277CA edits for Medicare Advantage plans: United Healthcare quick reference guide
UnitedHealthcare applies edits when an electronically submitted claim is either missing key health care professional information or does not match internal systems. These claims will be returned electronically on a 277CA (claims acknowledgement) clearinghouse rejection report with instructions on what to correct and subsequently resubmit the claim for adjudication. Please ensure you are receiving these messages from your clearinghouse. Enhancements to these edits may occur periodically.
List of commonly rejected claim events
- Address issue. The place of service is often used instead of the billing address on record. Resubmit the claim using the pay to or billing address on record.
- Missing group name. The internal system of record shows to pay the group, but only the individual or rendering provider is noted in 2010AA. Resubmit claim as entity type 2 and include full group name in Loop 2010AA Segment NM103.
- Missing rendering provider name. The internal system of record shows to pay the individual provider. Loop 2310B is incomplete or missing. Resubmit the claim noting the rendering provider full name in Loop 2310B completing all applicable segments.
- Incorrect tax ID number (TIN). The TIN submitted on the claim does not match the system of records. Resubmit the claim with correct TIN. If there is a new or different TIN, the provider profile will need to be updated prior to resubmission.
To learn more about EDI and become a certified EDI Professional please visit our course schedule page.