New claim edit: Limit line item control number to 30 characters

Stedi now rejects 837P professional, 837D dental, and 837I institutional when a line item control number exceeds 30 characters.

The line item control number, also called the provider control number, is a provider-assigned identifier for each service line. Payers return this number on service lines in 277CA claim acknowledgments and 835 Electronic Remittance Advice (ERAs). Providers use it to track service lines across claim submissions, acknowledgments, and remittance files.

Line item control numbers are different from patient control numbers, which are used to track a claim as a whole.

HIPAA-adopted standards limit this line item control numbers to a maximum of 30 characters. If the value is too long, 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 one of the following request field values is more than 30 characters:
  
  

  • Professional claims JSON endpoint: claimInformation.serviceLines.providerControlNumber

  • Dental claims JSON endpoint: claimInformation.serviceLines.providerControlNumber

  • Institutional claims JSON endpoint: claimInformation.serviceLines.lineItemControlNumber

• Raw X12

  If you’re using raw X12, the edit fails if REF-02 (Line Item Control Number) in any Loop 2400 (Service Line Number) is more than 30 characters.
  
  

• Stedi portal
  You can’t specify line item control numbers using the Stedi portal’s CMS-1500 claim form. As a result, you can’t fail this edit using the form.

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": Submitted Line Item Control Number, {123456789012345678901234567890123}, is invalid as it exceeds 30 characters. This field must be between 1-30 characters. 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.