Medicare started the concept of Smart Edits. The Claim rejects at the Clearinghouse level with an alert explaining that the Claim may be denied when processed.
Some claims are rejected by a Smart Edit and do not enter the claims processing system. These claims must be corrected and resubmitted.
To be processed by Medicare, the claim must be resubmitted.
Other Smart Edits are informational only and will still be passed to the claims processing system for payment consideration.
The following link directs you to Palmetto GBA Advance Clinical Editing (P-ACE) Smart Edits
277CA Edit Lookup Tool (External link)
If you want to send the Claim without making any changes disregarding the Smart Edit warning, change the Claim Status to Ready for Submission/Resubmission.
The Claim response will now be Payer Accepted.
It will be adjudicated by the Payer and visible on the Payer portal.
UHC also utilizes Smart Edits, but their behavior is different from Medicare and likely more common.
If no Claim is resubmitted with changes, UHC will release the Claim for processing after 5 days.
If no changes need to be made, no additional Claim is required
If you want to make changes to the Claim based on the advice of the SmartEdit, make the changes, and send a new Claim which may be subject to a different Smart Edit.
Use these links for more information on UHC Smart Edits: UHC Smart Edits Guide and Smart Edits Lookup (external links).