Electronic data interchange
Electronic data interchange (EDI) is available for all eligible UnitedHealthcare dental transactions and may help your organization improve efficiency, reduce costs and increase cash flow.
- Use the Eligibility and Benefits Inquiry (270) transaction to inquire about the health care eligibility and benefits associated with a subscriber or dependent
- Use Service Type Code 35 to request comprehensive dental 271 responses
- Use the Eligibility and Benefit Response (271) transaction to respond to a 270 inquiry
Electronic eligibility verification may result in a series of benefits including:
- Increased productivity and efficiency
- Fewer denials for eligibility
- Less time spent on administrative tasks including phone inquiries
- Ability to exchange information with multiple payers
EDI makes the process of checking eligibility automated. It eliminates the need to call in to verify benefits and check on accumulators or sign into our provider portal to check each patient.
EDI is a 2-way communication between 2 parties, and data is passed back and forth in a standardized format.
- The provider sends a 270 request to the payer for a particular member
- The payer responds with a 271 response that contains the member’s eligibility and benefit levels
These transactions are completed with EDI protocol.
You can complete the simple set-up process with minimal involvement from UnitedHealthcare Dental.
- Notify your clearinghouse that you would like to enroll for 270/271 delivery for UHC/DBP Payer ID 52133 and/or for UMR Payer ID 39026
- Promptly complete a series of tasks assigned by the clearinghouse to ensure there are no delays
- Notify your dental Practice Management Software (PMS) vendor of intent to move forward with sending and receiving 270/271 transactions for UHC/DBP and UMR. This will allow your system to automatically generate an inquiry and/or to enable automatic posting of benefit information to patient accounts.
| Category | EDI 270/271 |
|---|---|
Member coverage status |
✓ |
Deductible calendar year |
✓ |
Deductible year to date |
✓ |
Deductible remaining |
✓ |
Deductible (specialty) |
✓ |
Out-of-pocket (stop loss) calendar year |
✓ |
Out-of-pocket (stop loss) year to date |
✓ |
Out-of-pocket (stop loss) remaining |
✓ |
Service in/out of network status |
✓ |
Coinsurance |
✓ |
Copayment |
✓ |
Limitations |
✓ |
Member information such as name, date of birth, gender, address and ID number |
✓ |
See insurance information such as Payer, Payer ID, plan description and claims address |
✓ |
Find member copay and coinsurance amounts |
✓ |
See deductible amounts |
✓ |
View out-of-pocket maximums |
✓ |
View vendor coverage |
✓ |
Referral requirements |
✓ |
Service type codes that are compatible with the 271 response
| HIPAA service type | HIPAA service type description |
|---|
| 23 | Diagnostic dental |
| 24 | Periodontics |
| 25 | Restorative |
| 26 | Endodontics |
| 27 | Maxillofacial prosthetics |
| 28 | Adjunctive dental services |
| 35 | All dental service type codes |
| 36 | Dental crowns |
| 37 | Dental accident |
| 38 | Orthodontics |
| 39 | Prosthodontics |
| 40 | Oral surgery |
| 41 | Routine (preventive) dental |
Common errors:
Problem: You are receiving AAA*Y*73*C˜AAA*Y**71*C˜ (Invalid or missing name and date of birth)
Solution: Verify name and date of birth in your records and include member ID.
Problem: You are receiving AAA*Y**75 (Subscriber/insured not found)
Solution: Member may not be a UnitedHealthcare member or has no active coverage.
Problem: You are receiving AAA*Y**71 (Subscriber/insured date of birth doesn’t match patient database)
Solution: Check formatting of date of birth. Format should be YYMMDD.
Problem: You are not receiving benefit information you are expecting to see
Solution: Contact your PMS vendor and check if the 270/271 is fully activated or if they are not translating the code appropriately.
For more assistance, please reach out to your associated clearinghouse if you run into any issues during the 270/271 setup process. They work directly with Optum360, UnitedHealthcare Dental’s clearinghouse, to set up the EDI connection.