New claim edit: Non-zero adjustment amounts

Stedi now rejects 837P professional, 837D dental, and 837I institutional claims when an adjustment amount is zero.

In healthcare claims, an adjustment represents an amount that was written off, applied as patient responsibility, or previously paid by another payer. Adjustments can be applied at both the claim level and the service line level.

Payers expect adjustments in a claim to reflect a real dollar amount. A zero amount isn’t valid and will cause the claim to be rejected downstream, which can cause delays.

This new edit – an industry term for an automated validation rule – catches the issue before it reaches the payer. The edit ensures that no claim-level or line-level adjustment in a claim equals zero. If so, the claim fails the edit.

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 details in the errors array:

{
  "errors": [
    {
      "code": "33",
      "description": "Claim Adjustments at the Line-level (Segment CAS) contain one or more zero values. Segment CAS-03 represents the monetary amount for each adjustment, which must be greater than zero (0.00). 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 initial treatment date and resubmit the claim.