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November 2018: New Smart Edits and Enhanced Payer/Provider Collaboration

In the August Network Bulletin, we introduced you to UnitedHealthcare’s Smart Edits, which identify and return claims with potential errors before they enter the claims processing system. Medicare edits went live on Aug. 16, 2018, and additional Commercial and Medicaid edits went live on Oct. 4, 2018. The list of active Smart Edits and their descriptions is available at UHCprovider.com/ace.

Among the features of Smart Edits:

  • 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.
  • Providers are encouraged to make recommended changes and re-submit the claim within five calendar days to minimize the potential denials or rework. However, if the returned claims are not acted on during the grace period, claims will be released for processing.
  • Go to UHCprovider.com/ace for information related to EDI Claims and Smart Edits. 

UnitedHealthcare is also offering an ACE Smart Edits Training series on UHC On Air. The first training session provides an overview of UnitedHealthcare Smart Edits. Topics include:Smart Edits overview

  • How to interact with Smart Edits
  • Where to go if you have additional questions about Smart Edits 

Follow these steps to access the ACE Smart Edits Training Series:

  • Sign in to Link by going to UHCprovider.com and clicking on the Link button in the top right corner.
  • Select the UHC On Air tool on your Link dashboard, then choose the UHC News Now Channel, and then ACE Smart Edit to view content. 

If you have questions about UHC On Air and how to access Smart Edit training content, send an email to uhconair@uhc.com.

To help ensure a smooth experience with Smart Edits, we’re collaborating with clearinghouses and care provider groups to design edits and workflows with you in mind. We’re also building out a care provider outreach program to communicate with individual provider groups about how they can best use Smart Edits to increase accurate claims submissions and decrease denials.