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 our 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 our Claims Payer List 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.
Submit CMS-1500 and UB04 Claims 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 appropriate Payer ID. Contact your software vendor or clearinghouse if you need help.
- Secondary/Coordination of Benefits (COB) Claims: UnitedHealthcare claims can be submitted electronically without the primary payer’s paper explanation of benefits (EOB). Your PMS or HIS may need to be updated if you don’t have the ability to send primary EOB information. For more information, go to EDI Quick Tips for Claims.
- Medicare Crossover: When Medicare is the primary payer, a crossover statement is sent directly to UnitedHealthcare, eliminating the need for care providers to file the secondary claim when the member is enrolled in Medicare Crossover. Enrollment is automatic for eligible UnitedHealthcare commercial members. View Filing Secondary Claims When Medicare is Primary Payer or go to EDI Quick Tips for Claims for more information.
- Corrected Claims: Most corrected claims can be sent electronically using frequency code 7 on the 837 transaction to indicate the replacement of a previous claim. For more information, go to EDI Quick Tips for Claims.