Professional Claims (837P) JSON
Submit an 837P professional claim in JSON format
/change/medicalnetwork/professionalclaims/v3/submissionThis endpoint sends 837P professional claims to payers.
- Call this endpoint with a JSON payload.
- Stedi translates your request to the X12 837 EDI format and sends it to the payer.
- The endpoint returns a response from Stedi in JSON format containing information about the claim you submitted and whether the submission was successful.
Visit Submit professional claims for a full how-to guide.
CMS-1500 Claim Form PDF
When you submit a professional claim, Stedi automatically generates a 1500 claim form PDF. If you plan to send these PDFs to payers or retain them for your records, we strongly recommend reviewing the CMS-1500 claim form PDF documentation to learn how to structure claim submissions for optimal generation, the correct printer settings for generated PDFs, and general best practices.
A Stedi API Key for authentication.
Body
Information about the billing provider.
- For tax identification, you must include either the provider's Social Security Number (SSN) in the
ssnproperty or their Employer Identification Number (EIN) in theemployerIdproperty, but not both. - If the billing provider has an NPI, you must include it in the
npiproperty. If the billing provider does not have an NPI, you must include either thecommercialNumberor thelocationNumberfor identification. Some payers may require thenpiand either thecommercialNumberor thelocationNumberas a secondary identifier. - Some solo providers may use their SSN as their EIN. In this case, submit the SSN in the
ssnproperty and leave theemployerIdproperty blank.
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The billing provider's address. This must be a physical practice location where care is delivered. If the billing provider receives mail at a PO Box, lockbox, or other non-physical address, you can provide that address in the payToAddress object.
For United States addresses, you must include the full nine-digit zip code with no separators, such as 100031502. If you don't know the full zip code, you can find it using the USPS ZIP Code Lookup tool.
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The first line of the street address. This typically contains the building number and street name.
The second line of the street address. This typically contains the apartment or suite number.
The city name.
Use the alpha-2 country codes from Part 1 of ISO 3166.
Use the country subdivision codes from Part 2 of ISO 3166.
The postal zone or zip code. Exclude punctuation and spaces.
The state or province code. Only required when the city is in the Unites States and Canada.
The billing provider's commercial number, as assigned by this payer. The commercial number is a unique identifier that the payer assigns to the provider. For providers without an NPI, you must provide either the commercialNumber or the locationNumber for identification.
Contact information for the billing provider. You can include a maximum of two objects in this array.
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The email address.
The fax number.
The full name of the person or office.
The phone extension, if applicable.
The phone number, formatted as AAABBBCCCC, where AAA represents the area code, BBB is the telephone number prefix, and CCCC is the telephone number. The phone number should only include the digits 0 to 9. Don't include separators, such as dashes, and don't include long distance access numbers, such as 1. For example, you would format the phone number 123-456-7890 as 1234567890.
The billing provider's Employer Identification Number (EIN). Typically a string of exactly nine numbers with no separators, unless otherwise instructed by the payer. If you include this value, you cannot include the ssn.
The billing provider's first name, if the provider is an individual.
The provider's last name, if the provider is an individual.
The billing provider's location number. For providers without an NPI, you must provide either the commercialNumber or the locationNumber for identification.
The provider's middle name or initial, if the provider is an individual.
The billing provider's National Provider Identifier (NPI).
The provider's business name.
This field is now automatically populated and it only remains for backwards compatibility.
Deprecated; do not use.
The billing provider's Social Security Number. Must be a string of exactly nine numbers with no separators. If you include this value, you cannot include the employerId.
The billing provider's state license number. This is assigned directly by a payer in order to identify the provider in their system. This is not commonly used.
The provider's name suffix, such as Jr. or III.
Code from the National Uniform Claims Committee Health Care Provider Taxonomy Code Set. This identifies the billing provider's type and/or area of specialty.
A code specifying the type of transaction. Defaults to CH if not provided.
31: Only for use by state Medicaid agencies performing post payment recovery.CH: Use when the transaction contains only fee for service claims or claims with at least one chargeable line item. Also use when it's not clear whether a transaction contains claims or capitated encounters, or if the transaction contains a mix of claims and capitated encounters.RP: Use for capitated encounters. Also use when the transaction is being sent to an entity for purposes other than adjudication of a claim. For example, when you're sending the claim to a state health agency that is using the claim for health data reporting purposes.
31CHRPInformation about the healthcare claim.
Note that the objects and properties marked as required are required for all claims, while others are conditionally required, depending on type of claim and claim circumstances. For example, you must always provide the patient's diagnosis codes in the healthCareCodeInformation object, but you only need to provide the otherSubscriberInformation object in coordination of benefits scenarios. When you include a conditionally required object, you must provide all of its required properties.
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Required when the claim involves ambulance transport services.
Array item
Code indicating whether there is an ambulance certification.
NY0104050607The address where the ambulance dropped off the patient.
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The first line of the street address. This typically contains the building number and street name.
The second line of the street address. This typically contains the apartment or suite number.
The city name.
Use the alpha-2 country codes from Part 1 of ISO 3166.
Use the country subdivision codes from Part 2 of ISO 3166.
The postal zone or zip code. Exclude punctuation and spaces.
The state or province code. Only required when the city is in the Unites States and Canada.
The address where the ambulance picked up the patient. If the ambulance pickup location is in an area where there are no street addresses, enter a description of where the service was rendered. For example Exit near mile marker 123 on I-95.
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The first line of the street address. This typically contains the building number and street name.
The second line of the street address. This typically contains the apartment or suite number.
The city name.
Use the alpha-2 country codes from Part 1 of ISO 3166.
Use the country subdivision codes from Part 2 of ISO 3166.
The postal zone or zip code. Exclude punctuation and spaces.
The state or province code. Only required when the city is in the Unites States and Canada.
Information about the ambulance service provided to the patient.
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Code indicating the reason for ambulance transport. For example, A - Patient was transported to nearest facility for care of symptoms, complaints, or both. Visit Claims code lists for a complete list.
ABCDEThe weight of the patient, in pounds, at the time of transport. Provide this value as a decimal, such as 150.5
The reason for the round trip ambulance service.
The reason for usage of a stretcher during ambulance service.
The number of miles the ambulance traveled to transport the patient. Provide this value as a decimal, such as 20.5. Note that 0 (zero) is a valid value when ambulance services do not include a charge for mileage.
The surgical code. Required on claims where anesthesiology services are being billed or reported when the provider knows the surgical code and knows the adjudication of the claim will depend on provision of the surgical code.
The country code where the accident occurred. Use when relatedCausesCode = AA and the accident occurred in a country other than US or Canada.
A code identifying the state or province in which the automobile accident occurred. Use this code when relatedCausesCode is set to AA.
A code indicating whether the patient or an authorized person has authorized the plan to remit payment directly to the provider. Use W when the patient refuses to assign benefits. Can be set to N - No (Payment should go to the patient), Y - Yes (Payment should go directly to the provider), or W - Not Applicable (use when patient refuses to assign benefits).
NWYThe total dollar amount charged for the services on this claim, expressed as a decimal. For example, 100.50. This is the total amount before any adjustments or payments. The amount must balance to the sum of the service line charges.
Required when the submitter is contractually obligated to supply this information on post-adjudicated claims.
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^\d+(\.\d{1,2})?$The total dollar amount of the contract, expressed as a decimal. For example, 100.50.
The contract code. This is a unique identifier for the contract.
The allowance or charge percent, expressed as a decimal. For example, 0.80.
A code identifying the type of contract. Can be set to 01 - Diagnosis Related Group (DRG), 02 - Per Diem, 03 - Variable Per Diem, 04 - Flat, 05 - Capitated, 06 - Percent, or 09 - Other.
0102030405An additional identifer for the contract. Identifies the revision level of a particular format, program, technique or algorithm.
Terms discount percentage, expressed as a percent, available to the purchaser if an invoice is paid on or before the Terms Discount Due Date.
You must provide at least one date related to the claim. For example, the date on which the patient was admitted to the hospital.
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The date of the accident related to this claim. Required when relatedCausesCode is set to AA - Auto Accident or OA - Other Accident. Also required when relatedCausesCode is set to EM - Employment and this claim is the result of an accident.
The date the patient first experienced acute symptoms for a chronic condition. Required when the patientConditionCode = A (Acute Condition) or M (Acute Manifestation of a Chronic Condition), the claim involves spinal manipulation, and the payer is Medicare.
The date the patient was admitted to the hospital. Required on ambulance claims when the patient was known to be admitted to the hospital. Also required on inpatient claims.
The date the provider filing this claim assumed care from another provider during post-operative care. Required when providers share post-operative care (global surgery claims).
The date the provider filing this claim relinquished post-operative care to another provider. Required when providers share post-operative care (global surgery claims).
The date the provider has authorized the patient to return to work. Required on claims where this information is necessary for adjudication, such as workers compensation claims.
The start date of the patient's disability period. You can include this date without providing a disabilityEndDate if the patient is currently disabled and the end date is unknown. Used for claims involving disability where the provider judges that the patient was or will be unable to perform the duties normally associated with their work.
The end date of the patient's disability period. You can include this date without including a disabilityStartDate if the patient is no longer disabled and the start date is unknown. Used for claims involving disability where the provider judges that the patient was or will be unable to perform the duties normally associated with their work.
The date the patient was discharged from the hospital. Required for inpatient claims when the patient was discharged from the facility and the discharge date is known
Date the patient first consulted the provider for their condition by any means. This is not necessarily the same as the initial treatment date. Required for Property and Casualty claims when state mandated.
The date of the patient's hearing and vision prescription. Required on claims where a prescription has been written for hearing devices or vision frames and lenses and it is being billed on this claim.
The date the patient first received treatment for the current illness or condition. Required when the Initial Treatment Date is known to impact adjudication for claims involving spinal manipulation, physical therapy, occupational therapy, speech language pathology, dialysis, optical refractions, or pregnancy.
The date of the patient's last menstrual period. Required when the provider believes the services on this claim are related to the patient's pregnancy.
The date that the patient was seen by the attending or supervising physician for the qualifying medical condition related to the services performed. Required when claims involve services for routine foot care and this date is known to impact the payer's adjudication process.
The date the patient last worked, related to disability claims. Required on claims where this information is necessary for adjudication, such as workers compensation claims.
The date of the patient's last x-ray. Required when claim involves spinal manipulation and an x-ray was taken.
The date the repricing entity received the initial claim. Required when a repricer is passing the claim onto the payer.
The date the patient began experiencing acute symptoms for the current illness or condition. Required for the initial medical service or visit performed in response to a medical emergency when the date is available and is different than the date of service.
A code identifying the type of claim. For example DS - Disability.
- Use
OFwhen submitting Medicare Part D claims. - Use
ZZwhen you don't know the type of insurance. - Some payers reject claims with invalid codes. If you're not sure which code to use, we recommend running a real-time eligibility check and using the value returned in the most relevant
benefitsInformation.insuranceTypeCodeproperty. Note that the eligibility response uses a different code list than claims, so you may need to map that code value to the appropriate claim filing code.
Visit Claims code lists for a complete list.
1112131415Bill Type Frequency Code specifying the frequency of the claim. Can be set to 1 - Admit thru Discharge Claim, 7 - Replacement of Prior Claim, or 8 - Void/Cancel of Prior Claim.
- Set this to
1when 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 set this property to1for every resubmission to Original Medicare because Original Medicare doesn't accept code7. - Set this to
7when you need to resubmit a corrected claim that the payer has already processed. These are claims that the payer has already adjudicated or claims that the payer has rejected with a 277CA containing the Payer Claim Control Number (PCCN), indicating it has entered the payer's system. - When resubmitting with code
7or voiding with code8, you must also include the Payer Claim Control Number (sometimes called the ICN) in theclaimInformation.claimSupplementalInformation.claimControlNumberproperty. An exception is Original Medicare, which requires that you omit the Payer Claim Control Number from resubmissions. - For resubmissions and cancellations, we strongly recommend including a unique Patient Control Number in the
claimInformation.patientControlNumberfor tracking purposes.
Visit Resubmit or cancel claims for complete details.
178Comments or special instructions related to the claim. Contains information required to substantiate the medical treatment that isn't provided elsewhere in the claim.
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Additional information.
Certification narrative.
Additional information about the diagnosis.
Information about goals, rehabilitation potential, or discharge plans.
Notes from a third-party organization.
Repricing information to be completed by repricers, not providers. For capitated encounters, pricing or repricing information usually is not applicable and is provided to qualify other information within the claim.
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Code specifying the exception reason for consideration of out-of-network health care services. This is the reason generated by the third-party health organization. Visit Claims code lists for a complete list.
12345Code indicating the policy compliance. Visit Claims code lists for a complete list.
12345Code indicating the pricing or repricing methodology. Visit Claims code lists for a complete list.
0001020304Code indicating the rejection message returned from the third party organization. Visit Claims code lists for a complete list.
T1T2T3T4T5^\d+(\.\d{1,2})?$The dollar amount, expressed as a decimal. For example, 100.50.
^\d+(\.\d{1,2})?$The dollar amount, expressed as a decimal.
The code indicating the type of repricing.
^\d+(\.\d{1,2})?$The dollar amount, expressed as a decimal.
The identifier of the organization that repriced the claim.
The pricing rate associated with per diem or flat rate repricing, expressed as a decimal.
Additional information or documentation required for the claim. This is where you can include information about attachments, if applicable.
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Required when the repricer believes this information is necessary. Providers should not complete this property.
Required when the physician is billing Medicare for Care Plan Oversight (CPO). This is the number of the home health agency or hospice providing Medicare covered services to the patient.
This is the Payer Claim Control Number (PCCN) for an existing claim that this claim is meant to replace or cancel. This property is generally required when the claimInformation.claimFrequencyCode is set to 7 or 8. One exception to this guidance is Original Medicare, which specifies that you omit the PCCN from resubmissions.
Visit Resubmit or cancel claims for complete details and information about where to find the PCCN for an existing claim.
The claim number assigned by clearinghouse, van, etc.
Stedi overwrites this value when it sends the claim to the payer, so you shouldn't include this property in your request. We strongly recommend using the claimInformation.patientControlNumber property as your claim tracking ID.
Required for all CLIA certified facilities performing CLIA covered laboratory services. When this claim contains both in-house and outsourced laboratory services, use the CLIA Number for laboratory services performed by the billing or rendering provider. You can report outsourced laboratory services in the serviceLines object.
Required when it is necessary to identify claims that are atypical in ways such as content, purpose, and/or payment. For example, claims made as the result of a demonstration or a clinical trial.
Required when claim involves a Food and Drug Administration (FDA) assigned investigational device exemption (IDE) number. When more than one IDE applies, you must split into separate claims.
Required when mammography services are rendered by a certified mammography provider.
Required when the provider needs to identify the actual medical record of the patient for this episode of care.
Required when the submitter is Medicare and the claim is a Medigap or COB crossover claim.
Required when an authorization number is assigned by the payer or UMO and the services on this claim were preauthorized. The UMO (Utilization Management Organization) is generally the entity empowered to make a decision regarding the outcome of a health services review or the owner of information.
Required when a referral number is assigned by the payer or Utilization Management Organization (UMO) and a referral is involved.
Required when you plan to submit an attachment for the claim electronically through Stedi APIs or SFTP, when there is a paper attachment following this claim, or when the provider deems it necessary to identify additional information that is being held at the provider's office and is available upon request.
Use this object when there is a single attachment for the claim. If there are multiple attachments, use the reportInformations array instead.
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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
attachmentIdin 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.
^[0-9a-f]{8}-[0-9a-f]{4}-[0-9a-f]{4}-[0-9a-f]{4}-[0-9a-f]{12}$Length: 36The unique identifier for an attachment file you previously uploaded to Stedi. This value is returned in the attachmentId property of the Create Claim Attachment (275) JSON response. Stedi uses it to generate and submit the 275 claim attachment transaction to the payer.
- This property is required when you're submitting attachment files through Stedi.
- You must include either this property or
attachmentControlNumberin the request, but not both. Including both properties will result in an error.
Code indicating the title or contents of a document, report or supporting item. For example, 08 - Plan of Treatment or CT - Certification. Visit Claims code lists for a complete list.
0304050607Code identifying the method by which the provider's report is attached. Can be set to AA - Available on Request at Provider Site, BM - By Mail, EL - Electronically Only, EM - E-Mail, FT - File Transfer, or FX - By Fax.
Set this to EL when you plan to submit attachments electronically through Stedi APIs.
AABMELEMFTAn array of report information for the claim. Use this when you need to submit multiple report information records. You can submit up to 10 objects in this array.
Required when you plan to submit attachments for the claim electronically through Stedi APIs or SFTP, when there is a paper attachment following this claim, or when the provider deems it necessary to identify that they have additional information at their office that is available upon request.
Array item
A control number assigned to the attachment. The payer uses this identifier to match the attachment to the claim.
- You must include either this property or
attachmentIdin the request, but not both. Including both properties will result in an error. - We recommend using a ULID or UUID of up to 50 characters.
- Stedi autogenerates a control number if you don't provide one.
^[0-9a-f]{8}-[0-9a-f]{4}-[0-9a-f]{4}-[0-9a-f]{4}-[0-9a-f]{12}$Length: 36The 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
attachmentControlNumberin the request, but not both. Including both properties will result in an error.
Code indicating the title or contents of a document, report or supporting item. For example, 08 - Plan of Treatment or CT - Certification. Visit Claims code lists for a complete list.
0304050607Code identifying the method by which the provider's report is attached. Can be set to AA - Available on Request at Provider Site, BM - By Mail, EL - Electronically Only, EM - E-Mail, FT - File Transfer, or FX - By Fax.
Set this to EL when you plan to submit attachments electronically through Stedi APIs.
AABMELEMFTRequired when the repricer believes this information is necessary. Providers should not complete this property.
Code indicating the reason for the service authorization exception. Visit Claims code lists for a complete list.
12345Required when condition information applies to the claim. You can include up to 24 codes in the array. Visit the National Uniform Claim Committee for a complete list of possible condition codes.
Array item
An array of condition codes.
The patient's date of death.
Code indicating the reason for the delay in claim submission. Visit Claims code lists for a complete list.
12345Required on Early & Periodic Screening, Diagnosis, and Treatment (EPSDT) claims when the screening service is being billed in this claim.
This is required if any of the claim service lines are for EPSDT services. That means you must include this object if any claimInformation.serviceLines.professionalService.epsdtIndicator properties are set to Y.
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Code indicating whether an EPSDT referral was given to the patient. Can be set to N - No or Y - Yes.
NYCode indicating the patient's status. Set to AV when the patient refused the referral. Set to NU when you set certificationConditionCodeAppliesIndicator to N. Set to S2 when the patient is currently under treatment for the referred diagnostic or corrective health problem. Set to ST when either the patient is referred to another provider for diagnostic or corrective treatment for at least one health problem identified during an initial or periodic screening service (not including dental referrals) or the patient is scheduled for another appointment with the screening provider for diagnostic or corrective treatment for at least one health problem identified during an initial or periodic screening service (not including dental referrals).
AVNUS2STPlease use the fileInformationList array instead.
An array of additional information items the payer requested. Not commonly used.
Details about the patient's healthcare diagnosis.
- Use
ABKas the type for the principal diagnosis code andABFfor any other diagnosis codes you include. - One
ABKcode is required as the first object, and then you can submit up to 11ABFcodes as needed. If you need to submit more codes than this, you must create additional, separate claims.
Array item
The diagnosis code.
- 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.
Code indicating the specific industry code list. Can be set to ABK - International Classification of Diseases Clinical Modification (ICD-10-CM) Principal Diagnosis or ABF - International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis.
BKABKBFABFRequired for Medicare claims when an independent laboratory renders an EKG tracing or obtains a specimen from a homebound or institutionalized patient.
Required when other payers are known to potentially be involved in paying on this claim. This object contains information about other health plans under which the patient has coverage. It's used for coordination of benefits scenarios.
Array item
Code indicating whether or not the insured has authorized the plan to remit payment directly to the provider. Can be set to N - No (Payment should go to the patient), Y - Yes (Payment should go directly to the provider), or W - Not Applicable.
NWYA code identifying the type of claim. For example DS - Disability. Use OF when submitting Medicare Part D claims. Use ZZ when you don't know the type of insurance. Visit Claims code lists for a complete list.
1112131415Use this object to report prior payers' claim level adjustments that cause the amount paid to differ from the amount originally charged. Codes and associated amounts must come from either paper remittance advice or 835s (Electronic Remittance Advice) received on the claim. When the information originates from a paper remittance advice that does not use the standard Claim Adjustment Reason Codes, you must convert them to standard Claim Adjustment Reason Codes.
Array item
The adjustment reason codes and amounts. You can include up to six objects in this array to describe a single adjustment group code.
Array item
^\d+(\.\d{1,2})?$The dollar amount of the adjustment, expressed as a decimal. For example, 100.50.
The units of service being adjusted.
Code identifying the detailed reason the adjustment was made. Visit the X12 Claim Adjustment Reason Codes for a complete list.
Code identifying the general category of payment adjustment. Can be set to CO - Contractual Obligations, CR - Correction and Reversals, OA - Other Adjustments, PI - Payor Initiated Reductions, or `PR - Patient Responsibility.
COCROAPIPRCode identifying the relationship to the person insured. Visit Claims code lists for a complete list.
0118192021The group or policy number.
Code identifying the type of insurance policy within a specific insurance program. Visit Claims code lists for a complete list.
1213141516Claim-level data related to the adjudication of Medicare claims not related to an inpatient setting. Required when outpatient adjudication information is reported in the remittance advice or when you need to report remark codes.
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The remark code. Visit the X12 Remittance Advice Remark Codes for a complete list. You can include up to five codes in this array.
^\d+(\.\d{1,2})?$The End-Stage Renal Disease (ESRD) payment amount, expressed as a decimal.
^\d+(\.\d{1,2})?$The claim Health Care Financing Administration Common Procedural Coding System (HCPCS) payable amount, expressed as a decimal.
^\d+(\.\d{1,2})?$The professional component amount billed but not payable, expressed as a decimal.
The reimbursement percentage, expressed as a decimal.
^\d+(\.\d{1,2})?$Required when the destination payer's cost avoidance policy allows providers to bypass claim submission to the otherwise prior payer identified in otherSubscriberInformation.otherPayerName. The amount must equal the total claim charge amount you reported in claimInformation.claimChargeAmount.
The name of the health plan.
Information about the billing provider.
Array item
Code identifying the type of entity. Can be set to 1 - Person or 2 - Non-Person Entity.
12Identifiers for the billing provider.
Array item
The identifier. The format and length of this value depends on the qualifier you set.
The identifier for the other payer who provided this reference number. This is only required when the reference number is provided by the non-destination payer. The value must match the claimInformation.otherSubscriberInformation[].otherPayerName.otherPayerIdentifier property.
Set to LU - Location Number, or G2 - Provider Commercial Number.
Details about the other payer.
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The payer's address.
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The first line of the street address. This typically contains the building number and street name.
The second line of the street address. This typically contains the apartment or suite number.
The city name.
Use the alpha-2 country codes from Part 1 of ISO 3166.
Use the country subdivision codes from Part 2 of ISO 3166.
The postal zone or zip code. Exclude punctuation and spaces.
The state or province code. Only required when the city is in the Unites States and Canada.
The date the other payer adjudicated the claim. Required when this payer has previously adjudicated the claim and you aren’t including a value for LineAdjudicationInformation.adjudicationOrPaymentDate.
The only valid value is true. Required when Required when the claim is being sent in the payer-to-payer COB model AND the destination payer is secondary to this payer AND this payer has re-adjudicated the claim.
The claim control number assigned by this payer.
The identifier specified in otherPayerIdentifierCode. When sending Line Adjudication Information for this payer, the identifier sent in lineAdjudicationInformation.otherPayerPrimaryIdentifier must match this value.
Code designating the type of identifier. Can be set to PI - Payor Identification or XV - Centers for Medicare/Medicaid Services PlanID. Use code value XV when reporting Health Plan ID (HPID) or Other Entity Identifier (OEID).
PIXVThe payer's organization name.
The authorization number assigned by this payer.
The referral number assigned by this payer.
An additional identification number to identify the other payer.
Array item
The identifier. The format and length of this value depends on the qualifier you set.
The identifier for the other payer who provided this reference number. This is only required when the reference number is provided by the non-destination payer. The value must match the claimInformation.otherSubscriberInformation[].otherPayerName.otherPayerIdentifier property.
Set to 2U - Payer Identification Number, EI - Employer Identification Number, FY - Claim Office Number, or NF - National Association of Insurance Commissioners (NAIC) Code.
Information about the provider who directed the patient to the rendering provider for care. For example, a primary care physician may refer patients to a specialist.
Array item
Identifiers for the referring provider.
Array item
The identifier. The format and length of this value depends on the qualifier you set.
The identifier for the other payer who provided this reference number. This is only required when the reference number is provided by the non-destination payer. The value must match the claimInformation.otherSubscriberInformation[].otherPayerName.otherPayerIdentifier property.
Set to 0B - State License Number, 1G - Provider UPIN Number, or G2 - Provider Commercial Number. Note that UPIN is deprecated and shouldn't be used for new claims.
Information about the rendering provider.
Array item
Code identifying the type of entity. Can be set to 1 - Person or 2 - Non-Person Entity.
12Identifiers for the rendering provider.
Array item
The identifier. The format and length of this value depends on the qualifier you set.
The identifier for the other payer who provided this reference number. This is only required when the reference number is provided by the non-destination payer. The value must match the claimInformation.otherSubscriberInformation[].otherPayerName.otherPayerIdentifier property.
Set to 0B - State License Number, 1G - Provider UPIN Number, LU - Location Number, or G2 - Provider Commercial Number. Note that UPIN is deprecated and shouldn't be used for new claims.
Information about the service facility location.
Array item
A secondary identifier for the service facility location.
Array item
The identifier. The format and length of this value depends on the qualifier you set.
The identifier for the other payer who provided this reference number. This is only required when the reference number is provided by the non-destination payer. The value must match the claimInformation.otherSubscriberInformation[].otherPayerName.otherPayerIdentifier property.
Set to 0B - State License Number, LU - Location Number, or G2 - Provider Commercial Number.
Information about the supervising provider.
Array item
Identifiers for the supervising provider.
Array item
The identifier. The format and length of this value depends on the qualifier you set.
The identifier for the other payer who provided this reference number. This is only required when the reference number is provided by the non-destination payer. The value must match the claimInformation.otherSubscriberInformation[].otherPayerName.otherPayerIdentifier property.
Set to 0B - State License Number, 1G - Provider UPIN Number, LU - Location Number or G2 - Provider Commercial Number. Note that UPIN is deprecated and shouldn't be used for new claims.
The person or entity who is the primary policyholder for the other payer's health plan.
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The primary policyholder's Social Security Number. The Social Security Number must be a string of exactly nine numbers with no separators. For example 123456789.
The other subscriber's address.
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The first line of the street address. This typically contains the building number and street name.
The second line of the street address. This typically contains the apartment or suite number.
The city name.
Use the alpha-2 country codes from Part 1 of ISO 3166.
Use the country subdivision codes from Part 2 of ISO 3166.
The postal zone or zip code. Exclude punctuation and spaces.
The state or province code. Only required when the city is in the Unites States and Canada.
The primary policyholder's first name, if they are an individual.
The identifier you specified in otherInsuredIdentifierTypeCode.
Code identifying the type of identifier. Can be set to II - Standard Unique Health Identifier for each individual in the United States or MI - Member Identification Number. The code MI should be the subscriber's identification number as assigned by the payer, such as their subscriber ID. You should also use MI in claims submitted to the Indian Health Service/Contract Health Services (IHS/CHS) Fiscal Intermediary for the purpose of reporting the Tribe Residency Code (Tribe County State). For IHS/CHS claims, you should also put the SSN in the otherInsuredAdditionalIdentifier property.)
IIMIThe primary policyholder's last name or organizational name. Don't include the primary policyholder's name suffix, such as Jr. or III. Use the designated otherInsuredNameSuffix property instead.
The primary policyholder's middle name or initial, if they are an individual.
The primary policyholder's name suffix, such as Jr. or III. Only include the subscriber's personal name suffix - don't include professional or academic titles, such as M.D. or MBA.
Code identifying the type of entity. Can be set to 1 - Person or 2 - Non-Person Entity.
12Code indicating how the patient or subscriber authorization signatures were obtained and how they are being retained by the provider. Can be set to true - Signature generated by provider because the patient was not physically present for services. This means the signature was generated by an entity other than the patient according to State or Federal law. This property is required for claims submitted to Medicare.
^\d+(\.\d{1,2})?$The total amount in dollars the payer has paid on this claim. It is acceptable to set this to 0 (Zero). This is required when you include the payToPlan object, and you should set it to the amount the Medicaid agency actually paid.
Code identifying the payer's level of responsibility for paying this claim. Visit Claims code lists for a complete list.
- Either this property or
subscriber.paymentResponsibilityLevelCodemust be set toPto indicate the primary insurance payer. Stedi rejects claims - including secondary and tertiary claims - that don't include information for the primary payer. - You may need to use other codes if the patient has multiple insurance policies. For example, if a patient is covered by both Medicare and an employer-sponsored commercial plan, you could bill the commercial payer first as
Pand then bill the Medicare payer second asS.
ABCDECode indicating whether the provider has on file a signed statement by the patient authorizing the release of medical data to other organizations. Can be set to I - Informed Consent to Release Medical Information or Y - Yes. Code I is required when the provider has not collected a signature AND state or federal laws do not require a signature be collected. Code Y is required when the provider has collected a signature OR when state or federal laws require a signature be collected.
IY^\d+(\.\d{1,2})?$This is the remaining amount (as determined by the provider) to be paid after the other payer identified in the otherPayerName object has adjudicated the claim.
The total amount in dollars the patient or their representatives have paid on this claim. For example, 20.50. This includes any co-payments, co-insurance, or other amounts already collected from the patient.
If the patient has not paid anything, you should omit this property entirely - don't set it to 0.
Required on vision claims involving replacement lenses or frames when this information is known to impact reimbursement.
Array item
Code indicating whether there is a certification. Can be set to N - No or Y - Yes.
NYIdentifies the category to which the conditionCode applies. Can be set to E1 - Spectacle Lenses, E2 - Contact Lenses, or E3 - Spectacle Frames.
E1E2E3Code indicating the reason for the vision services. Visit Claim code lists for a complete list.
L1L2L3L4L5An identifier you assign to the claim. We strongly recommend submitting a unique value for this property so you can use it to correlate this claim with responses, such as the 277CA and 835 ERA.
- We recommend using only alphanumeric characters and generating unique values that are the shortest possible length. Stedi accepts any valid value, but some payers replace non-alphanumeric characters and truncate shorter than the official 20-character limit. When this happens, the payer returns a different identifier in responses than the one you originally sent, making it more difficult to correlate the claim and perform real-time claim status checks.
- If you plan to submit the autogenerated CMS-1500 PDF for this claim, you must limit this value to 14 characters or this value will be truncated in the PDF.
Code indicating how the patient or subscriber authorization signatures were obtained and how they are being retained by the provider. Can be set to true - Signature generated by provider because the patient was not physically present for services. This means the signature was generated by an entity other than the patient according to State or Federal law. This property is required for claims submitted to Medicare.
The patient's weight in pounds, such as 150. You should only set this property if the payer specifically requests it, such as for some Medicare DME claims. Otherwise, including this property can trigger claim edits.
Code identifying the type of facility where the services were or may be performed. Visit Place of Service Codes for a complete list.
0102030405Code indicating whether the provider accepts assignment. This refers to whether the provider accepts assignment and/or has a participation agreement with the destination payer. It does not indicate whether the patient has assigned benefits to the provider. Can be set to A - Assigned, B - Assignment Accepted on Clinical Lab Services Only, or C - Not Assigned. Choose A when the provider accepts assignment and/or has a participation agreement with the destination payer, OR the provider does not accept assignment and/or have a participation agreement, but is advising the payer to adjudicate this specific claim under the participating provider benefits allowed under certain plans.
ABCCode indicating whether the patient is pregnant. Can be set to Y - Yes.
YThe agency claim number for this transaction. Used when services included in this claim are part of a property and casualty claim.
Code identifying an accompanying cause of an illness, injury or an accident. Can be set to AA - Auto Accident, EM - Employment, or OA - Other Accident. You can include up to two codes in this array.
AAEMOAIndicates whether the provider has on file a signed statement by the patient authorizing the release of medical data to other organizations. Can be set to Y - Yes, or I - Informed Consent to Release Medical Information for Conditions or Diagnoses Regulated by Federal Statues. Use I when the provider has not collected a signature AND state or federal laws do not require a signature be collected.
IYRequired when the location for the service is different from the billing provider's address. The purpose of this object is to identify specifically where the service was rendered. This can be healthcare facilities, such as surgical centers or reference labs, OR the patient's address when services were rendered in their home.
- Only include this object when the service facility location is different from the billing provider's address. If you include this object when the address is the same, Stedi omits all of the service facility location information from the claim submission, including the name and any identifiers.
- Don't use this object when reporting ambulance services - use
ambulancePickupLocationandambulanceDropoffLocationinstead. - Sometimes the billing provider is an actual physician group that is located at the same address as a hospital, but is in fact a separate entity. In this case, you can differentiate the service facility location by including the specific suite or building number of the physician group. This ensures that the service facility location is different from the billing provider's address and is reported accurately.
Show attributes
The address of where services were rendered.
If the service facility location is 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'.
For United States addresses, you must include the full nine-digit zip code with no separators, such as 100031502. If you don't know the full zip code, you can find it using the USPS ZIP Code Lookup tool.
Show attributes
The first line of the street address. This typically contains the building number and street name.
The second line of the street address. This typically contains the apartment or suite number.
The city name.
Use the alpha-2 country codes from Part 1 of ISO 3166.
Use the country subdivision codes from Part 2 of ISO 3166.
The postal zone or zip code. Exclude punctuation and spaces.
The state or province code. Only required when the city is in the Unites States and Canada.
The organization National Provider Identifier (NPI) assigned to the service facility. Only include this property when the service facility is not a component or subpart of the billing provider. Don't include when the service facility is the patient's home.
The laboratory or facility name. When services were rendered in the patient's home, we recommend setting this to Residence or something similar.
The telephone extension, if applicable. Only submit the numeric extension. For example, don't include data that indicates an extension, such as 'ext.' or 'x-'.
The full name of the person or office.
The phone number, formatted as AAABBBCCCC, where AAA represents the area code, BBB is the telephone number prefix, and CCCC is the telephone number. The phone number should only include the digits 0 to 9. Don't include separators, such as dashes, and don't include long distance access numbers, such as 1. For example, you would format the phone number 123-456-7890 as 1234567890.
Secondary identifiers for the service facility location. Used when another identifier is needed for the claims processor to identify the facility or when the entity is not a healthcare provider and does not have an NPI.
Array item
The identifier. The format and length of this value depends on the qualifier you set.
The identifier for the other payer who provided this reference number. This is only required when the reference number is provided by the non-destination payer. The value must match the claimInformation.otherSubscriberInformation[].otherPayerName.otherPayerIdentifier property.
Set to 0B - State License Number, LU - Location Number, or G2 - Provider Commercial Number.
Information about one or more services rendered to the patient.
- Each service line must be a unique service event as defined by the payer's billing policies. This means that you can use the same procedure code on multiple service lines as long as they are distinct events.
- Some procedure codes are date-specific. In these cases, you may need to create a separate service line with that code for each applicable date of service, even if the episode of care extended over multiple days.
- Service lines can share the same dates of service if the patient received multiple services on the same day.
Array item
Additional information the provider feels is necessary to substantiate the medical treatment that cannot be provided in other claim properties. Don't use this property to describe non-specific procedure codes.
Required when the claim involves ambulance transport services.
Array item
Code indicating whether there is an ambulance certification.
NY0104050607The address where the ambulance dropped off the patient.
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The first line of the street address. This typically contains the building number and street name.
The second line of the street address. This typically contains the apartment or suite number.
The city name.
Use the alpha-2 country codes from Part 1 of ISO 3166.
Use the country subdivision codes from Part 2 of ISO 3166.
The postal zone or zip code. Exclude punctuation and spaces.
The state or province code. Only required when the city is in the Unites States and Canada.
The number of patients transported by the ambulance. Required when more than one patient is transported in the same vehicle for Ambulance or non-emergency transportation services.
The address where the ambulance picked up the patient. If the ambulance pickup location is in an area where there are no street addresses, enter a description of where the service was rendered. For example Exit near mile marker 123 on I-95.
Show attributes
The first line of the street address. This typically contains the building number and street name.
The second line of the street address. This typically contains the apartment or suite number.
The city name.
Use the alpha-2 country codes from Part 1 of ISO 3166.
Use the country subdivision codes from Part 2 of ISO 3166.
The postal zone or zip code. Exclude punctuation and spaces.
The state or province code. Only required when the city is in the Unites States and Canada.
Information about the ambulance service provided to the patient.
Show attributes
Code indicating the reason for ambulance transport. For example, A - Patient was transported to nearest facility for care of symptoms, complaints, or both. Visit Claims code lists for a complete list.
ABCDEThe weight of the patient, in pounds, at the time of transport. Provide this value as a decimal, such as 150.5
The reason for the round trip ambulance service.
The reason for usage of a stretcher during ambulance service.
The number of miles the ambulance traveled to transport the patient. Provide this value as a decimal, such as 20.5. Note that 0 (zero) is a valid value when ambulance services do not include a charge for mileage.
Deprecated; Stedi computes this value for you.
Required when a Durable Medical Equipment Regional Carrier Certificate of Medical Necessity (DMERC CMN) or a DMERC Information Form (DIF), or Oxygen Therapy Certification is included on this service line and the information is necessary for adjudication.
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Code indicating whether there is a certification. Can be set to N - No or Y - Yes.
YNCode indicating the condition of the certificate. Can be set to 38 - Certification signed by the physician is on file at the supplier's office or ZV - Replacement Item.
38ZVA second code indicating the condition of the certificate. Can be set to 38 - Certification signed by the physician is on file at the supplier's office or ZV - Replacement Item.
38ZVRequired when the submitter is contractually obligated to supply this information on post-adjudicated claims.
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^\d+(\.\d{1,2})?$The total dollar amount of the contract, expressed as a decimal. For example, 100.50.
The contract code. This is an identifier for the contract.
The allowance or charge percent, expressed as a decimal. For example, 0.80.
Code indicating the type of contract. Can be set to 01 - Diagnosis Related Group (DRG), 02 - Per Diem, 03 - Variable Per Diem, 04 - Flat, 05 - Capitated, 06 - Percent, or 09 - Other.
0102030405An additional identifier for the contract. Identifies the revision level of a particular format, program, technique or algorithm.
Terms discount percentage, expressed as a decimal, available to the purchaser if an invoice is paid on or before the Terms Discount Due Date.
To report prescribed drugs and biologics.
Show attributes
Required when the provided medication involves the compounding of two or more drugs being reported and there is no prescription number. The link sequence number is a provider assigned number that is unique to this claim. It allows the receiver to piece together the components of the compound.
Code identifying the unit of measurement. Can be set to F2 - International Unit, GR - Gram, ME - Milligram, ML - Milliliter, or UN - Unit.
F2GRMEMLUNThe numeric value of the drug quantity.
In cases where a compound drug is being billed, the components of the compound will all have the same prescription number. Payers receiving the claim can relate all the components by matching the prescription number.
Code indicating the source of the drug code or product number. Visit Claims code lists for a complete list.
ENEOHIN4ONRequired on claims that include a Durable Medical Equipment Regional Carrier (DMERC) Certificate of Medical Necessity (CMN).
Show attributes
Code indicating the timing, transmission method, or format by which attachments will be sent. Required when the actual attachment is maintained by an attachment warehouse or similar vendor. Visit Claims code lists for a complete list. Use code NS when the paperwork is available on request at the provider's site, but is not being sent with the claim at this time.
ABADAFAGNSRequired when a Durable Medical Equipment Regional Carrier Certificate of Medical Necessity (DMERC CMN) or a DMERC Information Form (DIF) or Oxygen Therapy Certification is included on this service line.
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Code indicating the type of certification. Can be set to I - Initial, R - Renewal, or S - Revised.
IRSThe length of time the DME equipment is needed.
Information about durable medical equipment. For example, the rental and purchase price information.
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The length of medical treatment required.
Code indicating the frequency at which the rental equipment is billed. Can be set to 1 - weekly, 4 - monthly, or 6 - daily.
146The purchase price for the equipment, expressed as a decimal. For example, 100.50.
The rental price for the equipment, expressed as a decimal. For example, 100.50.
Used to send additional data specifically requested by the payer. Not commonly used.
Use this object to attach standardized supplemental information to the claim when required by the payer. One example is payer documentation requirements for home health services.
Array item
A code from the industry code list you identified in formTypeCode.
Code indicating the type of form. Can be set to AS - Form Type Code or UT - Centers for Medicare and Medicaid Services (CMS) Durable Medical Equipment Regional Carrier (DMERC) Certificate of Medical Necessity (CMN) Forms. Set this to AS when you plan to include a home health form in the formIdentifier property.
ASUTUse to provide information in response to a coded questionnaire document.
Array item
A text response to the question.
Date value.
Percent formatted as a decimal.
Code indicating a yes or no condition response to the question. Can be set to N - No, W - Not Applicable, or Y - Yes.
NWYThe provider's goals, rehabilitation potential, or discharge plans for the patient.
Whether the rendering provider is a hospice employee. Required on all Medicare claims involving physician services to hospice patients. Set to true if the rendering provider is a hospice employee, and false if they are not.
Includes service line adjudication information for coordination of benefits between the initial payers of a health care claim and all subsequent payers.
Array item
^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$The date the other payer adjudicated or paid the claim.
The LX assigned number of the service line into which this service line is bundled. It's only used to bundle service lines.
Required when the payer made line level adjustments which caused the amount paid to differ from the amount originally charged. You can include up to five objects in this array.
Array item
The adjustment reason codes and amounts. You can include up to six objects in this array to describe a single adjustment group code.
Array item
^\d+(\.\d{1,2})?$The dollar amount of the adjustment, expressed as a decimal. For example, 100.50.
The units of service being adjusted.
Code identifying the detailed reason the adjustment was made. Visit the X12 Claim Adjustment Reason Codes for a complete list.
Code identifying the general category of payment adjustment. Can be set to CO - Contractual Obligations, CR - Correction and Reversals, OA - Other Adjustments, PI - Payor Initiated Reductions, or `PR - Patient Responsibility.
COCROAPIPRThe payer ID for the payer responsible for reimbursement.
The number of paid units from the remittance advice. expressed as a decimal. When paid units are not present on the remittance advice, use the original billed units. The maximum length for this property is 8 digits excluding the decimal. When a decimal is used, the maximum number of digits allowed to the right of the decimal is three.
The procedure code.
The meaning of the procedure code.
Modifiers that convey special circumstances related to the performance of the service. You can include up to four modifiers in this array.
^\d+(\.\d{1,2})?$The amount of the service line that the patient is still responsible for, expressed as a decimal.
Code identifying the type of procedureCode. Visit Claims code lists for a complete list.
ERHCHPIVWK^\d+(\.\d{1,2})?$The amount paid for this service line, expressed as a decimal. Zero (0) is an acceptable value.
Repricing information to be completed by repricers, not providers. For capitated encounters, pricing or repricing information usually is not applicable and is provided to qualify other information within the claim.
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Code specifying the exception reason for consideration of out-of-network health care services. This is the reason generated by the third-party health organization. Visit Claims code lists for a complete list.
12345Code indicating the policy compliance. Visit Claims code lists for a complete list.
12345Code indicating the pricing or repricing methodology. Visit Claims code lists for a complete list.
0001020304Code indicating the rejection message returned from the third party organization. Visit Claims code lists for a complete list.
T1T2T3T4T5^\d+(\.\d{1,2})?$The dollar amount, expressed as a decimal. For example, 100.50.
^\d+(\.\d{1,2})?$The dollar amount, expressed as a decimal.
The code indicating the type of repricing.
^\d+(\.\d{1,2})?$The dollar amount, expressed as a decimal.
The identifier of the organization that repriced the claim.
The pricing rate associated with per diem or flat rate repricing, expressed as a decimal.
The number of units reported by an anesthesia provider to reflect additional complexity of services.
Information about the provider who requested the services or items reported in this service line.
This should be an individual, not an organization, and you should supply at least the provider's lastName and an identifier, which is typically the npi.
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Show attributes
The first line of the street address. This typically contains the building number and street name.
The second line of the street address. This typically contains the apartment or suite number.
The city name.
Use the alpha-2 country codes from Part 1 of ISO 3166.
Use the country subdivision codes from Part 2 of ISO 3166.
The postal zone or zip code. Exclude punctuation and spaces.
The state or province code. Only required when the city is in the Unites States and Canada.
Show attributes
The email address.
The fax number, formatted as AAABBBCCCC.
The full name of the person or office.
The phone extension, if applicable.
The phone number, formatted as AAABBBCCCC, where AAA represents the area code, BBB is the telephone number prefix, and CCCC is the telephone number. The phone number should only include the digits 0 to 9. Don't include separators, such as dashes, and don't include long distance access numbers, such as 1. For example, you would format the phone number 123-456-7890 as 1234567890.
The provider's first name.
The provider's last name.
The provider's middle name or initial.
The individual National Provider Identifier (NPI) assigned to the provider.
The provider's business name.
This field is now automatically populated and it only remains for backwards compatibility.
Secondary identifiers for the ordering provider.
Array item
The identifier. The format and length of this value depends on the qualifier you set.
The identifier for the other payer who provided this reference number. This is only required when the reference number is provided by the non-destination payer. The value must match the claimInformation.otherSubscriberInformation[].otherPayerName.otherPayerIdentifier property.
Set to 0B - State License Number, 1G - Provider UPIN Number, or G2 - Provider Commercial Number. Note that UPIN is deprecated and shouldn't be used for new claims.
Social Security Number without spaces or punctuation (9 digits)
The provider's name suffix, such as Jr. or III.
^[A-Za-z0-9]{10}$Length: 10^\d+(\.\d{1,2})?$The amount of the postage, formatted as a decimal. When you include this property, the total lineItemChargeAmount for this service line must include this postage value.
Information about the service rendered.
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Diagnosis code pointers in order of importance to this service line. These pointers are an index to the ICD-10-CM codes you included in the claimInformation.healthCareCodeInformation object array. The pointer values can be from 1 to 12 (integer numbers).
- You must set at least one pointer for the primary diagnosis. Then, you can add up to three additional pointers (up to four in total).
- The number of pointers cannot exceed the number of diagnosis codes in the
claimInformation.healthCareCodeInformationobject array. For example, if you only supplied one diagnosis code, then the only valid pointer value is 1. - Don't put ICD-10-CM codes here - they belong in
claimInformation.healthCareCodeInformation.
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A diagnosis code pointer for this service line.
Code indicating whether co-payment requirements were met. Can be set to O - Copay exempt.
0A free form description to clarify the procedure code and any procedure modifiers, as needed.
Code indicating whether the service was related to an emergency. Can be set to Y - Yes. An emergency is when the patient requires immediate medical intervention as a result of severe, life threatening, or potentially disabling conditions.
YCode indicating whether there was EPSDT involvement in the service. Can be set to Y - Yes. EPSDT is a program that provides comprehensive and preventive health care services for children under age 21 who are enrolled in Medicaid.
If this value is set to Y, you must also include the claimInformation.epsdtReferral object in your claim submission.
YCode indicating whether the service was related to family planning. Can be set to Y - Yes.
Y^\d+(\.\d{1,2})?$The total charge amount for the service, including the provider's base charge and any applicable tax or postage. It is acceptable to set this to 0 (zero).
Code identifying the unit of measurement. Can be set to MJ - Minutes or UN - Unit. Minutes is required for anesthesia services. Note that anesthesia time is counted from the moment that the practitioner, having completed the preoperative evaluation, starts an intravenous line, places monitors, administers pre-anesthesia sedation, or otherwise physically begins to prepare the patient for anesthesia. Time continues throughout the case and while the practitioner accompanies the patient to the post-anesthesia recovery unit (PACU). Time stops when the practitioner releases the patient to the care of PACU personnel.
MJUNA code identifying the location where services were rendered. Visit Place of Service Codes for a complete list.
The procedure code.
Code identifying the specific industry code list used for the procedureCode. Visit Claims code lists for a complete list.
ERHCIVWKA modifier code that clarifies or improves the reporting accuracy of the associated procedure code. If not required, do not send.
The number of units of the service provided, formatted as a decimal. The units depend on the procedure code being billed 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).
A unique identifier for this service line within the claim. It appears in the 835 (ERA) response as lineItemControlNumber, allowing you to correlate ERAs to the specific service lines from the original claim. If you don't set this property, Stedi uses a random ULID. Stedi returns service line identifiers in the claimReference.serviceLines.lineItemControlNumber object of the synchronous API response.
Specify information about services that were purchased. Required on non-vision service lines when adjudication is known to be impacted by the charge amount for services purchased from another source OR when adjudication is known to be impacted by the acquisition cost of lenses.
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The cost of the purchased service.
This must be the same identifier you provided within claimInformation.serviceLines.purchasedServiceProvider.
Information about the provider who performed the purchased service. A purchased service provider performs a service on a contractual or reassignment basis for the billing provider. Examples of purchased services include processing a laboratory specimen and performing diagnostic testing services (excluding clinical laboratory testing) subject to Medicare's anti-markup rule. Note that a substitute provider (a locum tenens physician) is not considered a purchased service provider.
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Show attributes
The first line of the street address. This typically contains the building number and street name.
The second line of the street address. This typically contains the apartment or suite number.
The city name.
Use the alpha-2 country codes from Part 1 of ISO 3166.
Use the country subdivision codes from Part 2 of ISO 3166.
The postal zone or zip code. Exclude punctuation and spaces.
The state or province code. Only required when the city is in the Unites States and Canada.
The provider's commercial number.
You must include at least one communication method (phone, fax, or email) in this object.
Show attributes
The email address.
The fax number.
The full name of the person or office.
The phone extension, if applicable.
The phone number, formatted as AAABBBCCCC, where AAA represents the area code, BBB is the telephone number prefix, and CCCC is the telephone number. The phone number should only include the digits 0 to 9. Don't include separators, such as dashes, and don't include long distance access numbers, such as 1. For example, you would format the phone number 123-456-7890 as 1234567890.
The National Provider Identifier (NPI) assigned to the provider.
The payer identification number. This must match the value you provided in claimInformation.otherSubscriberInformation.otherPayerName.otherPayerIdentifier.
This field is now automatically populated and it only remains for backwards compatibility.
Secondary identifiers for the purchased service provider.
Array item
The identifier. The format and length of this value depends on the qualifier you set.
The identifier for the other payer who provided this reference number. This is only required when the reference number is provided by the non-destination payer. The value must match the claimInformation.otherSubscriberInformation[].otherPayerName.otherPayerIdentifier property.
Set to 0B - State License Number, 1G - Provider UPIN Number, or G2 - Provider Commercial Number. Note that UPIN is deprecated and shouldn't be used for new claims.
^\d{9}$Social Security Number without spaces or punctuation (9 digits)
The provider's state license number. This is assigned directly by a payer in order to identify the provider in their system. This is not commonly used.
^[A-Za-z0-9]{10}$Length: 10Information about the provider who directed the patient to the rendering provider for care. For example, a primary care provider may refer patients to a specialist. Include this object when the referring provider is different than the one listed in the referring object for the entire claim.
This should be an individual, not an organization, and you should supply at least the provider's lastName and an identifier, which is typically the npi.
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Show attributes
The first line of the street address. This typically contains the building number and street name.
The second line of the street address. This typically contains the apartment or suite number.
The city name.
Use the alpha-2 country codes from Part 1 of ISO 3166.
Use the country subdivision codes from Part 2 of ISO 3166.
The postal zone or zip code. Exclude punctuation and spaces.
The state or province code. Only required when the city is in the Unites States and Canada.
The provider's commercial number.
You must include at least one communication method (phone, fax, or email) in this object.
Show attributes
The email address.
The fax number.
The full name of the person or office.
The phone extension, if applicable.
The phone number, formatted as AAABBBCCCC, where AAA represents the area code, BBB is the telephone number prefix, and CCCC is the telephone number. The phone number should only include the digits 0 to 9. Don't include separators, such as dashes, and don't include long distance access numbers, such as 1. For example, you would format the phone number 123-456-7890 as 1234567890.
The provider's Employer Identification Number (EIN). The EIN is typically a string of exactly nine numbers with no separators, unless otherwise specified by the provider. If you include this value, you cannot include the provider's ssn.
The provider's Employer Identification Number (EIN). This field is the same as employerId. The EIN is typically a string of exactly nine numbers with no separators, unless otherwise specified by the provider. If you include this value, you cannot include the provider's ssn.
The provider's first name.
The provider's last name.
The provider's location number.
The provider's middle name or initial.
The National Association of Insurance Commissioners (NAIC) code.
The individual National Provider Identifier (NPI) assigned to the provider.
The provider's organization name.
The payer identification number.
This field is now automatically populated and it only remains for backwards compatibility.
Deprecated; do not use.
Secondary identifiers for the referring provider.
Array item
The identifier. The format and length of this value depends on the qualifier you set.
The identifier for the other payer who provided this reference number. This is only required when the reference number is provided by the non-destination payer. The value must match the claimInformation.otherSubscriberInformation[].otherPayerName.otherPayerIdentifier property.
Set to 0B - State License Number, 1G - Provider UPIN Number, or G2 - Provider Commercial Number. Note that UPIN is deprecated and shouldn't be used for new claims.
The provider's Social Security Number. If you provide this value, you cannot include the provider's employerId.
The provider's state license number. This is assigned directly by a payer in order to identify the provider in their system. This is not commonly used.
The provider's name suffix, such as Jr. or III.
^[A-Za-z0-9]{10}$Length: 10Code from the National Uniform Claims Committee Health Care Provider Taxonomy Code Set. This identifies the provider's type and/or area of specialty.
Information about the provider who rendered the services. This can be a individual or a company (a laboratory or other facility). This is where you should enter the substitute provider's (locum tenens physician) information, if applicable.
You should only include this object when the rendering provider information for this service line is different than the information listed in the rendering object for the entire claim.
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The first line of the street address. This typically contains the building number and street name.
The second line of the street address. This typically contains the apartment or suite number.
The city name.
Use the alpha-2 country codes from Part 1 of ISO 3166.
Use the country subdivision codes from Part 2 of ISO 3166.
The postal zone or zip code. Exclude punctuation and spaces.
The state or province code. Only required when the city is in the Unites States and Canada.
The provider's commercial number.
You must include at least one communication method (phone, fax, or email) in this object.
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The email address.
The fax number.
The full name of the person or office.
The phone extension, if applicable.
The phone number, formatted as AAABBBCCCC, where AAA represents the area code, BBB is the telephone number prefix, and CCCC is the telephone number. The phone number should only include the digits 0 to 9. Don't include separators, such as dashes, and don't include long distance access numbers, such as 1. For example, you would format the phone number 123-456-7890 as 1234567890.
The provider's Employer Identification Number (EIN). The EIN is typically a string of exactly nine numbers with no separators, unless otherwise specified by the provider. If you include this value, you cannot include the provider's ssn.
The provider's Employer Identification Number (EIN). This field is the same as employerId. The EIN is typically a string of exactly nine numbers with no separators, unless otherwise specified by the provider. If you include this value, you cannot include the provider's ssn.
The provider's first name.
The provider's last name. You should include either the lastName or organizationName property in this object.
The provider's location number.
The provider's middle name or initial.
The National Association of Insurance Commissioners (NAIC) code.
The National Provider Identifier (NPI) assigned to the provider.
The provider's business name. You should include either the lastName or organizationName property in this object.
The payer identification number.
This field is now automatically populated and it only remains for backwards compatibility.
Deprecated; do not use.
An identifier for the provider.
Array item
The identifier. The format and length of this value depends on the qualifier you set.
The identifier for the other payer who provided this reference number. This is only required when the reference number is provided by the non-destination payer. The value must match the claimInformation.otherSubscriberInformation[].otherPayerName.otherPayerIdentifier property.
Set to 0B - State License Number, 1G - Provider UPIN Number, G2 - Provider Commercial Number, or LU - Location Number. Note that UPIN is deprecated and shouldn't be used for new claims.
The provider's Social Security Number. If you provide this value, you cannot include the provider's employerId.
The provider's state license number. This is assigned directly by a payer in order to identify the provider in their system. This is not commonly used.
The provider's name suffix, such as Jr. or III.
^[A-Za-z0-9]{10}$Length: 10Code from the National Uniform Claims Committee Health Care Provider Taxonomy Code Set. This identifies the provider's type and/or area of specialty.
Sales tax, formatted as a decimal. When you include this property, the total lineItemChargeAmount for this service line must include this sales tax value.
^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$The date the service was rendered (for services performed on a single day). When you send this property with serviceDateEnd, it will be used as the start date for the date range in which the service was rendered.
^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$The end date of the service period. If you send this property, you must also send serviceDate.
Information about where the services were rendered. This can be healthcare facilities, such as surgical centers or reference labs, OR the patient's address when services were rendered in their home.
- Only include this object when the service facility location is different from the billing provider's address. If you include this object when the address is the same, Stedi omits all of the service facility location information from the claim submission, including the name and any identifiers.
- Don't use this object when reporting ambulance services - use
ambulancePickupLocationandambulanceDropoffLocationinstead. - Sometimes the billing provider is an actual physician group that is located at the same address as a hospital, but is in fact a separate entity. In this case, you can differentiate the service facility location by including the specific suite or building number of the physician group. This ensures that the service facility location is different from the billing provider's address and is reported accurately.
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The address of where services were rendered.
If the service facility location is 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'.
For United States addresses, you must include the full nine-digit zip code with no separators, such as 100031502. If you don't know the full zip code, you can find it using the USPS ZIP Code Lookup tool.
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The first line of the street address. This typically contains the building number and street name.
The second line of the street address. This typically contains the apartment or suite number.
The city name.
Use the alpha-2 country codes from Part 1 of ISO 3166.
Use the country subdivision codes from Part 2 of ISO 3166.
The postal zone or zip code. Exclude punctuation and spaces.
The state or province code. Only required when the city is in the Unites States and Canada.
The organization National Provider Identifier (NPI) assigned to the service facility. Only include this property when the service facility is not a component or subpart of the billing provider. Don't include when the service facility is the patient's home.
The laboratory or facility name. When services were rendered in the patient's home, we recommend setting this to Residence or something similar.
The telephone extension, if applicable. Only submit the numeric extension. For example, don't include data that indicates an extension, such as 'ext.' or 'x-'.
The full name of the person or office.
The phone number, formatted as AAABBBCCCC, where AAA represents the area code, BBB is the telephone number prefix, and CCCC is the telephone number. The phone number should only include the digits 0 to 9. Don't include separators, such as dashes, and don't include long distance access numbers, such as 1. For example, you would format the phone number 123-456-7890 as 1234567890.
Secondary identifier for the service facility location. Used when another identifier is needed for the claims processor to identify the facility or when the entity is not a healthcare provider and does not have an NPI.
Array item
The identifier. The format and length of this value depends on the qualifier you set.
The identifier for the other payer who provided this reference number. This is only required when the reference number is provided by the non-destination payer. The value must match the claimInformation.otherSubscriberInformation[].otherPayerName.otherPayerIdentifier property.
Set to G2 - Provider Commercial Number, or LU - Location Number.
Identify specific dates related to the service rendered.
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^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$Required when a Durable Medical Equipment Regional Carrier Certificate of Medical Necessity (DMERC CMN) or DMERC Information Form (DIF), or Oxygen Therapy Certification is included on this service line.
^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$Required on initial EPO claims service lines for dialysis patients when test results are being billed or reported.
^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$Required when this date is known to impact adjudication for claims involving spinal manipulation, physcial therapy, occupational therapy, or speech language pathology.
^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$This is the date the ordering physician signed the CMN or Oxygen Therapy Certification, or the date the supplier signed the DMERC Information Form (DIF).
^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$Required for claims involving spinal manipulation.
^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$Required when a drug is billed for this line and a prescription was written (or otherwise communicated by the prescriber if not written).
^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$Required on initial EPO claims service lines for dialysis patients when test results are being billed or reported.
^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$Required when billing or reporting products that were shipped.
^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$This is the date of the latest visit or consultation.
Additional identifiers for the service line.
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Required when a repricing (pricing) organization needs to have an identifying number on an adjusted service line.
Array item
This must match the value in claimInformation.otherSubscriberInformation.otherPayerName.otherPayerIdentifier.
The prior authorization number.
Important: Only use this field for service-level prior authorization numbers that differ from the claim-level authorization (claimInformation.claimSupplementalInformation.priorAuthorizationNumber). If this value matches the claim-level value, only the claim-level authorization will appear in the X12 EDI transaction. Set claim-level authorizations first.
Required when a repricing (pricing) organization needs to have an identifying number on the service line.
Supporting documentation for the service line. Required when you plan to submit attachments for the service line electronically through Stedi APIs or SFTP, when there is a paper attachment following this claim, or when the provider deems it necessary to identify additional information that is being held at the provider's office and is available upon request.
You can submit up to 10 objects in this array.
Array item
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
attachmentIdin 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.
^[0-9a-f]{8}-[0-9a-f]{4}-[0-9a-f]{4}-[0-9a-f]{4}-[0-9a-f]{12}$Length: 36The 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
attachmentControlNumberin the request, but not both. Including both properties will result in an error.
Code indicating the title or contents of a document, report or supporting item. For example, 08 - Plan of Treatment or CT - Certification. Visit Claims code lists for a complete list.
0304050607Code identifying the method by which the provider's report is attached. Can be set to AA - Available on Request at Provider Site, BM - By Mail, EL - Electronically Only, EM - E-Mail, FT - File Transfer, or FX - By Fax.
Set this to EL when you plan to submit attachments electronically through Stedi APIs.
AABMELEMFTInformation about the provider who oversaw the rendering provider and the care reported in this service line. Include this object when the supervising provider is different than the one listed in the supervising object for the entire claim.
This should be an individual, not an organization, and you should supply at least the provider's lastName and an identifier, which is typically the npi.
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The first line of the street address. This typically contains the building number and street name.
The second line of the street address. This typically contains the apartment or suite number.
The city name.
Use the alpha-2 country codes from Part 1 of ISO 3166.
Use the country subdivision codes from Part 2 of ISO 3166.
The postal zone or zip code. Exclude punctuation and spaces.
The state or province code. Only required when the city is in the Unites States and Canada.
The provider's commercial number.
You must include at least one communication method (phone, fax, or email) in this object.
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The email address.
The fax number.
The full name of the person or office.
The phone extension, if applicable.
The phone number, formatted as AAABBBCCCC, where AAA represents the area code, BBB is the telephone number prefix, and CCCC is the telephone number. The phone number should only include the digits 0 to 9. Don't include separators, such as dashes, and don't include long distance access numbers, such as 1. For example, you would format the phone number 123-456-7890 as 1234567890.
The provider's Employer Identification Number (EIN). The EIN is typically a string of exactly nine numbers with no separators, unless otherwise specified by the provider. If you include this value, you cannot include the provider's ssn.
The provider's Employer Identification Number (EIN). This field is the same as employerId. The EIN is typically a string of exactly nine numbers with no separators, unless otherwise specified by the provider. If you include this value, you cannot include the provider's ssn.
The provider's first name.
The provider's last name.
The provider's location number.
The provider's middle name or initial.
The National Association of Insurance Commissioners (NAIC) code.
The individual National Provider Identifier (NPI) assigned to the provider.
The provider's business name. You should include either the lastName or organizationName property in this object.
The payer identification number.
This field is now automatically populated and it only remains for backwards compatibility.
Deprecated; do not use.
Secondary identifiers for the supervising provider.
Array item
The identifier. The format and length of this value depends on the qualifier you set.
The identifier for the other payer who provided this reference number. This is only required when the reference number is provided by the non-destination payer. The value must match the claimInformation.otherSubscriberInformation[].otherPayerName.otherPayerIdentifier property.
Set to 0B - State License Number, 1G - Provider UPIN Number, G2 - Provider Commercial Number, or LU - Location Number. Note that UPIN is deprecated and shouldn't be used for new claims.
The provider's SSN.
The provider's state license number. This is assigned directly by a payer in order to identify the provider in their system. This is not commonly used.
The provider's name suffix, such as Jr. or III.
^[A-Za-z0-9]{10}$Length: 10Code from the National Uniform Claims Committee Health Care Provider Taxonomy Code Set. This identifies the provider's type and/or area of specialty.
Required on Dialysis related service lines for ESRD, or required on on DMERC service lines to report the Patient's Height from the Certificate of Medical Necessity (CMN). Use HT qualifier.
Array item
Code identifying the specific measurement. Can be set to HT - Height, R1 - Hemoglobin, R2 - Hematocrit, R3 - Epoetin Starting Dosage, or R4 - Creatinine.
HTR1R2R3R4Code identifying the type of measurement. Can be set to OG - Original or TR - Test Results.
OGTRThe value of the measurement.
Required when the TPO/repricer needs to forward additional information to the payer. Providers shouldn't complete this property.
Indicates whether the provider's signature is on file. Can be set to N - No or Y - Yes.
NYCode indicating the Special Program under which the services rendered to the patient were performed. Used for Medicaid claims only. Can be set to 02 - Physically Handicapped Children's Program, 03 - Special Federal Funding, 05 - Disability, or 09 - Second Opinion or Surgery.
02030509Information about a chiropractic service rendered to the patient. Required on chiropractic claims involving spinal manipulation when the information is known to impact the payer's adjudication process.
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A code indicating the nature of a patient's condition. Can be set to A - Acute Condition, C - Chronic Condition, D- Non-acute, E - Non-Life Threatening, F - Routine, G - Symptomatic, or M - Acute Manifestation of a Chronic Condition.
ACDEFThe description of the patient's condition.
Additional description of the patient's condition
Not currently used.
Dependent who received the medical care associated with the claim. Note that if the dependent has their own member ID for the health plan, you should include the dependent's information in the subscriber object instead. To check whether a dependent has a member ID, submit an Eligibility Check to the payer. The payer returns the dependent's member ID in the dependents.memberId property in the response, if present.
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The dependent's address. Every claim must include address information in either the subscriber (when the patient is the subscriber) or dependent (when the patient is a dependent) object. You must include at least the address1 and city properties in this object. The state and postalCode properties are also required for all United States and Canadian addresses.
- The address must be the patient's correct address at the time of service. Don't use placeholder values to complete unknown address information. Use of outdated or placeholder values could cause the payer to reject, deny, or delay the claim due to suspected fraud.
- If you don't know the patient's address, you should first submit a Real-Time Eligibility Check for the patient and then copy the patient's address from either the
subscriberordependentobject in the response. - If the patient doesn't have a current address, you can populate the
address1property withUNKNOWNand populate the city, state, and zip code with appropriate values based on your discretion. However, some payers may have explicit rules for how to handle this situation, so you should check the payer's specific requirements before using this approach.
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The first line of the street address. This typically contains the building number and street name.
The second line of the street address. This typically contains the apartment or suite number.
The city name.
Use the alpha-2 country codes from Part 1 of ISO 3166.
Use the country subdivision codes from Part 2 of ISO 3166.
The postal zone or zip code. Exclude punctuation and spaces.
The state or province code. Only required when the city is in the Unites States and Canada.
Only use this object for payer administrative contacts on property and casualty claims. Otherwise, you shoudn't include contact information here. If you include this object, you must supply at least one communication method (phone, fax, or email).
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The email address.
The fax number.
The full name of the person or office.
The phone extension, if applicable.
The phone number, formatted as AAABBBCCCC, where AAA represents the area code. For example, you would format the phone number 123-456-7890 as 1234567890. You should always include the area code, if applicable. Don't include long distance access numbers (such as 1) or extensions in this field.
^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$The patient's date of birth
The patient's first name.
Code indiciating the patient's gender. Can be set to F - Female, M - Male, or U - Unknown.
Some payers may reject the claim if the patient's gender doesn't match the gender they have recorded in their member records. If the gender isn't known or the patient declines to answer, use U or perform an eligibility check to determine the gender according to the payer's records.
MFUThe patient's last name. Don't include the patient's name suffix, such as Jr. or III. Use the designated suffix property instead.
The patient's identification number. Only used in Property and Casualty claims.
The patient's middle name or initial.
Identifies the relationship of the patient to the subscriber. Can be set to 01 - Spouse, 19 - Child, 20 - Employee, 21 - Unknown, 39 - Organ Donor, 40 - Cadaver Donor, 53 - Life Partner, or G8 - Other Relationship.
0119202139The patient's Social Security Number. Only used for Property and Casualty claims.
The patient's name suffix, such as Jr. or III. Only include the patient's personal name suffix - don't include professional or academic titles, such as M.D. or MBA.
Deprecated; please use claimInformation.serviceLines.orderingProvider instead.
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The first line of the street address. This typically contains the building number and street name.
The second line of the street address. This typically contains the apartment or suite number.
The city name.
Use the alpha-2 country codes from Part 1 of ISO 3166.
Use the country subdivision codes from Part 2 of ISO 3166.
The postal zone or zip code. Exclude punctuation and spaces.
The state or province code. Only required when the city is in the Unites States and Canada.
You must include at least one communication method (phone, fax, or email) in this object.
Show attributes
The email address.
The fax number.
The full name of the person or office.
The phone extension, if applicable.
The phone number, formatted as AAABBBCCCC, where AAA represents the area code, BBB is the telephone number prefix, and CCCC is the telephone number. The phone number should only include the digits 0 to 9. Don't include separators, such as dashes, and don't include long distance access numbers, such as 1. For example, you would format the phone number 123-456-7890 as 1234567890.
This field is now automatically populated and it only remains for backwards compatibility.
Social Security Number without spaces or punctuation (9 digits)
Use when the address for payment is different than that of the billing provider for this claim.
This is also where you can provide the billing provider's mailing address when it's a PO Box, lockbox, or other non-physical address. The billing.address object must always contain a physical practice location where care is delivered.
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The first line of the street address. This typically contains the building number and street name.
The second line of the street address. This typically contains the apartment or suite number.
The city name.
Use the alpha-2 country codes from Part 1 of ISO 3166.
Use the country subdivision codes from Part 2 of ISO 3166.
The postal zone or zip code. Exclude punctuation and spaces.
The state or province code. Only required when the city is in the Unites States and Canada.
Use for subrogation payment requests. If you include this information, you must also set the claimInformation.otherSubscriberInformation.payerPaidAmount to the amount the payer (for example, Medicaid) actually paid.
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The address of the pay-to-plan organization.
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The first line of the street address. This typically contains the building number and street name.
The second line of the street address. This typically contains the apartment or suite number.
The city name.
Use the alpha-2 country codes from Part 1 of ISO 3166.
Use the country subdivision codes from Part 2 of ISO 3166.
The postal zone or zip code. Exclude punctuation and spaces.
The state or province code. Only required when the city is in the Unites States and Canada.
The last name of the individual, or the business name of the pay-to-plan organization.
The identifier you specified in primaryIdentifierTypeCode.
Code identifying the type of identifier. Can be set to PI - Payor Identification or XV - Centers for Medicare/Medicaid Services PlanID. Use code value XV when reporting Health Plan ID (HPID) or Other Entity Identifier (OEID).
PIXVThe secondary identifier you specified in secondaryIdentifierTypeCode.
Code identifying the type of secondary identifier. Can be set to 2U - Payer Identification Number, FY - Claim Office Number, or NF - National Association of Insurance Commissioners. You should only set this to 2U when you set the primaryIdentifierTypeCode to XV.
2UFYNFThe Employer Identification Number (EIN). This must be a string of exactly nine numbers with no separators.
The payer's address. Some payers use this for internal routing. Only provide this address if the payer explicitly requires it.
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The first line of the street address. This typically contains the building number and street name.
The second line of the street address. This typically contains the apartment or suite number.
The city name.
Use the alpha-2 country codes from Part 1 of ISO 3166.
Use the country subdivision codes from Part 2 of ISO 3166.
The postal zone or zip code. Exclude punctuation and spaces.
The state or province code. Only required when the city is in the Unites States and Canada.
Information about all providers, with each provider specified by its type (for example, Referring). You can't include this array in the same request as dedicated provider objects, such as referring or rendering.
Array item
Show attributes
The first line of the street address. This typically contains the building number and street name.
The second line of the street address. This typically contains the apartment or suite number.
The city name.
Use the alpha-2 country codes from Part 1 of ISO 3166.
Use the country subdivision codes from Part 2 of ISO 3166.
The postal zone or zip code. Exclude punctuation and spaces.
The state or province code. Only required when the city is in the Unites States and Canada.
The commercial number of the supervising provider.
You must include at least one communication method (phone, fax, or email) in this object.
Show attributes
The email address.
The fax number.
The full name of the person or office.
The phone extension, if applicable.
The phone number, formatted as AAABBBCCCC, where AAA represents the area code, BBB is the telephone number prefix, and CCCC is the telephone number. The phone number should only include the digits 0 to 9. Don't include separators, such as dashes, and don't include long distance access numbers, such as 1. For example, you would format the phone number 123-456-7890 as 1234567890.
The first name of the supervising provider.
The last name of the supervising provider.
The location number of the supervising provider.
The middle name or initial of the supervising provider.
The individual National Provider Identifier (NPI) assigned to the supervising provider.
The supervising provider's business name, when the provider is not an individual.
This field is now automatically populated and it only remains for backwards compatibility.
Deprecated; do not use.
Social Security Number without spaces or punctuation (9 digits)
The state license number of the supervising provider.
The suffix of the supervising provider's name, such as Jr. or III.
The entity responsible for the payment of the claim, such as an insurance company or government agency.
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The business name of the payer receiving the claim, such as Aetna or Cigna.
Information about the provider who directed the patient to the rendering provider for care. For example, a primary care physician may refer patients to a specialist. Use when the referring provider applies to the entire claim, not just a specific service line.
This should be an individual, not an organization, and you should supply at least the provider's lastName and an identifier, which is typically the npi.
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The first line of the street address. This typically contains the building number and street name.
The second line of the street address. This typically contains the apartment or suite number.
The city name.
Use the alpha-2 country codes from Part 1 of ISO 3166.
Use the country subdivision codes from Part 2 of ISO 3166.
The postal zone or zip code. Exclude punctuation and spaces.
The state or province code. Only required when the city is in the Unites States and Canada.
The provider's commercial number.
You must include at least one communication method (phone, fax, or email) in this object.
Show attributes
The email address.
The fax number.
The full name of the person or office.
The phone extension, if applicable.
The phone number, formatted as AAABBBCCCC, where AAA represents the area code, BBB is the telephone number prefix, and CCCC is the telephone number. The phone number should only include the digits 0 to 9. Don't include separators, such as dashes, and don't include long distance access numbers, such as 1. For example, you would format the phone number 123-456-7890 as 1234567890.
The provider's first name.
The provider's last name.
The provider's middle name or initial.
The individual National Provider Identifier (NPI) assigned to the provider.
The provider's business name.
This field is now automatically populated and it only remains for backwards compatibility.
Deprecated; do not use.
The provider's state license number. This is assigned directly by a payer in order to identify the provider in their system. This is not commonly used.
The provider's name suffix, such as Jr. or III.
Information about the person or company (laboratory or other facility) who rendered the care. Use this object for all types of rendering providers including laboratories. When a substitute provider (locum tenens) was used, enter that provider's information here.
- Use when the provider applies to the entire claim or to at least one service line. For example, if a claim had two service lines with two different rendering providers, you would include the provider for the first service line here and leave the
claimInformation.serviceLines.renderingProviderobject for that service line blank. Then, you would specify the second provider in the appropriate service line'sclaimInformation.serviceLines.renderingProviderobject. - You can omit this object when the rendering provider is the same as the billing provider. In that case, you would include the provider's information in the
billingobject and leave this object blank.
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The first line of the street address. This typically contains the building number and street name.
The second line of the street address. This typically contains the apartment or suite number.
The city name.
Use the alpha-2 country codes from Part 1 of ISO 3166.
Use the country subdivision codes from Part 2 of ISO 3166.
The postal zone or zip code. Exclude punctuation and spaces.
The state or province code. Only required when the city is in the Unites States and Canada.
The provider's commercial number.
You must include at least one communication method (phone, fax, or email) in this object.
Show attributes
The email address.
The fax number.
The full name of the person or office.
The phone extension, if applicable.
The phone number, formatted as AAABBBCCCC, where AAA represents the area code, BBB is the telephone number prefix, and CCCC is the telephone number. The phone number should only include the digits 0 to 9. Don't include separators, such as dashes, and don't include long distance access numbers, such as 1. For example, you would format the phone number 123-456-7890 as 1234567890.
The provider's first name, if the provider is an individual.
The provider's last name, if the provider is an individual. You must include either the lastName or organizationName property in this object.
The provider's location number.
The provider's middle name or initial, if the provider is an individual.
The National Provider Identifier (NPI) assigned to the provider.
The provider's business name, if the provider is an organization. You must include either the lastName or organizationName property in this object.
This field is now automatically populated and it only remains for backwards compatibility.
Deprecated; do not use.
The provider's state license number. This is assigned directly by a payer in order to identify the provider in their system. This is not commonly used.
The provider's name suffix, such as Jr. or III.
Code from the National Uniform Claims Committee Health Care Provider Taxonomy Code Set. This identifies the provider's type and/or area of specialty.
The entity submitting the healthcare claim. This can be either an individual or an organization, such as a doctor, hospital, or insurance company. You must submit at least organizationName or lastName properties and the contactInformation object. If you don't supply the submitterIdentification property, Stedi uses the value from billing.npi in the request.
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Contact information for the person or office handling administrative communications regarding the claim. You can include a maximum of two objects in this array.
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The email address.
The fax number.
The full name of the person or office.
The phone extension, if applicable.
The phone number, formatted as AAABBBCCCC, where AAA represents the area code, BBB is the telephone number prefix, and CCCC is the telephone number. The phone number should only include the digits 0 to 9. Don't include separators, such as dashes, and don't include long distance access numbers, such as 1. For example, you would format the phone number 123-456-7890 as 1234567890.
The first name of the individual submitting the claim.
The last name of the individual submitting the claim.
The middle name or initial of the individual submitting the claim.
The business name of the organization submitting the claim.
The submitter's Electronic Transmitter Identification Number (ETIN), as assigned by the payer. For some payers, this may be the same as the submitter's NPI or TIN, but it can also be another unique identifier. Payers can refer to this identifier as the Provider Number, Submitter ID, Submitter Identifier, Submitter Primary Number, Sender Code, Certified Contracted Provider ID, and other names.
If you don't provide this property, Stedi uses the billing provider's NPI from billing.npi property.
The person or entity who is the primary policyholder for the health plan or a dependent with their own member ID. The subscriber can be an individual or a business entity.
- When a dependent has a unique, payer-assigned member ID, treat them as the
subscriberfor the claim submission - include their information here and omit thedependentobject from the request. Stedi treats the subscriber as an individual when the request doesn't contain a value for thesubscriber.organizationNameproperty. - You must set the
dateOfBirthandgenderproperties when the subscriber is the patient. Stedi determines that the subscriber is the patient when thedependentobject is not included in the request. - If either
dateOfBirthorgenderis set, you must include both properties. You can either include both properties or neither within a single request.
Show attributes
The subscriber's address. Every claim must include address information in either the subscriber (when the patient is the subscriber) or dependent (when the patient is a dependent) object. You must include at least the address1 and city properties in this object. The state and postalCode properties are also required for all United States and Canadian addresses.
- The address must be the patient's correct address at the time of service. Don't use placeholder values to complete unknown address information. Use of outdated or placeholder values could cause the payer to reject, deny, or delay the claim due to suspected fraud.
- If you don't know the patient's address, you should first submit a Real-Time Eligibility Check for the patient and then copy the patient's address from either the
subscriberordependentobject in the response. - If the patient doesn't have a current address, you can populate the
address1property withUNKNOWNand populate the city, state, and zip code with appropriate values based on your discretion. However, some payers may have explicit rules for how to handle this situation, so you should check the payer's specific requirements before using this approach.
Show attributes
The first line of the street address. This typically contains the building number and street name.
The second line of the street address. This typically contains the apartment or suite number.
The city name.
Use the alpha-2 country codes from Part 1 of ISO 3166.
Use the country subdivision codes from Part 2 of ISO 3166.
The postal zone or zip code. Exclude punctuation and spaces.
The state or province code. Only required when the city is in the Unites States and Canada.
Only use this object for payer administrative contacts on property and casualty claims. Otherwise, you shoudn't include contact information here. If you include this object, you must supply at least one communication method (phone, fax, or email).
Show attributes
The email address.
The fax number.
The full name of the person or office.
The phone extension, if applicable.
The phone number, formatted as AAABBBCCCC, where AAA represents the area code. For example, you would format the phone number 123-456-7890 as 1234567890. You should always include the area code, if applicable. Don't include long distance access numbers (such as 1) or extensions in this field.
The subscriber's date of birth. This property is required if the subscriber is an individual.
The subscriber's first name. This property is recommended when the subscriber is an individual. Some payers reject requests without the firstName property.
Identifies the subscriber's gender. This property is required when the subscriber is the patient. Can be set to F - Female, M - Male, or U - Unknown.
Some payers may reject the claim if the patient's gender doesn't match the gender they have recorded in their member records. If the gender isn't known or the patient declines to answer, use U or perform an eligibility check to determine the gender according to the payer's records.
MFUThe subscriber's health plan group number.
- Provide this property OR the
policyNumber, not both. - Provide this property OR the
subscriberGroupName, not both. If this property is set, Stedi ignores thesubscriberGroupNameproperty.
Identifies the type of insurance policy within a specific insurance program. This property is required when sending claims to Medicare and Medicare is not the primary payer (paymentResponsibilityLevelCode is not set to P). Otherwise, don't include this property in the claim.
Visit Claims code lists for a complete list of insurance type codes.
1213141516The subscriber's last name. This property is required if the subscriber is an individual.
Don't include the subscriber's name suffix, such as Jr. or III. Use the designated suffix property instead.
The member ID for the subscriber's insurance policy. This property is required if the subscriber is an individual.
The subscriber's middle name or initial.
The business name of the entity submitting the claim. When the subscriber is an organization, you should identify the patient in the dependent object.
Code identifying the payer's level of responsibility for paying this claim. Visit Claims code lists for a complete list of possible codes.
- Stedi sets this property to
P- Primary by default. You only need to include it when you need to submit codes other thanP. This can happen when the patient has multiple insurance policies. For example, if a patient is covered by both Medicare and an employer-sponsored commercial plan, you could bill the commercial plan first asPand then bill the Medicare payer second asS. - Either this property or
otherSubscriberInformation.paymentResponsibilityLevelCodemust be set toPto indicate the primary insurance payer. Stedi rejects claims - including secondary and tertiary claims - that don't include information for the primary payer.
ABCDEThe subscriber's health plan policy number. You should provide either this property OR the groupNumber, not both.
The subscriber's Social Security Number.
The name of the subscriber's health plan. For example, Cigna or Blue Cross Blue Shield.
Provide either this property OR the groupNumber, not both. If groupNumber is set, Stedi ignores this value and uses the value in groupNumber.
The suffix of the subscriber's name, such as Jr. or Sr. Only include the subscriber's personal name suffix - don't include professional or academic titles, such as M.D. or MBA.
The entity responsible for overseeing the rendering provider and the care reported in this claim. Applies when the rendering provider is supervised by a physician. Use when the provider applies to the entire claim, not just a specific service line.
This should be an individual, not an organization, and you should supply at least the provider's lastName and an identifier, which is typically the npi.
Show attributes
Show attributes
The first line of the street address. This typically contains the building number and street name.
The second line of the street address. This typically contains the apartment or suite number.
The city name.
Use the alpha-2 country codes from Part 1 of ISO 3166.
Use the country subdivision codes from Part 2 of ISO 3166.
The postal zone or zip code. Exclude punctuation and spaces.
The state or province code. Only required when the city is in the Unites States and Canada.
The commercial number of the supervising provider.
You must include at least one communication method (phone, fax, or email) in this object.
Show attributes
The email address.
The fax number.
The full name of the person or office.
The phone extension, if applicable.
The phone number, formatted as AAABBBCCCC, where AAA represents the area code, BBB is the telephone number prefix, and CCCC is the telephone number. The phone number should only include the digits 0 to 9. Don't include separators, such as dashes, and don't include long distance access numbers, such as 1. For example, you would format the phone number 123-456-7890 as 1234567890.
The first name of the supervising provider.
The last name of the supervising provider.
The location number of the supervising provider.
The middle name or initial of the supervising provider.
The individual National Provider Identifier (NPI) assigned to the supervising provider.
The supervising provider's business name, when the provider is not an individual.
This field is now automatically populated and it only remains for backwards compatibility.
Deprecated; do not use.
Social Security Number without spaces or punctuation (9 digits)
The state license number of the supervising provider. This is assigned directly by a payer in order to identify the provider in their system. This is not commonly used.
The suffix of the supervising provider's name, such as Jr. or III.
This is the payer's business name, like Cigna or Aetna.
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.
Whether you want to send a test or production claim. This property also allows you to filter claims in the Stedi portal by production or test data. By default, this property is set to P for production data. Use T to designate a claim as test data.
Response
ClaimsSubmission 200 response
Information about the claim.
Show attributes
This shape is deprecated: Currently not used.
An identifier Stedi assigns to the claim.
A tracking number that Stedi assigns to the claim.
The X12 EDI version Stedi used to generate the claim for the payer. This is always 5010.
The patientControlNumber from the original request, if supplied. This is a unique identifier that you assign to the claim so you can track the claim and correlate it with responses from the payer.
This shape is deprecated: Please use payerId.
The payer's ID. This is the same as the tradingPartnerServiceId.
A tracking number Stedi assigns to the claim. This is the same as the correlationId.
Contains a unique identifier for each service line, listed in the order the service lines were included in the claim. You can use these identifiers to correlate payer responses to specific service lines.
Array item
A unique identifier for the service line, matching the value provided for the claimInformation.serviceLines.providerControlNumber property in the claim submission. If you didn't provide a value for providerControlNumber, this property contains a randomly generated a ULID for the service line.
Stedi's ID for the entity that submitted the claim.
A timestamp for Stedi's response to the claim submission.
An identifier for the transaction.
Currently not used.
Array item
This shape is deprecated: Currently not used.
Errors resulting from claim edits. You must review and fix these errors before resubmitting.
Array item
The error code.
The description of the error code.
The field related to the error.
Recommended followup actions to correct the error.
Where the error is located in the original request.
The value for the data causing the error.
Currently not used.
Show attributes
A 200 response indicates that Stedi successfully generated the X12 EDI claim format required by the payer. It does not indicate whether the payer has accepted the claim - the payer will respond later with a 277CA containing this information. Learn more about 277CAs. A 400 response indicates one or more problems with the claim data in the request. Examples include missing required fields, invalid values, or incorrect data types. The response includes a message describing the problem.
200 OK400 BAD_REQUESTMetadata from Stedi about the request.
Show attributes
Indicates where this request can be found for support.
The biller ID assigned to this request.
The sender ID assigned to this request.
The submitter ID assigned to this request.
The file execution ID, a unique identifier assigned to the processed file within the Stedi platform.
Information about the payer for the submitted claim.
The status of the claim submission.
An ID for the payer you identified in the original claim. 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.
A list of warnings. Currently not used.
Array item
A machine-readable code indicating the type of problem.
A human-readable description of the problem.
curl --request POST \ --url "https://healthcare.us.stedi.com/2024-04-01/change/medicalnetwork/professionalclaims/v3/submission" \ --header "Authorization: <api_key>" \ --header "Content-Type: application/json" \ --data '{ "billing": { "address": { "address1": "123 Some St", "address2": "Floor 1", "city": "A City", "postalCode": "123450000", "state": "NY" }, "contactInformation": { "name": "Test Data Health Services, Inc.", "phoneNumber": "5553334444" }, "employerId": "123456789", "npi": "1999999984", "organizationName": "Therapy Associates", "providerType": "BillingProvider", "taxonomyCode": "2084P0800X" }, "claimInformation": { "benefitsAssignmentCertificationIndicator": "Y", "claimChargeAmount": "109.20", "claimFilingCode": "CI", "claimFrequencyCode": "1", "healthCareCodeInformation": [ { "diagnosisCode": "F1111", "diagnosisTypeCode": "ABK" } ], "patientControlNumber": "<YOUR-CLAIM-ID>", "placeOfServiceCode": "02", "planParticipationCode": "A", "releaseInformationCode": "Y", "serviceFacilityLocation": { "address": { "address1": "1234 Other St", "city": "A City", "postalCode": "123450000", "state": "NY" }, "npi": "1999999984", "organizationName": "Smith Associates" }, "serviceLines": [ { "professionalService": { "compositeDiagnosisCodePointers": { "diagnosisCodePointers": [ "1" ] }, "lineItemChargeAmount": "109.20", "measurementUnit": "UN", "procedureCode": "90837", "procedureIdentifier": "HC", "procedureModifiers": [ "95" ], "serviceUnitCount": "1" }, "providerControlNumber": "111222333", "renderingProvider": { "firstName": "Jane", "lastName": "Smith", "npi": "1999999984", "providerType": "RenderingProvider", "taxonomyCode": "111YP2000X" }, "serviceDate": "20240101" } ], "signatureIndicator": "Y" }, "receiver": { "organizationName": "Cigna" }, "submitter": { "contactInformation": { "name": "Test Data Health Services, Inc.", "phoneNumber": "5552223333" }, "organizationName": "Test Data Health Services, Inc.", "submitterIdentification": "<YOUR-SUBMITTER-ID>" }, "subscriber": { "address": { "address1": "2222 Random St", "city": "A City", "postalCode": "123450000", "state": "NY" }, "dateOfBirth": "20000101", "firstName": "John", "gender": "M", "groupNumber": "3335555", "lastName": "Anon", "memberId": "U7777788888", "paymentResponsibilityLevelCode": "P", "subscriberGroupName": "Cigna" }, "tradingPartnerName": "Cigna", "tradingPartnerServiceId": "6400", "usageIndicator": "T" }'const body = JSON.stringify({ "billing": { "address": { "address1": "123 Some St", "address2": "Floor 1", "city": "A City", "postalCode": "123450000", "state": "NY" }, "contactInformation": { "name": "Test Data Health Services, Inc.", "phoneNumber": "5553334444" }, "employerId": "123456789", "npi": "1999999984", "organizationName": "Therapy Associates", "providerType": "BillingProvider", "taxonomyCode": "2084P0800X" }, "claimInformation": { "benefitsAssignmentCertificationIndicator": "Y", "claimChargeAmount": "109.20", "claimFilingCode": "CI", "claimFrequencyCode": "1", "healthCareCodeInformation": [ { "diagnosisCode": "F1111", "diagnosisTypeCode": "ABK" } ], "patientControlNumber": "<YOUR-CLAIM-ID>", "placeOfServiceCode": "02", "planParticipationCode": "A", "releaseInformationCode": "Y", "serviceFacilityLocation": { "address": { "address1": "1234 Other St", "city": "A City", "postalCode": "123450000", "state": "NY" }, "npi": "1999999984", "organizationName": "Smith Associates" }, "serviceLines": [ { "professionalService": { "compositeDiagnosisCodePointers": { "diagnosisCodePointers": [ "1" ] }, "lineItemChargeAmount": "109.20", "measurementUnit": "UN", "procedureCode": "90837", "procedureIdentifier": "HC", "procedureModifiers": [ "95" ], "serviceUnitCount": "1" }, "providerControlNumber": "111222333", "renderingProvider": { "firstName": "Jane", "lastName": "Smith", "npi": "1999999984", "providerType": "RenderingProvider", "taxonomyCode": "111YP2000X" }, "serviceDate": "20240101" } ], "signatureIndicator": "Y" }, "receiver": { "organizationName": "Cigna" }, "submitter": { "contactInformation": { "name": "Test Data Health Services, Inc.", "phoneNumber": "5552223333" }, "organizationName": "Test Data Health Services, Inc.", "submitterIdentification": "<YOUR-SUBMITTER-ID>" }, "subscriber": { "address": { "address1": "2222 Random St", "city": "A City", "postalCode": "123450000", "state": "NY" }, "dateOfBirth": "20000101", "firstName": "John", "gender": "M", "groupNumber": "3335555", "lastName": "Anon", "memberId": "U7777788888", "paymentResponsibilityLevelCode": "P", "subscriberGroupName": "Cigna" }, "tradingPartnerName": "Cigna", "tradingPartnerServiceId": "6400", "usageIndicator": "T"})fetch("https://healthcare.us.stedi.com/2024-04-01/change/medicalnetwork/professionalclaims/v3/submission", { headers: { "Authorization": "<api_key>" }, body})package mainimport ( "fmt" "net/http" "io/ioutil" "strings")func main() { url := "https://healthcare.us.stedi.com/2024-04-01/change/medicalnetwork/professionalclaims/v3/submission" body := strings.NewReader(`{ "billing": { "address": { "address1": "123 Some St", "address2": "Floor 1", "city": "A City", "postalCode": "123450000", "state": "NY" }, "contactInformation": { "name": "Test Data Health Services, Inc.", "phoneNumber": "5553334444" }, "employerId": "123456789", "npi": "1999999984", "organizationName": "Therapy Associates", "providerType": "BillingProvider", "taxonomyCode": "2084P0800X" }, "claimInformation": { "benefitsAssignmentCertificationIndicator": "Y", "claimChargeAmount": "109.20", "claimFilingCode": "CI", "claimFrequencyCode": "1", "healthCareCodeInformation": [ { "diagnosisCode": "F1111", "diagnosisTypeCode": "ABK" } ], "patientControlNumber": "<YOUR-CLAIM-ID>", "placeOfServiceCode": "02", "planParticipationCode": "A", "releaseInformationCode": "Y", "serviceFacilityLocation": { "address": { "address1": "1234 Other St", "city": "A City", "postalCode": "123450000", "state": "NY" }, "npi": "1999999984", "organizationName": "Smith Associates" }, "serviceLines": [ { "professionalService": { "compositeDiagnosisCodePointers": { "diagnosisCodePointers": [ "1" ] }, "lineItemChargeAmount": "109.20", "measurementUnit": "UN", "procedureCode": "90837", "procedureIdentifier": "HC", "procedureModifiers": [ "95" ], "serviceUnitCount": "1" }, "providerControlNumber": "111222333", "renderingProvider": { "firstName": "Jane", "lastName": "Smith", "npi": "1999999984", "providerType": "RenderingProvider", "taxonomyCode": "111YP2000X" }, "serviceDate": "20240101" } ], "signatureIndicator": "Y" }, "receiver": { "organizationName": "Cigna" }, "submitter": { "contactInformation": { "name": "Test Data Health Services, Inc.", "phoneNumber": "5552223333" }, "organizationName": "Test Data Health Services, Inc.", "submitterIdentification": "<YOUR-SUBMITTER-ID>" }, "subscriber": { "address": { "address1": "2222 Random St", "city": "A City", "postalCode": "123450000", "state": "NY" }, "dateOfBirth": "20000101", "firstName": "John", "gender": "M", "groupNumber": "3335555", "lastName": "Anon", "memberId": "U7777788888", "paymentResponsibilityLevelCode": "P", "subscriberGroupName": "Cigna" }, "tradingPartnerName": "Cigna", "tradingPartnerServiceId": "6400", "usageIndicator": "T" }`) req, _ := http.NewRequest("POST", url, body) req.Header.Add("Authorization", "<api_key>") req.Header.Add("Content-Type", "application/json") res, _ := http.DefaultClient.Do(req) defer res.Body.Close() body, _ := ioutil.ReadAll(res.Body) fmt.Println(res) fmt.Println(string(body))}import requestsurl = "https://healthcare.us.stedi.com/2024-04-01/change/medicalnetwork/professionalclaims/v3/submission"body = { "billing": { "address": { "address1": "123 Some St", "address2": "Floor 1", "city": "A City", "postalCode": "123450000", "state": "NY" }, "contactInformation": { "name": "Test Data Health Services, Inc.", "phoneNumber": "5553334444" }, "employerId": "123456789", "npi": "1999999984", "organizationName": "Therapy Associates", "providerType": "BillingProvider", "taxonomyCode": "2084P0800X" }, "claimInformation": { "benefitsAssignmentCertificationIndicator": "Y", "claimChargeAmount": "109.20", "claimFilingCode": "CI", "claimFrequencyCode": "1", "healthCareCodeInformation": [ { "diagnosisCode": "F1111", "diagnosisTypeCode": "ABK" } ], "patientControlNumber": "<YOUR-CLAIM-ID>", "placeOfServiceCode": "02", "planParticipationCode": "A", "releaseInformationCode": "Y", "serviceFacilityLocation": { "address": { "address1": "1234 Other St", "city": "A City", "postalCode": "123450000", "state": "NY" }, "npi": "1999999984", "organizationName": "Smith Associates" }, "serviceLines": [ { "professionalService": { "compositeDiagnosisCodePointers": { "diagnosisCodePointers": [ "1" ] }, "lineItemChargeAmount": "109.20", "measurementUnit": "UN", "procedureCode": "90837", "procedureIdentifier": "HC", "procedureModifiers": [ "95" ], "serviceUnitCount": "1" }, "providerControlNumber": "111222333", "renderingProvider": { "firstName": "Jane", "lastName": "Smith", "npi": "1999999984", "providerType": "RenderingProvider", "taxonomyCode": "111YP2000X" }, "serviceDate": "20240101" } ], "signatureIndicator": "Y" }, "receiver": { "organizationName": "Cigna" }, "submitter": { "contactInformation": { "name": "Test Data Health Services, Inc.", "phoneNumber": "5552223333" }, "organizationName": "Test Data Health Services, Inc.", "submitterIdentification": "<YOUR-SUBMITTER-ID>" }, "subscriber": { "address": { "address1": "2222 Random St", "city": "A City", "postalCode": "123450000", "state": "NY" }, "dateOfBirth": "20000101", "firstName": "John", "gender": "M", "groupNumber": "3335555", "lastName": "Anon", "memberId": "U7777788888", "paymentResponsibilityLevelCode": "P", "subscriberGroupName": "Cigna" }, "tradingPartnerName": "Cigna", "tradingPartnerServiceId": "6400", "usageIndicator": "T"}response = requests.request("POST", url, json = body, headers = { "Authorization": "<api_key>", "Content-Type": "application/json"})print(response.text)import java.net.URI;import java.net.http.HttpClient;import java.net.http.HttpRequest;import java.net.http.HttpResponse;import java.net.http.HttpResponse.BodyHandlers;import java.time.Duration;import java.net.http.HttpRequest.BodyPublishers;var body = BodyPublishers.ofString("""{ "billing": { "address": { "address1": "123 Some St", "address2": "Floor 1", "city": "A City", "postalCode": "123450000", "state": "NY" }, "contactInformation": { "name": "Test Data Health Services, Inc.", "phoneNumber": "5553334444" }, "employerId": "123456789", "npi": "1999999984", "organizationName": "Therapy Associates", "providerType": "BillingProvider", "taxonomyCode": "2084P0800X" }, "claimInformation": { "benefitsAssignmentCertificationIndicator": "Y", "claimChargeAmount": "109.20", "claimFilingCode": "CI", "claimFrequencyCode": "1", "healthCareCodeInformation": [ { "diagnosisCode": "F1111", "diagnosisTypeCode": "ABK" } ], "patientControlNumber": "<YOUR-CLAIM-ID>", "placeOfServiceCode": "02", "planParticipationCode": "A", "releaseInformationCode": "Y", "serviceFacilityLocation": { "address": { "address1": "1234 Other St", "city": "A City", "postalCode": "123450000", "state": "NY" }, "npi": "1999999984", "organizationName": "Smith Associates" }, "serviceLines": [ { "professionalService": { "compositeDiagnosisCodePointers": { "diagnosisCodePointers": [ "1" ] }, "lineItemChargeAmount": "109.20", "measurementUnit": "UN", "procedureCode": "90837", "procedureIdentifier": "HC", "procedureModifiers": [ "95" ], "serviceUnitCount": "1" }, "providerControlNumber": "111222333", "renderingProvider": { "firstName": "Jane", "lastName": "Smith", "npi": "1999999984", "providerType": "RenderingProvider", "taxonomyCode": "111YP2000X" }, "serviceDate": "20240101" } ], "signatureIndicator": "Y" }, "receiver": { "organizationName": "Cigna" }, "submitter": { "contactInformation": { "name": "Test Data Health Services, Inc.", "phoneNumber": "5552223333" }, "organizationName": "Test Data Health Services, Inc.", "submitterIdentification": "<YOUR-SUBMITTER-ID>" }, "subscriber": { "address": { "address1": "2222 Random St", "city": "A City", "postalCode": "123450000", "state": "NY" }, "dateOfBirth": "20000101", "firstName": "John", "gender": "M", "groupNumber": "3335555", "lastName": "Anon", "memberId": "U7777788888", "paymentResponsibilityLevelCode": "P", "subscriberGroupName": "Cigna" }, "tradingPartnerName": "Cigna", "tradingPartnerServiceId": "6400", "usageIndicator": "T"}""");HttpClient client = HttpClient.newBuilder() .connectTimeout(Duration.ofSeconds(10)) .build();HttpRequest.Builder requestBuilder = HttpRequest.newBuilder() .uri(URI.create("https://healthcare.us.stedi.com/2024-04-01/change/medicalnetwork/professionalclaims/v3/submission")) .header("Content-Type", "application/json") .header("Authorization", "<api_key>") .POST(body) .build();try { HttpResponse<String> response = client.send(requestBuilder.build(), BodyHandlers.ofString()); System.out.println("Status code: " + response.statusCode()); System.out.println("Response body: " + response.body());} catch (Exception e) { e.printStackTrace();}{
"claimReference": {
"correlationId": "01HTCX97F6XS6F2K22D4KD59TK",
"formatVersion": "5010",
"patientControlNumber": "22266555",
"payerId": "6400",
"rhclaimNumber": "01HTCX97F6XS6F2K22D4KD59TK",
"serviceLines": [
{
"lineItemControlNumber": "111222333"
}
],
"timeOfResponse": "2024-04-01T13:23:54.255Z"
},
"controlNumber": "555123",
"httpStatusCode": "200 OK",
"meta": {
"traceId": "a7f7c912-77f7-489d-96fc-c4ab3b5c33fc"
},
"payer": {
"payerId": "6400",
"payerName": "Cigna"
},
"status": "SUCCESS",
"tradingPartnerServiceId": "6400"
}{
"code": "string",
"message": "string"
}{
"code": "string",
"message": "string"
}{
"code": "string",
"message": "string"
}{
"code": "string",
"message": "string"
}{
"code": "string",
"message": "string"
}{
"code": "string",
"message": "string"
}{
"code": "string",
"message": "string"
}