Changelog

Stedi now rejects 837P professional, 837D dental, and 837I institutional claims that list a non-physical address for the billing provider. Non-physical addresses include Post Office (PO) Boxes, lockboxes, private mailboxes (PMBs), and similar mailbox-only addresses.

For claims, HIPAA requires that the provider’s billing address be a physical practice location where care is delivered. If you’re using Stedi’s JSON claim submission API endpoints, this address is in the request’s billing.address field. In X12, the address is in N3 (Billing Provider Address)  of Loop 2010AA (Billing Provider Name).

Payers may reject claims when the billing provider address is not a real street address, which can cause payment delays.

This edit – the industry’s term for an automated validation rule – catches the issue before it 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 error details in the errors array:

{
  "errors": [
    {
      "code": "33",
      "description": "Invalid Billing Provider address. The billing provider address must be a street address. Post Office Box or Lock Box addresses are to be sent in the Pay-To Address (2010AB Loop). 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 tips
If the billing provider receives mail at a PO Box, lockbox, or other non-physical address, you can provide a “pay-to” address in the claim.

If you’re using Stedi’s JSON claim submission API endpoints, you can specify the pay-to address in the request’s payToAddress field or, for institutional claims, the billingPayToAddressName field. In X12, you can specify the pay-to address in N3 (Pay-to Address) of Loop 2010AB (Pay-to Address Name).

Stedi now rejects 837P professional claims that are billed to Medicare Part B for chiropractic services when the primary diagnosis doesn’t indicate subluxation – a partial dislocation of a spinal joint.

Medicare requires the primary diagnosis on a chiropractic claim to indicate subluxation. In ICD-10-CM, this is represented by the M99.0x family of diagnosis codes: M99.00-M99.05.

Medicare Part B claims submitted with a non-subluxation primary diagnosis may be rejected by the Medicare Administrative Contractor (MAC) payer, which can cause delays.

This edit – the industry’s term for an automated validation rule – catches the issue before the claim reaches the MAC.

When this edit applies
A claim will fail this edit when all of the following are true:

• The claim is billed to Medicare Part B.

  • In raw X12, this is indicated by a value of MB (Medicare Part B) in SBR09 (Claim Filing Indicator Code) of Loop 2000B (Subscriber Information).

  • In the JSON professional claims submission endpoint, this is indicated by a Claim Filing Indicator Code of MB (Medicare Part B).

  • In the professional claim form, this is indicated in Box 1 – Insurance type by a value of Medicare.
    
    

• The claim includes a service line with one of the following Chiropractic Manipulative Treatment (CMT) procedure codes: 98940, 98941, or 98942.
  
  

• The claim’s primary diagnosis code is not within the M99.00-M99.05 range (inclusive).

  • In raw X12, the primary diagnosis is the first diagnosis code in HI (Health Care Diagnosis Code) of Loop 2300 (Claim Information).

  • In the JSON professional claims submission endpoint, the primary diagnosis is in the diagnosisCode field of the first object in the claimInformation.healthCareCodeInformation array.
    Note: Do not include decimal points in the diagnosis code.

  • In the professional claim form, the primary diagnosis is the first diagnosis code in Field A of Box 21 – Diagnosis or nature of illness or injury.

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 error details in the errors array:

{
  "errors": [
    {
      "code": "33",
      "description": "Chiropractic claims submitted to Medicare must have a primary diagnosis that lists the precise level of subluxation. 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.

You can now look up a patient’s Medicare Beneficiary Identifier (MBI) without a Social Security Number (SSN) using Stedi's Eligibility APIs or the Stedi portal.

Two types of MBI lookups
With this update, you can now perform an MBI lookup in two ways. Each uses a different payer ID:

Note: When running an MBI lookup without SSN using our raw X12 or SOAP eligibility endpoints, you must include a city, in addition to a U.S. state, in Loop 2100C N4. You can use a dummy city value, such as DUMMY, if needed. If you omit the city value, you'll receive an X12 validation error.

Transaction enrollment
Before running an MBI lookup without an SSN, enroll the provider for eligibility checks with the MBILUNOSSN payer ID using the Transaction Enrollment API or the Stedi portal. Enrollments for the MBILUNOSSN payer typically take 1-3 business days to complete.

You’ll get an email once the enrollment is live. You can also check enrollment status using the List Enrollments or Retrieve Enrollment API endpoints.

Run an MBI lookup without an SSN

After the enrollment is live, send an eligibility check to MBILUNOSSN. Include:

• The provider’s NPI

• The patient’s first name

• The patient’s last name

• The patient’s date of birth

• The patient’s U.S. state

• The patient's city (if using the raw X12 or SOAP eligibility endpoints)

For example, using Stedi’s JSON Eligibility API:

curl --request POST \
  --url https://healthcare.us.stedi.com/2024-04-01/change/medicalnetwork/eligibility/v3 \
  --header 'Authorization: <api-key>' \
  --header 'Content-Type: application/json' \
  --data '{
  "tradingPartnerServiceId": "MBILUNOSSN",
  "externalPatientId": "UAA111222333",
  "encounter": {
    "serviceTypeCodes": [
      "30"
    ]
  },
  "provider": {
    "organizationName": "ACME Health Services",
    "npi": "1999999984"
  },
  "subscriber": {
    "dateOfBirth": "19000101",
    "firstName": "Jane",
    "lastName": "Doe",
    "address": {
      "state": "NY"
    }
  }
}'

The response includes the MBI as the subscriber’s member ID. For example:

{
  "subscriber": {
    "memberId": "1AA2CC3DD45",
    "firstName": "JANE",
    "lastName": "DOE",
    ...
    "address": {
      "state": "NY",
      ...
    }
  },
  ...
}

For more details, see our announcement blog.

Stedi now rejects 837P professional, 837D dental, and 837I institutional claims that indicate an attachment was or will be sent by mail, electronically, email, fax, or file transfer – but don’t include an attachment control number.

Some payers require supporting documents, such as X-rays or treatment plans, before approving claims for certain services. Depending on the payer, you can send attachments in several ways, including by mail or electronically using a 275 claim attachment transaction through Stedi.

When a claim indicates that an attachment was or will be sent by mail, electronically, email, fax, or file transfer, you must include an attachment control number. The payer uses this value to match the attachment to the claim.

Payers may reject claims missing this number, which can cause delays.

This edit – the industry’s term for an automated validation rule – catches the issue before it reaches the payer.

This edit only applies when the claim indicates that an attachment was or will be sent. If the claim does not reference an attachment, this edit does not run.

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 error details in the errors array:

{
  "errors": [
    {
      "code": "33",
      "description": "Attachment control number is required when attachment is sent by mail, electronically, email, fax, or file transfer",
      "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.