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 Information System (HIS): Software used by physicians or facilities for scheduling, registration, billing and account receivables management. Claim files can easily be created in batch or individually for electronic submission. Submit claims directly from your system or upload claim files to another source for transmission to payers.
  • Direct Data Entry (DDE): Usually used by smaller practices or facilities, DDE solutions are ideal for those without a PMS or HIS who want to submit claims electronically. DDE allows you to key information into an online claim form for electronic submission.
  • Clearinghouse: A clearinghouse accept claims from a care provider’s PMS or HIS and from online resources to forward to insurance payers. Clearinghouses function as the intermediary between the care provider and the payer, while providing key services to prevent time-consuming processing errors and delays. For example, claims received by clearinghouses are checked for errors, validating the information required by HIPAA and the payer.
  • UHCprovider.com: Use the Claim Submission tool on Link to submit professional (CMS-1500) primary and secondary claims. With the Claim Submission tool, you’ll manually enter the information in an online tool.  For more information go to UHCprovider.com/claims > Submit a Claim.

Understanding Payer IDs

  • Payer IDs are used to route EDI transactions to the appropriate payer.
  • The member’s ID card will indicate the Payer ID to use for claims submissions.
  • View the Claims Payer ListOpens in a new windowopen_in_new of  Payer IDs for UnitedHealthcare, affiliates and strategic partners, including payers that accept secondary claims electronically and those that apply Smart Edits.
  • On the UnitedHealthcare Payer List, medical Payer IDs refer to professional and institutional claim submissions. Dental is listed separately, if applicable.
  • Your clearinghouse will also have a payer list that may or may not match up exactly with the UnitedHealthcare payer list. Please note that ours also contains former brand and plan names, as well as comments that may help you choose the correct Payer ID.  Contact your clearinghouse if current Payer IDs aren’t on their payer list.

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