Changelog

Stedi now rejects 837P professional claims when the MJ (minutes) unit of measurement code is used to incorrectly bill for anesthesia or non-anesthesia services.

In professional claims, the MJ unit of measurement code indicates a service was billed in minutes. While not a HIPAA mandate, it’s standard practice in the healthcare industry to bill for anesthesia services - but no other services – using MJ. Other services are billed using units, encounters, or time-based units – such as 15-minute increments – not raw minutes.

If MJ is used incorrectly, payers may reject the claim, which can lead to payment delays. This edit – the industry’s term for an automated validation rule – catches the issue before it reaches the payer.

When MJ must be used

An 837P professional claim will fail this edit when it contains a service line where all of the following are true:

• The procedure code is a CPT code in the range of 00100-01999, indicating it’s related to anesthesia.

• An anesthesia-related procedure modifier, as defined by the American Society of Anesthesiologists, is present. These modifiers include:

  • AA – Anesthesia services performed personally by an anesthesiologist

  • AD – Medical supervision by a physician; more than 4 concurrent anesthesia procedures

  • G8 – Monitored anesthesia care [MAC] for deep complex, complicated, or markedly invasive surgical procedure

  • G9 – Monitored anesthesia care [MAC] for patient who has history of severe cardiopulmonary condition

  • QK – Medical direction of 2, 3, or 4 concurrent anesthesia procedures involving qualified individuals

  • QS – Monitored anesthesiology care services

  • QX – Qualified non-physician anesthetist with medical direction by a physician

  • QY – Medical direction of one qualified non-physician anesthetist by an anesthesiologist

  • QZ – CRNA without medical direction by a physician

• The unit of measurement code is not MJ.

If you submit a claim that fails this requirement using Stedi’s 837P professional claim submission APIs or CMS-1500 professional claim form, you’ll get back an error message in real time. If you’re using the JSON API endpoint, the response includes details in the errors array:

{
  "errors": [
    {
      "code": "33",
      "description": Invalid Measurement Code for Anesthesia Procedure Code. 01001 is an Anesthesia service which must be reported in minutes (measurement code: MJ). Correct and resubmit.",
      "followupAction": "Please Correct and Resubmit"
    }
  ]
}

If you submit a claim that fails this requirement 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.

When MJ must not be used

An 837P professional claim will fail this edit when it contains a service line where all of the following are true:

• The procedure code is not in the range of 00100-01999, indicating it’s not related to anesthesia.

• No anesthesia-related procedure modifiers are present.

• The unit of measurement code is MJ.

If you submit a claim that fails this requirement using Stedi’s 837P professional claim submission APIs or CMS-1500 professional claim form, you’ll get back an error message in real time. If you’re using the JSON API endpoint, the response includes details in the errors array:

{
  "errors": [
    {
      "code": "33",
      "description": Invalid Measurement Code for Procedure Code. Measurement Code MJ is not valid for 90837 as it should be only used code for Anesthesia services. Correct and resubmit.",
      "followupAction": "Please Correct and Resubmit"
    }
  ]
}

If you submit a claim that fails this requirement 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.

Stedi now rejects 837P professional, 837D dental, and 837I institutional when a line item control number exceeds 30 characters.

The line item control number, also called the provider control number, is a provider-assigned identifier for each service line. Payers return this number on service lines in 277CA claim acknowledgments and 835 Electronic Remittance Advice (ERAs). Providers use it to track service lines across claim submissions, acknowledgments, and remittance files.

Line item control numbers are different from patient control numbers, which are used to track a claim as a whole.

HIPAA-adopted standards limit this line item control numbers to a maximum of 30 characters. If the value is too long, the payer may reject the claim, which can cause payment delays.

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

When this edit applies

A claim will fail this edit when:

• JSON API
  If you’re using one of Stedi’s JSON claim submission API endpoints, the edit fails if one of the following request field values is more than 30 characters:
  
  

  • Professional claims JSON endpoint: claimInformation.serviceLines.providerControlNumber

  • Dental claims JSON endpoint: claimInformation.serviceLines.providerControlNumber

  • Institutional claims JSON endpoint: claimInformation.serviceLines.lineItemControlNumber

• Raw X12
  If you’re using raw X12, the edit fails if REF-02 (Line Item Control Number) in any Loop 2400 (Service Line Number) is more than 30 characters.
  
  

• Stedi portal
  You can’t specify line item control numbers using the Stedi portal’s CMS-1500 claim form. As a result, you can’t fail this edit using the form.

Rejection errors

If you submit a claim that fails the edit using Stedi’s claim submission APIs, you’ll get back an error message in real time. If you’re using a JSON API endpoint, the response includes error details in the errors array:

{
  "errors": [
    {
      "code": "33",
      "description": Submitted Line Item Control Number, {123456789012345678901234567890123}, is invalid as it exceeds 30 characters. This field must be between 1-30 characters. 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.

You can now upload batch eligibility CSV files containing up to 10,000 checks – 10x the previous 1,000-check limit for CSV.

If you need to run more checks, you can upload and run multiple files at the same time.

For details, check out our Batch eligibility CSV upload docs.

You can now programmatically retrieve PDF versions of your 835 Electronic Remittance Advice (ERAs) using Stedi’s new ERA PDF API endpoint. The {transactionId} path parameter is the ERA's transaction ID.

By default, the endpoint returns the PDF as a base64-encoded string. To get the unencoded PDF data, include the Accept: application/pdf request header. To view the PDF, save the PDF data to a file with a .pdf extension.

curl -X GET \
  "https://healthcare.us.stedi.com/2024-04-01/electronic-remittance-advice/{transactionId}/pdf" \
  -H "Authorization: <api_key>" \
  -H "Accept: application/pdf" \
  > era.pdf

The PDFs are the same as the ones you can download from the Stedi portal:

For more, check out our announcement blog or the API reference.