New claim edit: Invalid or incomplete ZIP code

Stedi now rejects 837P professional, 837D dental, and 837I institutional claims that contain an invalid or incomplete ZIP code for a U.S. address.

How the edit works

Billing provider and service facility addresses

A claim’s billing provider and service facility addresses must use a full 9-digit ZIP code, called ZIP+4, for U.S. addresses.

If you provide a 5-digit ZIP code for the billing provider or service facility address, Stedi attempts to look up the full ZIP+4 using the full address. If successful, Stedi then updates the claim.

For example, if you submit a claim with a ZIP code of 20003 for a billing provider address of 1600 Pennsylvania Ave, Washington, D.C., Stedi will look up and use a ZIP+4 of 200033228.

Stedi also removes any separators from ZIP codes, such as dashes or spaces, before validating the ZIP code. For example, 20003-3228 becomes 200033228.

Other addresses

9-digit ZIP codes are not required for other U.S. addresses, such as the subscriber or payer address, in a claim. You can use either a 5-digit ZIP code or 9-digit ZIP+4 code.

Invalid or incomplete ZIP codes

This edit – the industry term for an automated validation rule – will reject a claim if:

• The ZIP code is incomplete. For example, it only contains 4 digits.

• The ZIP code is invalid. For example, it contains letters.

• Stedi can’t look up the ZIP+4 of a billing provider or service facility address. For example, the address doesn’t exist.

This prevents payer rejections, which are slower and delay payment for the provider.

Rejection errors

Billing provider and service facility addresses

If you submit a claim with a billing provider or service facility ZIP code that fails the edit using Stedi's Claim Submission API endpoints, you'll get back an error response in real time. The response includes details in the errors array:

{
  "errors": [
    {
      "code": "33",
      "description": "Incomplete ZIP Code. The billing provider address requires the full 9-digit ZIP code (ZIP+4) when the address is in the United States. Correct and resubmit.",
      "followupAction": "Please Correct and Resubmit"
    }
  ]
}

{
  "errors": [
    {
      "code": "33",
      "description": "Incomplete ZIP Code. The billing provider address requires the full 9-digit ZIP code (ZIP+4) when the address is in the United States. Correct and resubmit.",
      "followupAction": "Please Correct and Resubmit"
    }
  ]
}

{
  "errors": [
    {
      "code": "33",
      "description": "Incomplete ZIP Code. The billing provider address requires the full 9-digit ZIP code (ZIP+4) when the address is in the United States. 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 include a related claim status category code, claim status code, entity identifier code, and error message:

STC*A6>500*[DATE]*U*[AMOUNT]********Incomplete ZIP Code. The billing provider address requires the full 9-digit ZIP code (ZIP+4) when the address is in the United States. Correct and resubmit

STC*A6>500*[DATE]*U*[AMOUNT]********Incomplete ZIP Code. The billing provider address requires the full 9-digit ZIP code (ZIP+4) when the address is in the United States. Correct and resubmit

STC*A6>500*[DATE]*U*[AMOUNT]********Incomplete ZIP Code. The billing provider address requires the full 9-digit ZIP code (ZIP+4) when the address is in the United States. Correct and resubmit

Other addresses

If you submit a claim with another ZIP code that fails the edit using Stedi's Claim Submission API endpoints, you'll get back an error response in real time. The response includes details in the errors array:

{
  "errors": [
    {
      "code": "33",
      "description": "Invalid ZIP Code. The subscriber address requires either the 5-digit or full 9-digit ZIP code (ZIP+4) when the address is in the United States. Correct and resubmit.",
      "followupAction": "Please Correct and Resubmit"
    }
  ]
}

{
  "errors": [
    {
      "code": "33",
      "description": "Invalid ZIP Code. The subscriber address requires either the 5-digit or full 9-digit ZIP code (ZIP+4) when the address is in the United States. Correct and resubmit.",
      "followupAction": "Please Correct and Resubmit"
    }
  ]
}

{
  "errors": [
    {
      "code": "33",
      "description": "Invalid ZIP Code. The subscriber address requires either the 5-digit or full 9-digit ZIP code (ZIP+4) when the address is in the United States. 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 include a related claim status category code, claim status code, entity identifier code, and error message:

STC*A7>500*[DATE]*HK*[AMOUNT]********Invalid ZIP Code. The subscriber address requires either the 5-digit or full 9-digit ZIP code (ZIP+4) when the address is in the United States. Correct and resubmit

STC*A7>500*[DATE]*HK*[AMOUNT]********Invalid ZIP Code. The subscriber address requires either the 5-digit or full 9-digit ZIP code (ZIP+4) when the address is in the United States. Correct and resubmit

STC*A7>500*[DATE]*HK*[AMOUNT]********Invalid ZIP Code. The subscriber address requires either the 5-digit or full 9-digit ZIP code (ZIP+4) when the address is in the United States. Correct and resubmit