Stedi now rejects 837P professional, 837D dental, and 837I institutional claims that include an invalid service unit count.
What are service unit counts?
In a claim, a service line represents billing for a specific service, such as an office visit, lab test, or therapy session. The line’s procedure code indicates the type of service.
A service unit count is the number of units for a service line. The meaning of a unit – visits, tests, time increments, etc. – depends on the procedure code. For example, four units of a 15-minute therapy code equal one hour.
Invalid unit counts
X12 standards require service unit counts to be greater than zero. If a service line's unit count is zero or negative, the payer may reject the claim.
How this edit works
This edit catches claims with zero or negative service unit counts before the claims reach the payer. This prevents payer rejections, which take longer to resolve and delay payment for the provider.
The edit applies to three different service unit counts that can appear on a claim:
-
Submitted service unit counts – What the provider bills. Called the procedure count on dental claims.
-
Paid service unit counts – What a prior payer pays in coordination of benefits (COB) scenarios.
-
Repriced approved service unit counts – What a third-party repricer approves after reviewing the claim. Not commonly used by claim submitters.
Submitted service unit counts
A submitted service unit count is the number of units a provider bills on a service line, before any adjudication or adjustments.
Rejection errors
If you submit a claim with a submitted service unit count that's zero or negative using Stedi’s 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": "Invalid Service Units. Service units must be greater than zero for each service line. Line 1 contains an invalid value, 0. Correct and resubmit.",
"followupAction": "Please Correct and Resubmit"
}
]
}
If you submit a claim with a submitted service unit count that's zero or negative 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*A7>476*[DATE]*U*[AMOUNT]********Invalid Service Units. Service units must be greater than zero for each service line. Line 1 contains an invalid value, 0. Correct and resubmit.~
Paid service unit counts
When a patient has more than one insurance plan, say a child covered by both parents’ health insurance, claims go to the primary payer first, then the secondary, and so on. This is called coordination of benefits (COB).
Claims sent to non-primary payers must report each previous payer’s payments and adjustments.
A paid service unit count reports how many units a previous payer paid for a given service line. For example, if the primary payer paid 2 of 3 office visit units, the claim submitted to the secondary payer should include a paid service unit count of 2 for that service line.
Rejection errors
If you submit a claim with a paid service unit count that's zero or negative using Stedi’s 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": "Invalid Paid Service Unit Count. Submitted value -2 on line 1 must be zero or greater. Negative values are not allowed. Correct and resubmit.",
"followupAction": "Please Correct and Resubmit"
}
]
}
If you submit a claim with a paid service unit count that's zero or negative using SFTP, Stedi will reject the claim with a 277CA claim acknowledgment and an error message:
STC*A7>608*[DATE]*U*[AMOUNT]********Invalid Paid Service Unit Count. Submitted value -2 on line 1 must be zero or greater. Negative values are not allowed. Correct and resubmit.~
Repriced approved service unit counts
Important: Most Stedi customers will not use repriced approved service unit counts. They're typically set by a repricer, not the claim submitter.
A contracted rate is the prenegotiated maximum a payer will pay for a specific service. Payers sometimes contract with third-party repricers to apply contracted rates to claims. Repricers are common in managed care and provider networks.
The repricer reviews submitted claims and may approve fewer units than the provider billed. For example, if a provider bills four units of a 15-minute therapy code (one hour total), the repricer may only approve three units (45 minutes). The repricer then updates the claim with the repriced approved service unit count and forwards the claim to the payer.
The payer uses this approved count, along with the contracted rate, to adjudicate the claim.
Rejection errors
If you submit a claim with a repriced approved service unit count that's zero or negative using Stedi’s 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": "Invalid Repriced Approved Service Unit Count. Submitted value -1 on line 1 must be zero or greater. Negative values are not allowed. Correct and resubmit.",
"followupAction": "Please Correct and Resubmit"
}
]
}
If you submit a claim with a repriced approved service unit count that's zero or negative using SFTP, Stedi will reject the claim with a 277CA claim acknowledgment and an error message:
STC*A7>709*[DATE]*U*[AMOUNT]********Invalid Repriced Approved Service Unit Count. Submitted value -1 on line 1 must be zero or greater. Negative values are not allowed. Correct and resubmit.~
Resolution tips
Claim submitters sometimes use negative service unit counts to reverse charges, or submit zero units in error. Submit a void or replacement claim instead.
