New claim edit: Invalid billing provider address

Stedi now rejects 837P professional, 837D dental, and 837I institutional claims that list a non-physical address for the billing provider. Non-physical addresses include Post Office (PO) Boxes, lockboxes, private mailboxes (PMBs), and similar mailbox-only addresses.

For claims, HIPAA requires that the provider’s billing address be a physical practice location where care is delivered. If you’re using Stedi’s JSON claim submission API endpoints, this address is in the request’s billing.address field. In X12, the address is in N3 (Billing Provider Address)  of Loop 2010AA (Billing Provider Name).

Payers may reject claims when the billing provider address is not a real street address, which can cause payment delays.

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

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 error details in the errors array:

{
  "errors": [
    {
      "code": "33",
      "description": "Invalid Billing Provider address. The billing provider address must be a street address. Post Office Box or Lock Box addresses are to be sent in the Pay-To Address (2010AB Loop). 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 tips
If the billing provider receives mail at a PO Box, lockbox, or other non-physical address, you can provide a “pay-to” address in the claim.

If you’re using Stedi’s JSON claim submission API endpoints, you can specify the pay-to address in the request’s payToAddress field or, for institutional claims, the billingPayToAddressName field. In X12, you can specify the pay-to address in N3 (Pay-to Address) of Loop 2010AB (Pay-to Address Name).