Claim edit: Missing auto accident state or province
Stedi now rejects 837P professional and 837D dental claims that report an auto accident without the state or province where the accident occurred.
Auto accident claims
In a professional or dental claim, the related causes code tells the payer what caused the patient's condition. A claim can carry up to two codes. Valid codes are AA (Auto accident), EM (Employment), and OA (Other accident).
Related causes code
| Claim type | JSON API field | X12 element |
|---|---|---|
| 837P professional | claimInformation.relatedCausesCode | CLM11-01 or CLM11-02 (Related Causes Code) of Loop 2300 (Claim Information) |
| 837D dental | claimInformation.relatedCausesCode | CLM11-01 or CLM11-02 (Related Causes Code) of Loop 2300 (Claim Information) |
Per X12 standards, claims that report a related causes code of AA must include the state or province where the auto accident happened.
Auto accident state or province
| Claim type | JSON API field | X12 element |
|---|---|---|
| 837P professional | claimInformation.autoAccidentStateCode | CLM11-04 (Auto Accident State or Province Code) of Loop 2300 (Claim Information) |
| 837D dental | claimInformation.autoAccidentStateCode | CLM11-04 (Auto Accident State or Province Code) of Loop 2300 (Claim Information) |
Every state and province has its own laws for who pays after an auto accident. To apply the right rules, the payer needs the state or province that the accident occurred in.
In many states, auto insurance pays before health insurance. Without the state or province, the payer can't tell who pays first.
How the edit works
If you submit a claim with a related causes code of AA but don't include the auto accident state or province, 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": "Missing Auto Accident State or Province. When the related-cause information indicates an auto-accident, the accident state or province code must be provided. 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>750*[DATE]*U*[AMOUNT]********Missing Auto Accident State or Province. When the related-cause information indicates an auto-accident, the accident state or province code must be provided. Correct and resubmit.~Related claim edits
Stedi has another edit for a missing accident date. See Missing accident date.