New claim edit: Missing admission source code

Stedi now rejects 837I institutional claims that are missing a required admission source code.

In an institutional claim, the admission source code tells you where the patient came from, such as the emergency room (ER), a doctor’s referral, or another facility.

Most institutional claims require this code. Without it, the payer can’t adjudicate the claim. The one exception is non-patient lab services, where no patient is present.

If the code is missing when required, 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 the claim reaches the payer.

When this edit applies
An institutional claim will fail this edit in the following cases:

• JSON API
  If you’re using Stedi’s JSON institutional claim submission API endpoint, the edit fails if:

  • The admissionSourceCode field is missing or empty.
    AND

  • The placeOfServiceCode field does not contain 14 (Non-Patient Laboratory).
    
    

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

  • CL1-02 (Admission Source Code) of Loop 2300 (Claim Information) is missing or empty.
    AND

  • C023-01 (Facility Type Code) of Loop 2300 is NOT 14 (Non-Patient Laboratory).

Rejection errors
If you submit a claim that fails the edit using Stedi’s institutional claim submission API endpoints, you’ll get back an error message in real time. If you’re using the JSON API endpoint, the response includes error details in the errors array:

{
  "errors": [
    {
      "code": "33",
      "description": "Missing admission source code. This code is required on all institutional claims with the exception of non-patient laboratory claims (Type of Bill 014x). 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.