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Validate Professional Claim (CMS-1500) JSON

Validate a professional claim in the Stedi JSON format without submitting it

POST/professional-claim-submissions/validate

Validate 837P professional claims using a JSON request structure that follows the CMS-1500 paper form layout without submitting them to payers.

This endpoint runs the same validation checks as the Create Professional Claim JSON endpoint, including payer validation, claim edits and repairs, and mapping. However, this endpoint doesn't submit the claim to payers.

You can use this endpoint to validate claims before submission. It helps you catch errors early when building claim submission forms or testing your integration.

  1. Call this endpoint with a JSON payload.
  2. Stedi validates your request.
  3. The endpoint returns an HTTP 200 whether Stedi's edits pass or fail. Monitor the response shape for failures:
    • Success: The endpoint returns an empty response when the claim passes Stedi's edits.
    • Failures: The endpoint returns an errors array when the claim fails one or more of Stedi's edits. Address all issues in the errors array before submitting the claim through the Create Professional Claim JSON endpoint.

Authorizations

Authorization
RequiredHeader

A production Stedi API Key for authentication.

Body

application/json
authorization
ObjectRequired

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

Show attributes
billing
ObjectRequired

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

Show attributes
encounter
ObjectRequired

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

Show attributes
insured
ObjectRequired

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

Show attributes
otherInsured
Array of ObjectsMax items: 10

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

Array item
patient
Object

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

Show attributes
payer
ObjectRequired

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

Show attributes
purpose
StringRequired

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

Possible values
SUBROGATION_DEMAND
CHARGEABLE
REPORTING
serviceLines
Array of ObjectsRequiredItems: 1 - 50

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

Array item
submitter
ObjectRequired

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

Show attributes

Response

application/json
errors
Array of Objects

Failed claim edits that would cause Stedi to reject the claim. Absent when the claim passes Stedi's pre-submission checks.

Array item
Coordination of Benefits Check
Create Professional Claim JSON