Claim edit: Invalid remark code in COB claims

Stedi now rejects 837P professional, 837D dental, and 837I institutional claims that report an invalid remark code from a previous payer.

Remark codes in COB claims

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 can include the Remittance Advice Remark Codes (RARCs) from a previous payer's explanation of benefits (EOB) or Electronic Remittance Advice (ERA). A remark code gives more detail about why that payer adjusted the claim's payment.

Outpatient adjudication remark codes

Claim type	JSON API field	X12 element
837P professional	`claimInformation.otherSubscriberInformation[].medicareOutpatientAdjudication.claimPaymentRemarkCode`	`MOA-03` through `MOA-07` (Claim Payment Remark Code) of Loop `2320` (Other Subscriber Information)
837D dental	`claimInformation.otherSubscriberInformation[].medicareOutpatientAdjudication.claimPaymentRemarkCode`	`MOA-03` through `MOA-07` (Claim Payment Remark Code) of Loop `2320` (Other Subscriber Information)
837I institutional	`claimInformation.otherSubscriberInformation.medicareOutpatientAdjudication.claimPaymentRemarkCode`	`MOA-03` through `MOA-07` (Claim Payment Remark Code) of Loop `2320` (Other Subscriber Information)

Inpatient adjudication remark codes

Claim type	JSON API field	X12 element
837I institutional	`claimInformation.otherSubscriberInformation.medicareInpatientAdjudication.claimPaymentRemarkCode`	`MIA-05` and `MIA-20` through `MIA-23` (Claim Payment Remark Code) of Loop `2320` (Other Subscriber Information)

How the edit works

Each remark code must be a valid RARC and active on the date the previous payer adjudicated the claim. If it isn'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

How you get the error depends on how you submit the claim.

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 the remark code isn't a valid RARC:

{
  "errors": [
    {
      "code": "33",
      "description": "Invalid Claim Payment Remark Code (RARC). Other payer 60054, payer responsibility P, reported code(s) ZZ99 that are not in the X12 remittance advice remark code list. Correct and resubmit.",
      "followupAction": "Please Correct and Resubmit"
    }
  ]
}

If the remark code expired before the previous payer adjudicated the claim:

{
  "errors": [
    {
      "code": "33",
      "description": "Expired Claim Payment Remark Code (RARC). Other payer 60054, payer responsibility P, reported code(s) M33 (2004-07-31) that expired before the 2024-03-15 adjudication. Correct and resubmit.",
      "followupAction": "Please Correct and Resubmit"
    }
  ]
}

If the remark code took effect after the previous payer adjudicated the claim:

{
  "errors": [
    {
      "code": "33",
      "description": "Claim Payment Remark Code (RARC) Not Yet Effective. Other payer 60054, payer responsibility P, reported code(s) N905 (2025-03-01) that took effect after the 2024-03-15 adjudication. Correct and resubmit.",
      "followupAction": "Please Correct and Resubmit"
    }
  ]
}

Professional claims submitted through the Create Professional Claim (CMS-1500) JSON endpoint can't fail this edit. The endpoint doesn't accept remark codes.

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.