New claim edit: Missing member ID

Stedi now rejects 837P professional and 837D dental claims that are missing the subscriber’s member ID when the subscriber is a person.

Payers use the subscriber’s member ID to identify the patient and verify eligibility. It’s typically printed on the subscriber’s insurance card. If it’s missing, the payer will reject the claim, which delays processing.

This new edit – an industry term for an automated validation rule – catches the issue before the claim ever reaches the payer.

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 an error in the errors array:

{
  "errors": [
    {
      "code": "33",
      "description": "The subscriber identification is missing. When the subscriber is a person, then the subscriber identifier (commonly member id) is required. 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.

Resolution tip
Add the subscriber’s member ID and resubmit the claim. If you’re using Stedi’s JSON API endpoints, provide this value in the subscriber.memberID field.