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 1. Home
 2. Resource Library
 3. Electronic Data Interchange (EDI)
 4. Smart Edits and Documentation Edits

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SMART EDITS AND DOCUMENTATION EDITS

Claims submitted digitally using the UnitedHealthcare Provider Portal or
Electronic Data Interchange (EDI) are processed through our optimization tools
to help identify billing errors and documentation requests. If identified,
potential edits to your claims are reported within 24 hours of submission, so
you can make timely adjustments to avoid claim denials.




WHAT EDITS ARE AVAILABLE?


SMART EDITS

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.




DOCUMENTATION EDITS

Documentation Edits detect claims that require medical documentation.
Notification is sent by email, TrackIt within the portal, and EDI. Documentation
Edits will also provide direction on how to submit the required medical
documentation through the portal or the 277CA clearinghouse rejection report.



Expand All add_circle_outline
What do Smart Edits 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 Smart Edit (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 Smart Edit type has a unique status code to help you
organize your workflow. 

 * A3:21 indicates a Return Edit
 * A7:21 indicates a Rejection Edit
   * A3:54 indicates a duplicate claim rejection
   * A7:85 indicates a COB claim rejection
 * A1:19 indicates an Informational Edit





INSTRUCTOR-LED TRAINING

Learn about the latest updates to Smart Edits in an instructor-led training
session.

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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 respond. 

Find a course Interactive courses



HOW DO I ACCESS SUPPORT FOR SMART EDITS OR DOCUMENTATION EDITS?


For claims submitted through EDI or the portal, please 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 Documentation Edits, read their
descriptions and find our related policies.

Open guide Smart Edits guide open_in_new


CLAIMS PAYER LIST

Find out what additional Payer ID numbers receive Smart Edits.

View list Claims payer list open_in_new


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