Claim edit: Duplicate remaining patient liability

Stedi now rejects 837P professional, 837D dental, and 837I institutional claims that report a remaining patient liability amount for the same other payer at both the claim level and the service line level.

How the edit works

When a patient has more than one insurance plan, say a child covered by both parents' health insurance, claims go to the primary payer first, then the secondary, and so on. This is called coordination of benefits (COB).

Claims sent to a non-primary payer must report how much the patient still owes after adjudication from previous payers. This amount is called the remaining patient liability.

X12 standards state that a claim can report the remaining patient liability at the claim level (for the whole claim) or the service line level, but not both. Sending both creates ambiguity and potential double counting so requiring at one level forces the single authoritative source.

Claim-level remaining patient liability

Line-level remaining patient liability

If a claim reports both a claim-level and service-line-level remaining patient liability for a previous payer, the payer you submit the claim to 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 Remaining Patient Liability reporting. For a payer, the remaining patient liability amounts must only be reported at the claim or line-level. This information was submitted at the claim-level and for line(s) 1. Correct and resubmit.",
      "followupAction": "Please Correct and Resubmit"
    }
  ]
}

{
  "errors": [
    {
      "code": "33",
      "description": "Invalid Remaining Patient Liability reporting. For a payer, the remaining patient liability amounts must only be reported at the claim or line-level. This information was submitted at the claim-level and for line(s) 1. Correct and resubmit.",
      "followupAction": "Please Correct and Resubmit"
    }
  ]
}

{
  "errors": [
    {
      "code": "33",
      "description": "Invalid Remaining Patient Liability reporting. For a payer, the remaining patient liability amounts must only be reported at the claim or line-level. This information was submitted at the claim-level and for line(s) 1. 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, entity identifier code, and error message:

STC*A7>639>GB*[DATE]*U*[AMOUNT]******A7>247**Invalid Remaining Patient Liability reporting. For a payer, the remaining patient liability amounts must only be reported at the claim or line-level. This information was submitted at the claim-level and for line(s) 1. Correct and resubmit

STC*A7>639>GB*[DATE]*U*[AMOUNT]******A7>247**Invalid Remaining Patient Liability reporting. For a payer, the remaining patient liability amounts must only be reported at the claim or line-level. This information was submitted at the claim-level and for line(s) 1. Correct and resubmit

STC*A7>639>GB*[DATE]*U*[AMOUNT]******A7>247**Invalid Remaining Patient Liability reporting. For a payer, the remaining patient liability amounts must only be reported at the claim or line-level. This information was submitted at the claim-level and for line(s) 1. Correct and resubmit