Claim edit: Duplicate occurrence span codes in institutional claims

Stedi now rejects 837I institutional claims that include the same occurrence span code more than once within a single occurrence span group.

How the edit works

In institutional claims, occurrence spans are a range of dates for a significant event in a patient's care. Occurrence span codes tell the payer what each span of dates represents. These codes can affect how much a payer will approve or pay for a claim.

For example, occurrence span code 70 reports the qualifying inpatient stay dates that establish eligibility for a skilled nursing facility claim. Code 74 reports a noncovered level of care or leave of absence. Occurrence span codes are defined by the National Uniform Billing Committee (NUBC).

A claim can contain up to two groups of occurrence span codes. Each group can contain up to 12 codes.

Occurrence span code

The NUBC states that each occurrence span code must be unique within a single group. If a claim includes the same occurrence span code more than once within a single group, the payer may reject the claim.

This edit catches the issue before the claim reaches the payer. It prevents payer rejections, which take longer to resolve and delay payment for the provider.

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:

{
  "errors": [
    {
      "code": "33",
      "description": "Invalid Occurrence Span Code(s). If submitting multiple occurrence span codes, each code must be unique. The submitted occurrence span code(s) are submitted more than once, 70. Correct and resubmit.",
      "followupAction": "Please Correct and Resubmit"
    }
  ]
}

{
  "errors": [
    {
      "code": "33",
      "description": "Invalid Occurrence Span Code(s). If submitting multiple occurrence span codes, each code must be unique. The submitted occurrence span code(s) are submitted more than once, 70. Correct and resubmit.",
      "followupAction": "Please Correct and Resubmit"
    }
  ]
}

{
  "errors": [
    {
      "code": "33",
      "description": "Invalid Occurrence Span Code(s). If submitting multiple occurrence span codes, each code must be unique. The submitted occurrence span code(s) are submitted more than once, 70. Correct and resubmit.",
      "followupAction": "Please Correct and Resubmit"
    }
  ]
}

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, and error message:

STC*A7>721*[DATE]*U*[AMOUNT]******A7>732**Invalid Occurrence Span Code(s). If submitting multiple occurrence span codes, each code must be unique. The submitted occurrence span code(s) are submitted more than once, 70. Correct and resubmit

STC*A7>721*[DATE]*U*[AMOUNT]******A7>732**Invalid Occurrence Span Code(s). If submitting multiple occurrence span codes, each code must be unique. The submitted occurrence span code(s) are submitted more than once, 70. Correct and resubmit

STC*A7>721*[DATE]*U*[AMOUNT]******A7>732**Invalid Occurrence Span Code(s). If submitting multiple occurrence span codes, each code must be unique. The submitted occurrence span code(s) are submitted more than once, 70. Correct and resubmit

Related claim edits

Stedi has another edit for duplicate occurrence codes. Occurrence codes report a single event on a specific date. Occurrence span codes report a condition that applied over a range of dates. See Duplicate occurrence codes in institutional claims.