Claim edit: Invalid patient status code

Stedi now rejects 837I institutional claims that contain an invalid patient status code.

How the edit works

In an institutional claim, the patient status code describes the patient's condition at the end of the claim's billed period. It tells the payer whether the patient was discharged, transferred, or still admitted.

The patient status code must be a valid two-digit value from the UB-04 FL17 code set. If it isn’t a valid code, 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:

{
  "errors": [
    {
      "code": "33",
      "description": "Invalid Patient Status Code. Patient status codes must be submitted as two numeric digits and must be a valid discharge status code. The submitted status code is not valid, 00. 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>234*[DATE]*U*[AMOUNT]********Invalid Patient Status Code. Patient status codes must be submitted as two numeric digits and must be a valid discharge status code. The submitted status code is not valid, 00. Correct and resubmit.~