Claim edit: Duplicate value codes in institutional claims

Stedi now rejects 837I institutional claims that include the same value code more than once.

Value codes

In institutional claims, value codes are two-character alphanumeric codes used to report financial or clinical information that affects reimbursement to the payer. For example, 01 is the value code for "Most Common Semi-Private Room Rate." Value codes are paired with monetary amounts.

Value code

How the edit works

X12 standards allow up to 12 value codes per claim. Each value code within a claim must be unique. With duplicate codes, the payer can't determine which monetary amount to apply for the value code and 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": "Duplicate Value Code(s). Each value code must be unique. Submitted value code(s), D4, appear more than once on the claim. Correct and resubmit.",
      "followupAction": "Please Correct and Resubmit"
    }
  ]
}

{
  "errors": [
    {
      "code": "33",
      "description": "Duplicate Value Code(s). Each value code must be unique. Submitted value code(s), D4, appear more than once on the claim. Correct and resubmit.",
      "followupAction": "Please Correct and Resubmit"
    }
  ]
}

{
  "errors": [
    {
      "code": "33",
      "description": "Duplicate Value Code(s). Each value code must be unique. Submitted value code(s), D4, appear more than once on the claim. 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>725*[DATE]*U*[AMOUNT]******A7>732**Duplicate Value Code(s). Each value code must be unique. Submitted value code(s), D4, appear more than once on the claim. Correct and resubmit

STC*A7>725*[DATE]*U*[AMOUNT]******A7>732**Duplicate Value Code(s). Each value code must be unique. Submitted value code(s), D4, appear more than once on the claim. Correct and resubmit

STC*A7>725*[DATE]*U*[AMOUNT]******A7>732**Duplicate Value Code(s). Each value code must be unique. Submitted value code(s), D4, appear more than once on the claim. Correct and resubmit