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UnitedHealth Group requires compliance with the requirements of federal and state laws that prohibit the submission of false claims in connection with federal health care programs, including Medicare and Medicaid. Click here (PDF 38.15 KB) to download our policy.
For policy guidance for Medicare Advantage plan members, please click here to view the UnitedHealthcare Medicare Advantage Coverage Summaries Manual and corresponding policy update bulletins.
HIPAA Claim Edits
UnitedHealthcare applies HIPAA edits to professional (837p) and Institutional (837i) claims submitted electronically. Visit the EDI Claim Edits page for more information including a complete list of edits, edits related to ICD-10 codes and applicable payers. Claims that reject for HIPAA edits will appear on a clearinghouse level report, enabling you to Identify and correct rejected Information prior to UnitedHealthcare receiving the claim.
If UHG policies conflict with provisions of a state contract or with state or federal law, the contractual / statutory / regulatory provisions shall prevail. To see updated policy changes, select the Bulletin section at left.