Resolving Errors 270/271

Tips for Resolving Errors with 270/271 Eligibility and Benefits Transactions (United Healthcare) UnitedHealthcare helps partners resolve errors to obtain member eligibility and benefits from 270/271 Health Care Eligibility and Benefit Inquiry and Response transactions. UnitedHealthcare current search logic allows entering different criteria related to the member or patient for the eligibility and benefits inquiry transaction (270). If Read More →

Healthcare Cost Savings

Healthcare Cost Savings Using Electronic Data Interchange CAQH, a nonprofit alliance, is the leader in creating shared initiatives to streamline the business of health care. The 2019 CAQH Index shows that the average cost to conduct transactions manually is higher than the cost of electronic transactions for care providers and health plans. Providers can use Read More →

EDI Transactions medicare

Steps of an EDI Transaction: United Healthcare Scenario Example EDI transactions start with an inquiry from the care provider and conclude with a response from the payer. The inquiry is submitted by supplying certain required data fields, such as member ID number, date of birth and Payer ID. This inquiry can go directly to the Read More →

EDI training

How EDI Works and Helps Care Providers (United Healthcare Guides) Electronic Data Interchange (EDI) is the automated transfer of data between a care provider and a payer. The benefits to care providers include quicker turnaround of information, reducing administrative expenses and avoiding claim processing delays. Using EDI allows payers and care providers to send and Read More →

Medicare Crossover

Medicare Crossover: United Healthcare Explained Medicare Crossover is the process by which Medicare, as the primary payer, automatically forwards Medicare Part A (hospital) and Part B (medical) including Durable Medical Equipment (DME) claims to a secondary payer for processing. It is a standard offering for most Medicare-eligible members covered under UnitedHealthcare Commercial plans. Enrollment is automatic for Read More →

EDI healthcare

UnitedHealthcare COB Electronic Specifications Using Electronic Data Interchange (EDI) for all eligible UnitedHealthcare transactions can help your organization improve efficiency, reduce costs and increase cash flow. UnitedHealthcare encourage you to use the following mapping tips. For secondary professional or institutional claims to be paid electronically, the COB information must be submitted in the applicable loops and Read More →

COB Electronic Claim

COB Electronic Claim – Medicare Primary (United Healthcare Requirements) Adjustment Group Code: Submit other payer claim adjustment group code as found on the 835 payment advice or identified on the EOB. Do not enter at claim level any amounts included at line level. Deductible, co-insurance, copayment, contractual obligations and/or non-covered services are common reasons why the Read More →

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. Read More →


Submit CMS-1500 and UB04 Claims Electronically Submitting CMS-1500 and UB04 Claims Electronically gives more benefits and advantages. Here are some guidelines for submitting these transactions electronically. Single Page Claims: Claims without attachments are the simplest to file electronically. Identify those dropping to paper in your system and convert them to an EDI 837 transaction by applying the Read More →

EDI Claim Submission

EDI Claim Submission Methods The EDI 837 Health Care Claim transaction is the electronic transaction for claims submissions. UnitedHealthcare accepts the following claim types from both participating and non-participating care providers: 837P: Professional (physician) and vision claims 837I:  Institutional (hospital or facility) claims 837D: Dental claims Claim Submission Methods Practice Management System (PMS) and Hospital Read More →