Changelog

Claim edit: Missing property and casualty claim number

Stedi now rejects 837P professional claims that include a property and casualty date of first contact without a related claim number.

How the edit works

Property and casualty (P&C) insurance claims cover injuries from accidents or liability events like auto accidents, Workers' Compensation, personal injury, and liability cases. These claims go to a P&C insurer rather than a healthcare payer.

In P&C claims, the date of first contact notes when a healthcare provider first treated the patient for the injury. 

Property and casualty date of first contact

The insurer opens an incident file and assigns a related claim number before it can process any billing.

Property and casualty claim number

If a P&C claim includes the date of first contact but not the claim number, the payer may reject the claim.

This edit catches the issue before the claim reaches the payer. It prevents payer rejections, which are slower and delay payment for the provider.

Rejection errors

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

{
  "errors": [
    {
      "code": "33",
      "description": "Missing Property Casualty Claim Number. When the Property and Casualty Date of First Contact is submitted (20260101), the Property and Casualty Claim Number must also be present. Correct and resubmit.",
      "followupAction": "Please Correct and Resubmit"
    }
  ]
}

If you submit a claim using SFTP and the claim fails the edit, 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>629*[DATE]*U*[AMOUNT]********Missing Property Casualty Claim Number. When the Property and Casualty Date of First Contact is submitted (20260101), the Property and Casualty Claim Number must also be present. Correct and resubmit.~

Filter batch eligibility results by search outcome

You can now filter batch eligibility results in the Stedi portal and API by search outcome: whether the payer returned active insurance coverage, no coverage, or an error.

The Stedi portal also now displays the search outcome for each check directly in the batch results view.

Previously, the Stedi portal didn't show search outcomes for individual checks. To find patients with a specific outcome, you had to cross-reference the Eligibility searches page, which includes checks from all sources, not just your batch.

Filter using the API

Use the Retrieve Batch Check Statuses API endpoint’s eligibilitySearchOutcome query parameter to filter batch eligibility results by search outcome. You can pass multiple search outcomes as values.

For example, the following request returns all checks where the payer returned no coverage or an error:

curl "https://manager.us.stedi.com/2024-04-01/eligibility-manager/batch/{batchId}/items?eligibilitySearchOutcome=inactive&eligibilitySearchOutcome=failed" \
  -H "Authorization: Key <api_key>"

Claim edit: Missing first name

Stedi now rejects 837P professional, 837D dental, and 837I institutional claims that include a person entity with no first name.

How the edit works

In a claim, each entity, such as the billing provider or subscriber, is identified as either a person or a non-person using an entity type qualifier.

When an entity is a person, a first name is required. If the first name is missing, the payer may reject the claim.

This edit catches the issue before the claim reaches the payer. It prevents payer rejections, which are slower and delay payment for the provider.

How entity type qualifiers are specified

If you use Stedi's JSON Claim Submission API endpoints, Stedi sometimes infers the entity type qualifier. For example, if you provide a firstName and lastName for the billing provider in a JSON 837P Professional Claims API request, the entity is treated as a person. If you provide an organizationName, the entity is treated as an organization. Other entities, such as otherPayerBillingProvider, have an explicit entityTypeQualifier field.

If you use X12, you set the entity type qualifier directly in NM1-02 (Entity Type Qualifier), where 1 indicates a person and 2 indicates a non-person entity.

Rejection errors

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

{
  "errors": [
    {
      "code": "33",
      "description": "Missing First Name. When the Billing Provider entity is a person, as identified by the entity type qualifier 1, the entity first name is required. Correct and resubmit.",
      "followupAction": "Please Correct and Resubmit"
    }
  ]
}

If you submit a claim using SFTP and the claim fails the edit, Stedi will reject the claim with a 277CA claim acknowledgment. The acknowledgment will include a related claim status category code, claim status code, entity identifier code, and error message:

STC*A6>505>85*[DATE]*U*[AMOUNT]********Missing First Name. When the Billing Provider entity is a person, as identified by the entity type qualifier 1, the entity first name is required. Correct and resubmit.~

Introducing event destinations

You can now get real-time notifications for Stedi events using event destinations, Stedi's new webhook framework.

For this launch, event destinations support transaction enrollment events. You can get a real-time notification whenever a request goes live or is rejected. We plan to release more event types for event destinations soon.

For more details, see our announcement blog.

Claim edit: COB service lines must be balanced

Stedi now rejects 837P professional, 837D dental, and 837I institutional claims sent to a non-primary payer when a service line's coordination of benefits (COB) amounts don't balance.

How the edit works

When a patient has multiple insurance plans, the provider submits a claim to each payer in order. The first is the primary payer. Any that follow are secondary, tertiary, and so on. This process is called coordination of benefits (COB).

A service line is a line item for a specific service on a claim, like an office visit or X-ray.

When you submit a claim to a non-primary payer, you must include each previous payer's adjudications – their payments and adjustments. Include both claim-level and service line-level adjudications from each prior payer. Don't include the same amounts at both levels.

Balancing service lines

When you include prior payer adjudications at the service line level, the amounts must add up as follows:

Billed line charge

Prior payer line paid amount

Line adjustment amounts

If the amounts don't balance for any service line adjudication, the payer may reject the claim.

This edit catches the issue before the claim reaches the payer. It prevents payer rejections, which are slower and delay payment for the provider.

We previously added a separate edit for claim-level COB balancing.

Rejection errors

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

{
  "errors": [
    {
      "code": "33",
      "description": "Coordination of Benefits (COB) balancing failed. For line 1, the total charged amount of $150.00 does not equal the sum of the paid amount of $0.00 and all adjustment amounts of $200.00 for payer STEDITEST. Correct and resubmit.",
      "followupAction": "Please Correct and Resubmit"
    }
  ]
}

If you submit a claim using SFTP and the claim fails the edit, 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*A7>551*[DATE]*U*[AMOUNT]********Coordination of Benefits (COB) balancing failed. For line 1, the total charged amount of $150.00 does not equal the sum of the paid amount of $0.00 and all adjustment amounts of $200.00 for payer STEDITEST. Correct and resubmit.~

Introducing the Stedi NPI registry

You can now look up details for any U.S. healthcare provider by NPI using the Stedi NPI registry.

An NPI is required for most healthcare transactions, including eligibility checks, claims, and claim status checks. You can use the registry to verify a provider’s NPI and other information before submitting these transactions.

For more details, see our announcement blog.

Claim edit: Discharge hour on non-final institutional claims

Stedi now rejects 837I institutional claims that include a discharge hour but use a claim frequency code that indicates the patient has not been discharged.

How the edit works

In institutional claims, the discharge hour tells the payer when the patient left the facility.

Discharge hour

Institutional claims also include a claim frequency code that tells the payer where the claim falls in a patient's billing cycle.

Claim frequency code

Some claim frequency codes, such as 2 (Interim – First Claim), indicate the patient is still receiving care and has not yet been discharged. Claims with these frequency codes are called non-final claims.

A discharge hour should not be included on non-final claims. If it is, the payer may reject the claim.

This edit catches the issue before the claim reaches the payer. It prevents payer rejections, which are slower and delay payment for the provider.

Rejection errors

If you submit a claim using Stedi's Claim Submission API endpoints and the claim fails the edit, you'll get back an error response in real time. The response includes details in the errors array.

The error message references the claim’s bill type. This is a combination of the claim’s facility type code and claim frequency code.

For example, bill type 112 indicates facility type 11 (Hospital inpatient – general) with frequency code 2 (Interim – First Claim).

{
  "errors": [
    {
      "code": "33",
      "description": "Invalid Discharge Date/hour. Discharge information should not be present for the submitted bill type 112. These fields are only used for final inpatient claims. Correct and resubmit.",
      "followupAction": "Please Correct and Resubmit"
    }
  ]
}

If you submit a claim using SFTP and the claim fails the edit, 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*A7>190*[DATE]*U*[AMOUNT]********Invalid Discharge Date/hour. Discharge information should not be present for the submitted bill type 112. These fields are only used for final inpatient claims. Correct and resubmit.~

Claim edit: Missing country code for non-US addresses

Stedi now rejects 837P professional, 837D dental, and 837I institutional claims that include a non-US address without a country code.

How the edit works

HIPAA-adopted X12 EDI standards require a country code when any address in a claim is outside the United States.

If an address's state or province code is not a US state or territory, the address must include a country code. If the country code is missing from a non-US address, the payer may reject the claim.

If the country code for a non-US address in a claim is missing, Stedi attempts to look up the country code using the full address. If successful, Stedi then updates the claim.

For example, if a billing provider’s address lists a state/province code of ON (Ontario) and uses a Canadian postal code format, Stedi will automatically add a country code of CA (Canada).

If Stedi's lookup can't find the country code, this edit rejects the claim. It prevents payer rejections, which are slower and delay payment for the provider.

Rejection errors

If you submit a claim using Stedi's Claim Submission API endpoints and the claim fails the edit, you'll get back an error response in real time. The response includes details in the errors array.

The entity name in the error varies based on which address in the claim is missing the country code. For example, the following error indicates the billing provider's address is missing a country code:

{
  "errors": [
    {
      "code": "33",
      "description": "Missing Country Code. The country code for Billing Provider is required when the address is outside the United States. Correct and resubmit.",
      "followupAction": "Please Correct and Resubmit"
    }
  ]
}

If you submit a claim using SFTP and the claim fails the edit, Stedi will reject the claim with a 277CA claim acknowledgment. The acknowledgment will include a related claim status category code, claim status code, entity identifier code, and error message:

STC*A6>680>85*[DATE]*U*[AMOUNT]********Missing Country Code. The country code for Billing Provider is required when the address is outside the United States. Correct and resubmit.~

Introducing claims management features for the Stedi portal

We’ve released a dedicated set of claims management features in the Stedi portal, including an improved claims view.

The new claims view is built around the claim itself. You can see where each claim stands, review its history, and filter across your entire claims volume. Features include:

• A filterable list of all claims submitted through Stedi

• The ability to see the current status of a claim

• A timeline for each claim showing 837 claim submissions and related 277CA claim acknowledgments

• Detail pages for each claim submission and acknowledgment transaction

For more details, see our announcement blog.

Introducing the CPT/HCPCS to Service Type Code lookup tool

You can now look up common Service Type Code (STC) mappings for a CPT or HCPCS procedure code using Stedi's free lookup tool.

You can use the STCs returned by the tool to test payer STC support and find the right STC to use in eligibility checks.

For more details, see our announcement blog.