Professional Claims Error Messages
Using sandbox test00005
value
test00005
value✍️ In the sandbox request, using value: test00005
(lower case and not uppercase), for
fieldName: patientControlNumber
returns a EDITS
canned response.
Typo in the claim's diagnosisTypeCode
diagnosisTypeCode
```json
{
"errors": [
{
"field": "claimInformation.validHealthCareCodeInformation",
"description": "First healthCareCodeInformation.diagnosisTypeCode list item value must equal 'BK' or 'ABK' and subsequent values must equal 'BF' or 'ABF'"
},
{
"field": "claimInformation.healthCareCodeInformation[0].validCodeCategory",
"description": "Allowed Values are: 'BK' International Classification of Diseases Clinical Modification (ICD-9-CM) Principal Diagnosis, 'ABK' International Classification of Diseases Clinical Modification (ICD-10-CM) Principal Diagnosis, 'BF' International Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis, 'ABF' International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis"
}
]
}
```
Correct diagnosisTypeCode
but its associated diagnosisCode
is incorrect
diagnosisTypeCode
but its associated diagnosisCode
is incorrectThe API shows the EDI loop where the error can be found and fixed:
```json
{
"status": "EDITS",
"controlNumber": "000000001",
"tradingPartnerServiceId": "9496",
"claimReference": {
"correlationId": "201210R999898~2008177834152729",
"submitterId": "009998999898",
"customerClaimNumber": "000000001",
"patientControlNumber": "12345",
"timeOfResponse": "2020-12-10T18:23:58.559-06:00",
"claimType": "PRO",
"formatVersion": "5010"
},
"errors": [
{
"field": "01-2",
"value": "46",
"code": "BK",
"description": "When entered, the Diagnosis Code must be valid.\n\n
Note: The decimal point is not allowed in the diagnosis code.\n\n
LOOP 2300 HI",
"location": "2300 HI"
}
]
}
```
Typo or an incorrect value in a serviceLine chargeable amount
```json
{
"status": "EDITS",
"controlNumber": "000000001",
"tradingPartnerServiceId": "9496",
"claimReference": {
"correlationId": "201210R999898~31433371895808763",
"submitterId": "009998999898",
"customerClaimNumber": "000000001",
"patientControlNumber": "12345",
"timeOfResponse": "2020-12-10T18:59:38.596-06:00",
"claimType": "PRO",
"formatVersion": "5010"
},
"errors": [
{
"field": "02",
"value": "22.75",
"description": "The Total Claim Charge Amount must balance to the sum of all the Service Line Charge Amounts.\n\nLOOP 2300 CLM02",
"location": "2300 CLM"
}
]
}
```
Related Topic
Updated 15 days ago