New claim edit: Duplicate payer responsibility level codes

Stedi now rejects 837P professional, 837D dental, and 837I institutional claims that include duplicate payer responsibility level codes.

Payer responsibility level codes, also called payment responsibility sequence number codes, indicate which payer is supposed to pay first, second, and so on. For example, a code of P indicates the primary payer. A code of S indicates the secondary payer.

The process of determining this order is known as coordination of benefits (COB). Payers use this information to process secondary and tertiary claims correctly.

If a claim lists more than one payer at the same responsibility level – for example, two primary payers – the payer may reject the claim, which can cause payment delays.

This edit – the industry’s term for an automated validation rule – catches the issue before it reaches the payer.

When this edit applies
A claim will fail this edit when:

• JSON API
  If you’re using one of Stedi’s JSON claim submission API endpoints, the edit fails if the subscriber.paymentResponsibilityLevelCode field and/or any claimInformation.otherSubscriberInformation.paymentResponsibilityLevelCode fields contain a duplicate value.

• X12
  If you’re using X12, the edit fails if Loop 2000B (Subscriber Hierarchical Level) and/or Loop 2320 (Other Subscriber Information) contain a duplicate SBR-01 (Payer Responsibility Sequence Number Code) value.

• Stedi portal
  You can’t fail this edit using the Stedi portal’s professional claim submission form. Currently, the form only supports claims to a single primary payer. Secondary and tertiary claims aren't supported.

This edit does not fail if a claim lists multiple payers with a responsibility level code of U (Unknown). A code of U doesn’t indicate a specific payment order, so duplicates are allowed.

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

{
  "errors": [
    {
      "code": "33",
      "description": "Invalid payer responsibility submitted. Duplicate payer responsibility codes were detected: [P, S, S]. Payer responsibility values within a claim must be unique. 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.