Changelog

Stedi now rejects 837P professional claims and 837I institutional claims with an invalid diagnosis code.

In healthcare claims, diagnosis codes describe what’s wrong with the patient. HIPAA requires that professional and institutional claims only use valid, billable ICD-10-CM codes as diagnosis codes.

What the edits check

Stedi has introduced new edits – the healthcare industry’s term for automated validation rules – to help ensure claims include valid diagnosis codes.

The new edits reject a professional or institutional claim when any diagnosis code is:

• Not a valid ICD‑10‑CM code.
  For example, if the code is misspelled or doesn’t exist in the official ICD-10-CM code list.
  
  

• A non-billable ICD‑10‑CM code.
  Some ICD-10-CM codes are categories. They cover a broad diagnostic grouping rather than a specific condition. For example, E11 (Type 2 diabetes mellitus) is a category header.
  
  By themselves, category headers aren’t considered billable codes. They’re not specific enough to describe the exact condition or encounter being billed.
  
  A billable ICD-10-CM code must include both a category and a subcategory, such as E11.9 (Type 2 diabetes mellitus without complications).
  
  

• Not valid for the claim’s dates of service.
  Updates to the ICD-10-CM code set are published each year. If a claim uses a code that wasn’t valid on the dates of service, Stedi now rejects it.
  
  For example, Z11.52 (“Encounter for screening for COVID-19”) became effective on October 1, 2021. A claim with a date of service before that date would be rejected because the code wasn’t valid at the time.

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

{
  "errors": [
    {
      "code": "33",
      "description": "The ICD-10 code E11 submitted does not meet the level of specificity needed. The Diagnosis code is a header and not valid for HIPAA transactions. Please resubmit with a more specific ICD-10.",
      "followupAction": "Please Correct and Resubmit"
    }
  ],
  ...
}

If you submit a claim that fails the edits 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 claim attachments using the professional claims submission form in the Stedi portal.

For claim-level attachments, use Box 19 – Supplemental claim information.

For line-level attachments, use Box 24 – Service lines supplemental information.

You can upload JPG, PDF, PNG, or TIFF files as attachments. To upload an attachment, you must set the Transmission code to EL (EDI).

You must also choose the appropriate Report type for the attachment. For example, if you’re uploading a medical record, you’d select a Report type of M1 – Medical Record Attachment. See Attachment Report Type Codes for a full list.

Note: You can’t add attachments to claims that were already submitted through the portal. To include attachments for those claims, resubmit them with the attachments.

Previously, you could only upload attachments using Stedi’s Create Claim Attachment JSON API endpoint.

For more details, see our announcement blog.

You can now download a PDF version of your 835 Electronic Remittance Advice (ERAs) from the Stedi portal.

Each PDF follows the same layout as the CMS Standard Paper Remit (SPR), Medicare’s official paper form for remittance.

For more details, see our announcement blog.

Batch eligibility checks let you run up to 10,000 checks asynchronously using a single request. You can check the progress of those batches with two new API endpoints:

• Retrieve Batch Check Status – Shows the overall status of a batch, including counts for completed and in-progress checks.

• Retrieve Batch Check Statuses – Shows the status of each individual check in a batch.

For more details, see our announcement blog.