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Section 1557 of ACA Results in Claim System Updates

October 4, 2016

Currently, age and gender edits are applied during claims processing to avoid incorrect payments due to billing and data entry errors. With recent guidance under Section 1557 of the Affordable Care Act (ACA) nondiscrimination provision, UnitedHealthcare will make a number of modifications to existing edits effective Jan. 1, 2017.

Claim submission errors based on age or gender are infrequent, and we anticipate a negligible financial impact. Removing the edits supports plan compliance with anti-discrimination laws.  

Gender edits for preventive services in 2015 have been removed. Age edits will continue to be in place when based on clinical or evidenced-based guidelines. 

We will continue to monitor fraud, waste and abuse, and those situations will be handled accordingly. For more information, please contact your UnitedHealthcare representative.

January 1, 2017 PDL Updates


The following updates will take effect for the OptumRx direct Prescription Drug Lists (PDLs) on January 1, 2017. Learn more

New Sales Automation Management Tool


Check out our new Sales Automation Management (SAM). Learn more

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