New claim edit: Invalid date of birth

Stedi now rejects 837P professional, 837D dental, and 837I institutional claims that contain an invalid date of birth.

In a claim, you must provide a date of birth for the patient. If the subscriber is a different person, you must also provide the date of birth for the subscriber – the person who carries the insurance policy.

Payers use dates of birth to distinguish between members with similar names. If you provide an invalid date of birth for the patient or subscriber, 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 the patient or subscriber’s provided date of birth:

• Occurs after the claim’s transaction date. – the date the claim is submitted. Providers always submit claims after care is provided. Logically, the date of birth can’t occur after the date the claim is submitted.
  
  If you’re using Stedi’s JSON claim submission APIs or professional claim form, this is the date you submit the claim to Stedi.  In X12 claims, this date is in segment BHT-04 (Transaction Set Creation Date).
  
  OR
  
  

• Indicates an age of 150 years or older

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": "The subscriber date of birth, 18001231, is invalid. The date of birth cannot be later than the transaction date and must reflect a reasonable subscriber age. 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.