Claim edit: Invalid paid amount

Stedi now rejects 837P professional, 837D dental, and 837I institutional claims that report a negative or non-numeric other payer paid amount on a service line.

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 non-primary payers must report each previous payer’s payments for each service line.

Service line paid amount

A service line's paid amounts must be non-negative numbers. If they aren't, 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 Other Payer Paid Amount. The service line other payer paid amount must be a valid number greater than or equal to zero. The submitted value on line 1 is invalid, -150.00. Correct and resubmit.",
      "followupAction": "Please Correct and Resubmit"
    }
  ]
}

{
  "errors": [
    {
      "code": "33",
      "description": "Invalid Other Payer Paid Amount. The service line other payer paid amount must be a valid number greater than or equal to zero. The submitted value on line 1 is invalid, -150.00. Correct and resubmit.",
      "followupAction": "Please Correct and Resubmit"
    }
  ]
}

{
  "errors": [
    {
      "code": "33",
      "description": "Invalid Other Payer Paid Amount. The service line other payer paid amount must be a valid number greater than or equal to zero. The submitted value on line 1 is invalid, -150.00. 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>643>PR*[DATE]*U*[AMOUNT]******A8>710**Invalid Other Payer Paid Amount. The service line other payer paid amount must be a valid number greater than or equal to zero. The submitted value on line 1 is invalid, -150.00. Correct and resubmit

STC*A7>643>PR*[DATE]*U*[AMOUNT]******A8>710**Invalid Other Payer Paid Amount. The service line other payer paid amount must be a valid number greater than or equal to zero. The submitted value on line 1 is invalid, -150.00. Correct and resubmit

STC*A7>643>PR*[DATE]*U*[AMOUNT]******A8>710**Invalid Other Payer Paid Amount. The service line other payer paid amount must be a valid number greater than or equal to zero. The submitted value on line 1 is invalid, -150.00. Correct and resubmit