Claim edit: COB service lines must be balanced

Stedi now rejects 837P professional, 837D dental, and 837I institutional claims sent to a non-primary payer when a service line's coordination of benefits (COB) amounts don't balance.

How the edit works

When a patient has multiple insurance plans, the provider submits a claim to each payer in order. The first is the primary payer. Any that follow are secondary, tertiary, and so on. This process is called coordination of benefits (COB).

A service line is a line item for a specific service on a claim, like an office visit or X-ray.

When you submit a claim to a non-primary payer, you must include each previous payer's adjudications – their payments and adjustments. Include both claim-level and service line-level adjudications from each prior payer. Don't include the same amounts at both levels.

Balancing service lines

When you include prior payer adjudications at the service line level, the amounts must add up as follows:

Billed line charge

Prior payer line paid amount

Line adjustment amounts

If the amounts don't balance for any service line adjudication, the payer may reject the claim.

This edit catches the issue before the claim reaches the payer. It prevents payer rejections, which are slower and delay payment for the provider.

We previously added a separate edit for claim-level COB balancing.

Rejection errors

If you submit a claim using Stedi's Claim Submission API endpoints and the claim fails the edit, you'll get back an error response in real time. The response includes details in the errors array:

If you submit a claim using SFTP and the claim fails the edit, Stedi will reject the claim with a 277CA claim acknowledgment. The acknowledgment will include a related claim status category code, claim status code, entity identifier code, and error message: