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UnitedHealthcare to Boost HIPAA Edits to Claims


Starting April 23, 2014, UnitedHealthcare will begin applying a higher level of WEDI Strategic National Implementation Process HIPAA edits to professional (837p) and institutional (837i) claims submitted electronically to most UnitedHealthcare and affiliate payer IDs.

Because the new edits will be applied on a pre-adjudication basis, there may be an increase in the number of rejections. This will allow you to identify and correct rejected information prior to the claim's acceptance into UnitedHealthcare's adjudication system for processing. The benefit will be fewer denied claims and less interruption to revenue streams.

The biggest impact will come from new edits that will validate code sets (such as diagnosis, procedure, modifier and national drug codes) at a pre-adjudication level. The complete list of enhanced edits has been distributed to clearinghouses and software vendors. 

It's important to check all your claim submission reports regularly. Claims may be rejected by your clearinghouse or UnitedHealthcare; therefore, you may receive multiple reports per submission. Visit for more information about tracking your electronic claims. 

Any rejections will appear at a clearinghouse level. Your Electronic Data Interchange vendor or clearinghouse should be your first point of contact for assistance regarding these edits or to resolve rejections. For more information, please contact EDI Support at 1-800-842-1109.