Claim edit: Missing admission date for inpatient claims

Stedi now rejects 837P professional claims that indicate an inpatient setting but are missing an admission date.

How the edit works

In professional claims, an inpatient claim is a claim for services delivered to a patient who’s formally admitted to a hospital or similar facility.

Inpatient claims must include the patient's admission date. The date tells the payer when the patient was admitted to the facility for care.

Admission date

The place of service code identifies whether a claim is an inpatient claim. Codes such as 21 (Inpatient Hospital) or 51 (Inpatient Psychiatric Facility) indicate an inpatient setting.

Place of service code

If the place of service code indicates an inpatient setting and no admission date is present, 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": "Missing Admission Date/Hour. The admission date/hour should be present on all inpatient claims and some outpatient claims. The submitted place of service, 21, indicates an inpatient claim. 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>189*[DATE]*U*[AMOUNT]******A8>249**Missing Admission Date/Hour. The admission date/hour should be present on all inpatient claims and some outpatient claims. The submitted place of service, 21, indicates an inpatient claim. Correct and resubmit.~