Overview

You can use Stedi to automate your claims processing workflow from claim submission through payment. Once you integrate with Stedi, you can monitor claim submissions and responses in the Stedi portal.

Claims processing workflow

Here's an overview of the claims processing steps you can automate with Stedi.

Transaction enrollment

Transaction enrollment is the process of registering a provider to exchange specific healthcare transactions with a payer. It's always required for 835 Electronic Remittance Advice (ERAs) and sometimes required for other transaction types, depending on the payer.

You'll submit transaction enrollment requests through either the Enrollments API or the Stedi portal. Once submitted, Stedi handles the entire process for you, including sending the required information to the payer and monitoring each enrollment's status.

Submit claims and attachments

You can submit 837P professional, 837D dental, 837I institutional, workers' compensation, and automobile claims through the following methods:

• Clearinghouse APIs in either JSON or X12 EDI format.
• SFTP in X12 EDI format.
• Stedi portal in either X12 EDI format or through our CMS-1500 form.

Before sending claims to the payer, Stedi checks them against our growing library of claim edits to identify errors that could lead to rejections or denials. Our APIs return edit rejections in real time, so you can fix and resubmit claims immediately.

You can also submit unsolicited 275 claim attachments as needed to support claims, such as medical records and treatment plans. You can submit attachments through Stedi APIs, SFTP, or the Stedi portal.

Retrieve 277CA claim acknowledgments

You'll likely receive multiple 277CA claim acknowledgments for each claim as it moves through Stedi and the payer's systems. A 277CA indicates whether a claim was accepted or rejected at a particular processing stage.

• APIs: You can poll or set up webhooks to discover new 277CAs. Then, you can retrieve 277CAs through Stedi APIs in either JSON or X12 EDI format.
• SFTP: You can retrieve 277CA files from the from-stedi directory.
• Stedi portal: You can review the 277CAs for submitted claims from the claims view.

Resubmit rejected claims

When you receive a 277CA indicating a claim was rejected, you'll need to review the rejection reason, fix the errors in the claim data, and resubmit the claim. Common rejection reasons include invalid or missing data, incorrect patient or provider details, incorrect billing codes or modifiers, and missing attachments.

You can resubmit claims through Stedi APIs, SFTP, or the Stedi portal.

Run real-time claim status checks

Once a claim has been accepted into the payer's adjudication system, you can run real-time claim status checks to get the current status of the claim.

You can submit real-time claim status requests through Stedi APIs in either JSON or X12 EDI format. You can also submit them manually through the Stedi portal as needed.

Retrieve 835 Electronic Remittance Advice (ERAs)

When the payer has finished adjudicating a claim, they'll send back an 835 Electronic Remittance Advice (ERA) with details about payments for specific services and explanations for any adjustments or denials.

• APIs: You can either poll or set up webhooks to discover new 835 ERAs. Then, you can retrieve 835 ERAs through Stedi APIs in either JSON or X12 EDI format.
• SFTP: You can retrieve 835 ERA files from the from-stedi directory.

Example API implementation

To build a professional claims workflow using Stedi JSON APIs, you would typically follow these steps:

1. Submit required transaction enrollment requests through the Providers and Enrollments APIs.
2. Configure webhooks to listen for events indicating Stedi has processed new 277CA claim acknowledgments and 835 Electronic Remittance Advice (ERAs).
3. Call the Professional Claims JSON endpoint to submit claims in JSON format.
4. Call the 277CA Report endpoint to retrieve processed 277CAs from Stedi in JSON format.
5. Evaluate 277CAs. If the claim was rejected, fix the errors and resubmit through the Professional Claims JSON endpoint.
6. Call the 835 Report endpoint to retrieve 835 ERAs from Stedi in JSON format.

You may also call the Real-Time Claim Status JSON endpoint as needed to check on claims that have entered the payer's adjudication system.

Claims view

The claims view in the Stedi portal provides insight into your claims processing pipeline. In the claims view, you can:

• Review every claim you submit through Stedi and the details of related claim transactions, such as 277CA claim acknowledgments.
• Review a clear timeline of activity for each claim, including resubmissions and responses you receive from Stedi and the payer.
• Understand a claim's current status within the processing pipeline, such as whether the claim has been accepted or rejected.
• Filter submitted claims by key details, such as processed date, status, patient name, and service date(s).