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EDI Clearinghouse Options

Many health care professionals choose to submit electronic transactions to UnitedHealthcare through a clearinghouse. Clearinghouses facilitate the transfer of electronic transactions between payers and physicians, health care professionals or facilities. They offer multi-payer solutions, batch transactions and direct data entry.

Clearinghouses often integrate with practice management or hospital information systems to eliminate time spent keying information into multiple programs or requesting/submitting transactions individually.

We recommend you research clearinghouses and their capabilities to determine which ones best meet your needs and can integrate with your existing software systems.

Some questions you may want to consider include:

  • Do you need the ability to submit more claim types electronically?
  • Do you want an automated system for electronic eligibility, claim status and notification transactions?
  • Would you like to file secondary claims electronically?
  • Would you like to have secondary electronic claims automated?
  • Are you receiving electronic remittance statements and electronic funds transfers?
  • Does your system automatically post payments?

UnitedHealthcare interacts with many clearinghouses and doesn't endorse a specific one. However, most of our EDI transactions go through Optum, an affiliate of UnitedHealthcare.  Optum also interacts with many clearinghouses.

Avoid Clearinghouse Fees for EDI Claims Submissions

You may experience additional costs to submit UnitedHealthcare claims electronically if we are considered a non-participating payer with your clearinghouse. Although this isn’t common, we want to make sure you know how to avoid additional costs (or paper submissions) when you submit Electronic Data Interchange (EDI) 837 claims to us.

Submitting EDI Claims

If your clearinghouse classifies UnitedHealthcare as a non-participating payer and charges fees to submit claims electronically, please consider using the following options:

  • Optum Intelligent EDI: Through Optum Intelligent EDI, most UnitedHealthcare claim submissions are free. Visit UHCprovider.com/ediconnect for more information.
  • Clearinghouses that consider UnitedHealthcare a participating payer: These clearinghouses don’t charge additional fees and may allow you to submit UnitedHealthcare claims without requiring you to move all your other transactions.