Question: One of our claims has rejected showing a message that references Smart Edit. How do I fix this rejection?
Solution: Some payers (primarily United Healthcare) are now doing front-end checks similar to NCCI Edits, which they call Smart Edit. These edits will always reference either a procedure or modifier or diagnosis as being not reimbursable in the Submission Listing Messages. A Smart Edit rejection is the same as any other rejection - the payer did not accept the claim for processing.
Part of the Submission Listing Message is a URL (website) users can go access for additional details: UHCProvider.com/Smart Edits. If a user disagrees with the edit, or feels that the coding is correct, the claim can be resubmitted and should go through.
