From: Mast, Carolyn J [mailto:Carolyn.Mast@optum.com]
Sent: Thursday, January 02, 2014 4:01 PM
To: undisclosed-recipients:
Subject: OptumInsight System Notification: UNITEDHEALTHCARE SYSTEM NOTIFICATION-Enhanced HIPAA Edits

UNITEDHEALTHCARE SYSTEM NOTIFICATION

Date:       01/02/2014

Enhanced HIPAA Edits to be Applied to Claim Submissions in 2014

Effective April 23, 2014, UnitedHealthcare will enhance the level of HIPAA edits applied to professional (837p) and institutional (837i) claims submitted electronically to most UnitedHealthcare and affiliate payer IDs.*

Based on ANSI X12 TR3 compliance regulations, WEDI SNIP Types 1 through 5 will be enhanced at a pre-adjudication level during HIPAA validation.  Please view the complete list of enhanced edits and forward to your customers as needed.  UnitedHealthcare will notify providers of the enhanced edits starting the first week of January, 2014. 

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

Please encourage your users to check claim submission reports on a regular basis and in a timely manner.  Visit UnitedHealthcareOnline.com for more information about tracking your electronic claims.

If you have any questions about these changes, please contact Electronic Data Interchange (EDI) Support:

*Exceptions are:  Harvard Pilgrim (04271), Medica HealthCare Plans (78857), Preferred Care Partners (65088), The Alliance (88461) and TRICARE West (99726)

Thank you,

UnitedHealthcare

If you have further questions, please contact the OptumInsight Support team by opening a ticket online or by calling 877-309-4256. Please do not respond to this email with questions.

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