Retrieve Professional Claim (CMS-1500) JSON

Retrieve a claim's data and map it to Stedi's CMS-1500 JSON format

GET /professional-claim-submissions/{id}

Retrieve a claim submission and map it to Stedi's JSON format.

This endpoint is especially useful when building CMS-1500 form interfaces that need to handle resubmissions. You can retrieve the original claim data to pre-populate your form, allowing users to make corrections before resubmitting.

1. Call this endpoint with the submission ID. You can retrieve this ID from:
   • The submissionId property in the Create Professional Claim JSON endpoint response.
   • The timeline items from the Retrieve Claim Timeline endpoint response.
   • A submission's details page in the claims view.
2. Stedi retrieves the claim data and maps it to Stedi's JSON format.
3. The endpoint returns the claim in JSON format, using the same structure as the Create Professional Claim JSON endpoint.

Authorizations

Authorization · Required Header

A production Stedi API Key for authentication.

Path Parameters

id · String Length : 1 - 40

A unique identifier for a specific submission of a claim within Stedi. Stedi generates a submission ID for the initial submission and then a new submission ID for every resubmission of the same claim. This is different from the claim ID, which doesn't change throughout the claim's lifecycle.

You can retrieve this ID from the submissionId property in the Create Professional Claim JSON endpoint response.

Response

application/json

claimId · String Required Regex pattern : ^(clm_)?[0-7][0-9A-HJKMNP-TV-Z]{25}$

A unique identifier for the claim within Stedi. This ID stays the same throughout the claim's entire lifecycle. For example, the claim ID is the same for the initial submission and any resubmissions. This is how Stedi links a particular claim to responses, such as 277CA claim acknowledgments.

data · Object Required

The submitted claim in the Stedi professional claim JSON format.

authorization · data.authorization · Object Required

[CMS-1500 Box 12, 13, 27, 31] Signature and assignment-of-benefits indicators for the claim, covering whether the provider has the patient's and insured's authorizations on file and whether the provider accepts the payer's terms.

insuredAuthorizesAssignment · data.authorization.insuredAuthorizesAssignment · String Required

[CMS-1500 Box 13] Whether the insured has authorized payment of benefits directly to the provider.

Possible values

NO

NOT_APPLICABLE

YES

patientReleasesMedicalInfo · data.authorization.patientReleasesMedicalInfo · String Required

[CMS-1500 Box 12] Whether the provider has the patient's signature on file authorizing the release of medical information needed to process the claim.

Possible values

INFORMED_CONSENT

YES

providerAcceptsAssignment · data.authorization.providerAcceptsAssignment · String Required

[CMS-1500 Box 27] Whether the billing provider agrees to be paid under the payer's terms. Providers who are contracted with the payer are usually required to accept assignment.

Possible values

ASSIGNED

CLINICAL_LAB_ONLY

NOT_ASSIGNED

providerSignature · data.authorization.providerSignature · String Required

[CMS-1500 Box 31] Whether the provider has the rendering provider's signature on file. When ON_FILE, the generated CMS-1500 PDF shows SOF (Signature on File) in this box.

Possible values

ON_FILE

NOT_ON_FILE

billing · data.billing · Object Required

[CMS-1500 Box 25, 26, 28, 29, 32, 32a, 32b, 33, 33a, 33b] Billing details for the claim, including the billing provider, service facility, tax identification, and total charges.

amountPaid · data.billing.amountPaid · String Regex pattern : ^\d+(\.\d{1,2})?$

[CMS-1500 Box 29] The total amount the patient, or the patient's representative, has already paid toward services in this claim. This is the patient's payment only. Don't include amounts paid by other payers.

billingProvider · data.billing.billingProvider · Object Required

[CMS-1500 Box 33, 33a, 33b] The person or organization, such as a clinic or group practice, that will receive payment for the claim from the payer.

address · data.billing.billingProvider.address · Object Required Format : password

[CMS-1500 Box 33] The billing provider's physical address. This must be a street address where care is delivered or an administrative facility, not a PO Box.

addressLine1 · data.billing.billingProvider.address.addressLine1 · String Required Length : 1 - 55

The first line of the street address. This typically contains the building number and street name.

addressLine2 · data.billing.billingProvider.address.addressLine2 · String Length : 1 - 55

The second line of the street address. This typically contains the apartment or suite number.

city · data.billing.billingProvider.address.city · String Required Length : 2 - 30

The city name.

postalCode · data.billing.billingProvider.address.postalCode · String Length : 3 - 15

The postal or ZIP code, with no separators or spaces. For United States addresses, use the full nine-digit ZIP code, such as 100031502.

state · data.billing.billingProvider.address.state · String Length : 2

The two-letter state or province code. Required when the city is in the United States or Canada.

contact · data.billing.billingProvider.contact · Object

[CMS-1500 Box 33] The contact for the billing provider. Include only when the billing provider's contact information differs from the submitter's.

email · data.billing.billingProvider.contact.email · String Format : password Length : 1 - 256

The contact's email address.

faxNumber · data.billing.billingProvider.contact.faxNumber · String Format : password Length : 1 - 256

The contact's fax number.

name · data.billing.billingProvider.contact.name · String Length : 1 - 60

The name of the contact person or department. When omitted, questions are directed to the entity itself.

phoneExtension · data.billing.billingProvider.contact.phoneExtension · String Length : 1 - 256

The extension for phoneNumber.

phoneNumber · data.billing.billingProvider.contact.phoneNumber · String Format : password Length : 1 - 256

The contact's phone number.

identifiers · data.billing.billingProvider.identifiers · Object

[CMS-1500 Box 33a, 33b] Identifiers for the billing provider. You must provide the billing provider's NPI. When the provider doesn't have an NPI, you can supply an alternative, such as commercialNumber or locationNumber.

commercialNumber · data.billing.billingProvider.identifiers.commercialNumber · String Length : 1 - 50

[CMS-1500 Box 33b] A commercial number assigned to the billing provider by the payer. Include only when the payer requires it in addition to the NPI, or when the provider has no NPI.

locationNumber · data.billing.billingProvider.identifiers.locationNumber · String Length : 1 - 50

[CMS-1500 Box 33b] A location number assigned to the billing provider by the payer. Include only when the payer requires it in addition to the NPI, or when the provider has no NPI.

npi · data.billing.billingProvider.identifiers.npi · String Length : 2 - 80

[CMS-1500 Box 33a] The billing provider's National Provider Identifier (NPI). When the billing provider isn't assigned an NPI, supply commercialNumber or locationNumber instead.

stateLicenseNumber · data.billing.billingProvider.identifiers.stateLicenseNumber · String Length : 1 - 50

[CMS-1500 Box 33b] The billing provider's state license number, assigned by a state licensing board. Include only when the payer requires it in addition to the NPI.

taxonomyCode · data.billing.billingProvider.identifiers.taxonomyCode · String Length : 1 - 50

[CMS-1500 Box 33b] The billing provider's taxonomy code from the National Uniform Claim Committee Health Care Provider Taxonomy Code Set, which identifies the provider's type and specialty.

name · data.billing.billingProvider.name · Object Required

[CMS-1500 Box 33] The billing provider's name, either a person or an organization.

organization · data.billing.billingProvider.name.organization · String Required Length : 1 - 60

The organization's business name.

patientControlNumber · data.billing.patientControlNumber · String Required Format : password Length : 1 - 38

[CMS-1500 Box 26] The patient control number, a unique tracking ID you assign to the claim so you can correlate it with responses from the payer. The payer returns this ID in claim acknowledgments, Electronic Remittance Advice (ERAs), and claim status checks. We recommend using a random, 17-character alphanumeric string.

serviceFacility · data.billing.serviceFacility · Object

[CMS-1500 Box 32, 32a, 32b] The facility where the patient received care, also called the service facility location. This can be a healthcare facility like a surgical center or reference lab, or the patient's address when you rendered services in their home. Include when services were rendered somewhere other than the billing provider's address.

• For telehealth services, the service facility location is the provider's address, even though the patient may have been in their home or elsewhere when receiving services.
• When the billing provider is a physician group located at the same address as a hospital but is a separate entity, you can differentiate the service facility location by including the specific suite or building number of the physician group.

address · data.billing.serviceFacility.address · Object Required Format : password

[CMS-1500 Box 32] The facility's physical address. This must be a street address, not a PO Box. If the service was rendered in an area where there are no street addresses, enter a description of where the service was rendered. For example, 'crossroad of State Road 34 and 45' or 'Exit near Mile marker 265 on Interstate 80'.

addressLine1 · data.billing.serviceFacility.address.addressLine1 · String Required Length : 1 - 55

The first line of the street address. This typically contains the building number and street name.

addressLine2 · data.billing.serviceFacility.address.addressLine2 · String Length : 1 - 55

The second line of the street address. This typically contains the apartment or suite number.

city · data.billing.serviceFacility.address.city · String Required Length : 2 - 30

The city name.

postalCode · data.billing.serviceFacility.address.postalCode · String Length : 3 - 15

The postal or ZIP code, with no separators or spaces. For United States addresses, use the full nine-digit ZIP code, such as 100031502.

state · data.billing.serviceFacility.address.state · String Length : 2

The two-letter state or province code. Required when the city is in the United States or Canada.

identifiers · data.billing.serviceFacility.identifiers · Object

[CMS-1500 Box 32a, 32b] Identifiers for the service facility.

commercialNumber · data.billing.serviceFacility.identifiers.commercialNumber · String Length : 1 - 50

[CMS-1500 Box 32b] A commercial number assigned to the facility by the payer. Include only when the payer requires it in addition to the NPI.

locationNumber · data.billing.serviceFacility.identifiers.locationNumber · String Length : 1 - 50

[CMS-1500 Box 32b] A location number assigned to the facility by the payer. Include only when the payer requires it in addition to the NPI.

npi · data.billing.serviceFacility.identifiers.npi · String Length : 2 - 80

[CMS-1500 Box 32a] The facility's National Provider Identifier (NPI). Only required when the facility's NPI differs from the billing provider's NPI. Don't include when the service facility is the patient's home.

stateLicenseNumber · data.billing.serviceFacility.identifiers.stateLicenseNumber · String Length : 1 - 50

[CMS-1500 Box 32b] The facility's state license number, assigned by a state licensing board. Include only when the payer requires it in addition to the NPI.

name · data.billing.serviceFacility.name · Object Required

[CMS-1500 Box 32] The facility's organization name. When services were rendered in the patient's home, we recommend setting this to Residence or something similar.

organization · data.billing.serviceFacility.name.organization · String Required Length : 1 - 60

The organization's business name.

taxId · data.billing.taxId · Object Required

[CMS-1500 Box 25] The billing provider's federal tax identification number, provided as either an Employer Identification Number (EIN) or a Social Security Number (SSN).

ssn · data.billing.taxId.ssn · String Required Format : password Length : 1 - 50

The billing provider's Social Security Number. Must be a string of exactly nine numbers with no separators. If you provide this, don't provide ein.

totalCharge · data.billing.totalCharge · String Required Regex pattern : ^\d+(\.\d{1,2})?$

[CMS-1500 Box 28] The total charge for the claim, equal to the sum of all service line charges. It is acceptable to set this to 0 (zero).

encounter · data.encounter · Object Required

[CMS-1500 Box 10a, 10b, 10c, 10d, 14, 15, 16, 17, 17a, 17b, 18, 19, 21, 22, 23, 24h] Clinical details about the encounter, including diagnosis codes, the related providers, relevant dates, and supporting information for the claim.

additionalDiagnosisCodes · data.encounter.additionalDiagnosisCodes · Array of Strings Items : 1 - 11

[CMS-1500 Box 21] Additional diagnoses for the claim beyond primaryDiagnosisCode, in order of importance. Use this for diagnoses that apply to the claim but are not tied to a specific service line; you don't need to repeat codes that already appear in a service line's diagnosisCodes. Stedi places these directly after the primary diagnosis in the claim's diagnosis list.

• Use valid, billable codes at the highest level of specificity available.
• Don't submit the decimal point (e.g., submit I639 not I63.9).
• Don't submit header codes (codes with fewer than three characters, such as E10 for Type 1 diabetes).

attachments · data.encounter.attachments · Array of Objects Items : 1 - 10

[CMS-1500 Box 19] Supporting documentation attached to the claim, such as medical records or operative notes. Include only when required by the payer.

attachmentControlNumber · data.encounter.attachments[].attachmentControlNumber · String Length : 2 - 80

A control number assigned to the attachment. The payer uses this identifier to match the attachment to the claim.

• You must include either this property or attachmentId in the request, but not both. Including both properties will result in an error.
• We recommend using a ULID or UUID of up to 50 characters.
• Stedi autogenerates a control number if you don't provide one.

attachmentId · data.encounter.attachments[].attachmentId · String Regex pattern : ^[0-9a-fA-F]{8}-[0-9a-fA-F]{4}-[0-9a-fA-F]{4}-[0-9a-fA-F]{4}-[0-9a-fA-F]{12}$ Length : 36

The unique identifier for an attachment file you previously uploaded to Stedi. This value is returned in the attachmentId property of the Create Claim Attachment (275) JSON response. Stedi uses it to generate and submit the 275 claim attachment transaction to the payer.

• This property is required when you're submitting attachment files through Stedi.
• You must include either this property or attachmentControlNumber in the request, but not both. Including both properties will result in an error.

reportTypeCode · data.encounter.attachments[].reportTypeCode · String Required

The type of report being attached.

Possible values

REPORT_JUSTIFYING_TREATMENT

DRUGS_ADMINISTERED

TREATMENT_DIAGNOSIS

INITIAL_ASSESSMENT

FUNCTIONAL_GOALS

transmissionCode · data.encounter.attachments[].transmissionCode · String Required

How you're sending the attachment to the payer.

Possible values

AVAILABLE_ON_REQUEST

BY_MAIL

ELECTRONICALLY_ONLY

EMAIL

FILE_TRANSFER

claimCodes · data.encounter.claimCodes · Array of Strings Items : 1 - 12

[CMS-1500 Box 10d] Up to four National Uniform Claim Committee (NUCC) condition codes. A condition code is a two-character code that provides extra information about the patient's condition or the claim itself, such as whether the claim is part of disaster relief. For a list, visit the NUCC Condition Codes.

claimNote · data.encounter.claimNote · Object

[CMS-1500 Box 19] A free-text note with additional information the payer may need to process the claim that doesn't fit anywhere else on the form.

additionalInformation · data.encounter.claimNote.additionalInformation · String Required Format : password Length : 1 - 80

Additional information that helps explain the claim, such as a special billing situation or extra context. Don't use this to describe unspecified procedure codes.

clinicalDates · data.encounter.clinicalDates · Object

[CMS-1500 Box 14, 15, 16, 18] Dates relevant to the patient's condition and care, such as the onset of the current illness, hospitalization dates, and dates the patient was unable to work.

accident · data.encounter.clinicalDates.accident · String Length : 1 - 35

[CMS-1500 Box 15] The date of the accident related to this claim. Required when patientCondition.isAutoAccidentRelated or patientCondition.isOtherAccidentRelated is true, and when the condition is employment-related and resulted from an accident.

acuteManifestationOfChronicCondition · data.encounter.clinicalDates.acuteManifestationOfChronicCondition · String Length : 1 - 35

[CMS-1500 Box 15] The date the patient first experienced acute symptoms of a chronic condition. Required for certain spinal manipulation claims billed to Medicare.

assumedCare · data.encounter.clinicalDates.assumedCare · String Length : 1 - 35

[CMS-1500 Box 15] The date the provider assumed care of the patient, for shared-care arrangements.

firstVisitOrConsultation · data.encounter.clinicalDates.firstVisitOrConsultation · String Length : 1 - 35

[CMS-1500 Box 15] The date of the patient's first visit or consultation, when required by the payer.

hospitalization · data.encounter.clinicalDates.hospitalization · Object

[CMS-1500 Box 18] The date range during which the patient was hospitalized for services in this claim. Provide from for the admission date and to for the discharge date; omit to while the patient is still hospitalized.

end · data.encounter.clinicalDates.hospitalization.end · String Length : 1 - 35

The end date of the range, inclusive, in YYYY-MM-DD format.

start · data.encounter.clinicalDates.hospitalization.start · String Length : 1 - 35

The start date of the range, in YYYY-MM-DD format.

initialTreatment · data.encounter.clinicalDates.initialTreatment · String Length : 1 - 35

[CMS-1500 Box 15] The date the patient first received treatment for the current condition. Required when this date impacts adjudication for services such as spinal manipulation, physical or occupational therapy, or pregnancy.

lastMenstrualPeriod · data.encounter.clinicalDates.lastMenstrualPeriod · String Length : 1 - 35

[CMS-1500 Box 14] The date of the patient's last menstrual period (LMP) before pregnancy. Provide for claims related to a pregnancy.

lastSeen · data.encounter.clinicalDates.lastSeen · String Length : 1 - 35

[CMS-1500 Box 15] The date the patient was last seen by the attending or supervising physician for the qualifying condition. Required for routine foot care services when this date impacts adjudication.

lastWorked · data.encounter.clinicalDates.lastWorked · String Length : 1 - 35

[CMS-1500 Box 15] The last date the patient worked, for disability or workers' compensation claims.

lastXray · data.encounter.clinicalDates.lastXray · String Length : 1 - 35

[CMS-1500 Box 15] The date of the patient's last X-ray, for claims related to spinal manipulation.

onsetOfCurrentIllness · data.encounter.clinicalDates.onsetOfCurrentIllness · String Length : 1 - 35

[CMS-1500 Box 14] The date the patient first experienced acute symptoms of the current illness or injury. Required when a service in the claim is the first for a new illness or injury, when the claim is related to an employment or accident condition, or when the payer requires it. For an emergency, provide this date when it is known and differs from the date of service.

prescription · data.encounter.clinicalDates.prescription · String Length : 1 - 35

[CMS-1500 Box 15] The date of the patient's hearing or vision prescription. Required for claims billing hearing devices or vision frames and lenses.

relinquishedCare · data.encounter.clinicalDates.relinquishedCare · String Length : 1 - 35

[CMS-1500 Box 15] The date the provider relinquished care of the patient, for shared-care arrangements.

repricerReceived · data.encounter.clinicalDates.repricerReceived · String Length : 1 - 35

[CMS-1500 Box 15] The date the repricer received the claim, when applicable.

returnedToWork · data.encounter.clinicalDates.returnedToWork · String Length : 1 - 35

[CMS-1500 Box 15] The date the patient returned to work, for disability or workers' compensation claims.

unableToWork · data.encounter.clinicalDates.unableToWork · Object

[CMS-1500 Box 16] The date range during which the patient was unable to work, when applicable. Provide only to when the patient is no longer unable to work and the start date is unknown.

end · data.encounter.clinicalDates.unableToWork.end · String Length : 1 - 35

The end date of the range, inclusive, in YYYY-MM-DD format.

start · data.encounter.clinicalDates.unableToWork.start · String Length : 1 - 35

The start date of the range, in YYYY-MM-DD format.

epsdtReferralCodes · data.encounter.epsdtReferralCodes · Array of Strings Items : 1 - 3

[CMS-1500 Box 24h] Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) referral condition indicators for the claim. EPSDT is a Medicaid program that provides preventive health care services for children under age 21.

• Include when the claim bills an EPSDT screening service, with the referral outcome of the screening.
• Use NOT_USED when the screening did not result in a referral.
• Mark services that resulted from a screening with serviceLines[].isEpsdtRelated.

Possible values

AVAILABLE_NOT_USED

UNDER_TREATMENT

NEW_SERVICE_REQUESTED

NOT_USED

patientCondition · data.encounter.patientCondition · Object

[CMS-1500 Box 10a, 10b, 10c] Whether the patient's illness or injury is related to employment or an accident.

autoAccidentState · data.encounter.patientCondition.autoAccidentState · String Length : 2

[CMS-1500 Box 10b] The two-letter state code where the automobile accident occurred. Required when isAutoAccidentRelated is true.

isAutoAccidentRelated · data.encounter.patientCondition.isAutoAccidentRelated · Boolean

[CMS-1500 Box 10b] Whether the patient's condition is related to an automobile accident. When true, set autoAccidentState. Other insurance, such as automobile liability coverage, may be the primary payer.

isEmploymentRelated · data.encounter.patientCondition.isEmploymentRelated · Boolean

[CMS-1500 Box 10a] Whether the patient's condition is related to their employment.

isOtherAccidentRelated · data.encounter.patientCondition.isOtherAccidentRelated · Boolean

[CMS-1500 Box 10c] Whether the patient's condition is related to an accident other than an automobile accident.

primaryDiagnosisCode · data.encounter.primaryDiagnosisCode · String Required Length : 1 - 30

[CMS-1500 Box 21] The principal diagnosis for the claim, which describes the main reason for the encounter. Must be an ICD-10-CM code. Stedi combines this with additionalDiagnosisCodes and the diagnosis codes on the service lines to form the claim's diagnosis list, which can hold at most 12 codes.

• Use valid, billable codes at the highest level of specificity available.
• Don't submit the decimal point (e.g., submit I639 not I63.9).
• Don't submit header codes (codes with fewer than three characters, such as E10 for Type 1 diabetes).

primaryPlaceOfService · data.encounter.primaryPlaceOfService · String Length : 1 - 2

The primary place of service code identifying where the services were rendered. When omitted, it is inferred from the most common place of service across the claim's service lines. Visit Place of Service Codes for a complete list.

priorReferringProvider · data.encounter.priorReferringProvider · Object

[CMS-1500 Box 17, 17a, 17b] The provider who wrote the initial referral that began this patient's episode of care, often the patient's primary care provider. Supply this only when a different provider then referred the patient onward to the rendering provider, such as when a primary care provider refers to a specialist who refers to another specialist. Requires referringProvider to also be set.

identifiers · data.encounter.priorReferringProvider.identifiers · Object

[CMS-1500 Box 17a, 17b] Identifiers for the referring provider.

commercialNumber · data.encounter.priorReferringProvider.identifiers.commercialNumber · String Length : 1 - 50

[CMS-1500 Box 17a] A commercial number assigned to the referring provider by the payer. Include only when the payer requires it in addition to the NPI.

npi · data.encounter.priorReferringProvider.identifiers.npi · String Length : 2 - 80

[CMS-1500 Box 17b] The referring provider's National Provider Identifier (NPI), a unique 10-digit ID issued by the Centers for Medicare & Medicaid Services (CMS).

stateLicenseNumber · data.encounter.priorReferringProvider.identifiers.stateLicenseNumber · String Length : 1 - 50

[CMS-1500 Box 17a] The referring provider's state license number, assigned by a state licensing board. Include only when the payer requires it in addition to the NPI.

name · data.encounter.priorReferringProvider.name · Object Required

[CMS-1500 Box 17] The full name of the referring provider.

person · data.encounter.priorReferringProvider.name.person · Object Required Format : password

The person's name.

firstName · data.encounter.priorReferringProvider.name.person.firstName · String Length : 1 - 35

The person's first name.

lastName · data.encounter.priorReferringProvider.name.person.lastName · String Required Length : 1 - 60

The person's last name. Don't include a name suffix such as Jr. or III here. Use the suffix property instead.

middleName · data.encounter.priorReferringProvider.name.person.middleName · String Length : 1 - 25

The person's middle name or initial.

suffix · data.encounter.priorReferringProvider.name.person.suffix · String Length : 1 - 10

The person's name suffix, such as Jr. or III. Include only a personal name suffix here, not professional or academic credentials such as M.D.

referenceNumbers · data.encounter.referenceNumbers · Object

[CMS-1500 Box 23] Payer-issued reference numbers for the claim, such as a prior authorization, referral, CLIA, or mammography certification number.

clia · data.encounter.referenceNumbers.clia · String Length : 1 - 50

[CMS-1500 Box 23] The Clinical Laboratory Improvement Amendments (CLIA) certification number. Required for all CLIA-certified facilities performing CLIA-covered laboratory services. When the claim contains both in-house and outsourced laboratory services, use the CLIA number for services performed by the billing or rendering provider.

mammographyCertification · data.encounter.referenceNumbers.mammographyCertification · String Length : 1 - 50

[CMS-1500 Box 23] The facility's six-digit FDA Mammography Quality Standards Act (MQSA) certification number. Required when mammography services are rendered by a certified mammography provider.

priorAuthorization · data.encounter.referenceNumbers.priorAuthorization · String Length : 1 - 50

[CMS-1500 Box 23] A payer-issued prior authorization number that approves the services on this claim. Required when the payer or Utilization Management Organization (UMO) assigned an authorization number and the services were preauthorized. To override this for a specific service line, set serviceLines[].priorAuthorizations instead.

referral · data.encounter.referenceNumbers.referral · String Length : 1 - 50

[CMS-1500 Box 23] A referral number for the provider referral tied to the services on this claim. Required when the payer or Utilization Management Organization (UMO) assigned a referral number and a referral is involved.

referringProvider · data.encounter.referringProvider · Object

[CMS-1500 Box 17, 17a, 17b] The provider who referred the patient to the rendering provider for the care on this claim. Supply this whenever the claim involves a referral. When the patient passed through a chain of referrals, this is the most recent referral, the one the rendering provider acted on; identify the provider who wrote the earliest referral in priorReferringProvider.

identifiers · data.encounter.referringProvider.identifiers · Object

[CMS-1500 Box 17a, 17b] Identifiers for the referring provider.

commercialNumber · data.encounter.referringProvider.identifiers.commercialNumber · String Length : 1 - 50

[CMS-1500 Box 17a] A commercial number assigned to the referring provider by the payer. Include only when the payer requires it in addition to the NPI.

npi · data.encounter.referringProvider.identifiers.npi · String Length : 2 - 80

[CMS-1500 Box 17b] The referring provider's National Provider Identifier (NPI), a unique 10-digit ID issued by the Centers for Medicare & Medicaid Services (CMS).

stateLicenseNumber · data.encounter.referringProvider.identifiers.stateLicenseNumber · String Length : 1 - 50

[CMS-1500 Box 17a] The referring provider's state license number, assigned by a state licensing board. Include only when the payer requires it in addition to the NPI.

name · data.encounter.referringProvider.name · Object Required

[CMS-1500 Box 17] The full name of the referring provider.

person · data.encounter.referringProvider.name.person · Object Required Format : password

The person's name.

firstName · data.encounter.referringProvider.name.person.firstName · String Length : 1 - 35

The person's first name.

lastName · data.encounter.referringProvider.name.person.lastName · String Required Length : 1 - 60

The person's last name. Don't include a name suffix such as Jr. or III here. Use the suffix property instead.

middleName · data.encounter.referringProvider.name.person.middleName · String Length : 1 - 25

The person's middle name or initial.

suffix · data.encounter.referringProvider.name.person.suffix · String Length : 1 - 10

The person's name suffix, such as Jr. or III. Include only a personal name suffix here, not professional or academic credentials such as M.D.

resubmission · data.encounter.resubmission · Object

[CMS-1500 Box 22] Whether this claim replaces or voids a previously submitted claim. Omit when you're submitting a new claim and when you're resubmitting a claim that was rejected before it entered the payer's processing system. You must also omit this property for every resubmission to Original Medicare because Original Medicare doesn't accept REPLACEMENT_OF_PRIOR_CLAIM.

code · data.encounter.resubmission.code · String

Whether this claim replaces or cancels a previously submitted claim.

Possible values

REPLACEMENT_OF_PRIOR_CLAIM

CANCELLATION_OF_PRIOR_CLAIM

originalReferenceNumber · data.encounter.resubmission.originalReferenceNumber · String Length : 1 - 50

The Payer Claim Control Number (sometimes called the ICN) of the original claim being replaced or cancelled. Generally required when code is set. One exception is Original Medicare, which specifies that you omit this value from resubmissions.

supervisingProvider · data.encounter.supervisingProvider · Object

[CMS-1500 Box 17, 17a, 17b] The provider who oversaw the rendering provider and the care reported in this claim, when the rendering provider was supervised by a physician.

identifiers · data.encounter.supervisingProvider.identifiers · Object

[CMS-1500 Box 17a, 17b] Identifiers for the supervising provider.

commercialNumber · data.encounter.supervisingProvider.identifiers.commercialNumber · String Length : 1 - 50

[CMS-1500 Box 17a] A commercial number assigned to the supervising provider by the payer. Include only when the payer requires it in addition to the NPI.

locationNumber · data.encounter.supervisingProvider.identifiers.locationNumber · String Length : 1 - 50

[CMS-1500 Box 17a] A location number assigned to the supervising provider by the payer. Include only when the payer requires it in addition to the NPI.

npi · data.encounter.supervisingProvider.identifiers.npi · String Length : 2 - 80

[CMS-1500 Box 17b] The supervising provider's National Provider Identifier (NPI), a unique 10-digit ID issued by the Centers for Medicare & Medicaid Services (CMS).

stateLicenseNumber · data.encounter.supervisingProvider.identifiers.stateLicenseNumber · String Length : 1 - 50

[CMS-1500 Box 17a] The supervising provider's state license number, assigned by a state licensing board. Include only when the payer requires it in addition to the NPI.

name · data.encounter.supervisingProvider.name · Object Required

[CMS-1500 Box 17] The full name of the supervising provider.

person · data.encounter.supervisingProvider.name.person · Object Required Format : password

The person's name.

firstName · data.encounter.supervisingProvider.name.person.firstName · String Length : 1 - 35

The person's first name.

lastName · data.encounter.supervisingProvider.name.person.lastName · String Required Length : 1 - 60

The person's last name. Don't include a name suffix such as Jr. or III here. Use the suffix property instead.

middleName · data.encounter.supervisingProvider.name.person.middleName · String Length : 1 - 25

The person's middle name or initial.

suffix · data.encounter.supervisingProvider.name.person.suffix · String Length : 1 - 10

The person's name suffix, such as Jr. or III. Include only a personal name suffix here, not professional or academic credentials such as M.D.

insured · data.insured · Object Required

[CMS-1500 Box 1, 1a, 4, 7, 11, 11a, 11b, 11c] The person who carries the insurance policy being billed. The insured is also called the subscriber, primary policyholder, or primary cardholder, and may be a different person from the patient. For example, when a spouse or child receives care under an employee's plan, the employee is the insured.

address · data.insured.address · Object Format : password

[CMS-1500 Box 7] The mailing address for the insured's permanent residence.

addressLine1 · data.insured.address.addressLine1 · String Required Length : 1 - 55

The first line of the street address. This typically contains the building number and street name.

addressLine2 · data.insured.address.addressLine2 · String Length : 1 - 55

The second line of the street address. This typically contains the apartment or suite number.

city · data.insured.address.city · String Required Length : 2 - 30

The city name.

postalCode · data.insured.address.postalCode · String Length : 3 - 15

The postal or ZIP code, with no separators or spaces. For United States addresses, use the full nine-digit ZIP code, such as 100031502.

state · data.insured.address.state · String Length : 2

The two-letter state or province code. Required when the city is in the United States or Canada.

dateOfBirth · data.insured.dateOfBirth · String Format : password Length : 1 - 35

[CMS-1500 Box 11a] The insured's date of birth. Used to distinguish the insured from other members with similar names.

gender · data.insured.gender · String Format : password

[CMS-1500 Box 11a] The insured's sex.

Possible values

MALE

FEMALE

UNKNOWN

insuranceType · data.insured.insuranceType · String Required

[CMS-1500 Box 1] The type of health insurance plan being billed. Pick the type that best matches the plan and payer. For most commercial payers, use OTHER.

Possible values

MEDICARE

MEDICAID

TRICARE

CHAMPVA

FECA_BLK_LUNG

memberId · data.insured.memberId · String Format : password Length : 2 - 80

[CMS-1500 Box 1a] The member ID for the insured's insurance policy, typically found on the insurance card. For Medicare claims, this is the insured's Medicare Beneficiary Identifier (MBI).

name · data.insured.name · Object Required

[CMS-1500 Box 4] The full name of the insured. This is a person for most claims. Provide an organization only for workers' compensation or other property and casualty claims where the policy is held by an entity, such as the patient's employer.

organization · data.insured.name.organization · String Required Length : 1 - 60

The organization's business name.

paymentResponsibilityLevelCode · data.insured.paymentResponsibilityLevelCode · String Required

[CMS-1500 Box 11] The payer's responsibility level for this claim. This form supports claims to primary payers only.

Possible values

PRIMARY

planName · data.insured.planName · String Format : password Length : 1 - 60

[CMS-1500 Box 11c] The name of the insured's insurance plan, typically found on the insurance card.

policyOrGroupNumber · data.insured.policyOrGroupNumber · String Format : password Length : 1 - 50

[CMS-1500 Box 11] The payer's code for the employer or other party that purchased the plan, typically found on the insurance card. For workers' compensation claims, use the Federal Employees' Compensation Act (FECA) number for the case.

propertyCasualtyClaimNumber · data.insured.propertyCasualtyClaimNumber · String Format : password Length : 1 - 50

[CMS-1500 Box 11b] The claim number assigned by a property or casualty insurer. Include for workers' compensation, automobile accident, or other liability claims when the payer requires it.

ssn · data.insured.ssn · String Format : password Length : 1 - 50

[CMS-1500 Box 11b] The insured's Social Security Number. Only include when specifically instructed by a payer.

otherInsured · data.otherInsured · Array of Objects Max items : 10

[CMS-1500 Box 9, 9a, 9d] Coverage the patient holds under another insurance policy, relevant to coordination of benefits. Include this when the patient has coverage from another payer in addition to the one you're billing.

address · data.otherInsured[].address · Object Format : password

The mailing address of the person insured under the other policy.

addressLine1 · data.otherInsured[].address.addressLine1 · String Required Length : 1 - 55

The first line of the street address. This typically contains the building number and street name.

addressLine2 · data.otherInsured[].address.addressLine2 · String Length : 1 - 55

The second line of the street address. This typically contains the apartment or suite number.

city · data.otherInsured[].address.city · String Required Length : 2 - 30

The city name.

postalCode · data.otherInsured[].address.postalCode · String Length : 3 - 15

The postal or ZIP code, with no separators or spaces. For United States addresses, use the full nine-digit ZIP code, such as 100031502.

state · data.otherInsured[].address.state · String Length : 2

The two-letter state or province code. Required when the city is in the United States or Canada.

authorization · data.otherInsured[].authorization · Object Required

Signature and assignment-of-benefits indicators for the other coverage.

insuredAuthorizesAssignment · data.otherInsured[].authorization.insuredAuthorizesAssignment · String Required

Whether the other insured has authorized payment of benefits directly to the provider.

Possible values

NO

NOT_APPLICABLE

YES

patientReleasesMedicalInfo · data.otherInsured[].authorization.patientReleasesMedicalInfo · String Required

Whether the provider has the other insured's authorization to release medical information needed to process the claim.

Possible values

INFORMED_CONSENT

YES

providerGeneratedPatientSignature · data.otherInsured[].authorization.providerGeneratedPatientSignature · Boolean

Whether the provider generated the patient's signature because the patient was physically unable to sign.

claimFilingIndicator · data.otherInsured[].claimFilingIndicator · String Required

The type of plan or payer the other coverage is filed under.

Possible values

OTHER_NON_FEDERAL_PROGRAMS

PREFERRED_PROVIDER_ORGANIZATION

POINT_OF_SERVICE

EXCLUSIVE_PROVIDER_ORGANIZATION

INDEMNITY_INSURANCE

medicareSecondaryInsuranceType · data.otherInsured[].medicareSecondaryInsuranceType · String

The Medicare secondary payer reason, when the other coverage makes Medicare the secondary payer.

Possible values

WORKING_AGED_BENEFICIARY_OR_SPOUSE_WITH_EGHP

END_STAGE_RENAL_DISEASE_IN_MANDATED_COORDINATION_PERIOD_WITH_EGHP

NO_FAULT_INSURANCE_INCLUDING_AUTO_IS_PRIMARY

WORKERS_COMPENSATION

PUBLIC_HEALTH_SERVICE_OR_OTHER_FEDERAL_AGENCY

memberId · data.otherInsured[].memberId · String Required Format : password Length : 2 - 80

[CMS-1500 Box 9] The member ID for the other policy.

name · data.otherInsured[].name · Object Required

[CMS-1500 Box 9] The name of the person insured under the other policy.

organization · data.otherInsured[].name.organization · String Required Length : 1 - 60

The organization's business name.

otherPayer · data.otherInsured[].otherPayer · Object Required

The payer that provides the other coverage.

id · data.otherInsured[].otherPayer.id · Object Required

The other payer's identifier.

payerId · data.otherInsured[].otherPayer.id.payerId · String Required Length : 2 - 80

The other payer's payer identification number.

name · data.otherInsured[].otherPayer.name · Object Required

The other payer's business name.

organization · data.otherInsured[].otherPayer.name.organization · String Required Length : 1 - 60

The organization's business name.

planName · data.otherInsured[].planName · String Format : password Length : 1 - 60

[CMS-1500 Box 9d] The name of the other insurance plan.

policyOrGroupNumber · data.otherInsured[].policyOrGroupNumber · String Format : password Length : 1 - 50

[CMS-1500 Box 9a] The policy or group number for the other coverage.

relationshipToInsured · data.otherInsured[].relationshipToInsured · String Required

How the patient is related to the person insured under the other policy.

Possible values

SPOUSE

SELF

CHILD

EMPLOYEE

UNKNOWN

responsibilityLevel · data.otherInsured[].responsibilityLevel · String Required

The other payer's responsibility level for this claim, relative to the payer being billed.

Possible values

PRIMARY

SECONDARY

TERTIARY

ssn · data.otherInsured[].ssn · String Format : password Length : 1 - 50

The Social Security Number of the person insured under the other policy. Only include when specifically instructed by a payer.

patient · data.patient · Object

[CMS-1500 Box 2, 3, 5, 6] The person who received care. Only include this object when the patient is someone other than the insured, such as a spouse or dependent on the insured's plan. When the patient is the insured, leave this empty.

address · data.patient.address · Object Required Format : password

[CMS-1500 Box 5] The mailing address for the patient's permanent residence.

addressLine1 · data.patient.address.addressLine1 · String Required Length : 1 - 55

The first line of the street address. This typically contains the building number and street name.

addressLine2 · data.patient.address.addressLine2 · String Length : 1 - 55

The second line of the street address. This typically contains the apartment or suite number.

city · data.patient.address.city · String Required Length : 2 - 30

The city name.

postalCode · data.patient.address.postalCode · String Length : 3 - 15

The postal or ZIP code, with no separators or spaces. For United States addresses, use the full nine-digit ZIP code, such as 100031502.

state · data.patient.address.state · String Length : 2

The two-letter state or province code. Required when the city is in the United States or Canada.

dateOfBirth · data.patient.dateOfBirth · String Required Format : password Length : 1 - 35

[CMS-1500 Box 3] The patient's date of birth. Used to distinguish the patient from other members with similar names.

gender · data.patient.gender · String Required Format : password

[CMS-1500 Box 3] The patient's sex.

Possible values

MALE

FEMALE

UNKNOWN

name · data.patient.name · Object Required

[CMS-1500 Box 2] The full name of the person who received care.

person · data.patient.name.person · Object Required Format : password

The person's name.

firstName · data.patient.name.person.firstName · String Length : 1 - 35

The person's first name.

lastName · data.patient.name.person.lastName · String Required Length : 1 - 60

The person's last name. Don't include a name suffix such as Jr. or III here. Use the suffix property instead.

middleName · data.patient.name.person.middleName · String Length : 1 - 25

The person's middle name or initial.

suffix · data.patient.name.person.suffix · String Length : 1 - 10

The person's name suffix, such as Jr. or III. Include only a personal name suffix here, not professional or academic credentials such as M.D.

relationshipToInsured · data.patient.relationshipToInsured · String Required

[CMS-1500 Box 6] How the patient is related to the insured.

Possible values

SPOUSE

CHILD

EMPLOYEE

OTHER_RELATIONSHIP

payer · data.payer · Object Required

[CMS-1500 Carrier Block] The payer being billed for this claim, identified by a Stedi payer ID. Visit the Payer Network for a complete list of payers and their IDs.

address · data.payer.address · Object Format : password

[CMS-1500 Carrier Block] The payer's mailing address.

addressLine1 · data.payer.address.addressLine1 · String Required Length : 1 - 55

The first line of the street address. This typically contains the building number and street name.

addressLine2 · data.payer.address.addressLine2 · String Length : 1 - 55

The second line of the street address. This typically contains the apartment or suite number.

city · data.payer.address.city · String Required Length : 2 - 30

The city name.

postalCode · data.payer.address.postalCode · String Length : 3 - 15

The postal or ZIP code, with no separators or spaces. For United States addresses, use the full nine-digit ZIP code, such as 100031502.

state · data.payer.address.state · String Length : 2

The two-letter state or province code. Required when the city is in the United States or Canada.

id · data.payer.id · String Required Length : 2 - 80

[CMS-1500 Carrier Block] The Stedi payer ID for the payer being billed. Visit the Payer Network for a complete list.

• You can send requests using the primary payer ID, the Stedi payer ID, or any alias listed in the payer record.
• You must include leading 0 characters. Payer IDs are alphanumeric strings and must be treated as complete strings, not integers. For example, use 00540 for SISCO, not 540.

name · data.payer.name · Object

[CMS-1500 Carrier Block] The payer's business name, such as Aetna or Cigna.

organization · data.payer.name.organization · String Required Length : 1 - 60

The organization's business name.

receiverId · data.payer.receiverId · String Length : 2 - 80

[CMS-1500 Carrier Block] The ID of the receiver that processes the claim, typically the clearinghouse or payer. Only include when the receiver differs from the payer.

purpose · data.purpose · String Required

[CMS-1500 Carrier Block] The purpose of the submission. Use CHARGEABLE for standard fee-for-service claims, which covers most submissions.

Possible values

SUBROGATION_DEMAND

CHARGEABLE

REPORTING

serviceLines · data.serviceLines · Array of Objects Required Items : 1 - 50

[CMS-1500 Box 17, 17a, 17b, 20, 24a-24j] The individual services, procedures, or supplies being billed. Each service line corresponds to one row in Box 24 of the CMS-1500 form.

attachments · data.serviceLines[].attachments · Array of Objects Items : 1 - 10

[CMS-1500 Box 24] Supporting documentation attached to this service line. Only include when the payer requires it. Visit Submit claim attachments for more information.

attachmentControlNumber · data.serviceLines[].attachments[].attachmentControlNumber · String Length : 2 - 80

A control number assigned to the attachment. The payer uses this identifier to match the attachment to the claim.

• You must include either this property or attachmentId in the request, but not both. Including both properties will result in an error.
• We recommend using a ULID or UUID of up to 50 characters.
• Stedi autogenerates a control number if you don't provide one.

attachmentId · data.serviceLines[].attachments[].attachmentId · String Regex pattern : ^[0-9a-fA-F]{8}-[0-9a-fA-F]{4}-[0-9a-fA-F]{4}-[0-9a-fA-F]{4}-[0-9a-fA-F]{12}$ Length : 36

The unique identifier for an attachment file you previously uploaded to Stedi. This value is returned in the attachmentId property of the Create Claim Attachment (275) JSON response. Stedi uses it to generate and submit the 275 claim attachment transaction to the payer.

• This property is required when you're submitting attachment files through Stedi.
• You must include either this property or attachmentControlNumber in the request, but not both. Including both properties will result in an error.

reportTypeCode · data.serviceLines[].attachments[].reportTypeCode · String Required

The type of report being attached.

Possible values

REPORT_JUSTIFYING_TREATMENT

DRUGS_ADMINISTERED

TREATMENT_DIAGNOSIS

INITIAL_ASSESSMENT

FUNCTIONAL_GOALS

transmissionCode · data.serviceLines[].attachments[].transmissionCode · String Required

How you're sending the attachment to the payer.

Possible values

AVAILABLE_ON_REQUEST

BY_MAIL

ELECTRONICALLY_ONLY

EMAIL

FILE_TRANSFER

datesOfService · data.serviceLines[].datesOfService · Object Required

[CMS-1500 Box 24a] The date or date range when the patient received the service.

end · data.serviceLines[].datesOfService.end · String Length : 1 - 35

The end date of the range, inclusive, in YYYY-MM-DD format.

start · data.serviceLines[].datesOfService.start · String Length : 1 - 35

The start date of the range, in YYYY-MM-DD format.

diagnosisCodes · data.serviceLines[].diagnosisCodes · Array of Strings Required Items : 1 - 4

[CMS-1500 Box 24e] Up to four diagnoses this service relates to. Must be ICD-10-CM codes. List them in order of importance to the service, with the most relevant diagnosis first. Across encounter.primaryDiagnosisCode and the codes on every service line, a claim can use at most 12 distinct diagnosis codes.

• You must submit a valid, billable code at the highest level of specificity. Include the 4th - 7th characters as applicable.
• Don't submit the decimal point for ICD codes. The decimal point is implied.
• Don't submit ICD-10 header codes. Header codes exist to group related codes and aren't valid for billing. These header codes can change with each new version of ICD-10, so we recommend reviewing your diagnosis codes every year to ensure that they aren't classified as header codes in the most recent version. To determine whether a code is a header code, you can also search the Value Set Authority Center. If the 'Header' property is set, the code is a header code and you shouldn't use it in claim submissions.

drugIdentification · data.serviceLines[].drugIdentification · Object

[CMS-1500 Box 24] Drug identification details for the service line. Required when a drug is billed for this line and a prescription was written.

associationNumber · data.serviceLines[].drugIdentification.associationNumber · Object

A prescription number or, for compound drugs, a link sequence number that ties the components of the compound together.

linkSequenceNumber · data.serviceLines[].drugIdentification.associationNumber.linkSequenceNumber · String Required Length : 1 - 50

A provider-assigned number, unique to this claim, that ties together the components of a compound drug when there is no prescription number.

nationalDrugCode · data.serviceLines[].drugIdentification.nationalDrugCode · String Required Length : 1 - 48

The dispensed drug's National Drug Code (NDC).

originalNdc · data.serviceLines[].drugIdentification.originalNdc · String Length : 1 - 80

The original National Drug Code (NDC), when it differs from the code reported in nationalDrugCode.

unitCount · data.serviceLines[].drugIdentification.unitCount · String Required Regex pattern : ^\d{1,8}(\.\d{1,3})?$

The quantity of the drug administered, expressed in the unit given by unitOfMeasure.

unitOfMeasure · data.serviceLines[].drugIdentification.unitOfMeasure · String Required

The unit of measure for unitCount.

Possible values

INTERNATIONAL_UNIT

GRAM

MILLIGRAM

MILLILITER

UNIT

isEmergency · data.serviceLines[].isEmergency · Boolean

[CMS-1500 Box 24c] Whether the service was related to an emergency, meaning the patient required immediate intervention for a severe, life-threatening, or potentially disabling condition.

isEpsdtRelated · data.serviceLines[].isEpsdtRelated · Boolean

[CMS-1500 Box 24h] Whether the service is related to an Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) encounter. Set this on services that resulted from an EPSDT screening, not on the screening service itself. Report the screening's referral outcome in encounter.epsdtReferralCodes.

isFamilyPlanning · data.serviceLines[].isFamilyPlanning · Boolean

[CMS-1500 Box 24h] Whether the service was related to a family planning program.

lineItemChargeAmount · data.serviceLines[].lineItemChargeAmount · String Required Regex pattern : ^\d+(\.\d{1,2})?$

[CMS-1500 Box 24f] The charge for this service line, including the provider's base charge and any applicable tax or postage. It is acceptable to set this to 0 (zero).

lineItemControlNumber · data.serviceLines[].lineItemControlNumber · String Length : 1 - 50

A control number you assign to this service line for your own tracking. Each must be unique within the claim. If you don't set it, Stedi sets it for you – a random ULID.

narrativeForUnspecifiedCode · data.serviceLines[].narrativeForUnspecifiedCode · String Length : 1 - 80

[CMS-1500 Box 24] A free-text description that clarifies the procedure code and any modifiers. Provide when billing an unspecified or unlisted procedure code.

orderingProvider · data.serviceLines[].orderingProvider · Object

[CMS-1500 Box 17, 17a, 17b] The provider who ordered the services, tests, or supplies billed on this service line. For example, a physician who ordered lab work or imaging. Include when the ordering provider differs from the rendering provider for this line.

identifiers · data.serviceLines[].orderingProvider.identifiers · Object

[CMS-1500 Box 17a, 17b] Identifiers for the ordering provider.

commercialNumber · data.serviceLines[].orderingProvider.identifiers.commercialNumber · String Length : 1 - 50

[CMS-1500 Box 17a] A commercial number assigned to the ordering provider by the payer. Include only when the payer requires it in addition to the NPI.

npi · data.serviceLines[].orderingProvider.identifiers.npi · String Length : 2 - 80

[CMS-1500 Box 17b] The ordering provider's National Provider Identifier (NPI), a unique 10-digit ID issued by the Centers for Medicare & Medicaid Services (CMS).

stateLicenseNumber · data.serviceLines[].orderingProvider.identifiers.stateLicenseNumber · String Length : 1 - 50

[CMS-1500 Box 17a] The ordering provider's state license number, assigned by a state licensing board. Include only when the payer requires it in addition to the NPI.

name · data.serviceLines[].orderingProvider.name · Object Required

[CMS-1500 Box 17] The full name of the ordering provider.

person · data.serviceLines[].orderingProvider.name.person · Object Required Format : password

The person's name.

firstName · data.serviceLines[].orderingProvider.name.person.firstName · String Length : 1 - 35

The person's first name.

lastName · data.serviceLines[].orderingProvider.name.person.lastName · String Required Length : 1 - 60

The person's last name. Don't include a name suffix such as Jr. or III here. Use the suffix property instead.

middleName · data.serviceLines[].orderingProvider.name.person.middleName · String Length : 1 - 25

The person's middle name or initial.

suffix · data.serviceLines[].orderingProvider.name.person.suffix · String Length : 1 - 10

The person's name suffix, such as Jr. or III. Include only a personal name suffix here, not professional or academic credentials such as M.D.

placeOfService · data.serviceLines[].placeOfService · String Length : 1 - 2

[CMS-1500 Box 24b] The place of service code identifying where the patient received the service. Visit Place of Service Codes for a complete list.

priorAuthorizations · data.serviceLines[].priorAuthorizations · Array of Objects Items : 1 - 5

Prior authorization numbers that apply to this service line. Include only numbers that differ from the claim-level prior authorization in encounter.referenceNumbers.priorAuthorization. You can use the same number on multiple service lines.

otherPayerPrimaryId · data.serviceLines[].priorAuthorizations[].otherPayerPrimaryId · String Length : 1 - 50

The identifier of the other payer that issued this prior authorization number. Include only when the number was issued by a payer other than the one being billed, and match the other payer's identifier in otherInsured[].otherPayer.id.

priorAuthorizationNumber · data.serviceLines[].priorAuthorizations[].priorAuthorizationNumber · String Required Length : 1 - 50

The payer-issued prior authorization number for this service line.

procedureCode · data.serviceLines[].procedureCode · Object Required

[CMS-1500 Box 24d] The procedure, service, or supply code being billed, with any applicable modifiers.

code · data.serviceLines[].procedureCode.code · String Required Length : 1 - 48

The procedure, service, or supply code, typically a CPT or HCPCS code.

modifiers · data.serviceLines[].procedureCode.modifiers · Array of Strings Items : 1 - 4

Up to four modifier codes that convey special circumstances related to the service, such as 25 or JW.

purchasedService · data.serviceLines[].purchasedService · Object

[CMS-1500 Box 20] The purchase of this service from a provider outside the billing provider's practice, such as an independent laboratory. Only include when the billing provider bought the service and is billing the payer for it.

chargeAmount · data.serviceLines[].purchasedService.chargeAmount · String Required Regex pattern : ^\d+(\.\d{1,2})?$

[CMS-1500 Box 20] The price the billing provider paid the outside provider for this service.

provider · data.serviceLines[].purchasedService.provider · Object Required

The outside provider the billing provider bought this service from.

entityType · data.serviceLines[].purchasedService.provider.entityType · String Required

Whether the outside provider is a person or an organization.

Possible values

PERSON

ORGANIZATION

identifiers · data.serviceLines[].purchasedService.provider.identifiers · Object Required

Identifiers for the purchased service provider.

npi · data.serviceLines[].purchasedService.provider.identifiers.npi · String Required Length : 2 - 80

[CMS-1500 Box 32a] The purchased service provider's National Provider Identifier (NPI), a unique 10-digit ID issued by the Centers for Medicare & Medicaid Services (CMS).

renderingProvider · data.serviceLines[].renderingProvider · Object

[CMS-1500 Box 24i, 24j] The provider who performed this service. Include only when the rendering provider for this line differs from the claim. This is also where you supply a substitute (locum tenens) provider's information.

identifiers · data.serviceLines[].renderingProvider.identifiers · Object

[CMS-1500 Box 24i, 24j] Identifiers for the rendering provider.

commercialNumber · data.serviceLines[].renderingProvider.identifiers.commercialNumber · String Length : 1 - 50

[CMS-1500 Box 24i] A commercial number assigned to the rendering provider by the payer. Include only when the payer requires it in addition to the NPI.

locationNumber · data.serviceLines[].renderingProvider.identifiers.locationNumber · String Length : 1 - 50

[CMS-1500 Box 24i] A location number assigned to the rendering provider by the payer. Include only when the payer requires it in addition to the NPI.

npi · data.serviceLines[].renderingProvider.identifiers.npi · String Length : 2 - 80

[CMS-1500 Box 24j] The rendering provider's National Provider Identifier (NPI), a unique 10-digit ID issued by the Centers for Medicare & Medicaid Services (CMS).

stateLicenseNumber · data.serviceLines[].renderingProvider.identifiers.stateLicenseNumber · String Length : 1 - 50

[CMS-1500 Box 24i] The rendering provider's state license number, assigned by a state licensing board. Include only when the payer requires it in addition to the NPI.

taxonomyCode · data.serviceLines[].renderingProvider.identifiers.taxonomyCode · String Length : 1 - 50

[CMS-1500 Box 24i] The rendering provider's taxonomy code from the National Uniform Claim Committee Health Care Provider Taxonomy Code Set, which identifies the provider's type and specialty.

name · data.serviceLines[].renderingProvider.name · Object Required

[CMS-1500 Box 24j] The rendering provider's name. Provide a person's name or an organization's business name.

organization · data.serviceLines[].renderingProvider.name.organization · String Required Length : 1 - 60

The organization's business name.

units · data.serviceLines[].units · String Required Regex pattern : ^\d{1,8}(\.\d{1,3})?$

[CMS-1500 Box 24g] The number of units of the service provided. The units depend on the procedure code and the nature of the service. For example, they may correspond to office visits (1 unit per visit), individual diagnostic tests (1 unit per test), or time (when a service is billed in 15-minute increments, 4 units could equal 1 hour). For anesthesia procedure codes (00100-01999), report the total anesthesia time in minutes; Stedi reports the unit of measure as minutes for these codes automatically.

submitter · data.submitter · Object Required

[CMS-1500 Carrier Block] The entity submitting the claim to Stedi.

contact · data.submitter.contact · Object

[CMS-1500 Carrier Block] The contact for questions about this claim submission. Provide at least a phone number or an email address.

email · data.submitter.contact.email · String Format : password Length : 1 - 256

The contact's email address.

faxNumber · data.submitter.contact.faxNumber · String Format : password Length : 1 - 256

The contact's fax number.

name · data.submitter.contact.name · String Length : 1 - 60

The name of the contact person or department. When omitted, questions are directed to the entity itself.

phoneExtension · data.submitter.contact.phoneExtension · String Length : 1 - 256

The extension for phoneNumber.

phoneNumber · data.submitter.contact.phoneNumber · String Format : password Length : 1 - 256

The contact's phone number.

etin · data.submitter.etin · String Length : 2 - 80

[CMS-1500 Carrier Block] The submitter's Electronic Transmitter Identification Number (ETIN), a payer-assigned ID that identifies the entity transmitting the claim.

name · data.submitter.name · Object Required

[CMS-1500 Carrier Block] The name of the submitter, either a person or an organization.

organization · data.submitter.name.organization · String Required Length : 1 - 60

The organization's business name.

processedAt · String Required Format : date-time

The time Stedi processed the submission.

stediPayerId · String Regex pattern : ^[A-Z]{5}$

The payer identifier in Stedi's system.

submissionId · String Required Max length : 40

A unique identifier for a specific submission of a claim within Stedi. Stedi generates a submission ID for the initial submission and then a new submission ID for every resubmission of the same claim. This is different from the claim ID, which doesn't change throughout the claim's lifecycle.

Request

curl --request GET \
  --url "https://claims.us.stedi.com/2025-03-07/professional-claim-submissions/{id}" \
  --header "Authorization: <api_key>"

Response

{
  "claimId": "clm_01K6XFP3TZ8RA9X84963NMW40M",
  "data": {
    "authorization": {
      "insuredAuthorizesAssignment": "YES",
      "patientReleasesMedicalInfo": "YES",
      "providerAcceptsAssignment": "ASSIGNED",
      "providerSignature": "ON_FILE"
    },
    "billing": {
      "amountPaid": "100.00",
      "billingProvider": {
        "address": {
          "addressLine1": "501 Main Street",
          "city": "Springfield",
          "postalCode": "627010500",
          "state": "IL"
        },
        "contact": {
          "phoneNumber": "2175558800"
        },
        "identifiers": {
          "locationNumber": "LOC-001",
          "npi": "1730289013",
          "taxonomyCode": "207Q00000X"
        },
        "name": {
          "organization": "Springfield Family Medical Center"
        }
      },
      "patientControlNumber": "CLM-2026-04219",
      "serviceFacility": {
        "address": {
          "addressLine1": "501 Main Street",
          "city": "Springfield",
          "postalCode": "627010500",
          "state": "IL"
        },
        "identifiers": {
          "npi": "1730289013",
          "stateLicenseNumber": "IL-FAC-77821"
        },
        "name": {
          "organization": "Springfield Family Medical Center"
        }
      },
      "taxId": {
        "ein": "841234567"
      },
      "totalCharge": "1432.50"
    },
    "encounter": {
      "attachments": [
        {
          "attachmentControlNumber": "PWK-2026-0001",
          "attachmentId": "1f2e3d4c-5b6a-7980-9abc-def012345678",
          "reportTypeCode": "PROGRESS_REPORT",
          "transmissionCode": "ELECTRONICALLY_ONLY"
        }
      ],
      "claimCodes": [
        "AV"
      ],
      "claimNote": {
        "additionalInformation": "Patient presented with persistent cough and bronchospasm; treated in office."
      },
      "clinicalDates": {
        "hospitalization": {
          "end": "2026-03-06",
          "start": "2026-03-04"
        },
        "initialTreatment": "2026-03-03",
        "onsetOfCurrentIllness": "2026-03-02",
        "unableToWork": {
          "end": "2026-03-10",
          "start": "2026-03-03"
        }
      },
      "patientCondition": {
        "isAutoAccidentRelated": false,
        "isEmploymentRelated": false,
        "isOtherAccidentRelated": false
      },
      "primaryDiagnosisCode": "J0190",
      "priorReferringProvider": {
        "identifiers": {
          "npi": "1083827763"
        },
        "name": {
          "person": {
            "firstName": "David",
            "lastName": "Kim"
          }
        }
      },
      "referenceNumbers": {
        "clia": "14D2089999",
        "priorAuthorization": "PA-2026-77831",
        "referral": "REF-55421"
      },
      "referringProvider": {
        "identifiers": {
          "npi": "1245319599",
          "stateLicenseNumber": "IL-MD-44512"
        },
        "name": {
          "person": {
            "firstName": "Maya",
            "lastName": "Patel"
          }
        }
      },
      "resubmission": {
        "code": "REPLACEMENT_OF_PRIOR_CLAIM",
        "originalReferenceNumber": "CLM-ORIG-998877"
      },
      "supervisingProvider": {
        "identifiers": {
          "npi": "1396718825"
        },
        "name": {
          "person": {
            "firstName": "Elena",
            "lastName": "Rossi"
          }
        }
      }
    },
    "insured": {
      "address": {
        "addressLine1": "742 Evergreen Terrace",
        "addressLine2": "Apt 3B",
        "city": "Springfield",
        "postalCode": "627010001",
        "state": "IL"
      },
      "dateOfBirth": "1982-04-12",
      "gender": "FEMALE",
      "insuranceType": "OTHER",
      "memberId": "W123456789",
      "name": {
        "person": {
          "firstName": "Sarah",
          "lastName": "Johnson",
          "middleName": "A"
        }
      },
      "paymentResponsibilityLevelCode": "PRIMARY",
      "planName": "Aetna Choice POS II",
      "policyOrGroupNumber": "GRP-AETNA-987654",
      "ssn": "111223333"
    },
    "otherInsured": [
      {
        "address": {
          "addressLine1": "742 Evergreen Terrace",
          "addressLine2": "Apt 3B",
          "city": "Springfield",
          "postalCode": "627010001",
          "state": "IL"
        },
        "authorization": {
          "insuredAuthorizesAssignment": "YES",
          "patientReleasesMedicalInfo": "YES",
          "providerGeneratedPatientSignature": false
        },
        "claimFilingIndicator": "BLUE_CROSS_BLUE_SHIELD",
        "memberId": "BCBS-IL-554433221",
        "name": {
          "person": {
            "firstName": "Michael",
            "lastName": "Johnson"
          }
        },
        "otherPayer": {
          "id": {
            "payerId": "00621"
          },
          "name": {
            "organization": "Blue Cross Blue Shield of Illinois"
          }
        },
        "planName": "BCBS PPO",
        "policyOrGroupNumber": "BCBS-GRP-3344",
        "relationshipToInsured": "SPOUSE",
        "responsibilityLevel": "SECONDARY"
      }
    ],
    "patient": {
      "address": {
        "addressLine1": "742 Evergreen Terrace",
        "addressLine2": "Apt 3B",
        "city": "Springfield",
        "postalCode": "627010001",
        "state": "IL"
      },
      "dateOfBirth": "2015-08-21",
      "gender": "MALE",
      "name": {
        "person": {
          "firstName": "Liam",
          "lastName": "Johnson"
        }
      },
      "relationshipToInsured": "CHILD"
    },
    "payer": {
      "address": {
        "addressLine1": "151 Farmington Avenue",
        "city": "Hartford",
        "postalCode": "06156",
        "state": "CT"
      },
      "id": "60054",
      "name": {
        "organization": "Aetna"
      },
      "receiverId": "60054"
    },
    "purpose": "CHARGEABLE",
    "serviceLines": [
      {
        "datesOfService": {
          "end": "2026-03-03",
          "start": "2026-03-03"
        },
        "diagnosisCodes": [
          "J0190",
          "R0602"
        ],
        "isEmergency": false,
        "lineItemChargeAmount": "185.00",
        "lineItemControlNumber": "LN-0001",
        "placeOfService": "11",
        "procedureCode": {
          "code": "99213",
          "modifiers": [
            "25"
          ]
        },
        "renderingProvider": {
          "identifiers": {
            "npi": "1396718825",
            "taxonomyCode": "207Q00000X"
          },
          "name": {
            "person": {
              "firstName": "Elena",
              "lastName": "Rossi"
            }
          }
        },
        "units": "1"
      },
      {
        "datesOfService": {
          "end": "2026-03-03",
          "start": "2026-03-03"
        },
        "diagnosisCodes": [
          "J0190"
        ],
        "drugIdentification": {
          "associationNumber": {
            "pharmacyPrescriptionNumber": "RX-2026-118822"
          },
          "nationalDrugCode": "00409120130",
          "unitCount": "300",
          "unitOfMeasure": "MILLIGRAM"
        },
        "isEmergency": false,
        "lineItemChargeAmount": "1247.50",
        "lineItemControlNumber": "LN-0002",
        "orderingProvider": {
          "identifiers": {
            "npi": "1245319599"
          },
          "name": {
            "person": {
              "firstName": "Maya",
              "lastName": "Patel"
            }
          }
        },
        "placeOfService": "11",
        "priorAuthorizations": [
          {
            "otherPayerPrimaryId": "60054",
            "priorAuthorizationNumber": "PA-2026-77831"
          }
        ],
        "procedureCode": {
          "code": "J1885",
          "modifiers": [
            "JW"
          ]
        },
        "renderingProvider": {
          "identifiers": {
            "npi": "1396718825"
          },
          "name": {
            "person": {
              "firstName": "Elena",
              "lastName": "Rossi"
            }
          }
        },
        "units": "10"
      }
    ],
    "submitter": {
      "contact": {
        "email": "billing@acmehealth.example",
        "faxNumber": "3135551235",
        "phoneNumber": "3135551234"
      },
      "etin": "SUBMITTER0001",
      "name": {
        "organization": "Acme Health Billing"
      }
    }
  },
  "processedAt": "2026-03-03T15:30:00Z",
  "stediPayerId": "AETNA",
  "submissionId": "sbm_01K6XFP3TZ8RA9X84963NMW40N"
}