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Healthcare
EDI platform
Claim Status Raw X12
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": "<string>"
}'{
"controlNumber": "<string>",
"tradingPartnerServiceId": "<string>",
"payer": {
"organizationName": "<string>",
"payerIdentification": "<string>",
"centersForMedicareAndMedicaidServicePlanId": "<string>",
"contactInformation": {
"name": "<string>",
"electronicDataInterChangeAccessNumber": "<string>",
"email": "<string>",
"fax": "<string>",
"phone": "<string>",
"phoneExtension": "<string>"
}
},
"providers": [
{
"organizationName": "<string>",
"firstName": "<string>",
"lastName": "<string>",
"npi": "<string>",
"spn": "<string>",
"tin": "<string>",
"taxId": "<string>",
"etin": "<string>",
"providerType": "BillingProvider"
}
],
"subscriber": {
"memberId": "<string>",
"firstName": "<string>",
"lastName": "<string>",
"gender": "M",
"dateOfBirth": "<string>",
"groupNumber": "<string>"
},
"dependent": {
"firstName": "<string>",
"lastName": "<string>",
"gender": "M",
"dateOfBirth": "<string>",
"groupNumber": "<string>"
},
"claims": [
{
"claimStatus": {
"statusCategoryCode": "<string>",
"statusCategoryCodeValue": "<string>",
"statusCode": "<string>",
"statusCodeValue": "<string>",
"entityCode": "<string>",
"entity": "<string>",
"effectiveDate": "<string>",
"submittedAmount": "<string>",
"amountPaid": "<string>",
"paidDate": "<string>",
"checkIssueDate": "<string>",
"checkNumber": "<string>",
"trackingNumber": "<string>",
"claimServiceDate": "<string>",
"tradingPartnerClaimNumber": "<string>",
"patientAccountNumber": "<string>",
"clearingHouseClaimNumber": "<string>"
},
"serviceDetails": [
{
"service": {
"serviceIdQualifierCode": "AD",
"serviceIdQualifier": "<string>",
"procedureId": "<string>",
"submittedAmount": "<string>",
"amountPaid": "<string>",
"revenueCode": "<string>",
"submittedUnits": "<string>"
},
"status": [
{
"statusCategoryCode": "<string>",
"statusCategoryCodeValue": "<string>",
"statusCode": "<string>",
"statusCodeValue": "<string>",
"entityCode": "<string>",
"entity": "<string>",
"effectiveDate": "<string>"
}
]
}
]
}
],
"reassociationKey": "<string>",
"errorResponse": {
"code": "<string>",
"description": "<string>",
"transactionIdentifier": {
"customerTransactionId": "<string>",
"transactionId": "<string>"
},
"errors": [
{
"field": "<string>",
"value": "<string>",
"code": "<string>",
"description": "<string>",
"location": "<string>",
"followupAction": "<string>"
}
]
},
"status": "<string>",
"transactionSetAcknowledgement": "<string>",
"implementationTransactionSetSyntaxError": "<string>",
"x12": "<string>",
"meta": {
"submitterId": "<string>",
"senderId": "<string>",
"billerId": "<string>",
"traceId": "<string>",
"applicationMode": "<string>"
}
}A direct replacement for the CHC Claim Status x12 API.
Authorizations
API key authentication via the 'Authorization' header
Body
Response
Provided by the submitter in the 270 Request. Transaction Set Control Number.
ID used by Clearing House for the trading partner.
Loop: 2100A
Segment: NM1, Element: NM103, Notes: Payers’s organization name.
Segment: NM1, Element: NM109, Notes: Payers’s identification number established through trading partner agreement. NM108=PI
Segment: NM1, Element: NM109, Notes: Use when reporting Health Plan ID (HPID) or Other Entity Identifier (OEID). NM108=XV
Segment: PER
Segment: PER, Element: PER02, Notes: Payer’s name.
Segment: PER, Element: PER04, PER06 or PER08, Notes: Payer's electronic data interchange access number. PER03=PER05=PER07=ED
Segment: PER, Element: PER04, PER06 or PER08, Notes: Payer's email. PER03=PER05=PER07=EM
Segment: PER, Element: PER04, PER06 or PER08, Notes: Payer's facsimile number. PER03=PER05=PER07=FX
Segment: PER, Element: PER04, PER06 or PER08, Notes: Payer's telephone number. PER03=PER05=PER07=TE
Segment: PER, Element: PER04, PER06 or PER08, Notes: Payer's telephone extension. PER05=PER07=EX
Loop: 2100B and 2100C
Segment: NM1, Element: NM103, Notes: Provider’s organization name. Can use organization or last name.
Segment: NM1, Element: NM104, Notes: Maps to providerName
Segment: NM1, Element: NM103, Notes: Provider last name. Can use organization or last name.
Loop: 2100B, 2100C, Segment: NM1, Element: NM109, Notes: National Provider Identification. Maps to provider NPI. NM108=XX
Loop: 2100B, 2100C, Segment: NM1, Element: NM109, Notes: Service Provider Number. Maps to provider SPN. NM108=SV
Loop: 2100B, 2100C, Segment: NM1, Element: NM109, Notes: Taxpayer’s Identification Number. Maps to provider TIN. NM108=FI
Loop: 2100B, Segment: NM1, Element: NM109, Notes: Taxpayer’s Identification Number used when ProviderType = BillingProvider
Loop: 2100B, Segment: NM1, Element: NM109, Notes: Electronic transmitter identification Number (ETIN) used when ProviderType = BillingProvider
Segment: NM1, Notes: Code for entity (Billing or Service) Billing Provider: Loop 2100B, NM101=41 (required), Service Provider: Loop 2100C, NM101=1P if not present it is added and assigned tin = BillingProvider taxId
BillingProvider, ServiceProvider Loop: 2000D
Loop: 2100D, Segment: NM1, Element: NM109, Notes: The subscriber's insurance member ID. Maps to subscriberId.
Loop: 2100D, Segment: NM1, Element: NM104, Notes: The subscriber's first name as specified on their policy
Loop: 2100D, Segment: NM1, Element: NM103, Notes: The subscriber's last name as specified on their policy.
Loop: 2000D, 2000E, Segment: DMG, Element: DMG03, Notes: The subscriber's gender as specified on their policy.
M, F, U Loop: 2000D, Segment: DMG, Element: DMG02, Notes: The birth date as specified on the policy for the subscriber. Maps to BirthDate
Loop: 2200D, Segment: REF, Element: REF01, Notes: The group number associated with the subscriber.
Loop: 2000E
Loop: 2100E, Segment: NM1, Element: NM104, Notes: The dependent's first name as specified on their policy.
Loop: 2100E, Segment: NM1, Element: NM103, Notes: The dependent's last name as specified on their policy.
Loop: 2000E, Segment: DMG, Element: DMG03, Notes: dependent's gender as specified on their policy.
M, F, U Loop: 2000E, Segment: DMG, Element: DMG02, Notes: The birth date as specified on the policy for the dependent.
Loop: 2200E, Segment: REF, Element: REF02 when REF01=6P, Notes: The group number associated with the subscriber and dependent. Maps to dependent groupNumber.
Loop: 2200D and 2200E
Loop: 2200D, 2200E
Segment: STC, Element: STC01-1, Notes: Status Category Code
Segment: STC, Element: STC01-1, Notes: Status Category Code value
Segment: STC, Element: STC01-2, Notes: Status Code
Segment: STC, Element: STC01-2, Notes: Status Code value
Segment: STC, Element: STC01-3, Notes: Entity Code
Segment: STC, Element: STC01-3, Notes: Entity Code value
Segment: STC, Element: STC02, Notes: Effective Date
Segment: STC, Element: STC04, Notes: Total Claim Charge Amount
Segment: STC, Element: STC05, Notes: Claim Payment Amount
Segment: STC, Element: STC06, Notes: Adjudication Finalized Date
Segment: STC, Element: STC08, Notes: Remittance Date
Segment: STC, Element: STC09, Notes: Remittance Trace Number
Segment: TRN, Element: TRN02, Notes: Tracking Number
Segment: DTP, Element: DTP03, Notes: Claim Service Period
Segment: REF, Element: REF02, Notes: REF01 for this will be 1K
Segment: REF, Element: REF02, Notes: REF01 for this will be EJ
Segment: REF, Element: REF02, Notes: REF01 for this will be D9
Loop: 2220D, 2220E
Loop: 2220D, 2220E, Segment: SVC, Notes: Service Line Information
Loop: 2220D, 2220E, Segment: SVC, Element: SVC01-1, Notes: Code identifying the type/source of the descriptive number used in Product/Service ID. Code Example: AD, Allowed Values are 'AD' American Dental Association Codes, 'ER' Jurisdiction Specific Procedure and Supply Codes, 'HC' Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes, 'HP' Health Insurance Prospective Payment System (HIPPS) Skilled Nursing Facility Rate Code, 'IV' Home Infusion EDI Coalition (HIEC) Product/Service Code, 'N4' National Drug Code in 5-4-2 Format, 'NU' National Uniform Billing Committee (NUBC) UB92 Codes, 'WK' Advanced Billing Concepts (ABC) Codes
AD, ER, HC, HP, IV, N4, NU, WK Loop: 2220D, 2220E, Segment: SVC, Element: SVC01-1, Notes: description associated with the service code. Example: American Dental Association Codes
Loop: 2220D, 2220E, Segment: SVC, Element: SVC01-2, Notes: Identifying number for a product or service.
Loop: 2220D, 2220E, Segment: SVC, Element: SVC02, Notes: Amount submitted for the service. This is the line item total on the current claim service status.
Loop: 2220D, 2220E, Segment: SVC, Element: SVC03, Notes: Amount paid for the service.
Loop: 2220D, 2220E, Segment: SVC, Element: SVC04, Notes: National uniform billing committee revenue code.
Loop: 2220D, 2220E, Segment: SVC, Element: SVC07, Notes: Original submitted units of service.
Loop: 2220D, 2220E, Segment: STC, Notes: Service Line Status Information
Loop: 2220D and 2220E, Segment: STC, Element: STC01-1, Notes: The health care claim status category code. Example: F3
Loop: 2220D and 2220E, Segment: STC, Element: STC01-1, Notes: Value of the category code. F3 = Finalized/Revised - Adjudication information has been changed
Loop: 2220D and 2220E, Segment: STC, Element: STC01-2, Notes: Status code used to identify the status of an entire claim or a service line. Example: 3
Loop: 2220D and 2220E, Segment: STC, Element: STC01-2, Notes: Status Code value. 3 = Claim has been adjudicated and is awaiting payment cycle.
Loop: 2220D and 2220E, Segment: STC, Element STC01-3, Notes:Code for the entity. Example: 2P
Loop: 2220D and 2220E, Segment: STC, Element STC01-3, Notes: Value of the entity code. Example: 2P=Public Health Service Facility
Loop: 2220D and 2220E, Segment: STC, Element: STC02, Notes: Effective date of the status information. Date the service was placed in this status by the information source’s adjudication process. Date or Date range, format YYYYMMDD
Segment: ISA, Element: ISA13, Notes: Interchange control number
Code for the error.
Description of the error code. Value provided in payer id should be a valid Optum assigned ERA payer Id.
The number assigned by the originator to identify the transaction within the originator's business application system
The number assigned by the originator to identify the transaction within the originator's business application system
Attribute that is bad
Value of bad attribute
Code for the error. Example: INVALID_VALUE
Description of the error code. Value provided in payer id should be a valid Optum assigned ERA payer ID
Segment/location where the error occurred. If this is a network/system error, there is no location attribute. Example: $.payerBenefits[0].payer
Any follow action required for the error. For AAA errors, this would be value for AAA04
Loop: 2200D, Segment: STC, Element: STC01, Health care claim status, Used to convey status of the entire claim or specific service line.
The 999 acknowledgment code
The 999 syntax error code
Basic x12 edi response (for x12 endpoint)
Meta data about the request
submitterId assigned to this request
senderId assigned to this request
billerId assigned to this request
Unique Id assigned to each request by Optum
Used by Optum to identify where this request can be found for support
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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": "<string>"
}'{
"controlNumber": "<string>",
"tradingPartnerServiceId": "<string>",
"payer": {
"organizationName": "<string>",
"payerIdentification": "<string>",
"centersForMedicareAndMedicaidServicePlanId": "<string>",
"contactInformation": {
"name": "<string>",
"electronicDataInterChangeAccessNumber": "<string>",
"email": "<string>",
"fax": "<string>",
"phone": "<string>",
"phoneExtension": "<string>"
}
},
"providers": [
{
"organizationName": "<string>",
"firstName": "<string>",
"lastName": "<string>",
"npi": "<string>",
"spn": "<string>",
"tin": "<string>",
"taxId": "<string>",
"etin": "<string>",
"providerType": "BillingProvider"
}
],
"subscriber": {
"memberId": "<string>",
"firstName": "<string>",
"lastName": "<string>",
"gender": "M",
"dateOfBirth": "<string>",
"groupNumber": "<string>"
},
"dependent": {
"firstName": "<string>",
"lastName": "<string>",
"gender": "M",
"dateOfBirth": "<string>",
"groupNumber": "<string>"
},
"claims": [
{
"claimStatus": {
"statusCategoryCode": "<string>",
"statusCategoryCodeValue": "<string>",
"statusCode": "<string>",
"statusCodeValue": "<string>",
"entityCode": "<string>",
"entity": "<string>",
"effectiveDate": "<string>",
"submittedAmount": "<string>",
"amountPaid": "<string>",
"paidDate": "<string>",
"checkIssueDate": "<string>",
"checkNumber": "<string>",
"trackingNumber": "<string>",
"claimServiceDate": "<string>",
"tradingPartnerClaimNumber": "<string>",
"patientAccountNumber": "<string>",
"clearingHouseClaimNumber": "<string>"
},
"serviceDetails": [
{
"service": {
"serviceIdQualifierCode": "AD",
"serviceIdQualifier": "<string>",
"procedureId": "<string>",
"submittedAmount": "<string>",
"amountPaid": "<string>",
"revenueCode": "<string>",
"submittedUnits": "<string>"
},
"status": [
{
"statusCategoryCode": "<string>",
"statusCategoryCodeValue": "<string>",
"statusCode": "<string>",
"statusCodeValue": "<string>",
"entityCode": "<string>",
"entity": "<string>",
"effectiveDate": "<string>"
}
]
}
]
}
],
"reassociationKey": "<string>",
"errorResponse": {
"code": "<string>",
"description": "<string>",
"transactionIdentifier": {
"customerTransactionId": "<string>",
"transactionId": "<string>"
},
"errors": [
{
"field": "<string>",
"value": "<string>",
"code": "<string>",
"description": "<string>",
"location": "<string>",
"followupAction": "<string>"
}
]
},
"status": "<string>",
"transactionSetAcknowledgement": "<string>",
"implementationTransactionSetSyntaxError": "<string>",
"x12": "<string>",
"meta": {
"submitterId": "<string>",
"senderId": "<string>",
"billerId": "<string>",
"traceId": "<string>",
"applicationMode": "<string>"
}
}