Integrated accounts

An integrated account is a streamlined version of the Stedi portal that allows healthcare providers to monitor, manage, and troubleshoot their eligibility checks and claims directly. Stedi Platform Partners use integrated accounts to offer their customers this additional functionality without extensive development work.

Here's the typical use case:

1. A provider signs up for an integrated account with Stedi and then installs the Stedi app for their vendor. This process connects the provider's Stedi account to their vendor account.
2. The vendor sends transactions through the Stedi clearinghouse on the provider's behalf.
3. The provider can monitor and manage these transactions in their Stedi account. For example, they can perform manual eligibility checks, view submitted claims, and resubmit denied claims.

This page helps providers create an integrated account and use it in their eligibility and claim submission workflows.

Account setup

The following steps will help you create and configure an integrated account.

Create an integrated account

You can create an integrated account with Stedi directly. To create an integrated account:

1. Create a sandbox.
2. Click Upgrade.
3. Select Integrated Account and follow the prompts.

Install Stedi apps

Once you create an integrated account, you can install Stedi apps to quickly connect your account to third-party Revenue Cycle Management (RCM) systems, Practice Management Systems (PMS), Electronic Healthcare Record (EHR) platforms, and other Platform Partners.

Contact Stedi support to get early access to partner apps.

You may be asked to give your vendor information to complete the integration, such as SFTP credentials or API keys.

Add members

Your integrated account can have many members - a member represents an individual email address used to log into the account. You may want to add additional members so that other individuals in your organization can help manage transactions and troubleshoot issues. Your vendor may also request to be invited to your account, so they can investigate and troubleshoot issues directly during support sessions.

Members can have different roles, depending on the permissions you want them to have within your account. An Admin has the highest permissions, and they can access and update all resources in your account, including members and billing details. We recommend assigning most members to the Operator role. This role allows members to manage transactions (like claims and eligibility checks) and submit transaction enrollments requests, but not change account settings or billing information.

To add members to an integrated account:

1. Go to the Members page in Account settings.
2. Click Invite member.
3. Enter the email address of the member you want to add and select their role.
4. Click Send invitation.

The invited member will receive an email with instructions about how to accept the invitation and log into the account.

Visit Accounts and billing for complete details about managing your account, including enabling Multi-Factor Authentication (MFA).

Submit transaction enrollments

You must complete transaction enrollment with each payer before you can receive 835 Electronic Remittance Advice (ERA) transactions through Stedi. Transaction enrollment is also required for some other types of transactions, depending on the payer.

After signing up for your integrated account, we recommend:

1. Check the Payer Network to determine whether your payers require enrollment for the transaction types you want to send and receive. For transactions marked as Supported, enrollment required, you must complete the transaction enrollment process before you or your vendor can begin exchanging that transaction type through Stedi.
2. Submit transaction enrollment requests for all required payers.

You can track the status of your transaction enrollment requests from the Enrollments page in your account.

Eligibility & benefit verification

In your integrated account, you can:

• Review every historical eligibility check in your account.
• Search and filter eligibility checks by status, Payer ID, date, and error code.
• Edit and retry failed eligibility checks.
• Use the Debug view to systematically troubleshoot failed eligibility checks.

Run eligibility checks

Stedi stores eligibility check requests in groups called eligibility searches.

When you submit an eligibility check, Stedi creates a new eligibility search record. Every time you retry that eligibility check, Stedi stores the retry details within the existing eligibility search. This creates a clear timeline of troubleshooting efforts for failed requests.

To run a new eligibility check:

1. Go to the Eligibility searches page and click + New eligibility check.
2. Enter the required information. You can click Select fields to include additional information in the request.
3. Click Submit.

Stedi runs the eligibility check and stores it in a new eligibility search. Stedi sets the eligibility search to a status indicating whether the check was successful.

MBI lookup

A Medicare Beneficiary Identifier (MBI) is a unique, randomly-generated identifier assigned to individuals enrolled in Medicare. You must include the patient's MBI in every eligibility check you submit to the Centers for Medicare and Medicaid Services.

When patients don't know their MBI, you can perform an MBI lookup using their Social Security Number instead. To perform an MBI lookup:

1. Go to the Eligibility searches page and click + New eligibility check.
2. Construct an eligibility check request that includes the patient's first name, last name, date of birth, and Social Security Number (SSN). To do this, you'll need to click Select fields and check the box next to Social Security Number (SSN) under the Subscriber (required) section.
3. Set the Trading partner service ID to CMS MBI Lookup.
4. Click Submit.

Stedi uses the patient’s demographic data and SSN to perform an MBI lookup. If there is a match, Stedi submits an eligibility check to CMS. Stedi returns a complete eligibility response from CMS for the patient and returns the patient's MBI as the subscriber's member ID.

Medicare Advantage plans have their own unique member ID, which isn't returned in the MBI lookup response. You also shouldn't submit eligibility checks for Medicare Advantage plans to CMS (HETS) - you should submit them to the actual Medicare Advantage plan payer instead.

Debug and retry eligibility checks

You can edit the request details for failed eligibility checks and resubmit them as many times as you need to get a successful response. For some types of errors, you can use the Stedi Agent to troubleshoot automatically.

Visit Retry failed eligibility checks for complete details.

Claims processing

You can manage claim submissions in your integrated account, including submitting new claims, tracking existing claims a vendor submitted on your behalf, resubmitting claims, and reviewing 277CA claim acknowledgments (277CA) and 835 Electronic Remittance Advice (ERAs).

Review claims and claim responses

You can review every claim and claim response in your account on the Transactions page.

Click any transaction to view its details. In the Related transactions tab, you can find links to all related transactions, such as 277CA and 835 ERA responses. Visit response types for more details about these responses and when you can expect to receive them after claim submission.

Submit professional claims

You can submit 837P professional claims manually through the Create professional claim page.

The in-app form is based on the CMS-1500 claim form, but it doesn’t support every data element. Specifically, it omits some parts of Item 19 (Additional Claim Information) and all of Item 24 supplemental information (shaded area). If you need this data, you'll need to submit claims directly through SFTP or through your vendor instead.

Download CMS-1500 PDF

Stedi automatically generates a PDF CMS-1500 claim form for each professional claim.

To download the PDF:

1. Go to the Transactions page and click the claim you want to download.
2. Click Download CMS 1500 claim PDF. You can choose to download it either with or without the CMS-1500 form overlay.

Payers have strict requirements for submitted CMS-1500 claim forms. If you plan to send generated PDFs to payers or retain them for your records, we strongly recommend visiting CMS-1500 Claim Form PDF for information about the correct printer settings for generated PDFs and general best practices.

Revise and resubmit claims

You may need to resubmit claims for several reasons, including changes to the patient's coverage, errors in the original claim's information, or appealing a denied claim. You may also need to cancel duplicate claims or claims that were submitted in error.

You can manually revise and resubmit professional and dental claims in your integrated account. To manually resubmit a claim:

1. Go to the Transactions page and click the claim you want to resubmit.
2. Click Edit and resubmit. Stedi opens the claim in an interactive editor, with the X12 EDI on the left and the EDI specification on the right.
3. Make any necessary changes to the claim EDI, then click Review and submit. Stedi shows a comparison of the original claim and the new claim containing your changes.
4. Click Resubmit claim to send the updated claim to the payer.

Claim Frequency Code

Set the Claim Frequency Code to one of the following values. In X12 EDI, this is the Loop 2300 CLM05-03 (Claim Frequency Code) component.

• Resubmit to Stedi or another payer: Set to 1 - Admit thru Discharge Claim. Either Stedi rejected the claim due to validation errors, or you're resubmitting the claim to a different payer for the first time. In either case, the payer hasn't yet processed the claim.
• Correct or replace claims: Set to 7 - Replacement of Prior Claim. In this case, the payer processed the original claim.
• Cancel claims: Set to 8 - Void/Cancel of Prior Claim.

Payer Claim Control Number

When correcting, replacing, or canceling claims, you should include the Payer Claim Control Number (sometimes called the ICN) from the original claim for identification. In X12 EDI, this is Loop 2300 REF02, where REF01 = F8 (Original Reference Number).

• The Payer Claim Control Number is different from the value you sent in the original claim's Loop 2300 CLM01 (Patient Control Number).
• You can retrieve the Payer Claim Control Number from one of the payer's 277CA claim acknowledgments in Loop 2200D REF02 when REF01 is set to 1K (Payor's Claim Number).

Patient Control Number

When correcting or replacing claims, we also recommend setting a new, unique Patient Control Number. In X12 EDI, this is the Loop 2300 CLM01 element. The payer includes this value in their 835 ERA, allowing you to easily correlate that response with your resubmission.