claims that are accurately submitted and in compliance with the latest policies and regulations result in less rework, quicker approvals and faster payments.

Learn more

  • For information on how to submit the primary payer EOB online, visit UHCprovider.com/ediclaimtips > Secondary/COB or Tertiary Claims and Medicare Crossover > COB Electronic Claim Requirements – Commercial 
  • Visit UHCprovider.com/smartedits to:
    • See the list of all available Smart Edits by selecting Smart Edits Guide
    • Take a self-paced training by selecting Smart Edits interactive guides

Questions?

  • For information about Smart Edits claims, please contact your electronic data interchange (EDI) vendor or clearinghouse
  • For additional help from us, visit our EDI Contacts page on UHCprovider.com
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