Claim edit: Negative service unit counts

Stedi now rejects 837P professional, 837D dental, and 837I institutional claims that include a negative service unit count.

What are service unit counts?

In a claim, a service line represents billing for a specific service, such as an office visit, lab test, or therapy session. The line’s procedure code indicates the type of service.

A service unit count is the number of units for a service line. The meaning of a unit – visits, tests, time increments, etc. – depends on the procedure code. For example, four units of a 15-minute therapy code equal one hour.

Negative unit counts

X12 standards require service unit counts to be zero or higher. If a service line’s unit count is below zero, the payer may reject the claim.

How this edit works

This edit catches claims with negative service unit counts before the claims reach the payer. This prevents payer rejections, which take longer to resolve and delay payment for the provider.

The edit applies to three different service unit counts that can appear on a claim:

• Submitted service unit counts – What the provider bills. Not used on dental claims.

• Paid service unit counts – What a prior payer pays in coordination of benefits (COB) scenarios.

• Repriced approved service unit counts – What a third-party repricer approves after reviewing the claim. Not commonly used by claim submitters.

Submitted service unit counts

A submitted service unit count is the number of units a provider bills on a service line, before any adjudication or adjustments.

Note: Dental claims don’t include submitted service unit counts.

Rejection errors

If you submit a claim with a negative submitted service unit count using Stedi’s Claim Submission API endpoints, you’ll get back an error response in real time. The response includes details in the errors array:

{
  "errors": [
    {
      "code": "33",
      "description": "Invalid Service Unit Count. Submitted value -3 on line 1 must be zero or greater. Negative values are not allowed. Correct and resubmit.",
      "followupAction": "Please Correct and Resubmit"
    }
  ]
}

{
  "errors": [
    {
      "code": "33",
      "description": "Invalid Service Unit Count. Submitted value -3 on line 1 must be zero or greater. Negative values are not allowed. Correct and resubmit.",
      "followupAction": "Please Correct and Resubmit"
    }
  ]
}

{
  "errors": [
    {
      "code": "33",
      "description": "Invalid Service Unit Count. Submitted value -3 on line 1 must be zero or greater. Negative values are not allowed. Correct and resubmit.",
      "followupAction": "Please Correct and Resubmit"
    }
  ]
}

If you submit a claim with a negative submitted service unit count using SFTP, 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*A7>476*[DATE]*U*[AMOUNT]********Invalid Service Unit Count. Submitted value -3 on line 1 must be zero or greater. Negative values are not allowed. Correct and resubmit

STC*A7>476*[DATE]*U*[AMOUNT]********Invalid Service Unit Count. Submitted value -3 on line 1 must be zero or greater. Negative values are not allowed. Correct and resubmit

STC*A7>476*[DATE]*U*[AMOUNT]********Invalid Service Unit Count. Submitted value -3 on line 1 must be zero or greater. Negative values are not allowed. Correct and resubmit

Paid service unit counts

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 and adjustments.

A paid service unit count reports how many units a previous payer paid for a given service line. For example, if the primary payer paid 2 of 3 office visit units, the claim submitted to the secondary payer should include a paid service unit count of 2 for that service line.

Rejection errors

If you submit a claim with a negative paid service unit count using Stedi’s Claim Submission API endpoints, you’ll get back an error response in real time. The response includes details in the errors array:

{
  "errors": [
    {
      "code": "33",
      "description": "Invalid Paid Service Unit Count. Submitted value -2 on line 1 must be zero or greater. Negative values are not allowed. Correct and resubmit.",
      "followupAction": "Please Correct and Resubmit"
    }
  ]
}

{
  "errors": [
    {
      "code": "33",
      "description": "Invalid Paid Service Unit Count. Submitted value -2 on line 1 must be zero or greater. Negative values are not allowed. Correct and resubmit.",
      "followupAction": "Please Correct and Resubmit"
    }
  ]
}

{
  "errors": [
    {
      "code": "33",
      "description": "Invalid Paid Service Unit Count. Submitted value -2 on line 1 must be zero or greater. Negative values are not allowed. Correct and resubmit.",
      "followupAction": "Please Correct and Resubmit"
    }
  ]
}

If you submit a claim with a negative paid service unit count using SFTP, Stedi will reject the claim with a 277CA claim acknowledgment and an error message:

STC*A7>608*[DATE]*U*[AMOUNT]********Invalid Paid Service Unit Count. Submitted value -2 on line 1 must be zero or greater. Negative values are not allowed. Correct and resubmit

STC*A7>608*[DATE]*U*[AMOUNT]********Invalid Paid Service Unit Count. Submitted value -2 on line 1 must be zero or greater. Negative values are not allowed. Correct and resubmit

STC*A7>608*[DATE]*U*[AMOUNT]********Invalid Paid Service Unit Count. Submitted value -2 on line 1 must be zero or greater. Negative values are not allowed. Correct and resubmit

Repriced approved service unit counts

Important: Most Stedi customers will not use repriced approved service unit counts. They're typically set by a repricer, not the claim submitter.

A contracted rate is the prenegotiated maximum a payer will pay for a specific service. Payers sometimes contract with third-party repricers to apply contracted rates to claims. Repricers are common in managed care and provider networks.

The repricer reviews submitted claims and may approve fewer units than the provider billed. For example, if a provider bills four units of a 15-minute therapy code (one hour total), the repricer may only approve three units (45 minutes). The repricer then updates the claim with the repriced approved service unit count and forwards the claim to the payer.

The payer uses this approved count, along with the contracted rate, to adjudicate the claim.

Rejection errors

If you submit a claim with a negative repriced approved service unit count using Stedi’s Claim Submission API endpoints, you’ll get back an error response in real time. The response includes details in the errors array:

{
  "errors": [
    {
      "code": "33",
      "description": "Invalid Repriced Approved Service Unit Count. Submitted value -1 on line 1 must be zero or greater. Negative values are not allowed. Correct and resubmit.",
      "followupAction": "Please Correct and Resubmit"
    }
  ]
}

{
  "errors": [
    {
      "code": "33",
      "description": "Invalid Repriced Approved Service Unit Count. Submitted value -1 on line 1 must be zero or greater. Negative values are not allowed. Correct and resubmit.",
      "followupAction": "Please Correct and Resubmit"
    }
  ]
}

{
  "errors": [
    {
      "code": "33",
      "description": "Invalid Repriced Approved Service Unit Count. Submitted value -1 on line 1 must be zero or greater. Negative values are not allowed. Correct and resubmit.",
      "followupAction": "Please Correct and Resubmit"
    }
  ]
}

If you submit a claim with a negative repriced approved service unit count using SFTP, Stedi will reject the claim with a 277CA claim acknowledgment and an error message:

STC*A7>709*[DATE]*U*[AMOUNT]********Invalid Repriced Approved Service Unit Count. Submitted value -1 on line 1 must be zero or greater. Negative values are not allowed. Correct and resubmit

STC*A7>709*[DATE]*U*[AMOUNT]********Invalid Repriced Approved Service Unit Count. Submitted value -1 on line 1 must be zero or greater. Negative values are not allowed. Correct and resubmit

STC*A7>709*[DATE]*U*[AMOUNT]********Invalid Repriced Approved Service Unit Count. Submitted value -1 on line 1 must be zero or greater. Negative values are not allowed. Correct and resubmit

Resolution tips

Claim submitters sometimes use negative service unit counts to reverse charges. Submit a void or replacement claim instead.