Claim edit: Service-line referral number without a claim-level referral number
Stedi now rejects 837P professional claims that report a referral number on a service line but not at the claim level.
Claim-level and service-line referral numbers
A referral number is the number a payer assigns when it approves a referral to another provider. For example, a payer may require a referral before a patient sees a specialist.
You can report the referral number at two levels. The claim-level referral number applies to every service line on the claim.
Claim-level referral number
| Claim type | JSON API field | X12 element |
|---|---|---|
| 837P professional | Claim Submission API: claimInformation.claimSupplementalInformation.referralNumberCMS-1500 API: encounter.referenceNumbers.referral | REF-02 (Referral Number) of Loop 2300 (Claim Information) |
A service-line referral number applies to a single service line.
Service-line referral number
| Claim type | JSON API field | X12 element |
|---|---|---|
| 837P professional | claimInformation.serviceLines[].serviceLineReferenceInformation.referralNumber | REF-02 (Referral Number) of Loop 2400 (Service Line Number) |
How the edit works
Per HIPAA standards, the claim-level referral number applies to every service line. You can also report a referral number on a service line when it differs from the claim-level number. Without a claim-level referral number, there's nothing for the line to differ from.
If a claim reports a referral number on a service line but omits the claim-level referral number, 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": "Invalid Line-Level Referral Number. The service-line referral number on line 1, REF789012, should not be submitted when a claim-level referral number is not present. 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, entity identifier code, and error message:
STC*A7>247*[DATE]*U*[AMOUNT]******A7>761>QC**Invalid Line-Level Referral Number. The service-line referral number on line 1, REF789012, should not be submitted when a claim-level referral number is not present. Correct and resubmit.~Related claim edits
Stedi has another edit for a referring provider on a service line without one at the claim level. See Missing claim-level referring provider.