Where are payer-specific edits checked during UB-04 submission?

• A. Pre-submission internal edits by the provider and payer-side edits during adjudication
• B. Post-submission only by the payer
• C. Only after payment
• D. Data archival and retention checks

Answer: (A)

Payer-specific edits are checked at two points in the UB-04 submission flow. First, providers run internal edits before sending a claim to catch issues that would trigger payer denials—things like missing fields, incorrect data formats, or obvious mismatches with payer rules. Then, after submission, the payer applies its own edits during adjudication to verify eligibility, coding accuracy, coverage rules, and payment eligibility based on the plan’s policies. This two-stage approach helps catch problems early and ensures that payment decisions align with payer requirements.

Other options miss this two-step reality: edits aren’t limited to after payment, and they aren’t solely post-submission by the payer or confined to data archival checks.