April 01, 2023
Three new smart edits for commercial plans
On March 2, 2023, we added 3 new smart edits that can help with coordination of benefits (COB) when you submit claims for UnitedHealthcare commercial plan members. Smart edits appear on your 277 Claims Acknowledgement report within 24 hours of a claim submission.
| Edit mnemonic | Edit name | Edit message | Description |
|---|---|---|---|
| uOPI | COB Primary | REJECT - This patient has primary insurance coverage with another carrier. Please resubmit as electronic secondary once adjudicated by the primary payor. | This member has a commercial plan and primary health insurance with another carrier. Our records indicate the other insurance carrier is primary. This claim can be resubmitted as electronic secondary once adjudicated by the primary payor. |
| uOPIND | COB Primary | REJECT - This patient has primary insurance coverage, effective <Effective Date (UDF26)>. Please resubmit as electronic secondary once adjudicated by the primary payor. | This member has a commercial plan and primary health insurance with another carrier. Our records indicate the other insurance carrier is primary. This claim can be resubmitted as electronic secondary once adjudicated by the primary payor. |
| uOPID | COB Primary | REJECT - This patient has primary insurance coverage with another carrier with effective date XX/XX/XXXX. Please resubmit as electronic secondary once adjudicated by the primary payor. | This member has a commercial plan and primary health insurance with another carrier. Our records indicate the other insurance carrier is primary. This claim can be resubmitted as electronic secondary once adjudicated by the primary payor. |
Please note that all smart edits for coordination of benefits include the status code A7:85.
Learn more
- For information on how to submit the primary payer explanation of benefits online, visit UHCprovider.com/ediclaimtips > Secondary/COB or Tertiary Claims and Medicare Crossover > COB Electronic Claim Requirements – Commercial
- Visit UHCprovider.com/smartedits to:
- See the list of all available smart edit messages by selecting Smart Edits guide
- Take an interactive course
Questions?
- For information about Smart Edits, contact your electronic data interchange vendor or clearinghouse
- For additional help from us, visit our EDI Contacts page
