New claim edit: COB claims must be balanced

Stedi now rejects secondary and tertiary 837P professional, 837D dental, and 837I institutional claims if the claim’s Coordination of Benefits (COB) amounts don’t balance.

When you submit a secondary or tertiary claim, you must include the payments and adjustments, like patient responsibility or disallowed amounts, from previous payers. These amounts must add up cleanly:

Total charges = All payments + All adjustments

This process is called Coordination of Benefits (COB) balancing.

If the numbers don’t match, the payer may reject the claim to avoid overpayment. This edit  – the industry term for an automated validation rule – catches the issue before it reaches the payer.

For more on COB balancing, see our How to balance COB claims guide.

Rejection errors
If you submit a claim that fails the edit using Stedi’s claim submission APIs or professional claim form, you’ll get back an error message in real time. If you’re using a JSON API endpoint, the response includes details in the errors array:

{
  "errors": [
    {
      "code": "33",
      "description": "Coordination of Benefits (COB) balancing failed. The total charged amount of $140.00 does not equal the sum of the paid amount of $80.00 and all adjustment amounts of $35.00. Correct and resubmit.",
      "followupAction": "Please Correct and Resubmit"
    }
  ]
}

If you submit a claim that fails the edit using SFTP, Stedi will reject the claim with a 277CA claim acknowledgment. The acknowledgment will contain a related claim status category code, claim status code, and error message. You can use the error message to correct and resubmit the claim.

Resolution tip
Double-check the payment and adjustment details from the previous payer’s Electric Remittance Advice (ERA), Explanation of Payment (EOP), or Explanation of Benefits (EOB). For help walking through the math, see How to balance COB claims.