Claim repair and edit: Incomplete ZIP Code

Stedi now validates ZIP Codes for US addresses in 837P professional, 837D dental, and 837I institutional claims.

X12 standards require a full 9-digit ZIP Code, called a ZIP+4, for the billing provider and service facility addresses when the address is in the United States.

For billing provider and service facility addresses without a full 9-digit ZIP+4, Stedi attempts to repair the claim by looking up the full 9-digit ZIP+4. If the lookup fails and the submitted ZIP is an invalid length, this edit rejects the claim.

Stedi also rejects claims with other addresses, such as subscriber or payer addresses, that contain ZIP Codes that don't meet length requirements.

Billing provider and service facility addresses

How the repair works

If the billing provider or service facility ZIP Code isn't a full 9-digit ZIP+4, Stedi attempts to look up the ZIP+4 using the rest of the address. If the lookup succeeds, Stedi repairs the claim with the resolved ZIP+4.

Billing provider address ZIP Code

Claim-level service facility address ZIP Code

Service-line-level service facility address ZIP Code

For example, if you submit a claim with a billing provider address of 1600 Pennsylvania Ave, Washington, DC, Stedi looks up and uses a ZIP+4 of 200033228.

Before the lookup, Stedi normalizes the submitted ZIP value. Hyphens and other separators are removed.

If Stedi can't look up the ZIP+4 (for example, because the address isn't recognized), Stedi preserves the submitted ZIP Code. If the value is only 5 digits, Stedi pads it with 0000 to reach the required 9-digit length. For example, a ZIP Code of 20003 becomes 200030000.

How the edit works

If the resulting ZIP Code isn't 9 digits after lookup and normalization, this edit rejects 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 that fails the edit for a billing provider or service facility address using Stedi's Claim Submission API endpoints, you'll get back an error response in real time. The response includes details in the errors array:

{
  "errors": [
    {
      "code": "33",
      "description": "Incomplete ZIP Code. The billing provider address requires the full 9-digit ZIP code (ZIP+4) when the address is in the United States. Correct and resubmit.",
      "followupAction": "Please Correct and Resubmit"
    }
  ]
}

If you submit a claim that fails the edit for a billing provider or service facility address using SFTP, Stedi rejects the claim with a 277CA claim acknowledgment. The acknowledgment includes a related claim status category code, claim status code, entity identifier code, and error message:

STC*A6>500>85*[DATE]*U*[AMOUNT]********Incomplete ZIP Code. The billing provider address requires the full 9-digit ZIP code (ZIP+4) when the address is in the United States. Correct and resubmit.~

Other addresses

Other addresses in a claim, such as the subscriber, payer, or patient address, can use either a valid 5-digit ZIP or 9-digit ZIP+4.

Stedi doesn't perform lookups for other addresses in the claim. Those addresses are rejected if they don't meet the 5-digit or 9-digit format requirement after Stedi normalizes them.

Rejection errors

If you submit a claim that fails the edit for an address other than the billing provider or service facility, such as the subscriber or payer address, using Stedi's Claim Submission API endpoints, you'll get back an error response in real time. The response includes details in the errors array:

{
  "errors": [
    {
      "code": "33",
      "description": "Invalid ZIP Code. The subscriber address requires either the 5-digit or full 9-digit ZIP code (ZIP+4) when the address is in the United States. Correct and resubmit.",
      "followupAction": "Please Correct and Resubmit"
    }
  ]
}

If you submit a claim that fails the edit for an address other than the billing provider or service facility using SFTP, Stedi rejects the claim with a 277CA claim acknowledgment:

STC*A6>500>HK*[DATE]*U*[AMOUNT]********Invalid ZIP Code. The subscriber address requires either the 5-digit or full 9-digit ZIP code (ZIP+4) when the address is in the United States. Correct and resubmit.~

Previous edit

This edit replaces the previous billing provider ZIP Code edit for institutional claims. The previous edit rejected institutional claims with an address missing a full ZIP+4. This edit adds the ZIP+4 lookup repair.