New claim edit: Missing initial treatment date for Medicare chiropractic claims

Stedi now rejects 837P professional claims that are billed to Medicare Part B for chiropractic services when the initial treatment date is missing.

Medicare requires chiropractic claims to include the initial treatment date. CMS defines this as the first date the chiropractor provided active treatment for the current episode. If that date is missing, the Medicare Administrative Contractor (MAC) payer will reject the claim, causing delays.

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

When this edit applies
A claim will fail this edit when all of the following are true:

• The claim is billed to Medicare Part B.

  • In raw X12, this is indicated by a value of MB (Medicare Part B) in SBR09 (Claim Filing Indicator Code) of Loop 2000B (Subscriber Information).

  • In the JSON professional claims submission endpoint, this is indicated by a Claim Filing Indicator Code of MB (Medicare Part B).

  • In the professional claim form, this is indicated in Box 1 – Insurance type by a value of Medicare.
    
    

• The claim includes a service line with one of the following Chiropractic Manipulative Treatment (CMT) procedure codes: 98940, 98941, or 98942.
  
  

• The claim is missing the initial treatment date.

  • In raw X12, this is indicated by a date with qualifier 454 (Initial Treatment) in DTP01 (Date - Initial Treatment Date) of Loop 2300 (Claim Information).

  • In the JSON professional claims submission endpoint, you can provide this in the initialTreatmentDate field.

  • In the professional claim form, enter the date in Box 15 – Other date with a Qualifier of 454 (Initial Treatment). 

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

{
  "errors": [
    {
      "code": "33",
      "description": "An initial treatment date is required when the chiropractic service, 98940, is submitted to Medicare. 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.