Real-Time Claim Status JSON

Submit a 276/277 real-time claim status check in JSON format

POST/change/medicalnetwork/claimstatus/v2

You may need to submit a 276 real-time claim status request when you don't receive a 277CA claim acknowledgment or 835 Electronic Remittance Advice (ERA) response from the payer within your expected timeframe.

  1. Call this endpoint with a JSON payload.
    • The request must be for a production claim that has entered the payer's processing system. Requests for test claims or claims that the payer hasn't yet accepted won't return results.
    • Providing too much information can negatively affect the results. You should start with our recommended base request.
  2. Stedi generates the X12 276 EDI transaction and sends it to the payer.
  3. The endpoint returns a synchronous 277 claim status response from the payer in JSON format. The response contains information about the claims matching the criteria you provided in the request and their current status.

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

Visit Check claim status for a complete how-to guide and more request/response examples.

Authorization
RequiredHeader

A Stedi API Key for authentication.

Body

application/json
controlNumber
StringDeprecatedLength: 9

Stedi generates a control number for each claim status check, so you don’t need to include this property in your request.

dependent
Object

Information about the dependent listed in the referenced claim. You must submit the dependent's firstName, lastName, dateOfBirth, and gender (if known). If the claim set the dependent's gender to U for unknown, you should omit the gender property.

Show attributes
dateOfBirth
dependent.dateOfBirth
StringRegex pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$

The dependent's date of birth.

firstName
dependent.firstName
StringRequiredLength: 1 - 35

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

gender
dependent.gender
String

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

Possible values
M
F
groupNumber
dependent.groupNumber
StringLength: 1 - 50

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

lastName
dependent.lastName
StringRequiredLength: 1 - 60

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

encounter
Object

Information about the referenced claim or claims for which you want to retrieve status information.

We recommend supplying a date range that is at least plus or minus 7 days from the date of the services listed in the claim, using the beginningDateOfService and endDateOfService properties. The payer may have stored a different date for the encounter than the one in your records, so providing a date range increases the likelihood that the payer will find a match.

Show attributes
beginningDateOfService
encounter.beginningDateOfService
StringRegex pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$

The date the service began.

billingType
encounter.billingType
StringLength: 1 - 50

The billing type reference ID. For example, the billing type for inpatient services is 111.

clearingHouseClaimNumber
encounter.clearingHouseClaimNumber
StringLength: 1 - 50

The claim number provided by the clearinghouse.

endDateOfService
encounter.endDateOfService
StringRegex pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$

The date the service ended.

locationIdentifier
encounter.locationIdentifier
StringLength: 1 - 50

The application or location identifier. Required if the application or location system identifier is known.

patientAccountNumber
encounter.patientAccountNumber
StringLength: 1 - 50

The patient account number provided by the service provider.

pharmacyPrescriptionNumber
encounter.pharmacyPrescriptionNumber
StringLength: 1 - 50

The patient's pharmacy prescription number.

submittedAmount
encounter.submittedAmount
StringLength: 1 - 18

The total charges submitted for the claim. Note that not all payer systems retain the original submitted charges; they are sometimes changed during processing.

trackingNumber
encounter.trackingNumber
StringLength: 1 - 50

This is the tracking number assigned to the claim status request. It is returned in the response as claims.trackingNumber. If the payer requires a tracking number and you do not supply one, Stedi generates a tracking number for you from a UUID.

tradingPartnerClaimNumber
encounter.tradingPartnerClaimNumber
StringLength: 1 - 50

An identifier for the claim, assigned by the payer.

providers
Array of ObjectsRequiredItems: 1 - 2147483647

Information about the billing and/or service providers related to the referenced claim. For each provider, you must set the providerType and one of the following identifiers: npi, taxId, or etin. - When the providerType = BillingProvider, you must include the provider's etin. - When providerType = ServiceProvider, you must include the npi if the provider has one. Otherwise, include the taxId.

Array item
etin
providers[].etin
StringLength: 2 - 80

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.

firstName
providers[].firstName
StringLength: 1 - 35

The provider's first name. Use when the provider is an individual.

lastName
providers[].lastName
StringLength: 1 - 60

The provider's last name. Use when the provider is an individual.

npi
providers[].npi
StringRegex pattern: ^\d{10}$
organizationName
providers[].organizationName
StringLength: 1 - 60

The provider's organization name. Use when the provider is not an individual, such as a hospital or clinic.

providerType
providers[].providerType
StringRequired

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.

Possible values
BillingProvider
ServiceProvider
spn
providers[].spn
StringDeprecatedLength: 2 - 80

Deprecated; The service provider number. Use npi to identify the service provider instead.

taxId
providers[].taxId
StringRegex pattern: ^\d{9}$

The Taxpayer Identification Number (TIN).

tin
providers[].tin
StringLength: 2 - 80
serviceLineInformation
ObjectDeprecated

Identify a service line listed in the referenced claim. Used to request status for a specific service line.

Show attributes
lineItemChargeAmount
serviceLineInformation.lineItemChargeAmount
StringRequired

The original submitted charge for the service line, expressed as a decimal. For example, 100.00.

lineItemControlNumber
serviceLineInformation.lineItemControlNumber
String

An identifier for the service line. This matches the claimInformation.serviceLines.providerControlNumber submitted for the service line in the original claim.

procedureCode
serviceLineInformation.procedureCode
StringRequired

The procedure code.

procedureModifiers
serviceLineInformation.procedureModifiers
Array of StringsItems: 1 - 4

A modifier code that clarifies or improves the reporting accuracy of the associated procedureCode. If not required, do not send.

productOrServiceIDQualifier
serviceLineInformation.productOrServiceIDQualifier
StringRequired

Code identifying the specific industry code list used for the procedureCode. Visit Claims code lists for a complete list.

Possible values
AD
ER
HC
HP
IV
revenueCode
serviceLineInformation.revenueCode
String

The revenue code for the service line. This is the National Uniform Billing Committee revenue code.

serviceLineDate
serviceLineInformation.serviceLineDate
StringRequiredRegex pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$

The date the service line began.

serviceLineEndDate
serviceLineInformation.serviceLineEndDate
StringRegex pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$

The date the service line ended.

unitsOfServiceCount
serviceLineInformation.unitsOfServiceCount
StringRequired

The number of units of service for the service line.

serviceLinesInformation
Array of ObjectsMin items: 1

Identify a service line listed in the referenced claim. Used to request status for a specific service line.

Array item
lineItemChargeAmount
serviceLinesInformation[].lineItemChargeAmount
StringRequired

The original submitted charge for the service line, expressed as a decimal. For example, 100.00.

lineItemControlNumber
serviceLinesInformation[].lineItemControlNumber
String

An identifier for the service line. This matches the claimInformation.serviceLines.providerControlNumber submitted for the service line in the original claim.

procedureCode
serviceLinesInformation[].procedureCode
StringRequired

The procedure code.

procedureModifiers
serviceLinesInformation[].procedureModifiers
Array of StringsItems: 1 - 4

A modifier code that clarifies or improves the reporting accuracy of the associated procedureCode. If not required, do not send.

productOrServiceIDQualifier
serviceLinesInformation[].productOrServiceIDQualifier
StringRequired

Code identifying the specific industry code list used for the procedureCode. Visit Claims code lists for a complete list.

Possible values
AD
ER
HC
HP
IV
revenueCode
serviceLinesInformation[].revenueCode
String

The revenue code for the service line. This is the National Uniform Billing Committee revenue code.

serviceLineDate
serviceLinesInformation[].serviceLineDate
StringRequiredRegex pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$

The date the service line began.

serviceLineEndDate
serviceLinesInformation[].serviceLineEndDate
StringRegex pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$

The date the service line ended.

unitsOfServiceCount
serviceLinesInformation[].unitsOfServiceCount
StringRequired

The number of units of service for the service line.

subscriber
ObjectRequired

Information about the subscriber listed in the referenced claim.

  • You must set both the dateOfBirth and gender properties when the subscriber is the patient unless the gender is unknown. Stedi determines that the subscriber is the patient when the dependent object is not included in the request.
  • If either dateOfBirth or gender is set, you must include both properties unless the gender is unknown.
Show attributes
dateOfBirth
subscriber.dateOfBirth
StringRegex pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$

The subscriber's date of birth.

firstName
subscriber.firstName
StringRequiredLength: 1 - 35

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

gender
subscriber.gender
String

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

Possible values
M
F
groupNumber
subscriber.groupNumber
StringLength: 1 - 50

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

lastName
subscriber.lastName
StringRequiredLength: 1 - 60

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

memberId
subscriber.memberId
StringRequiredLength: 2 - 80

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

This is the payer name, such as Cigna or Aetna.

tradingPartnerServiceId
StringRequiredLength: 2 - 80

This is the Payer ID. 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.

Response

application/json

ClaimStatus 200 response

claims
Array of Objects

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

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

Array item
claimStatus
claims[].claimStatus
Object

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

Show attributes
amountPaid
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.

checkIssueDate
claims[].claimStatus.checkIssueDate
StringRegex pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$

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

checkNumber
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.

claimServiceDate
claims[].claimStatus.claimServiceDate
String

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

clearingHouseClaimNumber
claims[].claimStatus.clearingHouseClaimNumber
String

The claim number provided by the clearinghouse.

effectiveDate
claims[].claimStatus.effectiveDate
StringRegex pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$

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

entity
claims[].claimStatus.entity
String

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

Possible values
Health Maintenance Organization (HMO)
Oncology Center
Kidney Dialysis Unit
Preferred Provider Organization (PPO)
Acute Care Hospital
entityCode
claims[].claimStatus.entityCode
String

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

Visit Claims code lists for a complete list.

Possible values
1E
1G
1H
1I
1O
paidDate
claims[].claimStatus.paidDate
StringRegex pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$

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

patientAccountNumber
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.

statusCategoryCode
claims[].claimStatus.statusCategoryCode
String

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

statusCategoryCodeValue
claims[].claimStatus.statusCategoryCodeValue
String

The description of the statusCategoryCode.

statusCode
claims[].claimStatus.statusCode
String

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

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

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

statusCodeValue
claims[].claimStatus.statusCodeValue
String

The description of the statusCode.

submittedAmount
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.

trackingNumber
claims[].claimStatus.trackingNumber
String

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

tradingPartnerClaimNumber
claims[].claimStatus.tradingPartnerClaimNumber
String

An identifier for the claim, assigned by the payer.

serviceDetails
claims[].serviceDetails
Array of Objects

Information about specific service lines and their status. Payers may not return service line details for all claims, even when you requested them.

Array item
service
claims[].serviceDetails[].service
Object

Information about a service line listed in the referenced claim.

Show attributes
amountPaid
claims[].serviceDetails[].service.amountPaid
String

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

procedureId
claims[].serviceDetails[].service.procedureId
String

Identifying number for product or service.

procedureModifiers
claims[].serviceDetails[].service.procedureModifiers
Array of StringsItems: 1 - 4

Procedure modifier codes that provide additional information about the service performed.

revenueCode
claims[].serviceDetails[].service.revenueCode
String

The National Uniform Billing Committee revenue code.

serviceIdQualifier
claims[].serviceDetails[].service.serviceIdQualifier
String

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

serviceIdQualifierCode
claims[].serviceDetails[].service.serviceIdQualifierCode
String

A code identifying the type/source of the procedureId. Visit Claims code lists for a complete list.

Possible values
AD
ER
HC
HP
IV
submittedAmount
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.

submittedUnits
claims[].serviceDetails[].service.submittedUnits
String

The number of units of service submitted.

status
claims[].serviceDetails[].status
Array of Objects

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

Array item
effectiveDate
claims[].serviceDetails[].status[].effectiveDate
StringRegex pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$

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

entity
claims[].serviceDetails[].status[].entity
String

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

Possible values
Health Maintenance Organization (HMO)
Oncology Center
Kidney Dialysis Unit
Preferred Provider Organization (PPO)
Acute Care Hospital
entityCode
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.

Visit Claims code lists for a complete list.

Possible values
1E
1G
1H
1I
1O
statusCategoryCode
claims[].serviceDetails[].status[].statusCategoryCode
String

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

statusCategoryCodeValue
claims[].serviceDetails[].status[].statusCategoryCodeValue
String

The description of the statusCategoryCode.

statusCode
claims[].serviceDetails[].status[].statusCode
String

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

statusCodeValue
claims[].serviceDetails[].status[].statusCodeValue
String

The description of the statusCode.

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

dependent
Object

Information about the dependent listed in the referenced claim.

Show attributes
dateOfBirth
dependent.dateOfBirth
StringRegex pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$

The dependent's date of birth.

firstName
dependent.firstName
StringRequiredLength: 1 - 35

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

gender
dependent.gender
String

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

Possible values
M
F
groupNumber
dependent.groupNumber
StringLength: 1 - 50

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

lastName
dependent.lastName
StringRequiredLength: 1 - 60

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

Show attributes
code
errorResponse.code
String
description
errorResponse.description
String
errors
errorResponse.errors
Array of Objects
Array item
code
errorResponse.errors[].code
String

The error code.

description
errorResponse.errors[].description
String

The description of the error code.

field
errorResponse.errors[].field
String

The attribute that caused the error.

followupAction
errorResponse.errors[].followupAction
String

Follow-up actions to correct the error.

location
errorResponse.errors[].location
String

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

value
errorResponse.errors[].value
String

The value that caused the error.

transactionIdentifier
errorResponse.transactionIdentifier
Object
Show attributes
customerTransactionId
errorResponse.transactionIdentifier.customerTransactionId
String
transactionId
errorResponse.transactionIdentifier.transactionId
String

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

meta
Object

Metadata about the response.

Show attributes
applicationMode
meta.applicationMode
String

Identifies where this request can be found for support.

billerId
meta.billerId
String

The biller ID assigned to this request.

senderId
meta.senderId
String

The sender ID assigned to this request.

submitterId
meta.submitterId
String

The submitter ID assigned to this request.

traceId
meta.traceId
String

The unique ID assigned to this request within Stedi.

payer
Object

Information about the payer listed in the referenced claim.

Show attributes
centersForMedicareAndMedicaidServicePlanId
payer.centersForMedicareAndMedicaidServicePlanId
String

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

contactInformation
payer.contactInformation
Object
Show attributes
electronicDataInterChangeAccessNumber
payer.contactInformation.electronicDataInterChangeAccessNumber
String

The payer's Electronic Data Interchange Access number.

email
payer.contactInformation.email
String

The payer's email address.

fax
payer.contactInformation.fax
String

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

name
payer.contactInformation.name
String

The payer contact name.

phone
payer.contactInformation.phone
String

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

phoneExtension
payer.contactInformation.phoneExtension
String

The payer's telephone extension.

organizationName
payer.organizationName
String

The payer's organization name. For example UNITEDHEALTHCARE.

payerIdentification
payer.payerIdentification
String

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

providers
Array of Objects

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

Array item
etin
providers[].etin
StringLength: 2 - 80

The Electronic Transmitter Identification Number (ETIN).

firstName
providers[].firstName
StringLength: 1 - 35

The provider's first name.

lastName
providers[].lastName
StringLength: 1 - 60

The provider's last name.

npi
providers[].npi
StringRegex pattern: ^\d{10}$
organizationName
providers[].organizationName
StringLength: 1 - 60

The provider's organization name.

providerType
providers[].providerType
StringRequired

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

Possible values
BillingProvider
ServiceProvider
spn
providers[].spn
StringDeprecatedLength: 2 - 80

The service provider number.

taxId
providers[].taxId
StringRegex pattern: ^\d{9}$

The Taxpayer Identification Number (TIN).

tin
providers[].tin
StringLength: 2 - 80

The control number for the transaction.

status
String

The status of the entire claim.

Information about the subscriber listed in the referenced claim.

Show attributes
dateOfBirth
subscriber.dateOfBirth
StringRegex pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$

The subscriber's date of birth.

firstName
subscriber.firstName
StringRequiredLength: 1 - 35

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

gender
subscriber.gender
String

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

Possible values
M
F
groupNumber
subscriber.groupNumber
StringLength: 1 - 50

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

lastName
subscriber.lastName
StringRequiredLength: 1 - 60

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

memberId
subscriber.memberId
StringRequiredLength: 2 - 80

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

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.

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

x12
String

The raw X12 response from the payer.