New claim edit: ZIP or postal code required for U.S. and Canada addresses

Stedi now rejects 837P professional, 837D dental, and 837I institutional claims that include a U.S. or Canadian address without a ZIP or postal code.

X12 states that when an address is in the United States or Canada, a ZIP or postal code is required. If it isn’t, the payer may reject the claim, which can delay payment to the provider.

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

Rejection errors

If you submit a claim that fails the edit using Stedi’s JSON or X12 Claim Submission API endpoints, you’ll get back an error response in real time. The response includes details in the errors array:

{
  "errors": [
    {
      "code": "33",
      "description": "Missing Postal Code(s). For U.S. addresses, a postal code must also be included. The postal code is missing for the following address fields: Billing Provider. 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 include a related claim status category code, claim status code, and error message:

STC*A6:N500*[DATE]*85*[AMOUNT]********Missing Postal Code(s). For U.S. addresses, a postal code must also be included. The postal code is missing for the following address fields: Billing Provider. Correct and resubmit

Addresses outside the U.S. and Canada

If an address is not in the U.S. or Canada, ensure the claim includes the correct country code for the address.

For example, for an 837P professional claim’s billing provider’s address, you can use the billing.address.countryCode field in JSON 837P Professional Claims API endpoint.