Claim edit: Missing ambulance transport information
Stedi now rejects 837P professional claims for ambulance services that don't include ambulance transport information.
Place of service and ambulance transport information
A place of service code of 41 (Ambulance – Land) or 42 (Ambulance – Air or Water) marks an ambulance claim.
Place of service code
| Claim type | JSON API field | X12 element |
|---|---|---|
| 837P professional | Claim Submission API: claimInformation.placeOfServiceCodeCMS-1500 API: encounter.primaryPlaceOfService | CLM-05-01 (Place of Service Code) of Loop 2300 (Claim Information) |
An ambulance procedure code identifies the service, but not the details of the transport. Ambulance transport information gives the reason for the transport and the distance. Payers use these details to evaluate coverage, medical necessity, and payment.
Ambulance transport information
| Claim type | JSON API field | X12 element |
|---|---|---|
| 837P professional | claimInformation.ambulanceTransportInformation | CR1 (Ambulance Transport Information) segment of Loop 2300 (Claim Information) |
How the edit works
X12 standards require ambulance claims to include ambulance transport information at the claim level. Ambulance transport information on a service line doesn't replace it. If an ambulance claim omits the claim-level information, 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 the Create Professional Claim (CMS-1500) JSON endpoint and the claim fails the edit, you'll get back a 201 response with an errors array in real time:
{
"errors": [
{
"description": "Missing Ambulance Transport Information. When a claim indicates ambulance services (POS 41, 42), the ambulance transport information segment (CR1) is required. Correct and resubmit."
}
]
}Ambulance claims submitted through the Create Professional Claim (CMS-1500) JSON endpoint can't pass this edit. The endpoint doesn't support ambulance transport information. Use another Claim Submission API endpoint or SFTP instead.
If you submit a claim using Stedi's other 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": "Missing Ambulance Transport Information. When a claim indicates ambulance services (POS 41, 42), the ambulance transport information segment (CR1) is required. 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*A6>428*[DATE]*U*[AMOUNT]********Missing Ambulance Transport Information. When a claim indicates ambulance services (POS 41, 42), the ambulance transport information segment (CR1) is required. Correct and resubmit.~