CMS-1500 PDF: Business Identifier
This endpoint uses a business identifier to retrieve autogenerated CMS-1500 Claim Form PDFs for submitted 837 professional claims.
- 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. - Stedi returns an array of PDFs for all claims with the specified business identifier value. PDFs are returned as a base64 encoded string.
- Decode the base64 string and save it to a file with a .pdf extension.
You can also review and download claim form PDFs from each claim’s transaction details page in Stedi.
Setting a claim’s correlation ID
A claim’s correlation ID is a business identifier that you can use to retrieve claim form PDFs.
- When you submit claims through the JSON endpoint, Stedi generates the correlation ID for you, and this value will be unique for each claim.
- When you submit claims in X12 EDI through the API or an SFTP connection, you can specify your own correlation ID in the
BHT03
field. This allows you to use the same value for multiple claims if desired.
Generation notes
Review these behaviors and recommendations if you plan to send the generated PDFs to payers or retain them for your records:
PDF background
You can generate CMS-1500 PDFs with a white background by adding the query parameter ?background=false
when calling the PDF generation endpoints.
The National Uniform Claim Committee (NUCC) and CMS provide exact specifications for blank CMS-1500 forms, including paper size and ink color. Many provider offices are accustomed to using these pre-printed forms, and their Practice Management System (PMS) applications are designed to print claim data onto them. Generating PDFs with a white background allows you to print the claim data directly onto official pre-printed forms.
Note that the form boxes and labels must be printed in red ink and the item values must be printed in black ink for the claim form to be read by a scanner. Your vendor may choose not to process claim forms that don’t conform to these specifications.
Due to mechanical variations between printer models, we can’t guarantee that the generated PDFs will align perfectly with pre-printed forms. We recommend testing the alignment with your printer before using the generated PDFs for official submissions.
The PDF may truncate claim data.
The maximum length for many fields in the 1500 claim form is less than the maximum length for the corresponding properties in the claim request.
Recommendation: Ensure that your claim data is within the maximum length for claim form fields. We especially recommend using USPS abbreviations to avoid truncated addresses in the generated PDF.
The PDF may omit the second line of some addresses.
Some 1500 claim form items contain address fields that can only be mapped to a single address line. If you include the address2
JSON property (X12 EDI N302
) in your claim submission, that information may not appear in the PDF.
Recommendation: Put all street address line data into the address1
JSON property (X12 EDI N301
), ensuring that you adhere to the claim form length constraints.
The PDF won’t populate Item 7 when the patient is a dependent.
Stedi validates the claim data you submit to the API and uses it to generate a compliant X12 EDI transaction to send to the payer. The PDF is generated from the final X12 EDI transaction.
The X12 EDI standard specifies that claims should only contain the insured’s address when the patient is the subscriber. To maintain compliance, Stedi doesn’t include the insured’s address information in the generated X12 EDI transaction when the patient is a dependent, even if you provided the subscriber’s address in the original API request. Since this address information isn’t present in final X12 EDI claim, it’s also not added to Item 7 (Insured’s Address) in the generated PDF.
Payer address (Carrier Block)
You can populate the payer’s address on the PDF by providing the payerAddress
object in your claim submission API request. Include the payer’s address details that you want to appear on the form.
Standard form size
The generated PDFs use the standard 8.5” x 11” format.
Authorizations
A Stedi API Key for authentication.
Query Parameters
The business identifier for the claim PDF you want to retrieve. This value is returned as the claimReference.correlationId
in the synchronous response Stedi returns when you submit a professional claim.
If false, the generated PDF will only contain the form data on a white background, suitable for printing on pre-printed forms. The default is true.
Response
Errors that prevented Stedi from returning one or more PDFs for the specified businessId
. This array may be empty if there were no errors.
Data for PDF files Stedi generated for the specified businessId
. This array may be empty if there are no PDFs available for the specified businessId
. It may also contain multiple PDFs if there is more than one claim with the same businessId
value.
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