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835 ERA Reports: Claim adjustment reason and remittance advice remark descriptions

The 835 ERA Report API retrieves 835 Electronic Remittance Advice (ERA) transactions from Stedi in developer-friendly JSON. The ERA data now contains full Claim Adjustment Reason Code (CARC) and Remittance Advice Remark Code (RARC) descriptions, making it easier to interpret the payer’s response. 

CARC codes describe why a claim or service line was paid differently than it was billed. Now, adjustments objects for both the claim and specific service lines contain an adjustmentReason property with the full code description. The following example shows the adjustmentReason1 property within the transactions.detailInfo.paymentInfo.serviceLines.serviceAdjustments object.

"serviceAdjustments": [
  {
    "adjustmentAmount1": "21",
    "adjustmentReasonCode1": "131",
    "adjustmentReason1": "Claim specific negotiated discount."
    "claimAdjustmentGroupCode": "CO",
    "claimAdjustmentGroupCodeValue": "Contractual Obligation"
  }
]

RARC codes provide additional explanations for adjustments or convey information about remittance processing. Now, transactions.detailInfo.paymentInfo.claimAdjustments.serviceLines.healthCareCheckRemarkCodes objects contain an additional remark property with the full code description. 

"healthCareCheckRemarkCodes": [
  {
    "codeListQualifierCode": "HE",
    "codeListQualifierCodeValue": "Claim Payment Remark Codes",
    "remarkCode": "M30",
    "remark": "Missing pathology report."
  }
]

New CMS-1500 PDF endpoint: Retrieve PDFs by business identifier

This new endpoint allows you to use a Stedi business identifier (the claim’s correlation ID) to retrieve the CMS-1500 PDF for submitted 837 professional claims.

  1. Call the endpoint with the business identifier as a query parameter for the claim form PDFs you want to retrieve. The business identifier should be the claim’s correlation ID. You can find this value in the claimReference.correlationId property in the synchronous responses from the Professional Claims and Professional Claims Raw X12 endpoints.

  2. Stedi returns an array of PDFs for all claims with the specified business identifier value. The PDFs are returned as a base64 encoded string. 

  3. Decode the base64 string and save it to a file with a .pdf extension.

Visit the CMS-1500 PDF: Business Identifier API docs for complete details.

Introducing test mode for clearinghouse transactions

Test mode provides a separate test environment where you can simulate transactions in your Stedi account without PHI/PII and without sending any data to payers. 

In test mode, you can submit mock real-time eligibility checks and Stedi sends back a realistic benefits response so you know what kinds of data to expect in production. You can send mock requests for a variety of well-known payers, including:

  • Aetna

  • Cigna

  • UnitedHealthcare

  • National Centers for Medicare & Medicaid Services (CMS)

  • Many more - Visit Eligibility mock requests for a complete list

After you submit a mock eligibility check, you can review all of the request and response details in the Stedi portal. This includes a user-friendly benefits view designed to help you quickly understand the patient’s active coverage and payment responsibilities.

To access test mode in your account, toggle Test mode to ON. Visit the test mode docs for more details.

Introducing bulk CSV import for transaction enrollments

Developers and operations teams can now submit transaction enrollments to payers using bulk CSV import functionality. This allows you to submit hundreds of enrollment requests to Stedi in minutes. 

Here’s how it works:

  1. Go to the Bulk imports page and click New bulk import.

  2. Download the CSV template with the required fields. The upload page contains detailed formatting instructions. 

  3. Complete and upload the CSV file containing enrollment information—one row equals one enrollment request for a specific transaction to a payer. 

  4. Stedi checks the file for errors and notifies you of any issues. You can fix the errors and re-upload the file as many times as needed. 

  5. Once you execute the import, Stedi automatically creates provider records and enrollment requests. 

  6. When the import is complete, you can download a report that shows the status of each row in the CSV file to ensure all your enrollment requests were submitted successfully. You can also track the status of each new enrollment request through the Enrollments page.

  7. The Stedi team will contact you with any additional information required for the enrollment and will let you know when it is live.

Visit the Stedi Payer Network to find out if a payer requires enrollment for a particular transaction type.

Submit claims through Stedi-managed SFTP

You can use Stedi’s fully-managed SFTP server to submit claims to payers and retrieve claim responses. Stedi SFTP is a great option if you have an existing system that generates X12 EDI files and you want to send them through the Stedi clearinghouse without an API integration.

Here’s how SFTP claims processing works:

  1. Create both test and production SFTP users through the Healthcare page in Account settings. Test users can only send claims to Stedi’s test clearinghouse, which helps ensure you never accidentally send test claims to payers while you’re getting up and running.

  2. Connect to Stedi's server and drop compliant X12 EDI claim files into the to-stedi directory. 

  3. Stedi automatically validates the claim data. If there are no errors, Stedi routes your claims to the test or production clearinghouse.

  4. Stedi places claim responses - 277 Claim Acknowledgments and 835 Electronic Remittance Advice (ERAs) - into the from-stedi directory in X12 EDI format. 

  5. You retrieve claim responses from the SFTP server at your preferred cadence.

You can also configure Stedi webhooks to send claim processing events to your endpoint. This allows you to monitor for processing issues, confirm successful claim submissions, and get notified when new payer responses are available.

Visit the SFTP claim submission docs for complete details.

MBI lookup for CMS eligibility checks

A Medicare Beneficiary Identifier (MBI) is a unique, randomly-generated identifier assigned to individuals enrolled in Medicare. You must include the patient’s MBI in every eligibility check you submit to the Centers for Medicare and Medicaid Services (payer ID: CMS). When patients don’t know their MBI, you can use Stedi's eligibility check APIs to perform an MBI lookup using their Social Security Number (SSN) instead.

To perform an MBI lookup:

  1. Construct an eligibility check request with the patient’s first name, last name, date of birth, and Social Security Number (SSN).

  2. Set the tradingPartnerServiceId to MBILU. This is a special payer ID that tells Stedi to perform an MBI lookup for the patient in addition to a standard eligibility check.

  3. Stedi returns a complete benefits response from CMS with the patient's MBI in the subscriber object for future reference.

Visit our Medicare Beneficiary Identifier (MBI) lookup docs for complete details.

Improvements to 277CA Claim Status view

The view for 277CA Claim Status transactions includes the following improvements:

  • Key claim details, including the patient account number and the claim value, are at the top for easy access.

  • Claim Status codes are displayed with clear descriptions, and processing issues are flagged to help you quickly catch errors and understand what went wrong.

  • Related transactions, including the original claim, are identified and linked.

  • The transaction’s raw input and output are available for review and download. 

To check out the updated view, click any 277CA Claim Status transaction listed on the Stedi Transactions page.

Coordination of Benefits Check API is Generally Available

You can now submit coordination of benefits (COB) checks through the Coordination of Benefits Check API for any of Stedi’s supported COB payers.

  • You submit COB checks programmatically in developer-friendly JSON. The information required is similar to a standard eligibility check – the patient's first name, last name, DOB, and either member ID or SSN.

  • Stedi synchronously returns summary information about each of the patient’s active health plans and whether there is coverage overlap. When there is coverage overlap, Stedi returns the responsibility sequence number for each payer (such as primary or secondary, if that can be determined).

Visit the Coordination of Benefits Check API documentation for full details, test requests and responses, and more.

Introducing test API keys for select APIs

You can now create test API Keys for development and integration testing. 

Test API keys allow you to conduct integration testing on specific Stedi APIs without sending data to partners or processing PHI or PII. You can generate production and test API keys from the API Keys page in your Stedi account.

At launch, test API keys support hitting the Real-Time Eligibility Check API with the mock requests we have available. We will add support for other APIs in the near future. All mock requests sent with a test API key are free for testing purposes and won’t incur charges in your Stedi account.

Introducing coordination of benefits (COB) checks

When a patient is covered by more than one health plan, you need to know which plan is primarily responsible for paying claims (coordination of benefits). You can now submit coordination of benefits (COB) checks in the Stedi UI to determine:

  • If a patient is covered by more than one health plan

  • Whether coverage overlap requires coordination of benefits

  • Each payer’s responsibility for payment (primacy) in coordination of benefits scenarios

For each COB check, Stedi searches a national database of eligibility data from state and commercial payers. This database has 245+ million patient coverage records from 45+ health plans, ASOs, TPAs, and others, including participation from the vast majority of national commercial health plans. Data is updated weekly to ensure accuracy.

The response includes information about the patient’s active health plans, whether coordination of benefits is required, and the responsibility sequence number for each payer if available (such as primary or secondary).

To help reduce claim denials, we recommend coordination of benefits checks for all new patients with coverage through one of Stedi’s supported COB payers. Visit the Payer Network for a complete list.