New claim edit: Invalid revenue code

Stedi now rejects 837I institutional claims that contain an invalid service line revenue code.

Revenue codes are standardized, 4-digit codes that hospitals and other care facilities use to identify the type of room, service, or supply billed on a service line. Example revenue codes include:

• 0450 – Emergency Room

• 0360 – Operating Room Services

• 0300 – Laboratory

Revenue codes are different from procedure codes, such as CPT or HCPCS codes. A procedure code describes what kind of care was delivered. A revenue code describes the type of facility associated with the charge.

Revenue codes are maintained by the National Uniform Billing Committee (NUBC). They are always 4 digits and start with a 0, 1, 2, or 3.

Revenue codes often drive how payers price and reimburse institutional claims. If a claim includes an invalid revenue code, the payers may reject the claim, which can delay payment.

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

When this edit applies
An institutional claim fails this edit if a service line revenue code:

• Is not exactly 4 digits

• Does not start with a 0, 1, 2, or 3

If you're using Stedi’s JSON institutional claim submission endpoint, you provide the revenue code in the serviceLineRevenueCode field for the service line.

In raw X12, you provide the revenue code for a service line in SV2-01 (Service Line Revenue Code) of Loop 2400 (Service Line Number).

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

{
  "errors": [
    {
      "code": "33",
      "description": "The Revenue Code value does not match the required format. Revenue codes must be 4 digits and have a valid leading digit of 0, 1, 2, or 3. Please review 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.