Changelog

Claim edit: Service date outside the statement covers period

Stedi now rejects 837I institutional claims with a service line date outside the claim's statement covers period.

Statement covers periods and service dates

An institutional claim can bill for a range of dates. This range is called the statement covers period. You report the statement covers period at the claim level.

Statement covers period

Service lines can also carry their own service dates. X12 standards require service dates on outpatient service lines when the statement covers period is longer than one day.

Service date

How the edit works

Each service date on a claim must fall within the statement covers period. If you include a service date outside the statement covers period, 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": "Invalid Service Date. The service date must fall within the claim's statement dates. The service date, 20241020-20241020, on line 1 falls outside the claim's statement dates of 20241015-20241017. 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>187**U*******A8>188**Invalid Service Date. The service date must fall within the claim's statement dates. The service date, 20241020-20241020, on line 1 falls outside the claim's statement dates of 20241015-20241017. Correct and resubmit.~

Resolution tips

You have two ways to fix the claim:

• Widen the statement covers period. Change the begin or end date so it includes the service date.

• Split the claim. Move the service line to its own claim, with a statement covers period that includes the service date.

Related claim edits

Stedi has another edit for date ranges that start after they end. See Invalid date range.

ERA PDFs now show the crossover carrier's name

Stedi's Electronic Remittance Advice (ERA) PDFs now show the crossover carrier's name in the status line when the payer sends it.

If a patient's care is covered by more than one payer, a payer may forward the claim to the next payer after adjudication. These are called crossover claims. The payer that receives the forwarded claim is the crossover carrier.

Previously, the PDF status line only stated Forwarded to Additional Payer(s) when a claim was forwarded. To find the crossover carrier, you often had to check the underlying ERA or the payer's portal. Now, ERA PDFs show the name in these cases:

You can download ERA PDFs using the Stedi portal or the ERA PDF API endpoint. For more details, check out our Introducing ERA PDFs blog post.

Pay-as-you-go signups now start at $25

You can now sign up for a production Stedi account for as little as $25.

Stedi's pay-as-you-go plan now only requires a starting balance of $25. Stedi adds $25 to your balance whenever it drops below $10.

Previously, signing up required a $100 starting balance, and Stedi added $100 whenever your balance dropped below $25.

Per-transaction rates stay the same. Each transaction uses your balance at the rate set by its pricing tier. To estimate costs or see all tiers, check our pricing page.

For more details, check out our Pay-as-you-go accounts now start at $25 blog post.

Claim edit: Invalid facility type code on institutional claims

Stedi now rejects 837I institutional claims that contain an invalid facility type code.

Facility type codes

In an institutional claim, the facility type code tells the payer what kind of facility, such as a hospital or a skilled nursing facility, delivered the care.

Facility type code

The National Uniform Billing Committee (NUBC) maintains an official list of valid facility type codes.

Every valid facility type code consists of two digits. The first digit represents the type of facility. The second digit represents the bill classification. For example, 13 indicates a hospital (first digit of 1) outpatient claim (second digit of 3).

How this edit works

Each digit of the facility type code must be in the range of 1 through 9 (inclusive). Facility type codes containing 0 in any position, such as 09 or 80, aren't valid.

If you submit an institutional claim that contains an invalid facility type code, 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": "Invalid Facility Type Code. The facility type code (bill type) must be two digits with each between 1 and 9. The submitted value, 09, is not a valid code. 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>228*[DATE]*U*[AMOUNT]********Invalid Facility Type Code. The facility type code (bill type) must be two digits with each between 1 and 9. The submitted value, 09, is not a valid code. Correct and resubmit.~

Related claim edits

Stedi has another edit for invalid place of service codes on professional and dental claims. See Claim edit: Invalid place of service code.

Claim edit: Missing auto accident state or province

Stedi now rejects 837P professional and 837D dental claims that report an auto accident without the state or province where the accident occurred.

Auto accident claims

In a professional or dental claim, the related causes code tells the payer what caused the patient's condition. A claim can carry up to two codes. Valid codes are AA (Auto accident), EM (Employment), and OA (Other accident).

Related causes code

Per X12 standards, claims that report a related causes code of AA must include the state or province where the auto accident happened.

Auto accident state or province

Every state and province has its own laws for who pays after an auto accident. To apply the right rules, the payer needs the state or province that the accident occurred in.

In many states, auto insurance pays before health insurance. Without the state or province, the payer can't tell who pays first.

How the edit works

If you submit a claim with a related causes code of AA but don't include the auto accident state or province, 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 Auto Accident State or Province. When the related-cause information indicates an auto-accident, the accident state or province code must be 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, and error message:

STC*A6>750*[DATE]*U*[AMOUNT]********Missing Auto Accident State or Province. When the related-cause information indicates an auto-accident, the accident state or province code must be provided. Correct and resubmit.~

Related claim edits

Stedi has another edit for a missing accident date. See Missing accident date.

Introducing filtered claims and ERA list exports in the Stedi portal

You can now export a filtered list of claims or Electronic Remittance Advice (ERAs) as an Excel file (.xlsx) from the Stedi portal.

You can already use the Stedi portal's claims view and ERA view to see a filtered list of claims or ERAs you've processed with Stedi.

Now, you can also export them as a spreadsheet to load them into another system or work them manually. For example, you can use the spreadsheet to analyze trends, reconcile payments, or generate weekly or monthly reports.

For more details, check out our Introducing filtered claims and ERA list exports in the Stedi portal blog post.

Claim edit: Missing billing provider identifier

Stedi now rejects 837P professional and 837D dental claims where the billing provider has no identifier.

Billing provider identifiers

The billing provider is the person or organization, like a clinic or group practice, that will receive payment (if any) for the claim from the payer.

X12 standards require the billing provider's National Provider Identifier (NPI) whenever the provider is eligible for one. Atypical providers – providers without an NPI – are identified by a secondary identifier instead, like a state license number or a payer-assigned provider number.

The billing provider's tax ID doesn't count. A tax ID identifies the business for payment reporting, not the provider that delivered care. A claim carrying only a tax ID still can't be matched to a provider.

Billing identifiers in 837P professional claims

Billing identifiers in 837D dental claims

How the edit works

Any one of the identifiers above is enough. The edit rejects the claim only when all of them are missing.

If you submit a claim without an identifier for the billing provider, 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 Billing Provider identifier. The billing provider must be identified by an NPI when required after the HIPAA NPI mandate, or an applicable secondary provider identifier. 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>562>85*[DATE]*U*[AMOUNT]********Missing Billing Provider identifier. The billing provider must be identified by an NPI when required after the HIPAA NPI mandate, or an applicable secondary provider identifier. Correct and resubmit.~

Related claim edits

Stedi has another edit for a missing billing provider tax ID. See Missing billing provider tax ID.

Claim edit: Adjudication date at both the claim and service line level

Stedi now rejects 837P professional, 837D dental, and 837I institutional claims that report a previous payer's adjudication date at both the claim level and the service line level.

Adjudication dates

When a patient has more than one insurance plan, claims go to the primary payer first, then the secondary, and so on. The process is called coordination of benefits (COB).

Claims sent to non-primary payers must report the date on which each previous payer adjudicated – or determined how to pay – the claim. This date is called the adjudication date.

Claim-level adjudication date

Service line adjudication date

How the edit works

Per X12 standards, a claim can report a previous payer's adjudication date at the claim level or on each service line, but not both. When both are present, the payer receiving the claim can't tell which date to use and 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.

The edit evaluates each previous payer separately, so a claim-level date for one payer and a service line date for a different payer is valid.

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": "Invalid Coordination of Benefits (COB) Structure. The claim-level Check or Remittance Date (20240115) should not be submitted when at least one service line contains COB adjudication information for the same payer. 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*A8>516>SEP*[DATE]*U*[AMOUNT]********Invalid Coordination of Benefits (COB) Structure. The claim-level Check or Remittance Date ([CLAIM-LEVEL DATE]) should not be submitted when at least one service line contains COB adjudication information for the same payer. Correct and resubmit.~

The entity identifier code reflects the previous payer's position in the COB sequence: PRP for primary, SEP for secondary, TTP for tertiary, and PR otherwise.

Related claim edits

Stedi has another edit for COB claims that omit a previous payer's adjudication date entirely. See Missing other payer adjudication date in COB claims.

Claim edit: Invalid NPI

Stedi now rejects 837P professional, 837D dental, and 837I institutional claims that contain a provider National Provider Identifier (NPI) that isn't registered in the National Plan and Provider Enumeration System (NPPES).

NPIs

An NPI is a unique, 10-digit identifier for US healthcare providers. The Centers for Medicare & Medicaid Services (CMS) issues NPIs and maintains them in the NPPES.

A claim can include an NPI for every provider it names: billing, referring, rendering, ordering, supervising, and service facility. NPIs can appear at the claim level or on an individual service line.

How the edit works

Payers often check the NPPES to confirm that a provider exists and that the NPI belongs to that provider. If the NPPES doesn't list the NPI, the payer may reject the claim.

This edit checks every provider NPI in the claim against the NPPES before it reaches the payer. That 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": "Invalid National Provider Identifier (NPI). The Billing Provider NPI submitted, 1234567890, is not found within the National Plan and Provider Enumeration System (NPPES). An active NPI is required for claim submission. 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*A7>562>85*[DATE]*U*[AMOUNT]********Invalid National Provider Identifier (NPI). The Billing Provider NPI submitted, 1234567890, is not found within the National Plan and Provider Enumeration System (NPPES). An active NPI is required for claim submission. Correct and resubmit.~

Test claims

Stedi runs this edit on production claims only. The edit skips test claims, so you can keep using dummy NPIs when you test.

Related claim edits

Stedi has another edit for NPIs that are registered but deactivated. See Deactivated NPI.

Claim edit: Invalid HIPPS rate code

Stedi now rejects 837I institutional claims that contain an invalid Health Insurance Prospective Payment System (HIPPS) rate code.

HIPPS rate codes

A HIPPS rate code is a five-character alphanumeric code that tells Medicare which payment group applies to a patient.

Skilled nursing facilities, home health agencies, and inpatient rehabilitation facilities report these codes on institutional claims so the payer can calculate reimbursement.

A HIPPS code sits in the service line's procedure code element, but it isn't a procedure code. Providers get the code from a grouper, software that reads the patient's assessment data and returns the code for the payment group the patient falls into.

HIPPS rate code

You report a HIPPS code by setting the service line's procedure identifier to HP.

Procedure identifier

How the edit works

The Centers for Medicare & Medicaid Services (CMS) publishes all valid HIPPS rate codes in the HIPPS code set. Each code carries an effective date range. CMS retires codes over time.

When you submit a HIPPS rate code on an institutional claim, Stedi compares it against the CMS HIPPS code set. If the code isn't in the set or wasn't active on the claim's date of service, this edit rejects the claim before it reaches the payer. This 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.

If the HIPPS code isn't in the CMS HIPPS code set:

{
  "errors": [
    {
      "code": "33",
      "description": "Invalid HIPPS rate code. The submitted HIPPS code, 11111, on line 1 is not a recognized HIPPS rate code. Correct and resubmit.",
      "followupAction": "Please Correct and Resubmit"
    }
  ]
}

If the HIPPS code exists but wasn't active on the claim's date of service:

{
  "errors": [
    {
      "code": "33",
      "description": "Invalid HIPPS rate code. The submitted HIPPS code, HAEJ1, on line 1 was not active for the date of service. 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.

If the HIPPS code isn't in the CMS HIPPS code set:

STC*A7>513**U*********Invalid HIPPS rate code. The submitted HIPPS code, 11111, on line 1 is not a recognized HIPPS rate code. Correct and resubmit.~

If the HIPPS code exists but wasn't active on the claim's date of service:

STC*A7>513**U*********Invalid HIPPS rate code. The submitted HIPPS code, HAEJ1, on line 1 was not active for the date of service. Correct and resubmit.~

Related claim edits

Stedi has another edit for HCPCS Level II procedure codes that aren't in the CMS code set. See Invalid HCPCS Level II code.