Changelog

When an eligibility check to the Centers for Medicare & Medicaid Services (CMS) fails with AAA error 41 – meaning the provider’s NPI isn’t enrolled for eligibility transactions – Stedi now automatically submits the required transaction enrollment request. CMS usually processes these enrollments within 24-48 hours.

With this change, Stedi customers no longer need to track down and submit missing enrollments when a Medicare eligibility check fails. Stedi now handles that work for you. This reduces your operational overhead and helps ensure future Medicare checks will succeed.

For more information, see the related announcement blog.

Stedi now rejects 837I institutional claims that include an invalid billing provider ZIP code.

Institutional claims must include a full nine-digit ZIP code – called a ZIP+4 – with no spaces or hyphens for the billing provider. For example: 100031502. If you don’t know the full ZIP+4, you can look it up using the USPS ZIP Code Lookup tool.

If you submit institutional claims through Stedi’s institutional claim submission JSON API endpoint, this ZIP code is provided in the providers.address.postalCode field.

Payers reject claims that are missing a full ZIP+4 or that contain an invalid code, which can cause delays.

This edit – the industry’s term for an automated validation rule – prevents these claims from reaching the payer.

Rejection errors
If you submit a claim that fails the edit using Stedi’s institutional claim submission API, you’ll get back an error message in real time. If you’re using the JSON API endpoint, the response includes an error in the errors array:

{
  "errors": [
    {
      "code": "33",
      "description": "Billing provider zip code, 11113527 is invalid. Zip codes must be a nine-digit number with no spaces or hyphens. Correct and resubmit.",
      "followupAction": "Please Correct and Resubmit"
    }
  ]
}

If you submit an institutional claim that fails the edit using SFTP, Stedi will reject the claim with a 277CA claim acknowledgment. The acknowledgment will contain a related claim status category code, claim status code, and error message. You can use the error message to correct and resubmit the claim.

Stedi now rejects 837P professional and 837D dental claims that are missing the subscriber’s member ID when the subscriber is a person.

Payers use the subscriber’s member ID to identify the patient and verify eligibility. It’s typically printed on the subscriber’s insurance card. If it’s missing, the payer will reject the claim, which delays processing.

This new edit – an industry term for an automated validation rule – catches the issue before the claim ever reaches the payer.

Rejection errors
If you submit a claim that fails the edit using Stedi’s claim submission APIs or professional claim form, you’ll get back an error message in real time. If you’re using a JSON API endpoint, the response includes an error in the errors array:

{
  "errors": [
    {
      "code": "33",
      "description": "The subscriber identification is missing. When the subscriber is a person, then the subscriber identifier (commonly member id) is required. Correct and resubmit.",
      "followupAction": "Please Correct and Resubmit"
    }
  ]
}

If you submit a claim that fails the edit using SFTP, Stedi will reject the claim with a 277CA claim acknowledgment. The acknowledgment will contain a related claim status category code, claim status code, and error message. You can use the error message to correct and resubmit the claim.

Resolution tip
Add the subscriber’s member ID and resubmit the claim. If you’re using Stedi’s JSON API endpoints, provide this value in the subscriber.memberID field.

Stedi now rejects 837P professional, 837D dental, and 837I institutional claims when an adjustment amount is zero.

In healthcare claims, an adjustment represents an amount that was written off, applied as patient responsibility, or previously paid by another payer. Adjustments can be applied at both the claim level and the service line level.

Payers expect adjustments in a claim to reflect a real dollar amount. A zero amount isn’t valid and will cause the claim to be rejected downstream, which can cause delays.

This new edit – an industry term for an automated validation rule – catches the issue before it reaches the payer. The edit ensures that no claim-level or line-level adjustment in a claim equals zero. If so, the claim fails the edit.

Rejection errors
If you submit a claim that fails the edit using Stedi’s claim submission APIs or professional claim form, you’ll get back an error message in real time. If you’re using a JSON API endpoint, the response includes details in the errors array:

{
  "errors": [
    {
      "code": "33",
      "description": "Claim Adjustments at the Line-level (Segment CAS) contain one or more zero values. Segment CAS-03 represents the monetary amount for each adjustment, which must be greater than zero (0.00). Correct and resubmit",
      "followupAction": "Please Correct and Resubmit"
    }
  ]
}

If you submit a claim that fails the edit using SFTP, Stedi will reject the claim with a 277CA claim acknowledgment. The acknowledgment will contain a related claim status category code, claim status code, and error message. You can use the error message to correct and resubmit the claim.

Resolution tip
Add the initial treatment date and resubmit the claim.