Claim Rejection - Smart Edits (CLIA ID not submitted)

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Rejection Message

Rejected by Payer, Claims Has been rejected as unprocessable. Cannot provide further status electronically (X12 Info: 2300 CLM), P49999INFO SMART EDIT (INFO) For support documentation regarding this edit, refer to UnitedHealthcare policies for the smart edits policy reference guide at UHCPROVIDER.COM/SMARTEDITS. If applicable, update your submission. 

or

CLIA ID DOES NOT MEET THE CERTIFICATION LEVEL FOR PROCEDURE CODE. CLAIM HAS BEEN REJECTED AND WILL NOT BE PROCESSED

Definition

This rejection occurs when the CLIA ID is missing from a claim with UHC as the payer. For more information on Smart Edits please visit the UHC Smart Edits page

Smart Edits are not true rejections, but are warnings that the claim has potential billing errors on the claim and it has flagged their system.

Providers have five days to correct or edit the claim, then the payer will go ahead and process the claim as it was originally submitted. With that being said, if the claim was already billed correctly, there is no action required. The claim will be processed as it was submitted with the CLIA ID number.

For more info on smart edits, visit the site in the rejection message. Please note that it's typical for payers to pay on the claim after sending these smart edits. 

Resolution

The CLIA ID is entered when setting up the provider in AveaOffice. To add the CLIA ID please see this article: Claim Rule - Adding CLIA Numbers to Claims.

If the CLIA ID is correct on the claim, update the payer status from Rejected to Accepted with the steps in Edit Payer Status on Rejected Claims.

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