Claim edit: Missing other payer adjudication date in COB claims
Stedi now rejects 837P professional, 837D dental, and 837I institutional claims that list a previous payer but are missing that payer's adjudication date.
How the edit works
When a patient has more than one insurance plan, say a child covered by both parents' health insurance, claims go to the primary payer first, then the secondary, and so on. This is called coordination of benefits (COB).
Claims sent to non-primary payers must report each previous payer's payments and adjustments. These claims must also include the date on which each previous payer adjudicated – or determined how to pay – the claim. This information helps the payer establish the sequence of benefits as well as timely filing determinations.
You can provide the adjudication date for either the entire claim or each service line.
Claim-level adjudication date
| Claim type | JSON API field | X12 element |
|---|---|---|
| 837P professional | claimInformation.otherSubscriberInformation[].otherPayerName.otherPayerAdjudicationOrPaymentDate | DTP*573 (Adjudication or Payment Date) of Loop 2330B (Other Payer Name) |
| 837I institutional | claimInformation.otherSubscriberInformation.otherPayerName.otherPayerAdjudicationOrPaymentDate | DTP*573 (Adjudication or Payment Date) of Loop 2330B (Other Payer Name) |
| 837D dental | claimInformation.otherSubscriberInformation[].otherPayerName.otherPayerAdjudicationOrPaymentDate | DTP*573 (Adjudication or Payment Date) of Loop 2330B (Other Payer Name) |
Service line adjudication date
| Claim type | JSON API field | X12 element |
|---|---|---|
| 837P professional | claimInformation.serviceLines[].lineAdjudicationInformation[].adjudicationOrPaymentDate | DTP*573 (Adjudication or Payment Date) of Loop 2430 (Line Adjudication Information) |
| 837I institutional | claimInformation.serviceLines[].lineAdjudicationInformation[].adjudicationOrPaymentDate | DTP*573 (Adjudication or Payment Date) of Loop 2430 (Line Adjudication Information) |
| 837D dental | claimInformation.serviceLines[].lineAdjudicationInformation[].adjudicationOrPaymentDate | DTP*573 (Adjudication or Payment Date) of Loop 2430 (Line Adjudication Information) |
If you don't specify a previous adjudication date in a COB claim, 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": "Missing Claim Check or Remittance Date. This date is required when the identified other payer, [other payer name], has previously adjudicated the claim and the line check or remittance date is not provided. 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, entity identifier code, and error message:
STC*A6>516>PR*[DATE]*U*[AMOUNT]********Missing Claim Check or Remittance Date. This date is required when the identified other payer, [other payer name], has previously adjudicated the claim and the line check or remittance date is not provided. Correct and resubmit.~