Changelog

Updated guidance for claim resubmissions

Stedi has updated its claim resubmission guidance to align with the new claims management functionality in the Stedi portal. Customers that follow the updated guidance will see resubmitted claims linked to the original claim in the claims view and claim timeline.

Important: This guidance only affects how claim submissions are linked in the Stedi portal. It doesn’t affect claims processing. You can continue to submit claims to Stedi without following the updated guidance, but it will lead to a suboptimal viewing experience in the portal.

The update covers two fields in the claim submission: patient control numbers (PCNs) and claim frequency codes (CFCs).

If you don't update your resubmission logic, resubmissions will still succeed, but the resubmitted claim won't appear linked to the original claim in the Stedi portal's claims view and claim timeline.

Claims and resubmissions already submitted under previous guidance won't be retroactively linked in the claims view or claim timeline.

Patient control numbers

A patient control number (PCN) is a tracking ID for a claim. You include a PCN when you submit a claim. The payer sends the PCN back in follow-up transactions: claim acknowledgments, Electronic Remittance Advice (ERAs), and real-time claim status checks.

You can set the PCN in the following locations:

• JSON API: claimInformation.patientControlNumber

• X12 (API or SFTP): Loop 2300 CLM01 (Patient Control Number)

• CMS-1500 claim form: Box 26 (Patient account number)

Stedi matches claims and resubmissions in the claims view and claim timeline using the PCN. We recommend using nanoid to generate strong, unique 17-character PCNs. See our docs for best practices.

What’s changing

Previously, our guidance was to use a new, unique PCN for any claim resubmission. Since Stedi’s claims management views use the PCN to link claims and resubmissions, this meant that a claim and a resubmission with different PCNs would not be linked in the portal.

We now recommend reusing the same PCN from the original submission in two scenarios:

• Pre-adjudication claims (any payer): The claim hasn't yet entered the payer's adjudication system. The clearest signals that a claim is in pre-adjudication are that the payer's 277CA doesn't contain a payer claim control number (PCCN), no real-time claim status check has returned a PCCN, and you haven't received an ERA for the original claim. See Pre-adjudication vs. adjudication in our docs.

• Medicare claims in adjudication: The clearest signals that a claim is in adjudication are that the payer's 277CA contains a PCCN, a real-time claim status check returned a PCCN, or you've received an ERA for the original claim. Medicare resubmissions don’t use the PCCN, so reusing the PCN doesn't risk duplicate-claim errors. See Medicare resubmission in our docs.

Reusing the PCN in these scenarios allows Stedi to link resubmissions to the same claim timeline.

For non-Medicare claims in adjudication, our guidance is unchanged: use a new, unique PCN. This helps avoid duplicate-claim errors from the payer. It also makes it easier to differentiate ERA responses for the original claim from those for resubmissions.

Claim frequency codes

The claim frequency code (CFC) tells the payer whether a claim is an original claim, a correction, or part of an ongoing stay.

You can set the CFC in the following locations:

• JSON API: claimInformation.claimFrequencyCode

• X12 (API or SFTP): Loop 2300 CLM05-03 (Claim Frequency Code)

• CMS-1500 claim form: Qualifier in Box 22 (Resubmission code)

Institutional claims support a broader set of CFC values than professional or dental claims. For example, long-term care facilities often submit interim claims every 30 days using CFC 2 (Interim - First Claim), 3 (Interim - Continuing Claims), or 4 (Interim - Last Claim). Resubmitting an interim claim with CFC 1 would incorrectly signal a final end-to-end claim.

What’s changing

Previously, our guidance was to use CFC 1 (Admit thru Discharge Claim) for pre-adjudication claims and Medicare claims in adjudication, and CFC 7 (Replacement of Prior Claim) for corrections or 8 (Void/Cancel of Prior Claim) for cancellations, for non-Medicare claims in adjudication. This guidance didn't account for institutional interim claims (described above), which retain their original CFC across resubmissions.

We now recommend institutional claims use the original submission's CFC in two scenarios:

• Pre-adjudication institutional claims (any payer): The claim hasn't yet entered the payer's adjudication system. The clearest signals that a claim is in pre-adjudication are that the payer's 277CA doesn't contain a PCCN, no real-time claim status check has returned a PCCN, and you haven't received an ERA for the original claim. See Pre-adjudication vs. adjudication in our docs.

• Institutional Medicare claims in adjudication: The clearest signals that a claim is in adjudication are that the payer's 277CA contains a PCCN, a real-time claim status check returned a PCCN, or you've received an ERA for the original claim. See Medicare resubmission in our docs.

Preserving the original CFC keeps the claim's intent intact – original, interim, or final – across resubmissions.

For professional and dental claims, and for non-Medicare claims in adjudication (all claim types), our guidance is unchanged.

Support

For more details, see our resubmit or cancel claims docs.

If you have questions or concerns, contact us using your dedicated support channel or our contact form.

Bulk transaction enrollment CSVs now support new fields

You can now include four optional fields when creating transaction enrollment requests using a bulk CSV import:

• providerTransactionAccessNumber – The Provider Transaction Access Number (PTAN) assigned by the payer. The PTAN is a Medicare-issued identifier that providers receive from their Medicare Administrative Contractor (MAC) in an approval letter after enrolling with Medicare.

• requestedEffectiveDate – Date you'd like an ERA enrollment to take effect with the payer. Uses the YYYYMMDD format. See Introducing requested effective dates for ERA enrollments.

• aggregationPreferenceNpi – National Provider Identifier (NPI) to use for ERA aggregation.

• aggregationPreferenceTaxId – Tax ID number (TIN), such as an employer identification number (EIN) or Social Security Number (SSN), to use for ERA aggregation.

You can only provide one aggregation preference field, aggregationPreferenceNpi or aggregationPreferenceTaxId, per row.

The aggregation preference fields tell the payer how you'd like them to group payment information in ERAs. The preference is a request to the payer, not a guarantee. See Introducing aggregation preferences for ERA enrollments.

Previously, these four fields were only available through the Create Enrollment API or the Stedi portal UI.

Now you can also use the fields in bulk CSV imports. Bulk CSV imports are commonly used for clearinghouse migrations, new customer onboarding, and group practice rollouts.

Claim edit: Missing adjustment reason code

Stedi now rejects 837P professional, 837D dental, and 837I institutional claims that include an adjustment amount or quantity without a corresponding adjustment reason code.

How the edit works

In a healthcare claim, an adjustment is a dollar amount that reduces what the payer owes the provider. Adjustments can cover things like a contractual write-off or the patient's responsibility, such as a co-pay or deductible.

Payers apply adjustments during adjudication and return them, along with other payment information, to the provider in an Electronic Remittance Advice (ERA). Adjustments are provided at both the claim and service-line level.

In the ERA, each adjustment's dollar amount is paired with a Claim Adjustment Reason Code (CARC). The reason code explains why the adjustment was made.

When billing a secondary or tertiary payer – a process called coordination of benefits (COB) – the provider or their billing system copies the prior payer's adjustments onto the claim.

Each adjustment has a reason code, a dollar amount, and an optional quantity. Not all three are required, but if an amount or quantity is present, the reason code must be too.

Claim-level adjustment reason code

Service line-level adjustment reason code

If the amount or quantity is copied without the corresponding reason code, the payer can't process the adjustment and will reject the claim.

This edit catches the issue before the claim reaches the payer. It prevents payer rejections, which are slower and delay payment for the provider.

Rejection errors

If you submit a claim using Stedi's Claim Submission API endpoints and the claim fails the edit, you'll get back an error response in real time. The response includes details in the errors array:

{
  "errors": [
    {
      "code": "33",
      "description": "Missing Adjustment Reason Code. When an adjustment amount or quantity is present on the claim then a corresponding adjustment reason code is required. Correct and resubmit.",
      "followupAction": "Please Correct and Resubmit"
    }
  ]
}

If you submit a claim using SFTP and the claim fails the edit, Stedi will reject the claim with a 277CA claim acknowledgment. The acknowledgment will include a related claim status category code, claim status code, and error message:

STC*A6>521*[DATE]*U*[AMOUNT]********Missing Adjustment Reason Code. When an adjustment amount or quantity is present on the claim then a corresponding adjustment reason code is required. Correct and resubmit.~

Claim edit: Missing adjustment amount

Stedi now rejects 837P professional, 837D dental, and 837I institutional claims that include an adjustment reason code without a corresponding adjustment amount.

How the edit works

In a healthcare claim, an adjustment is a dollar amount that reduces what the payer owes the provider. Adjustments can cover things like a contractual write-off or the patient's responsibility, such as a co-pay or deductible.

Payers apply adjustments during adjudication and return them, along with other payment information, to the provider in an Electronic Remittance Advice (ERA). Adjustments are provided at both the claim and service-line level.

In the ERA, each adjustment's dollar amount is paired with a Claim Adjustment Reason Code (CARC). The reason code explains why the adjustment was made.

When billing a secondary or tertiary payer – a process called coordination of benefits (COB) – the provider or their billing system copies the prior payer's adjustments onto the claim.

Each adjustment has a reason code, a dollar amount, and an optional quantity. Not all three are required, but if a reason code is present, the amount must be too.

Claim-level adjustment amount

Service line-level adjustment amount

If the reason code is copied without the corresponding amount, the payer can't process the adjustment and will reject the claim.

This edit catches the issue before the claim reaches the payer. It prevents payer rejections, which are slower and delay payment for the provider.

Rejection errors

If you submit a claim using Stedi's Claim Submission API endpoints and the claim fails the edit, you'll get back an error response in real time. The response includes details in the errors array:

{
  "errors": [
    {
      "code": "33",
      "description": "Missing Adjustment Amount. When an adjustment reason code is present then a corresponding adjustment amount is required. Impacted adjustment reason code(s) 96. Correct and resubmit.",
      "followupAction": "Please Correct and Resubmit"
    }
  ]
}

If you submit a claim using SFTP and the claim fails the edit, Stedi will reject the claim with a 277CA claim acknowledgment. The acknowledgment will include a related claim status category code, claim status code, and error message:

STC*A6>519*[DATE]*U*[AMOUNT]********Missing Adjustment Amount. When an adjustment reason code is present then a corresponding adjustment amount is required. Impacted adjustment reason code(s) 96. Correct and resubmit.~

FirstCare is now one-click enrollment

Healthcare payer FirstCare (Payer ID: 94998) now supports one-click transaction enrollment for Electronic Remittance Advice (ERAs).

About one-click enrollment

Transaction enrollment is the process of registering a provider to exchange specific healthcare transactions with a payer. Payers always require transaction enrollment for ERAs.

Transaction enrollment requirements vary by payer. Some payers may require the submitter to sign PDFs or complete tasks in the payer's portal.

With one-click transaction enrollment, you only need to submit an enrollment request. There are no follow-up steps. Stedi handles everything else.

You can check whether a payer supports one-click enrollment using the Stedi Payer Network or the Payer APIs.

Health Payment Systems Incorporated is now one-click enrollment

Healthcare payer Health Payment Systems Incorporated (Payer ID: 20270) now supports one-click transaction enrollment for Electronic Remittance Advice (ERAs).

About one-click enrollment

Transaction enrollment is the process of registering a provider to exchange specific healthcare transactions with a payer. Payers always require transaction enrollment for ERAs.

Transaction enrollment requirements vary by payer. Some payers may require the submitter to sign PDFs or complete tasks in the payer's portal.

With one-click transaction enrollment, you only need to submit an enrollment request. There are no follow-up steps. Stedi handles everything else.

You can check whether a payer supports one-click enrollment using the Stedi Payer Network or the Payer APIs.

Introducing requested effective dates for ERA enrollments

You can now set an optional requested effective date on ERA transaction enrollment requests. This date tells the payer when you'd like them to start routing ERAs to Stedi.

A provider can only receive Electronic Remittance Advice (ERAs) from a payer through one clearinghouse at a time. You change that clearinghouse through a transaction enrollment.

Without a predictable start date, you can't tell providers when to expect ERAs at Stedi or when to stop checking for ERAs at their old clearinghouse.

A requested effective date gives you that start date. This makes clearinghouse migrations and provider go-live dates easier to plan.

How requested effective dates work

Requested effective dates are a request to the payer, not a guarantee. The payer, not Stedi, controls when an enrollment takes effect.

Checking payer support

Not all payers support requested effective dates. You can check whether a payer supports them using the Payers API or the Stedi Payer Network before submitting an enrollment request.

In the Stedi Payer Network:

The field is omitted when Stedi has yet to determine a payer's support for requested effective dates.

In Payers API responses, check the requestedEffectiveDate field in the claimPayment enrollment process to determine support:

{
  "payer": {
    "enrollment": {
      "transactionEnrollmentProcesses": {
        "claimPayment": {
          "requestedEffectiveDate": "SUPPORTED", // Payer supports requested effective dates for ERA enrollments
          ...
        }
      },
      ...
    },
    ...
  }
}

Enrollments API

Setting a requested effective date

You can now pass an optional requestedEffectiveDate field in Create Enrollment API requests. The date uses YYYYMMDD format and can be today or any date up to 6 months from now.

{
  "transactions": {
    "claimPayment": {
      "enroll": true // ERA enrollment
    }
  },
  "requestedEffectiveDate": "20260601", // Requested effective date
  ...
}

On DRAFT enrollments, omitting the requestedEffectiveDate field leaves the value empty. For enrollments in the STEDI_ACTION_REQUIRED status, the requested effective date defaults to the submission date.

If the payer explicitly doesn't support requested effective dates, Stedi rejects the request.

Updating existing enrollments

You can update a DRAFT enrollment’s requestedEffectiveDate using an Update Enrollment API request.

Viewing requested effective dates

The Retrieve Enrollment API and List Enrollments API responses return requestedEffectiveDate on each enrollment record. For example, in a Retrieve Enrollment response:

{
  "id": "db6675c5-7be7-4af9-8c68-a54a336d2911",
  "requestedEffectiveDate": "20260601",
  ...
}

Filtering and sorting by requested effective dates

The List Enrollments API also accepts new query parameters to filter and sort by requested effective date:

• Use requestedEffectiveDateFrom and requestedEffectiveDateTo to filter enrollments with a requested effective date in a given range

• Use sortBy=requestedEffectiveDate:asc or sortBy=requestedEffectiveDate:desc to sort results by requested effective date

For example, the following request returns enrollments with a Q2 2026 requested effective date, sorted from earliest to latest:

curl --request GET \
  --url "https://enrollments.us.stedi.com/2024-09-01/enrollments?requestedEffectiveDateFrom=20260401&requestedEffectiveDateTo=20260630&sortBy=requestedEffectiveDate:asc" \
  --header "Authorization: <api_key>"

Stedi portal

Requested effective dates appear in the enrollments list view.

You can filter enrollments by requested effective date.

They also appear, when applicable, on each enrollment's detail page in the Stedi portal.

Availability

Transaction enrollment is free on all Stedi plans.

To learn more, check out our transaction enrollment docs.

Point C is now one-click enrollment

Healthcare payer Point C (Payer ID: 22823) now supports one-click transaction enrollment for Electronic Remittance Advice (ERAs).

About one-click enrollment

Transaction enrollment is the process of registering a provider to exchange specific healthcare transactions with a payer. Payers always require transaction enrollment for ERAs.

Transaction enrollment requirements vary by payer. Some payers may require the submitter to sign PDFs or complete tasks in the payer's portal.

With one-click transaction enrollment, you only need to submit an enrollment request. There are no follow-up steps. Stedi handles everything else.

You can check whether a payer supports one-click enrollment using the Stedi Payer Network or the Payer APIs.

San Francisco Health Plan is now one-click enrollment

Healthcare payer San Francisco Health Plan (Payer ID: SFHP1) now supports one-click transaction enrollment for Electronic Remittance Advice (ERAs).

About one-click enrollment

Transaction enrollment is the process of registering a provider to exchange specific healthcare transactions with a payer. Payers always require transaction enrollment for ERAs.

Transaction enrollment requirements vary by payer. Some payers may require the submitter to sign PDFs or complete tasks in the payer's portal.

With one-click transaction enrollment, you only need to submit an enrollment request. There are no follow-up steps. Stedi handles everything else.

You can check whether a payer supports one-click enrollment using the Stedi Payer Network or the Payer APIs.

Blue Cross Blue Shield of South Carolina is now one-click enrollment

Blue Cross Blue Shield of South Carolina (Payer ID: 00401) now supports one-click transaction enrollment for Electronic Remittance Advice (ERAs).

About one-click enrollment

Transaction enrollment is the process of registering a provider to exchange specific healthcare transactions with a payer. Payers always require transaction enrollment for ERAs.

Transaction enrollment requirements vary by payer. Some payers may require the submitter to sign PDFs or complete tasks in the payer's portal.

With one-click transaction enrollment, you only need to submit an enrollment request. There are no follow-up steps. Stedi handles everything else.

You can check whether a payer supports one-click enrollment using the Stedi Payer Network or the Payer APIs.