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.~