UHC Expanding Smart Edits EDI Capability to Identify Potential Billing Claim Errors

United Healthcare (UHC) released a new claims optimization tool in the electronic data interchange (EDI) workflow to identify potential billing claim errors.

Known as Smart Edits, this EDI capability sends a message to the submitting care provider within 24 hours to explain why the claim was returned and to offer steps to resolve the issue. This follows the same process as that used to communicate Health Insurance Portability and Accountability Act edit rejections. Because Smart Edits are delivered using the 277CA clearinghouse rejection report, no special software is needed.

UHC originally adopted Smart Edits in September 2017 for 837P (professional claims) for a small number of its commercial plans. The insurer is now extending Smart Edits to care providers for all lines of business to reduce the need for rework and make faster payments, with the ultimate goal of collaboration between UHC and care providers.

The four types of Smart Edits are return edits, rejection edits, documentation edits, and informational edits. Because one claim can result in multiple Smart Edits, all edits must be corrected to avoid the partially corrected claim being returned. For any line being submitted for relative value unit tracking purposes rather than reimbursement, UHC recommends billing these claim lines at $0.03 or less to bypass Smart Edits.

To learn more about instructor-led training and interactive courses and to access support, visit the UHC provider website.

Sources:
https://osteopathic.org/index.php?aam-media=/wp-content/uploads/United-Smart-Edits.pdf