Establishing an EDI connection with UnitedHealthcare has never been easier. Learn more about the benefits of EDI. You can use EDI for:
- Claims submissions (837)
- Eligibility and benefits (270/271)
- Claims status (276/277)
- Referrals and authorizations (278)
- Hospital admission notifications (278N)
- Electronic remittance advice (835/ERA)
- Practice Management System (PMS) or Hospital Information System (HIS): EDI transactions can be submitted directly from your PMS or HIS software system, or uploaded to an online resource for transmission to insurance payers, through a clearinghouse. Contact your software vendor for more information on how to enable EDI within your system.
- Clearinghouse: You can use any clearinghouse with a connection to UnitedHealthcare for EDI transactions. Before choosing a clearinghouse, review EDI Clearinghouse Options to:
- Help determine the EDI needs of your practice or facility
- Avoid clearinghouse fees if UnitedHealthcare is considered a non-participating payer
- Optum Intelligent EDI: A multi-payer web service and clearinghouse solution for all your EDI transactions. Submit transactions directly to Optum by using data from your PMS or HIS or manually enter the data using direct data entry (DDE) online. DDE can be used for professional (CMS-1500) claims and institutional (UB04) claims, as well as other EDI transactions. Optum Intelligent EDI is free* for UnitedHealthcare transactions and simplifies the process from patient check-in to payment posting. Learn more about Optum Intelligent EDI.
- To get started, call 866-367-9778, option 3.
- *Excludes Harvard Pilgrim, The Alliance and NDC Home Infusion Specialty Pharmacy Claims; charges apply for an all-payer solution.
UnitedHealthcare Payer Lists
EDI transactions are routed to payers using a Payer ID based on the transaction type. Payer IDs can be found on our payer lists.
- Claims Payer List: Indicates Payer IDs to use for EDI 837 claim submissions
- ERA Payer List: Indicates Payer IDs to use for EDI 835 ERA delivery directly to your PMS or HIS
- Payer List for Other EDI Transactions: Coming soon
View Understanding Payer IDs for more information