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August 2018: New Smart Edits Deploying on Aug. 16 and Sept. 10

In the April and May Network Bulletins, we introduced you to UnitedHealthcare’s Smart Edits. On Aug. 16, 2018, Smart Edits will go live for professional claims for all UnitedHealthcare commercial, Medicare Advantage and Community Plans that submit to Payer ID 87726. On Sept. 10, 2018, UnitedHealthcare will further expand the number of live edits. The list of “Active Smart Edits” and their descriptions is available under “Helpful Resources” on the Smart Edits landing page at UHCprovider.com/ace

Among the features:

  • Smart Edits are delivered via the industry standard EDI 277CA clearinghouse rejection report. There’s no need to install new software. Simply check your rejected claims report to find the Smart Edit.
  • You’ll have five calendar days to correct and resubmit claims returned by Smart Edits. If you don’t take any action within five days, the original claim will be released for processing.

What are Smart Edits?

UnitedHealthcare’s Smart Edits solution identifies and returns claims with potential errors before they enter the claims processing system. This way, you can review problematic claims in a matter of hours instead of getting denials days later. Smart Edits are expected to increase the rate of clean and complete claims you submit, help improve the claims processing time, and reduce claims denials and resubmissions. Interacting with Smart Edits helps you submit accurate, complete claims more quickly, reducing potential claims denials or rework. 

Smart Edit messages explain why the claim was returned and provide direction on how to correct the claim for re-submission. The explanation won’t affect the process you use to correct a returned claim. Re-submit the claim electronically with the modifications suggested by Smart Edit notifications to minimize potential denials or rework.

Not sure what payer ID you submit to? Find out by checking our payer list at UHCprovider.com/content/dam/provider/docs/public/resources/edi/Payer-List-UHCAffiliates-Strategic-Alliances.pdf.

Want more information on Smart Edits?

Visit UHCprovider.com and search for Smart Edits. If you experience problems with Smart Edits, please contact EDI support online using the EDI Transaction Support Form, by email at SupportEDI@uhc.com or call 800-842-1109