Claim edit: Missing DME certification revision date
Stedi now rejects 837P professional claims that renew or revise a durable medical equipment (DME) certification without a certification revision date.
DME certifications and revision dates
A DME certification is the provider's statement that a piece of equipment, such as a wheelchair, is medically necessary. The certification type code tells the payer whether the certification is I (Initial), R (Renewal), or S (Revised).
Certification type code
| Claim type | JSON API field | X12 element |
|---|---|---|
| 837P professional | claimInformation.serviceLines[].durableMedicalEquipmentCertification.certificationTypeCode | CR3-01 (Certification Type Code) of Loop 2400 (Service Line Number) |
The certification revision date tells the payer when a change to the patient's certified DME needs took effect. This helps the payer confirm medical necessity.
Certification revision date
| Claim type | JSON API field | X12 element |
|---|---|---|
| 837P professional | claimInformation.serviceLines[].serviceLineDateInformation.certificationRevisionOrRecertificationDate | DTP*607 (Certification Revision/Recertification Date) of Loop 2400 (Service Line Number) |
How the edit works
HIPAA standards require a certification revision date when the certification type code is R or S. If a service line omits the date, 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:
{
"errors": [
{
"code": "33",
"description": "Missing Certification Revision/Recertification Date. The certification on line 1 is a renewal (type R) or revision (type S), but the required certification revision/recertification date is missing. 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 DME certifications.
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>335**U*********Missing Certification Revision/Recertification Date. The certification on line 1 is a renewal (type R) or revision (type S), but the required certification revision/recertification date is missing. Correct and resubmit.~