Claim edit: Duplicate occurrence codes in institutional claims

Stedi now rejects 837I institutional claims that include the same occurrence code more than once within a single occurrence code group.

How the edit works

In institutional claims, occurrence codes report significant events in a patient's care. These codes can affect how much a payer will approve or pay for a claim or service.

For example, occurrence code 11 reports the onset of symptoms or illness. Code 42 reports the date of discharge. Occurrence codes are defined by the National Uniform Billing Committee (NUBC).

A claim can contain up to two groups of occurrence codes. Each group can contain up to 12 codes.

Occurrence code

The NUBC states that each occurrence code must be unique within a single group. If a claim includes the same occurrence code more than once within a single group, the payer may reject the claim.

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 Occurrence Code(s). If submitting multiple occurrence codes, each code must be unique. The submitted occurrence code(s) are submitted more than once, 45. 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>719*[DATE]*U*[AMOUNT]******A7>732**Invalid Occurrence Code(s). If submitting multiple occurrence codes, each code must be unique. The submitted occurrence code(s) are submitted more than once, 45. Correct and resubmit.~

Related claim edits

Stedi has another edit for duplicate occurrence span codes. Occurrence codes report a single event on a specific date. Occurrence span codes report a condition that applied over a range of dates. See Duplicate occurrence span codes in institutional claims.