New claim edit: Missing accident date

Stedi now rejects 837P professional and 837D dental claims that relate to an auto or other accident but don’t include an accident date.

When you submit a professional or dental claim, you can indicate that the patient’s condition is related to an accident using a related causes code. Valid codes are AA (Auto accident), EM (Employment), and OA (Other accident).

If you provide a related causes code of AA or OA, payers also require an accident date – the date the injury occurred. Payers use this date to determine liability, coordinate benefits with other payers, and correctly adjudicate the claim.

If you don’t include the accident date in these cases, the payer may reject the claim, which can delay payment.

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

When this edit applies
A professional or dental claim will fail this edit in the following cases:

• JSON API
  If you’re using one of Stedi’s JSON claim submission API endpoints, the edit fails if:

  • The claimInformation.relatedCausesCode array contains AA (Auto accident) or OA (Other accident).
    AND

  • The claimInformation.claimDateInformation.accidentDate field is empty or missing.

• Raw X12
  If you’re using raw X12, the edit fails if:

  • The CLM11-1 (Related Causes Code)  or CLM11-2 (Related Causes Code) of Loop 2300 (Claim Information) contains AA (Auto accident) or OA (Other accident).
    AND

  • The DTP-03 (Accident Date) of Loop 2300 is empty or missing.

• Stedi portal
  If you’re using the Stedi portal’s professional claim form, the edit fails if:

  • The Auto accident? or Other? field of Box 11 – Is patient's condition related to is Yes.

  • Box 15 – Other Date does not contain a Date with a Qualifier of 439 (Accident)

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 Accident Date is missing. This date is required when the claim is marked as accident-related, Auto Accident, in Related Causes Code. 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.