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.
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].
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.
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.
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.
