Claim edit: Missing adjustment amount
Stedi now rejects 837P professional, 837D dental, and 837I institutional claims that include an adjustment reason code without a corresponding adjustment amount.
How the edit works
In a healthcare claim, an adjustment is a dollar amount that reduces what the payer owes the provider. Adjustments can cover things like a contractual write-off or the patient's responsibility, such as a co-pay or deductible.
Payers apply adjustments during adjudication and return them, along with other payment information, to the provider in an Electronic Remittance Advice (ERA). Adjustments are provided at both the claim and service-line level.
In the ERA, each adjustment's dollar amount is paired with a Claim Adjustment Reason Code (CARC). The reason code explains why the adjustment was made.
When billing a secondary or tertiary payer – a process called coordination of benefits (COB) – the provider or their billing system copies the prior payer's adjustments onto the claim.
Each adjustment has a reason code, a dollar amount, and an optional quantity. Not all three are required, but if a reason code is present, the amount must be too.
Claim-level adjustment amount
| Claim type | JSON API field | X12 element |
|---|---|---|
| 837P professional | claimInformation.otherSubscriberInformation[].claimLevelAdjustments[].adjustmentDetails[].adjustmentAmount | CAS-03, CAS-06, CAS-09, CAS-12, CAS-15, and CAS-18 of Loop 2320 (Other Subscriber Information) |
| 837D dental | claimInformation.otherSubscriberInformation[].claimLevelAdjustments[].adjustmentDetails[].adjustmentAmount | CAS-03, CAS-06, CAS-09, CAS-12, CAS-15, and CAS-18 of Loop 2320 (Other Subscriber Information) |
| 837I institutional | claimInformation.otherSubscriberInformation.claimLevelAdjustments[].claimAdjustmentDetails[].adjustmentAmount | CAS-03, CAS-06, CAS-09, CAS-12, CAS-15, and CAS-18 of Loop 2320 (Other Subscriber Information) |
Service line-level adjustment amount
| Claim type | JSON API field | X12 element |
|---|---|---|
| 837P professional | claimInformation.serviceLines[].lineAdjudicationInformation[].claimAdjustmentInformation[].adjustmentDetails[].adjustmentAmount | CAS-03, CAS-06, CAS-09, CAS-12, CAS-15, and CAS-18 of Loop 2430 (Line Adjudication Information) |
| 837D dental | claimInformation.serviceLines[].lineAdjudicationInformation[].claimAdjustmentInformation[].adjustmentDetails[].adjustmentAmount | CAS-03, CAS-06, CAS-09, CAS-12, CAS-15, and CAS-18 of Loop 2430 (Line Adjudication Information) |
| 837I institutional | claimInformation.serviceLines[].lineAdjudicationInformation[].lineAdjustment[].claimAdjustmentDetails[].adjustmentAmount | CAS-03, CAS-06, CAS-09, CAS-12, CAS-15, and CAS-18 of Loop 2430 (Line Adjudication Information) |
If the reason code is copied without the corresponding amount, the payer can't process the adjustment and will 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": "Missing Adjustment Amount. When an adjustment reason code is present then a corresponding adjustment amount is required. Impacted adjustment reason code(s) 96. 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*A6>519*[DATE]*U*[AMOUNT]********Missing Adjustment Amount. When an adjustment reason code is present then a corresponding adjustment amount is required. Impacted adjustment reason code(s) 96. Correct and resubmit.~