Institutional Claims Error Messages

Error messages will reference the claim in the reply and list the individual issues.

✍️ In the sandbox request, using value: test00005 (lower case and not uppercase), for
fieldName: patientControlNumber returns a EDITS canned response.

This example shows two error messages in a small array:

```json
{
    "status": "EDITS",
    "controlNumber": "000000001",
    "tradingPartnerServiceId": "9496",
    "claimReference": {
        "correlationId": "201117R999898~53196482361992277",
        "submitterId": "009998999898",
        "customerClaimNumber": "000000001",
        "patientControlNumber": "12345",
        "timeOfResponse": "2020-11-17T17:46:02.792-06:00",
        "claimType": "INS"
    },
    "errors": [
        {
            "field": "01",
            "value": "1",
            "description": "The Type of Admission is required and must be valid.\n\nLOOP 2300 CL101",
            "location": "2300 CL1"
        },
        {
            "field": "claimInformation.otherSubscriberInformation.individualRelationshipCode",
            "description": "Allowed Values are: '01' Spouse, '18' Self, '19' Child, '20' Employee, '21' Unknown, '39' Organ Donor, '40' Cadaver Donor, '53' Life Partner, 'G8' Other Relationship"
        }
    ]
}
```

These errors list the attributes that are missing relevant information or have incorrect information for the claim.
Majority of error messages contain the following fields:

• field (error.field) — describes the hierarchical JSON path for the attribute exhibiting the error.
• description (error.description) — provides a brief plain-language description of the error, and will sometimes list the range of allowed values for the field showing the error.

Also, for some error messages:

• location field — gives the location in the X12 EDI message body for the submission.

In the preceding example, the field entry in the claimInformation error message delimits the JSON hierarchy with periods symbol:

claimInformation.otherSubscriberInformation.individualRelationshipCode

The hierarchy is as follows:

claimInformation (the home object)
-->otherSubscriberInformation
---->individualRelationshipCode (this contains the incorrect data flagged by the error message)

All error messages will list either the EDI location or the errored value location in the JSON hierarchy.

Some error listings list the EDI loop and segment in which the error occurred. The location value shows that the admissionTypeCode in Loop 2300, Element CL101, has an incorrect value and must contain one of the values specified in the correction text.

If something is wrong with the syntax of the data, you may get a response from our /validation endpoint.

```javascript
{
    "errors": [
        {
            "field": "claimInformation.validReleaseInformationCode",
            "description": "Allowed Values are: 'I' Informed Consent to Release Medical Information for Conditions or Diagnoses Regulated by Federal Statutes,'Y' Yes, Provider has a Signed Statement Permitting Release of Medical Billing Data Related to a Claim"
        }
    ]
}
```

The error is in the claimInformation object's validReleaseInformationCode attribute. The API also lists out the permissible values that you can apply to correct the error (of course, the chosen value must be correct in the context of the claim).

If the syntax is correct but an error in the format of the claim makes it to the clearinghouse, you may get a response from our Edit engine similar to the following.

{
    "status": "EDITS",
    "controlNumber": "000000001",
    "tradingPartnerServiceId": "9496",
    "claimReference": {
        "correlationId": "200331R999898~1612903439033376",
        "submitterId": "009998999898",
        "customerClaimNumber": "000000001",
        "patientControlNumber": "12345",
        "timeOfResponse": "2020-03-31T16:41:00.895-05:00",
        "claimType": "INS"
    },
    "errors": [
        {
            "field": "03",
            "value": "981010000",
            "description": "When entered, the Billing Provider Postal Code must be nine numeric characters and valid for the state.\n\nLOOP 2010AA N403",
            "location": "2010AA N4"
        }
    ]
}

The error reports the X12 loop and segment where the incorrect value occurred. It corresponds to the postalCode attribute in the subscriber object.

📘

NOTE

We recommend using the Validation API before sending the claim request to the payer. The Validation rules help prevent claims with incorrect information from being sent to the payer, such as a typo in the NPI, errors in calculations, or poor formatting and syntax in the claim. You can use the /institutionalclaims/v1/healthcheck endpoint to check the operating status of the service endpoint before sending the claim.

Related Topic

• Institutional Claims FAQs