Changelog

You can now filter provider records in the List Providers API endpoint by NPI and Tax ID using the providerNpis and providerTaxIds query parameters.

Both parameters expect exact matches and accept multiple values. They can be combined with other filters. The endpoint uses AND logic to return the intersection of all filters.

Example
The following request returns up to 50 provider records whose name contains Dental and whose NPI matches either 1234567890 or 0987654321 and whose tax ID matches either 111223333 or 444556666.

curl --request GET \
  --header "Authorization: <api_key>" \
  --url "https://enrollments.us.stedi.com/2024-09-01/providers" \
  --data-urlencode "filter=Dental" \
  --data-urlencode "providerNpis=1234567890" \
  --data-urlencode "providerNpis=0987654321" \
  --data-urlencode "providerTaxIds=111223333" \
  --data-urlencode "providerTaxIds=444556666" \
  --data-urlencode "pageSize=50"

The List Providers endpoint is used to filter provider records used in transaction enrollment requests. For more information, see the transaction enrollment docs.

You can now see how long – minutes, hours, days, or weeks – it takes for an enrollment to go from submission to live with a payer in the Stedi Payer Network or the Payers API.

Payer Network
In the Stedi Payer Network, enrollment timeframes are shown in the Payer pane, in the Activation Timeframe field for the transaction type:

Activation Timeframe fields are also listed on the Payer page:

A value of Instant means the enrollment typically goes live within minutes of submission. Other values, like Hours or Days, indicate how long the process usually takes.

Payers API
In Payers API responses, each payer object lists enrollment details, if any, for each transaction type under transactionEnrollmentProcesses. The timeframe field shows the expected enrollment timeline for the transaction type.

{
  "payer": {    "displayName": "Blue Cross Blue Shield of Michigan",
    "primaryPayerId": "00710",
    "enrollment": {
      "ptanRequired": false,
      "transactionEnrollmentProcesses": {
        "claimPayment": {                  // This payer requires enrollment for ERAs.
          "timeframe": "INSTANT",          // ERA enrollment typically takes minutes.
          "type": "ONE_CLICK"
        }
      }
    },
    ...
  }
}

For more details, see our announcement blog.

Stedi now rejects 837P professional claims and 837I institutional claims with an invalid diagnosis code.

In healthcare claims, diagnosis codes describe what’s wrong with the patient. HIPAA requires that professional and institutional claims only use valid, billable ICD-10-CM codes as diagnosis codes.

What the edits check
Stedi has introduced new edits – the healthcare industry’s term for automated validation rules – to help ensure claims include valid diagnosis codes.

The new edits reject a professional or institutional claim when any diagnosis code is:

• Not a valid ICD‑10‑CM code.
  For example, if the code is misspelled or doesn’t exist in the official ICD-10-CM code list.
  
  

• A non-billable ICD‑10‑CM code.
  Some ICD-10-CM codes are categories. They cover a broad diagnostic grouping rather than a specific condition. For example, E11 (Type 2 diabetes mellitus) is a category header.
  
  By themselves, category headers aren’t considered billable codes. They’re not specific enough to describe the exact condition or encounter being billed.
  
  A billable ICD-10-CM code must include both a category and a subcategory, such as E11.9 (Type 2 diabetes mellitus without complications).
  
  

• Not valid for the claim’s dates of service.
  Updates to the ICD-10-CM code set are published each year. If a claim uses a code that wasn’t valid on the dates of service, Stedi now rejects it.
  
  For example, Z11.52 (“Encounter for screening for COVID-19”) became effective on October 1, 2021. A claim with a date of service before that date would be rejected because the code wasn’t valid at the time.

If you submit a claim that fails the edits using Stedi’s claim submission APIs or professional claim form, you’ll get back an error message in real time. If you’re using a JSON API endpoint, the response include error details in the errors array:

{
  "errors": [
    {
      "code": "33",
      "description": "The ICD-10 code E11 submitted does not meet the level of specificity needed. The Diagnosis code is a header and not valid for HIPAA transactions. Please resubmit with a more specific ICD-10.",
      "followupAction": "Please Correct and Resubmit"
    }
  ],
  ...
}

If you submit a claim that fails the edits using SFTP, Stedi will reject the claim with a 277CA claim acknowledgment. The acknowledgment will contain a related claim status category code, claim status code, and error message. You can use the error message to correct and resubmit the claim.

You can now upload claim attachments using the professional claims submission form in the Stedi portal.

For claim-level attachments, use Box 19 – Supplemental claim information.

For line-level attachments, use Box 24 – Service lines supplemental information.

You can upload JPG, PDF, PNG, or TIFF files as attachments. To upload an attachment, you must set the Transmission code to EL (EDI).

You must also choose the appropriate Report type for the attachment. For example, if you’re uploading a medical record, you’d select a Report type of M1 – Medical Record Attachment. See Attachment Report Type Codes for a full list.

Note: You can’t add attachments to claims that were already submitted through the portal. To include attachments for those claims, resubmit them with the attachments.

Previously, you could only upload attachments using Stedi’s Create Claim Attachment JSON API endpoint.

For more details, see our announcement blog.