Updated guidance for claim resubmissions

Stedi has updated its claim resubmission guidance to align with the new claims management functionality in the Stedi portal. Customers that follow the updated guidance will see resubmitted claims linked to the original claim in the claims view and claim timeline.

Important: This guidance only affects how claim submissions are linked in the Stedi portal. It doesn’t affect claims processing. You can continue to submit claims to Stedi without following the updated guidance, but it will lead to a suboptimal viewing experience in the portal.

The update covers two fields in the claim submission: patient control numbers (PCNs) and claim frequency codes (CFCs).

If you don't update your resubmission logic, resubmissions will still succeed, but the resubmitted claim won't appear linked to the original claim in the Stedi portal's claims view and claim timeline.

Claims and resubmissions already submitted under previous guidance won't be retroactively linked in the claims view or claim timeline.

Patient control numbers

A patient control number (PCN) is a tracking ID for a claim. You include a PCN when you submit a claim. The payer sends the PCN back in follow-up transactions: claim acknowledgments, Electronic Remittance Advice (ERAs), and real-time claim status checks.

You can set the PCN in the following locations:

• JSON API: claimInformation.patientControlNumber

• X12 (API or SFTP): Loop 2300 CLM01 (Patient Control Number)

• CMS-1500 claim form: Box 26 (Patient account number)

Stedi matches claims and resubmissions in the claims view and claim timeline using the PCN. We recommend using nanoid to generate strong, unique 17-character PCNs. See our docs for best practices.

What’s changing

Previously, our guidance was to use a new, unique PCN for any claim resubmission. Since Stedi’s claims management views use the PCN to link claims and resubmissions, this meant that a claim and a resubmission with different PCNs would not be linked in the portal.

We now recommend reusing the same PCN from the original submission in two scenarios:

• Pre-adjudication claims (any payer): The claim hasn't yet entered the payer's adjudication system. The clearest signals that a claim is in pre-adjudication are that the payer's 277CA doesn't contain a payer claim control number (PCCN), no real-time claim status check has returned a PCCN, and you haven't received an ERA for the original claim. See Pre-adjudication vs. adjudication in our docs.

• Medicare claims in adjudication: The clearest signals that a claim is in adjudication are that the payer's 277CA contains a PCCN, a real-time claim status check returned a PCCN, or you've received an ERA for the original claim. Medicare resubmissions don’t use the PCCN, so reusing the PCN doesn't risk duplicate-claim errors. See Medicare resubmission in our docs.

Reusing the PCN in these scenarios allows Stedi to link resubmissions to the same claim timeline.

For non-Medicare claims in adjudication, our guidance is unchanged: use a new, unique PCN. This helps avoid duplicate-claim errors from the payer. It also makes it easier to differentiate ERA responses for the original claim from those for resubmissions.

Claim frequency codes

The claim frequency code (CFC) tells the payer whether a claim is an original claim, a correction, or part of an ongoing stay.

You can set the CFC in the following locations:

• JSON API: claimInformation.claimFrequencyCode

• X12 (API or SFTP): Loop 2300 CLM05-03 (Claim Frequency Code)

• CMS-1500 claim form: Qualifier in Box 22 (Resubmission code)

Institutional claims support a broader set of CFC values than professional or dental claims. For example, long-term care facilities often submit interim claims every 30 days using CFC 2 (Interim - First Claim), 3 (Interim - Continuing Claims), or 4 (Interim - Last Claim). Resubmitting an interim claim with CFC 1 would incorrectly signal a final end-to-end claim.

What’s changing

Previously, our guidance was to use CFC 1 (Admit thru Discharge Claim) for pre-adjudication claims and Medicare claims in adjudication, and CFC 7 (Replacement of Prior Claim) for corrections or 8 (Void/Cancel of Prior Claim) for cancellations, for non-Medicare claims in adjudication. This guidance didn't account for institutional interim claims (described above), which retain their original CFC across resubmissions.

We now recommend institutional claims use the original submission's CFC in two scenarios:

• Pre-adjudication institutional claims (any payer): The claim hasn't yet entered the payer's adjudication system. The clearest signals that a claim is in pre-adjudication are that the payer's 277CA doesn't contain a PCCN, no real-time claim status check has returned a PCCN, and you haven't received an ERA for the original claim. See Pre-adjudication vs. adjudication in our docs.

• Institutional Medicare claims in adjudication: The clearest signals that a claim is in adjudication are that the payer's 277CA contains a PCCN, a real-time claim status check returned a PCCN, or you've received an ERA for the original claim. See Medicare resubmission in our docs.

Preserving the original CFC keeps the claim's intent intact – original, interim, or final – across resubmissions.

For professional and dental claims, and for non-Medicare claims in adjudication (all claim types), our guidance is unchanged.

Support

For more details, see our resubmit or cancel claims docs.

If you have questions or concerns, contact us using your dedicated support channel or our contact form.