New claim edit: Missing primary payer

Stedi now rejects 837P professional, 837D dental, and 837I institutional claims that don’t include a primary payer.

Every claim must include exactly one primary payer. For primary claims, this payer determines routing. For secondary and tertiary claims, payers use this information to determine coordination of benefits (COB) and adjudicate the claim correctly. If it’s missing, the payer may reject the claim, which can cause payment delays.

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

When this edit applies
A claim will fail this edit when:

• JSON API
  If you’re using one of Stedi’s JSON claim submission API endpoints, the edit fails if neither the subscriber.paymentResponsibilityLevelCode nor any claimInformation.otherSubscriberInformation.paymentResponsibilityLevelCode fields contains a value of P (Primary) in the request.

• Raw X12
  If you’re using raw X12, the edit fails if neither Loop 2000B (Subscriber Hierarchical Level)) nor Loop 2320 (Other Subscriber Information) contains an SBR-01 (Payer Responsibility Sequence Number Code) value of P (Primary).

• Stedi portal
  You can’t fail this edit using the Stedi portal’s professional claim submission form. Currently, the form only supports claims to a single primary payer. Secondary and tertiary claims aren't supported.

Rejection errors
If you submit a claim that fails the edit using Stedi’s claim submission APIs, 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": "The Primary Payer information is missing. A primary payer must be indicated in either the Subscriber or Other Subscriber loops of the claim. 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
For secondary and tertiary claims, include a single primary payer in other subscriber information:

• JSON API
  If you’re using one of Stedi’s JSON claim submission API endpoints, you can provide this information in a claimInformation.otherSubscriberInformation object with a paymentResponsibilityLevelCode of P (Primary) in the request.

• Raw X12
  If you’re using raw X12, you can provide this information in Loop 2320 (Other Subscriber Information) with an SBR-01 value of P (Primary).