Error messages in Institutional claims

Error messages will reference the claim in the reply and list the individual issues. This example shows two error messages in a small array:

{
    "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.

The vast 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:

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

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

claimInformation.otherSubscriberInformation.individualRelationshipCode

The hierarchy is the following:

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 location of the errored value in the JSON hierarchy.

Some error listings will 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.


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