What is a headless clearinghouse?

Most companies, including healthcare organizations, now use AI coding agents like Claude Code and Codex to build software. If that software touches the revenue cycle, it likely needs to talk to a healthcare clearinghouse.

Legacy clearinghouses aren't designed to work well with software or AI. Many don't offer their features over an API, the way one piece of software talks to another. That makes it difficult – or impossible – for software developers and AI agents to use them.

Stedi is the only headless clearinghouse and RCM engine. Virtually every feature is available over our API. You can embed Stedi inside your own product. Your AI agents get all of it.

This guide answers the questions we hear about what a "headless" clearinghouse is. You'll learn what an RCM engine is, what it gives you, and what teams build with it. You don't need to write code or know what an API is to follow along.

What's a healthcare clearinghouse?

A clearinghouse helps healthcare providers exchange billing transactions – also called payer transactions – with healthcare insurers, called payers.

Payers include commercial insurance companies like Aetna and Cigna. They also include government payers like Medicare and state Medicaid programs.

The clearinghouse has two main jobs:

• Connect providers (or their vendors) to payers
• Ensure payer transactions use the data format required by HIPAA

That format is X12 EDI. HIPAA is a federal law that, among other things, requires certain payer transactions to use X12 EDI, also called X12.

X12 is hard to read, even for experienced developers and AI agents. Stedi lets you send and receive transactions as JSON, a format that's easier to read. We handle the translation to and from X12.

Every clearinghouse handles the major HIPAA transactions, including:

• Eligibility checks
• Claim submissions
• 277CA claim acknowledgments
• Electronic Remittance Advice (ERAs)
• Claim status checks

Stedi is a healthcare clearinghouse. We handle all these transactions and more.

What does "headless" mean?

Headless means virtually every feature is available over an API. Stedi is a headless clearinghouse. You can use Stedi's API to build an interface your users can see and interact with.

For example, you can use Stedi's API to run an eligibility check, submit a claim, or get an ERA. You don't need to log in to a portal or other interface. The API gives you everything you need.

AI agents and developers can also call the API directly. This is useful for building scripts or other automations.

Does Stedi only offer APIs?

No. We like to say that Stedi is API-first, but not API-only. Stedi also has a user interface, called the Stedi portal. You can log in to the portal to do the same things our API does: run eligibility checks, submit and track claims, and more.

The portal uses the very APIs we make available to our customers. You can build something that works like the Stedi portal in your own product if you want.

What's an RCM engine?

An RCM engine gives you the parts you need to build revenue cycle software.

Most clearinghouses give you payer connections and handle transactions. Stedi also gives you the data model, business logic, and APIs you'll need.

That means your team can spend its time on building features and serving your customers. Companies that partner with Stedi can ship more meaningful features faster than companies working with other clearinghouses.

What's a data model, and why does it matter?

A data model is the shape software gives its data. It's called a model because it's a representation of something real, with only the parts software needs.

Most legacy clearinghouses only model the transactions. Stedi gives you out-of-the-box models that work the way most billers and revenue cycle professionals expect.

For example, an electronic claim isn't one thing. It's built from several separate payer transactions:

• Claim submissions
• 277CA claim acknowledgments
• Electronic Remittance Advice (ERAs)

To figure out the status of a claim – where it stands with the payer – you have to write code that stitches together these transactions into a coherent model. Then you have to maintain it so it doesn't break, which takes time away from building features.

Stedi's Claim Lifecycle API handles all that for you. Each claim gets a unique ID that stays the same for the life of the claim.

You can pass that ID to the Retrieve Claim Timeline endpoint, and Stedi returns the claim's current status, based on every submission, acknowledgment, and ERA.

What's business logic?

Business logic is the set of rules software applies to your data. A data model tells you what status a claim is in. Business logic decides what happens before and after.

Claim edits are one example. A claim edit is an automated rule that payers use to check if a claim is valid. If a claim fails an edit, the payer rejects it. The claim submitter must fix it and resubmit.

Payers can often take hours or days to reject a claim. This can slow payments for providers.

To make the process faster, Stedi offers zero-config claim edits that mirror the ones run by payers. Unlike payer edits, these edits return errors in real time.

To build our database of claim edits, we monitor every rejection in our systems. We rank them by cost and volume. Then we write an edit for each one. Customers and payers can also request an edit.

Stedi ships dozens of new edits each week. We ship most of the edits customers request on the same day. Claims submitted through Stedi have a 98% payer acceptance rate.

Why do AI agents need APIs?

APIs let AI agents talk to other software quickly, efficiently, and at scale.

Other interfaces, like portals or EHRs, are built for humans. To use these interfaces, agents and other software have to use screen scraping or robotic process automation (RPA). These methods are slow, expensive to maintain, and often break.

Stedi's APIs are built for machines. They work at machine scales and speeds with costs as low as pennies per transaction. We also offer tools and features that make it easier for AI and developers to work with us:

• AI-friendly documentation: We offer documentation in formats like Markdown that you can provide to tools like ChatGPT, Claude, Cursor, and other AI assistants.

• OpenAPI specifications: We offer machine-readable versions of our API documentation so AI agents can get up to speed quickly.

• SDKs: Developers and AI agents can use our SDKs to write code in popular programming languages, like TypeScript and Python. SDKs make it faster for AI agents to produce high-quality code.

• MCP server: Stedi offers an MCP server that AI agents can use to run eligibility checks or look up payers. Your team doesn't need to write custom integration code or paste Stedi's docs into your agent's instructions.

• Test workflows: You can test Stedi end-to-end without sending real transactions to payers or using protected health information (PHI).

For more tips, see Build with AI in our docs.

How else is Stedi different from other clearinghouses?

• Differentiated products: Insurance discovery, claim edits and repairs, test mode, paper claims, Stedi Treasury, and Stedi Lockbox. Most clearinghouses stop at the core transactions.

• Real-time support: You can reach technical experts who can help fix your problem over Zoom, Teams, email, phone, or the Stedi portal. Our average response time is under ten minutes during business hours.

• Security and reliability: Stedi uses serverless, multi-region infrastructure. Our backend runs entirely on AWS. We're SOC 2 Type II compliant and HITRUST r2 certified. We also have a 99.9% uptime SLA.

Can I see what others have built on Stedi?

Yes. Check out our Platform Partners page. It lists over 200 EHRs, practice management systems, and RCM platforms using Stedi's APIs in production today.

Some of those partners build patient-facing workflows, like intake and registration. Others build back-office functions, like denial management. Many build everything in between. Our Customers page also contains user quotes and case studies.

How do I get started?

To get started with Stedi, sign up for a free sandbox account. It takes less than two minutes. No credit card is required.

When you're ready, upgrade to production on our pay-as-you-go plan. There are no monthly minimums or setup fees. You only pay for the transactions you use.