Claim edit: Symptom onset date matches a service date

Stedi now rejects 837P professional claims where the symptom onset date matches a service date.

How the edit works

In a professional claim, the onset of current illness or symptom date, also called the symptom onset date, is when the patient first experienced symptoms of the illness or condition being treated. This date helps payers establish a clinical timeline to support coverage determinations and medical necessity reviews.

The symptom onset date is situational. Submitters only report it when it's relevant to a service line in the claim. It should differ from any service dates on the claim. If the symptom onset date matches a service date, omit it.

Symptom onset date

X12 standards state that the symptom onset date must differ from the date of service, also called the service date, for any service line in a claim.

Service date

If the symptom onset date matches a service date – or falls within a service date range – 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 Onset of Current Illness date. The onset of illness/symptom date must be different from the service date, 20240301. Correct and resubmit.",
      "followupAction": "Please Correct and Resubmit"
    }
  ]
}

{
  "errors": [
    {
      "code": "33",
      "description": "Invalid Onset of Current Illness date. The onset of illness/symptom date must be different from the service date, 20240301. Correct and resubmit.",
      "followupAction": "Please Correct and Resubmit"
    }
  ]
}

{
  "errors": [
    {
      "code": "33",
      "description": "Invalid Onset of Current Illness date. The onset of illness/symptom date must be different from the service date, 20240301. 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*A7>397*[DATE]*U*[AMOUNT]******A7>187**Invalid Onset of Current Illness date. The onset of illness/symptom date must be different from the service date, 20240301. Correct and resubmit

STC*A7>397*[DATE]*U*[AMOUNT]******A7>187**Invalid Onset of Current Illness date. The onset of illness/symptom date must be different from the service date, 20240301. Correct and resubmit

STC*A7>397*[DATE]*U*[AMOUNT]******A7>187**Invalid Onset of Current Illness date. The onset of illness/symptom date must be different from the service date, 20240301. Correct and resubmit

Resolution tip

When the symptom onset date is the same as a service date in a claim, omit it and report only the service date.