Real-Time Claim Status Raw X12

Submit a 276/277 real-time claim status check in raw X12 EDI format

POST /change/medicalnetwork/claimstatus/v2/raw-x12

You may need to submit a 276 real-time claim status request when you don’t receive a 277CA or 835 ERA response from the payer within your expected timeframe. This endpoint is ideal if you have an existing system that generates X12 EDI files and you want to send them through Stedi.

1. Call this endpoint with a payload in 276 X12 EDI format.
2. Stedi validates the EDI and sends the transaction to the payer.
3. The endpoint returns a synchronous 277 claim status response from the payer in JSON format. The response contains information about the claims matching the criteria you provided in the request and their current status.

The response may contain information about more than one claim, if the payer has multiple claims on file that match the information you provided.

Visit Check claim status for a complete how-to guide.

Authorizations

Authorization · string · required · header

A Stedi API Key for authentication.

Body

application/json

x12 · string · required

Response

application/json

ClaimStatusRawX12 200 response

claims · array<object>

The status information for the claim referenced in the original claim status request.

The payer may return multiple claims in the response if they have more than one claim on file that matches the information you provided.

claims[]. claimStatus · object

The status, required action, and paid information of a claim or service line.

claims[].claimStatus. amountPaid · string

The total amount paid for the claim. May be zero when no payment is being made. Some payers can provide the adjudicated payment amount before they issue the remittance.

claims[].claimStatus. checkIssueDate · string

The date the payer issued the check for payment. This may also contain a non-payment remittance advice date, if available from the payer.

• Pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$

claims[].claimStatus. checkNumber · string

The check identification number or electronic funds transfer (EFT) trace number. This number is used to track the payment. This may also contain a non-payment remittance advice Trace Number (835 or paper), if available from the payer.

claims[].claimStatus. claimServiceDate · string

Either a single date (formatted as YYYYMMDD) or a range of dates (formatted as YYYYMMDD-YYYYMMDD) identifying the period of service related to the claim. This property is derived from the service level dates.

claims[].claimStatus. clearingHouseClaimNumber · string

The claim number provided by the clearinghouse.

claims[].claimStatus. effectiveDate · string

The date the claim was placed in this status by the payer's adjudication process.

• Pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$

claims[].claimStatus. entity · string

The description of the entityCode. For example, Home Health Care.

claims[].claimStatus. entityCode · string

Code identifying the organizational entity, physical location, property, or individual associated with the statusCode. For example 1G - Oncology Center.

claims[].claimStatus. paidDate · string

This is the date of denial or approval for the claim. This date may or may not be the same as the issue date of the check, EFT, or non-payment remittance. Some payers can provide this date before they issue the remittance.

• Pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$

claims[].claimStatus. patientAccountNumber · string

The patient account number provided by the service provider in the original claim. You can use this value to correlate the claim status response to the original claim.

claims[].claimStatus. statusCategoryCode · string

The status category code. Visit Claim Status Category Codes in the official X12 documentation for a complete list.

claims[].claimStatus. statusCategoryCodeValue · string

The description of the statusCategoryCode.

claims[].claimStatus. statusCode · string

The status code used to identify the status of an entire claim or a service line. For example, 20 - Accepted for Processing.

This is either a Health Care Claim Status Code or a National Council for Prescription Drug Programs (NCPDP) Reject/Payment Code, when the status is related to pharmacy claims.

Visit [Claim Status Codes](Health Care Claim Status Code in the official X12 documentation or the NCPDP website for a complete list of codes and their values.

claims[].claimStatus. statusCodeValue · string

The description of the statusCode.

claims[].claimStatus. submittedAmount · string

The total charges submitted for the claim. The total claim charge may change from the submitted claim total charge based on claims processing instructions, such as claim splitting. Some payers may not store the original submitted charge. Some HMO encounters supply zero as the amount of original charges.

claims[].claimStatus. trackingNumber · string

This is the trace or reference number of the original claim status request.

claims[].claimStatus. tradingPartnerClaimNumber · string

An identifier for the claim, assigned by the payer.

claims[]. serviceDetails · array<object>

Information about specific service lines and their status.

claims[].serviceDetails[]. service · object

Information about a service line listed in the referenced claim.

claims[].serviceDetails[].service. amountPaid · string

The amount paid for the service line, expressed as a decimal. For example, 100.00.

claims[].serviceDetails[].service. procedureId · string

Identifying number for product or service.

claims[].serviceDetails[].service. revenueCode · string

The National Uniform Billing Committee revenue code.

claims[].serviceDetails[].service. serviceIdQualifier · string

The definition of the serviceIdQualifierCode. For example, American Dental Association Codes.

claims[].serviceDetails[].service. serviceIdQualifierCode · string

A code identifying the type/source of the procedureId. Visit Check claim status for a complete list.

Possible values

AD

ER

HC

HP

IV

claims[].serviceDetails[].service. submittedAmount · string

The amount submitted for the service line, expressed as a decimal. For example, 100.00. This is the line item total on the current claim service status.

claims[].serviceDetails[].service. submittedUnits · string

The number of units of service submitted.

claims[].serviceDetails[]. status · array<object>

Information about the status, required action, and paid information of a service line.

claims[].serviceDetails[].status[]. effectiveDate · string

The date the service line was placed in this status by the payer's adjudication process.

• Pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$

claims[].serviceDetails[].status[]. entity · string

The description of the entityCode. For example, Public Health Service Facility.

claims[].serviceDetails[].status[]. entityCode · string

The code identifying the organizational entity, physical location, property, or individual associated with the statusCode. For example, 4H - Emergency Department.

claims[].serviceDetails[].status[]. statusCategoryCode · string

The category code for the status. Visit Claim Status Category Codes in the official X12 documentation for a complete list.

claims[].serviceDetails[].status[]. statusCategoryCodeValue · string

The description of the statusCategoryCode.

claims[].serviceDetails[].status[]. statusCode · string

The status code used to identify the status of an entire service line. This is either a Health Care Claim Status Code or a National Council for Prescription Drug Programs Reject/Payment Code, when the status is related to pharmacy claims.

claims[].serviceDetails[].status[]. statusCodeValue · string

The description of the statusCode.

controlNumber · string

The control number the payer provided in the claim status response. This is used to identify the transaction.

dependent · object

Information about the dependent listed in the referenced claim.

dependent. dateOfBirth · string

The dependent's date of birth.

• Pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$

dependent. firstName · string · required

The dependent's first name as specified on their insurance policy.

• Required string length: 1 - 35

dependent. gender · string

A code indicating the dependent's gender. If the claim set the dependent's gender to U for unknown, you should omit this property from the claim status request.

Possible values

M

F

dependent. groupNumber · string

The group number associated with the subscriber and dependent's insurance policy.

• Required string length: 1 - 50

dependent. lastName · string · required

The dependent's last name as specified on their insurance policy.

• Required string length: 1 - 60

errorResponse · object

errorResponse. code · string

errorResponse. description · string

errorResponse. errors · array<object>

errorResponse.errors[]. code · string

The error code.

errorResponse.errors[]. description · string

The description of the error code.

errorResponse.errors[]. field · string

The attribute that caused the error.

errorResponse.errors[]. followupAction · string

Follow-up actions to correct the error.

errorResponse.errors[]. location · string

Where the error occurred within the request syntax. If this is a network or system error, there is no location attribute.

errorResponse.errors[]. value · string

The value that caused the error.

errorResponse. transactionIdentifier · object

errorResponse.transactionIdentifier. customerTransactionId · string

errorResponse.transactionIdentifier. transactionId · string

implementationTransactionSetSyntaxError · string

The syntax error code in the 999 Implementation Acknowledgment. It indicates the type of error (if present) in the EDI request syntax. Visit IK502 in the Implementation Acknowledgment specification for a complete list.

meta · object

Metadata about the response.

meta. applicationMode · string

Identifies where this request can be found for support.

meta. billerId · string

The biller ID assigned to this request.

meta. senderId · string

The sender ID assigned to this request.

meta. submitterId · string

The submitter ID assigned to this request.

meta. traceId · string

The unique ID assigned to this request within Stedi.

payer · object

Information about the payer listed in the referenced claim.

payer. centersForMedicareAndMedicaidServicePlanId · string

The payer's Health Plan ID (HPID) or Other Entity Identifier (OEID).

payer. contactInformation · object

payer.contactInformation. electronicDataInterChangeAccessNumber · string

The payer's Electronic Data Interchange Access number.

payer.contactInformation. email · string

The payer's email address.

payer.contactInformation. fax · string

The payer's fax number, without separators. For example, 5551123345 for 555-112-3345

payer.contactInformation. name · string

The payer contact name.

payer.contactInformation. phone · string

The payer's telephone number. Phone numbers are formatted as AAABBBCCCC, where AAA represents the area code, BBB represents the telephone number prefix, and CCCC represents the telephone number. Phone numbers are provided without separators, such as dashes or parentheses. For example, 5551123345 for 555-112-3345.

payer.contactInformation. phoneExtension · string

The payer's telephone extension.

payer. organizationName · string

The payer's organization name. For example UNITEDHEALTHCARE.

payer. payerIdentification · string

The payer's identification number. This is the tradingPartnerServiceId.

providers · array<object>

Information about the billing and/or service providers related to the referenced claim.

providers[]. etin · string

The Electronic Transmitter Identification Number (ETIN).

• Required string length: 2 - 80

providers[]. firstName · string

The provider's first name.

• Required string length: 1 - 35

providers[]. lastName · string

The provider's last name.

• Required string length: 1 - 60

providers[]. npi · string

The National Provider Identification (NPI) number.

• Pattern: ^\d{10}$

providers[]. organizationName · string

The provider's organization name.

• Required string length: 1 - 60

providers[]. providerType · string · required

Identifies the type of provider related to the referenced healthcare claim.

Possible values

BillingProvider

ServiceProvider

providers[]. spn · string · deprecated

The service provider number.

• Required string length: 2 - 80

providers[]. taxId · string

The Taxpayer Identification Number (TIN).

• Pattern: ^\d{9}$

providers[]. tin · string

• Required string length: 2 - 80

reassociationKey · string

The control number for the transaction.

status · string

The status of the entire claim.

subscriber · object

Information about the subscriber listed in the referenced claim.

subscriber. dateOfBirth · string

The subscriber's date of birth.

• Pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$

subscriber. firstName · string · required

The subscriber's first name as specified on their policy.

• Required string length: 1 - 35

subscriber. gender · string

A code indicating the subscriber's gender. If the claim set the subscriber's gender to U for unknown, you should omit this property from the claim status request.

Possible values

M

F

subscriber. groupNumber · string

The group number associated with the subscriber's insurance policy.

• Required string length: 1 - 50

subscriber. lastName · string · required

The subscriber's last name as specified on their policy. The subscriber can be an individual or a business entity.

• Required string length: 1 - 60

subscriber. memberId · string · required

The subscriber's insurance member ID. This is the unique identifier for the subscriber on the insurance policy.

• Required string length: 2 - 80

tradingPartnerServiceId · string

An ID for the payer you identified in the original claim status request. This value may differ from the tradingPartnerServiceId you submitted in the original request because it reflects the payer's internal concept of their ID, not necessarily the ID Stedi uses to route requests to this payer.

transactionSetAcknowledgement · string

The acknowledgment code in the 999 Implementation Acknowledgment, an EDI file generated by the payer to acknowledge receipt of the claim status request. It indicates whether the claim status request was accepted or rejected due to errors in the EDI request syntax.

x12 · string

The raw X12 response from the payer.

cURL

curl --request POST \
  --url "https://healthcare.us.stedi.com/2024-04-01/change/medicalnetwork/claimstatus/v2/raw-x12" \
  --header "Authorization: <api_key>" \
  --header "Content-Type: application/json" \
  --data '{
    "x12": "ISA*00*          *00*          *ZZ*SENDER         *ZZ*RECEIVER       *240710*2300*^*00501*000000001*0*T*>~GS*HR*SENDERGS*RECEIVERGS*20240710*230011*000000001*X*005010X212~ST*276*0001*005010X212~BHT*0010*13*ABC276XXX*20050915*1425~HL*1**20*1~NM1*PR*2*UNITEDHEALTHCARE*****PI*3429~HL*2*1*21*1~NM1*41*2*XYZ SERVICE*****46*X67E~HL*3*2*19*1~NM1*1P*2*BEHAVIORAL SERVICES P.C.*****XX*123456789~HL*4*3*22*0~DMG*D8*19301210*M~NM1*IL*1*JANE*DOE****MI*111222333~TRN*1*222222222~REF*BLT*111~REF*EJ*SM123456~AMT*T3*238.44~DTP*472*RD8*20050831-20050906~HL*5*2*19*1~NM1*1P*2*BEHAVIORAL SERVICES P.C.*****XX*1999999984~HL*6*5*22*1~NM1*IL*1*DOE*JANE****MI*345678901~HL*7*6*23~DMG*D8*19951101*M~NM1*QC*1*DOE*JOHN~TRN*1*222222222~REF*EJ*MA345678~SVC*HC>99203*238.44*****1~DTP*472*D8*20050501~SE*28*0001~GE*1*000000001~IEA*1*000000001~"
  }'

JavaScript

const body = JSON.stringify({
  "x12": "ISA*00*          *00*          *ZZ*SENDER         *ZZ*RECEIVER       *240710*2300*^*00501*000000001*0*T*>~GS*HR*SENDERGS*RECEIVERGS*20240710*230011*000000001*X*005010X212~ST*276*0001*005010X212~BHT*0010*13*ABC276XXX*20050915*1425~HL*1**20*1~NM1*PR*2*UNITEDHEALTHCARE*****PI*3429~HL*2*1*21*1~NM1*41*2*XYZ SERVICE*****46*X67E~HL*3*2*19*1~NM1*1P*2*BEHAVIORAL SERVICES P.C.*****XX*123456789~HL*4*3*22*0~DMG*D8*19301210*M~NM1*IL*1*JANE*DOE****MI*111222333~TRN*1*222222222~REF*BLT*111~REF*EJ*SM123456~AMT*T3*238.44~DTP*472*RD8*20050831-20050906~HL*5*2*19*1~NM1*1P*2*BEHAVIORAL SERVICES P.C.*****XX*1999999984~HL*6*5*22*1~NM1*IL*1*DOE*JANE****MI*345678901~HL*7*6*23~DMG*D8*19951101*M~NM1*QC*1*DOE*JOHN~TRN*1*222222222~REF*EJ*MA345678~SVC*HC>99203*238.44*****1~DTP*472*D8*20050501~SE*28*0001~GE*1*000000001~IEA*1*000000001~"
})

fetch("https://healthcare.us.stedi.com/2024-04-01/change/medicalnetwork/claimstatus/v2/raw-x12", {
  headers: {
    "Authorization": "<api_key>"
  },
  body
})

Go

package main

import (
  "fmt"
  "net/http"
  "io/ioutil"
  "strings"
)

func main() {
  url := "https://healthcare.us.stedi.com/2024-04-01/change/medicalnetwork/claimstatus/v2/raw-x12"
  body := strings.NewReader(`{
    "x12": "ISA*00*          *00*          *ZZ*SENDER         *ZZ*RECEIVER       *240710*2300*^*00501*000000001*0*T*>~GS*HR*SENDERGS*RECEIVERGS*20240710*230011*000000001*X*005010X212~ST*276*0001*005010X212~BHT*0010*13*ABC276XXX*20050915*1425~HL*1**20*1~NM1*PR*2*UNITEDHEALTHCARE*****PI*3429~HL*2*1*21*1~NM1*41*2*XYZ SERVICE*****46*X67E~HL*3*2*19*1~NM1*1P*2*BEHAVIORAL SERVICES P.C.*****XX*123456789~HL*4*3*22*0~DMG*D8*19301210*M~NM1*IL*1*JANE*DOE****MI*111222333~TRN*1*222222222~REF*BLT*111~REF*EJ*SM123456~AMT*T3*238.44~DTP*472*RD8*20050831-20050906~HL*5*2*19*1~NM1*1P*2*BEHAVIORAL SERVICES P.C.*****XX*1999999984~HL*6*5*22*1~NM1*IL*1*DOE*JANE****MI*345678901~HL*7*6*23~DMG*D8*19951101*M~NM1*QC*1*DOE*JOHN~TRN*1*222222222~REF*EJ*MA345678~SVC*HC>99203*238.44*****1~DTP*472*D8*20050501~SE*28*0001~GE*1*000000001~IEA*1*000000001~"
  }`)
  req, _ := http.NewRequest("POST", url, body)
  req.Header.Add("Authorization", "<api_key>")
  req.Header.Add("Content-Type", "application/json")
  res, _ := http.DefaultClient.Do(req)
  defer res.Body.Close()
  body, _ := ioutil.ReadAll(res.Body)

  fmt.Println(res)
  fmt.Println(string(body))
}

Python

import requests

url = "https://healthcare.us.stedi.com/2024-04-01/change/medicalnetwork/claimstatus/v2/raw-x12"
body = {
  "x12": "ISA*00*          *00*          *ZZ*SENDER         *ZZ*RECEIVER       *240710*2300*^*00501*000000001*0*T*>~GS*HR*SENDERGS*RECEIVERGS*20240710*230011*000000001*X*005010X212~ST*276*0001*005010X212~BHT*0010*13*ABC276XXX*20050915*1425~HL*1**20*1~NM1*PR*2*UNITEDHEALTHCARE*****PI*3429~HL*2*1*21*1~NM1*41*2*XYZ SERVICE*****46*X67E~HL*3*2*19*1~NM1*1P*2*BEHAVIORAL SERVICES P.C.*****XX*123456789~HL*4*3*22*0~DMG*D8*19301210*M~NM1*IL*1*JANE*DOE****MI*111222333~TRN*1*222222222~REF*BLT*111~REF*EJ*SM123456~AMT*T3*238.44~DTP*472*RD8*20050831-20050906~HL*5*2*19*1~NM1*1P*2*BEHAVIORAL SERVICES P.C.*****XX*1999999984~HL*6*5*22*1~NM1*IL*1*DOE*JANE****MI*345678901~HL*7*6*23~DMG*D8*19951101*M~NM1*QC*1*DOE*JOHN~TRN*1*222222222~REF*EJ*MA345678~SVC*HC>99203*238.44*****1~DTP*472*D8*20050501~SE*28*0001~GE*1*000000001~IEA*1*000000001~"
}
response = requests.request("POST", url, json = body, headers = {
  "Authorization": "<api_key>",
  "Content-Type": "application/json"
})

print(response.text)

Java

import java.net.URI;
import java.net.http.HttpClient;
import java.net.http.HttpRequest;
import java.net.http.HttpResponse;
import java.net.http.HttpResponse.BodyHandlers;
import java.time.Duration;
import java.net.http.HttpRequest.BodyPublishers;

var body = BodyPublishers.ofString("""{
  "x12": "ISA*00*          *00*          *ZZ*SENDER         *ZZ*RECEIVER       *240710*2300*^*00501*000000001*0*T*>~GS*HR*SENDERGS*RECEIVERGS*20240710*230011*000000001*X*005010X212~ST*276*0001*005010X212~BHT*0010*13*ABC276XXX*20050915*1425~HL*1**20*1~NM1*PR*2*UNITEDHEALTHCARE*****PI*3429~HL*2*1*21*1~NM1*41*2*XYZ SERVICE*****46*X67E~HL*3*2*19*1~NM1*1P*2*BEHAVIORAL SERVICES P.C.*****XX*123456789~HL*4*3*22*0~DMG*D8*19301210*M~NM1*IL*1*JANE*DOE****MI*111222333~TRN*1*222222222~REF*BLT*111~REF*EJ*SM123456~AMT*T3*238.44~DTP*472*RD8*20050831-20050906~HL*5*2*19*1~NM1*1P*2*BEHAVIORAL SERVICES P.C.*****XX*1999999984~HL*6*5*22*1~NM1*IL*1*DOE*JANE****MI*345678901~HL*7*6*23~DMG*D8*19951101*M~NM1*QC*1*DOE*JOHN~TRN*1*222222222~REF*EJ*MA345678~SVC*HC>99203*238.44*****1~DTP*472*D8*20050501~SE*28*0001~GE*1*000000001~IEA*1*000000001~"
}""");
HttpClient client = HttpClient.newBuilder()
  .connectTimeout(Duration.ofSeconds(10))
  .build();

HttpRequest.Builder requestBuilder = HttpRequest.newBuilder()
  .uri(URI.create("https://healthcare.us.stedi.com/2024-04-01/change/medicalnetwork/claimstatus/v2/raw-x12"))
  .header("Content-Type", "application/json")
  .header("Authorization", "<api_key>")
  .POST(body)
  .build();

try {
  HttpResponse<String> response = client.send(requestBuilder.build(), BodyHandlers.ofString());
  System.out.println("Status code: " + response.statusCode());
  System.out.println("Response body: " + response.body());
} catch (Exception e) {
  e.printStackTrace();
}

200

{
  "claims": [
    {
      "claimStatus": {
        "amountPaid": "95.55",
        "claimServiceDate": "20240325",
        "effectiveDate": "20240329",
        "paidDate": "20240329",
        "patientAccountNumber": "3333333",
        "statusCategoryCode": "P5",
        "statusCategoryCodeValue": "Pending/Payer Administrative/System hold",
        "statusCode": "3",
        "statusCodeValue": "Claim has been adjudicated and is awaiting payment cycle.",
        "submittedAmount": "238.44",
        "trackingNumber": "222222222",
        "tradingPartnerClaimNumber": "5332034153-KK"
      },
      "serviceDetails": [
        {
          "service": {
            "amountPaid": "95.55",
            "procedureId": "90837",
            "serviceIdQualifier": "Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes",
            "serviceIdQualifierCode": "HC",
            "submittedAmount": "238.44",
            "submittedUnits": "1"
          },
          "status": [
            {
              "effectiveDate": "20240329",
              "statusCategoryCode": "P5",
              "statusCategoryCodeValue": "Pending/Payer Administrative/System hold",
              "statusCode": "3",
              "statusCodeValue": "Claim has been adjudicated and is awaiting payment cycle."
            }
          ]
        }
      ]
    }
  ],
  "controlNumber": "222222222",
  "meta": {
    "applicationMode": "production",
    "traceId": "bf27223e-46c3-451e-b2b4-46f3f0b6fe3b"
  },
  "payer": {
    "organizationName": "UNITEDHEALTHCARE",
    "payerIdentification": "3429"
  },
  "providers": [
    {
      "organizationName": "Behavioral Services P.C.",
      "providerType": "BillingProvider",
      "taxId": "123456789"
    },
    {
      "npi": "1999999984",
      "organizationName": "Behavioral Services P.C.",
      "providerType": "ServiceProvider"
    }
  ],
  "reassociationKey": "000000001",
  "status": "success",
  "subscriber": {
    "firstName": "JANE",
    "lastName": "DOE",
    "memberId": "111222333"
  },
  "tradingPartnerServiceId": "3429"
}

400

{
  "code": "string",
  "message": "string"
}

403

{
  "code": "string",
  "message": "string"
}

404

{
  "code": "string",
  "message": "string"
}

429

{
  "code": "string",
  "message": "string"
}

500

{
  "code": "string",
  "message": "string"
}

503

{
  "code": "string",
  "message": "string"
}

504

{
  "code": "string",
  "message": "string"
}