Claim edit: Duplicate contract amount on a service line
Stedi now rejects 837P professional and 837D dental claims that report the same contract amount on a service line and at the claim level.
Important: Most claims don't include a contract amount. Submitters send one only when the provider’s contract with the payer requires it. Confirm with the payer before including it.
What is a contract amount?
A contract amount is the dollar amount a payer agreed to pay for a service in their contract with the provider. This amount often differs from the provider’s billed charge amount.
When you submit a claim, you can specify the contract amount at two levels: the claim level and the service line level.
The claim-level contract amount covers the whole claim.
Claim-level contract amount
| Claim type | JSON API field | X12 element |
|---|---|---|
| 837P professional | claimInformation.claimContractInformation.contractAmount | CN1-02 (Contract Amount) of Loop 2300 (Claim Information) |
| 837D dental | claimInformation.claimContractInformation.contractAmount | CN1-02 (Contract Amount) of Loop 2300 (Claim Information) |
The service-line contract amount specifies the contracted dollar amount for a specific service on the claim. A claim can have multiple service-line contract amounts – one for each service.
Service-line contract amount
| Claim type | JSON API field | X12 element |
|---|---|---|
| 837P professional | claimInformation.serviceLines[].contractInformation.contractAmount | CN1-02 (Contract Amount) of Loop 2400 (Service Line Number) |
| 837D dental | claimInformation.serviceLines[].contractInformation.contractAmount | CN1-02 (Contract Amount) of Loop 2400 (Service Line Number) |
How the edit works
A service-line contract amount should not duplicate the claim-level contract amount.
Some payer systems treat service-line contract amounts as an override of the claim-level value. These systems may read a duplicate contract amount at the claim and service line level as a conflicting or erroneous override.
This edit catches the issue before the claim reaches the payer. It prevents payer rejections, which take longer to resolve 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:
{
"errors": [
{
"code": "33",
"description": "Invalid Service Line Contract Amount. The submitted service-line contract amount on line 1 must not equal the claim-level contract amount, 500. 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>545*[DATE]*U*[AMOUNT]******A8>710**Invalid Service Line Contract Amount. The submitted service-line contract amount on line 1 must not equal the claim-level contract amount, 500. Correct and resubmit.~Resolution tip
If a service line has the same contracted amount as the claim, remove the service line’s contract amount. The claim-level amount already applies to every line on the claim.