COB Electronic Claim

United Healthcare Guides: COB Electronic Claim Requirements (Commercial)

The following tips cover COB Electronic Claim topic for United Healthcare partners. They may help understand and resolve any issues that may occur with electronic claim submissions.

  • Primary Payer Paid Amount: Submit the primary paid amount for each service line reported on the 835 payment advice or EOB. The paid amount on institutional claims can be submitted at the claim level.
  • Adjustment Group Code: Submit other payer claim adjustment group code as found on the 835 payment advice or identified on the EOB. Deductible, co-insurance, copayment, contractual obligations and/or non-covered services are common reasons why the other payer paid less than billed.
  • Adjustment Reason Code: Submit other payer claim adjustment reason code as found on the 835 payment advice or identified on the EOB. Deductible, co-insurance, copayment, contractual obligations and/or non-covered services are common reasons why the other payer paid less than billed.
  • Adjustment Amount: Submit other payer adjustment monetary amount.
  • Preference: Submit professional claims at the line level and institutional claims at either the line or claim level. The service level and claim level should be balanced. UnitedHealthcare follows 837P/837I guidelines.

To learn more about Healthcare EDI and become a certified EDI Professional please visit our course schedule page.

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