This endpoint sends 276 Claim Status requests to payers in raw X12 EDI format. This is ideal if you have an existing system that generates X12 EDI files and you want to send them through Stedi’s API.
Stedi validates the EDI and sends the status request to the payer.
The endpoint returns a synchronous response from the payer in JSON format. The response contains information about the referenced claim and its current status.
This endpoint is a direct replacement for the Change Healthcare Claim Status x12 API.
Payers generally only allow a provider organization to check the status of the claims they submitted. This means that you likely won’t be able to check the status of a claim submitted by a different provider organization or by the patient themselves, even if you have all of the details about the claim. Payers impose these access controls to protect plan member privacy and confidential commercial data.
Payers also often archive claims older than 18 months, but this varies by payer. If you try to check the status of a claim from several years ago, the payer may return an error even if the information you submit matches a real historical claim.
Finally, we recommend keeping the dates of service range to 30 days or less. Some payers may reject requests with a date range that is too wide.
Authorizations
Authorization
string
headerrequired
API key authentication via the 'Authorization' header
Body
application/json
x12
string
required
Response
200 - application/json
controlNumber
string
The control number the the payer provided in the claim status response. This is used to identify the transaction.
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.
payer
object
Information about the payer listed in the referenced claim.
payer.organizationName
string
The payer's organization name. For example UNITEDHEALTHCARE.
payer.payerIdentification
string
The payer's identification number. This is the tradingPartnerServiceId.
payer.centersForMedicareAndMedicaidServicePlanId
string
The payer's Health Plan ID (HPID) or Other Entity Identifier (OEID).
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.phone
string
The payer's telephone number, without separators. For example, 5551123345 for 555-112-3345
payer.contactInformation.phoneExtension
string
The payer's telephone extension.
providers
object[]
Information about the provider making the claim status request.
providers.organizationName
string
The provider's organization name. Use when the provider is not an individual, such as a hospital or clinic. Can be 1-60 alphanumeric characters.
providers.firstName
string
The provider's first name. Use when the provider is an individual. Can be 1-35 alphanumeric characters.
providers.lastName
string
The provider's last name. Use when the provider is an individual. Can be 1-60 alphanumeric characters.
providers.npi
string
The National Provider Identification (NPI) number. The NPI is a unique, 10-digit identification number assigned to healthcare providers according to HIPAA standards.
providers.spn
string
Deprecated; The service provider number. Use npi to identify the service provider instead.
providers.tin
string
providers.taxId
string
The Taxpayer Identification Number (TIN).
providers.etin
string
The Electronic Transmitter Identification Number (ETIN). This identifier is preferred if the payer specifically assigned one for the provider. If not, most payers will accept the provider's NPI or TIN instead.
providers.providerType
enum<string>
required
Identifies the type of provider related to the referenced healthcare claim. You can include both a billing provider and a service provider if both are relevant to the request.
Available options:
BillingProvider,
ServiceProvider
subscriber
object
Information about the subscriber listed in the referenced claim.
subscriber.memberId
string
required
The subscriber's insurance member ID. This is the unique identifier for the subscriber on the insurance policy.
subscriber.firstName
string
required
The subscriber's first name as specified on their policy.
subscriber.lastName
string
required
The subscriber's last name as specified on their policy.
subscriber.gender
enum<string>
A code indicating the subscriber's gender.
Available options:
M,
F,
U
subscriber.dateOfBirth
string
The subscriber's date of birth, formatted as YYYYMMDD.
subscriber.groupNumber
string
The group number associated with the subscriber's insurance policy.
dependent
object
Information about the dependent listed in the referenced claim.
dependent.firstName
string
required
The dependent's first name as specified on their insurance policy.
dependent.lastName
string
required
The dependent's last name as specified on their insurance policy.
dependent.gender
enum<string>
A code indicating the dependent's gender.
Available options:
M,
F,
U
dependent.dateOfBirth
string
The dependent's date of birth, formatted as YYYYMMDD.
dependent.groupNumber
string
The group number associated with the subscriber and dependent's insurance policy.
claims
object[]
The status information for the claim referenced in the original claim status request.
claims.claimStatus
object
The status, required action, and paid information of a claim or service line.
claims.claimStatus.statusCategoryCode
string
The status category code. Visit Claim Status Category Codes in the X12 EDI 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 Reject/Payment Code, when the status is related to pharmacy claims.
claims.claimStatus.statusCodeValue
string
The description of the statusCode.
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.entity
string
The description of the entityCode. For example, Home Health Care.
claims.claimStatus.effectiveDate
string
The date the claim was placed in this status by the payer's adjudication process. Formatted as YYYYMMDD.
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.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.paidDate
string
This is the date of denial or approval for the claim, formatted as YYYYMMDD. 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.
claims.claimStatus.checkIssueDate
string
The date the payer issued the check for payment, formatted as YYYYMMDD. This may also contain a non-payment remittance advice date, if available from the payer.
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.trackingNumber
string
This is the trace or reference number of the original claim status request.
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 field is derived from the service level dates.
claims.claimStatus.tradingPartnerClaimNumber
string
This field corresponds to the providerControlNumber field from the claim, if set. You can use this value to correlate the claim status response to the original claim.
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.clearingHouseClaimNumber
string
The claim number provided by the clearinghouse.
claims.serviceDetails
object[]
Information about specific service lines and their status.
claims.serviceDetails.service
object
Information about a service line listed in the referenced claim.
A code identifying the type/source of the procedureId. Visit C00301 in the Status Request response specification for a complete list.
Available options:
AD,
ER,
HC,
HP,
IV,
N4,
NU,
WK
claims.serviceDetails.service.serviceIdQualifier
string
The definition of the serviceIdQualifierCode. For example, American Dental Association Codes.
claims.serviceDetails.service.procedureId
string
Identifying number for product or service.
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.amountPaid
string
The amount paid for the service line, expressed as a decimal. For example, 100.00.
claims.serviceDetails.service.revenueCode
string
The National Uniform Billing Committee revenue code.
claims.serviceDetails.service.submittedUnits
string
The number of units of service submitted.
claims.serviceDetails.status
object[]
Information about the status, required action, and paid information of a service line.
claims.serviceDetails.status.statusCategoryCode
string
The category code for the status. Visit Claim Status Category Codes in the X12 EDI documentation for a complete list.
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.
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.entity
string
The description of the entityCode. For example, Public Health Service Facility.
claims.serviceDetails.status.effectiveDate
string
The date the service line was placed in this status by the payer's adjudication process. Formatted as YYYYMMDD.
Where the error occurred within the request syntax. If this is a network or system error, there is no location attribute.
errorResponse.errors.followupAction
string
Follow-up actions to correct the error.
status
string
The status of the entire claim.
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.
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.
x12
string
The raw X12 response from the payer.
meta
object
Metadata about the response.
meta.submitterId
string
The submitter ID assigned to this request.
meta.senderId
string
The sender ID assigned to this request.
meta.billerId
string
The biller ID assigned to this request.
meta.traceId
string
The unique ID assigned to this request within Stedi.
meta.applicationMode
string
Identifies where this request can be found for support.
