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 1. Home
 2. Resource Library
 3. Electronic Data Interchange
 4. Smart Edits

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SMART EDITS

This is a claims optimization tool that identifies claim billing errors and
provides the opportunity to review and repair problematic claims. Smart Edits
are reported within 24 hours of claim submission so timely adjustments can be
made to avoid claim denials.


SMART EDITS 101

Learn what the different types of Smart Edits are, what they mean and what
actions you can take to respond to them.
Take course open_in_new



INTERACTIVE COURSES

Discover how Smart Edits can auto-detect claims with potential errors. Learn
where they’re found, the time frame for responding and step-by-step instructions
on how to do so. 

Find a course


FREQUENTLY ASKED QUESTIONS

Expand All add_circle_outline
WHAT ARE SMART EDITS?

expand_more

Smart Edits detect claims with potential errors within electronic claims and
send a message back within 24 hours explaining why. Smart Edits also provide
direction on how to resolve for resubmission via the 277CA clearinghouse
rejection report.

Learn more
WHAT DO THEY COMMUNICATE?

expand_more

A message on your 277CA clearinghouse rejection report will explain why the
claim was flagged and provide direction on how to resolve and resubmit the
claim.

The message will always begin with P4999, followed by the edit mnemonic, which
is a short combination of letters that identifies a unique edit.

Smart Edits are designed to identify the specific error that triggered the edit.
An example Smart Edit message is:

 * P4999mPI SmartEdit (mPI): Per the Medicare Physician Fee Schedule, Procedure
   Code [XXXXX] describes a physician interpretation for this service and is
   inappropriate in Place of Service [XX].

WHAT ARE THE EDI CODES?

expand_more

The status codes found on your 277CA are a way for you to identify the different
types of Smart Edits. Each type of Smart Edit has a unique status code to help
you organize your workflow. 

 1. A3:21 will indicate a Return Edit
 2. A7:21 will indicate a Rejection Edit
    * A3:54 will indicate a duplicate claim rejection
    * A7:85 will indicate a COB claim rejection
 3. A1:19 will indicate an Informational Edit
 4. R1:294 will indicate a Documentation Edit

HOW MANY ARE THERE?

expand_more

There are 4 types of Smart Edits that define what specific action is needed from
you: Return Edits, Rejection Edits, Documentation Edits and Informational Edits.
The message will always begin with P4999, followed by a short combination of
letters that identifies the required edit.

WHERE WILL THEY APPEAR?

expand_more

A message on your 277CA clearinghouse rejection report will explain why a claim
was flagged and provide direction on how to resolve and resubmit the claim.

Who do I contact for assistance?
expand_more

If you have questions, contact your EDI vendor or clearinghouse for help.

If you need further assistance from UnitedHealthcare, visit our EDI page.




RESOURCES


SMART EDITS GUIDE

View a complete list of Smart Edits and additional information to help guide you
to our policies about them.

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CLAIMS PAYER LIST

Find out what additional Payer ID numbers receive Smart Edits. 

View list open_in_new


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TEXAS MEDICAID: STAR+PLUS BILLING UNIT CHANGE

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UPDATE ON VIRTUAL CARD PAYMENT SERVICES

Read Full Update


NEW JERSEY: PROVIDERS ARE REQUIRED TO BE REGISTERED WITH MEDICAID

Read Full Update




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