UHC – New Smart Edit for Commercial Plans

Effective Aug. 25, 2022, a new Smart Edit will be available for commercial plans to help with coordination of benefits when you submit a claim.

How the new Smart Edit works
When you submit a claim for a member who has a commercial plan and primary health insurance with another carrier, you’ll receive 1 of the following 3 messages on your 277 Claims Acknowledgement report within 24 hours of submission:

1. REJECT – This patient has primary insurance coverage with <other insurance name>, <effective Date>. Please resubmit as electronic secondary once adjudicated by the primary payor.
   a. You’ll receive this message if we have the primary health insurer’s name and effective date, but don’t have the other carrier’s EOB.
2. REJECT – This patient has primary insurance coverage with another carrier with <effective date>. Please resubmit as electronic secondary once adjudicated by the primary payor.
   a. You’ll receive this message if we have the effective date, but don’t have the other carrier’s name or EOB.
3. REJECT – This patient has primary insurance coverage with another carrier. Please resubmit as electronic secondary once adjudicated by the primary payor.
   a. You’ll receive this message if we’re missing the carrier’s name, effective date and EOB.

Source: https://www.uhcprovider.com/en/resource-library/news/2022/launch-smart-edit-commercial.html