Receive and correlate claim responses

After you submit a claim, you may receive the following responses from the payer or peer clearinghouse:

• 999 Implementation Acknowledgment: A confirmation that the clearinghouse received the transformed EDI transaction and that it was formatted correctly. It does not indicate whether the claim itself was accepted or rejected.
• 277 Claim Acknowledgment: Indicates whether the claim was accepted or rejected and (if relevant) the reasons for rejection.
• 835 Electronic Remittance Advice (ERA): Details about payments for specific services and explanations for any adjustments or denials.

You can receive these responses from Stedi by polling or configuring an event-driven webhook. Then, you can map them to the Change Healthcare (CHC) 277 or 835 report format and correlate them with the original claim.

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Poll for transactions

Call the Poll Transactions endpoint to return a list of transactions in your Stedi account.

You must include the following information in the request:

• Your Stedi API key as the Authorization header.
• Either the startDateTime or pageToken query parameters. To retrieve a list of transactions after a specific date, use startDateTime. To retrieve the next page of transactions, use pageToken (you can find this value in the nextPageToken field in the response).

The following example shows an API call to retrieve transactions after a specific date:

  curl --request GET -L \
    --url https://core.us.stedi.com/2023-08-01/polling/transactions?startDateTime=2023-08-28T00:00:00Z \
    --header "Authorization: ${STEDI_API_KEY}" 

Filter for 277 and 835 transactions

The response includes all transactions that have been sent or received, including all 837 claims you have submitted and all 277, 835, and 999 responses you have received from payers and peer clearinghouses. You must filter for transactions that match the following criteria:

• direction: INBOUND - This indicates that the transaction came from the payer or peer clearinghouse.
• x12.transactionSetIdentifier: 277 or 835

The following example shows a response containing a processed 277 transaction:

{
  "items": [
    {
      "direction": "INBOUND",
      "mode": "production",
      "fileExecutionId": "f75168e4-e682-4410-bfec-b5b1541c7f21",
      "transactionId": "a15b68ca-fae0-42de-b8a3-f436668b8604",
      "processedAt": "2023-08-28T09:00:28.354Z",
      "artifacts": [
        {
          "artifactType": "application/edi-x12",
          "sizeBytes": 490,
          "usage": "input",
          "url": "https://core.us.stedi.com/2023-08-01/transactions/a15b68ca-fae0-42de-b8a3-f436668b8604/input"
        },
        {
          "artifactType": "application/json",
          "sizeBytes": 51,
          "usage": "output",
          "url": "https://core.us.stedi.com/2023-08-01/transactions/a15b68ca-fae0-42de-b8a3-f436668b8604/output"
        }
      ],
      "partnership": {
        "partnershipId": "customer_availity",
        "partnershipType": "x12",
        "sender": {
          "profileId": "availity_sender"
        },
        "receiver": {
          "profileId": "availity_receiver"
        }
      },
      "x12": {
        "metadata": {
          "interchange": {
            "acknowledgmentRequestedCode": "0",
            "controlNumber": 2
          },
          "functionalGroup": {
            "controlNumber": 2,
            "release": "008010",
            "date": "2023-08-28",
            "time": "09:00:20",
            "functionalIdentifierCode": "HN"
          },
          "transaction": {
            "controlNumber": "1",
            "transactionSetIdentifier": "277"
          },
          "receiver": {
            "applicationCode": "AV01101957",
            "isa": {
              "qualifier": "ZZ",
              "id": "AV01101957"
            }
          },
          "sender": {
            "applicationCode": "030240928",
            "isa": {
              "qualifier": "01",
              "id": "030240928"
            }
          }
        },
        "transactionSetting": {
          "guideId": "01H8PSWG4ZD6QPKC9VSD42PQX3",
          "transactionSettingId": "01H8PSWG4ZD6QPKC9VSD42PQX3"
        }
      }
    }
  ],
  "nextPageToken": "945ff6de213d3ef481d028065d4c12fb996a166a3a90ef98564318decfae50ce4b36d74b7e9d9bafa6e1d169"
}

For each matching transaction, extract the transactionId and x12.transactionSetIdentifier type to use when mapping the data to CHC’s format.

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Listen for webhooks

Instead of polling for transactions, we can help you set up webhooks that automatically send 277s, 835s, and 999s to your endpoint in Stedi’s JSON format. We’ll create one webhook for each transaction type.

These webhooks are triggered by the transaction.processed.v2 event Stedi emits after it successfully processes a response from the payer or peer clearinghouse. The event contains the transactionId, which you can use to map the data to CHC’s format.

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Map responses to CHC report format

Call the Map Transaction Output endpoint to transform payer responses into the Change Healthcare (CHC) 277 report or 835 report JSON format. There is no mapping for 999 Implementation Acknowledgments.

You must include the following information in the request:

• Your Stedi API key as the Authorization header.
• The transactionId query parameter, which specifies the processed transaction (277 or 835) you want Stedi to map. You can find this ID the response from either the Poll Transactions endpoint or the configured webhook.
• The mappingId query parameter, which is different for 277 and 835 reports. You can find the mapping ID on the mappings page in the Stedi app.
  • The 835 mapping may be named CHC JSON or [X12 HIPAA] 835 Health Care Claim Payment/Advice (X221A1).
  • The 277 mapping may be named CHC 277 Report or [X12 HIPAA] 277 Claim Ack X214.

The following shows an example request:

curl --request GET \
  --url https://mappings.us.stedi.com/2021-06-01/mappings/{id}/map-transaction-output/{transactionId} \
  --header 'Authorization: ${STEDI_API_KEY}'

The endpoint returns a 202 Accepted response when Stedi receives the initial request and while Stedi maps the transaction to CHC’s JSON shape. When the mapping process is complete, the endpoint returns a 302 Temporary redirect to a pre-signed S3 document download URL, which most API clients can automatically follow and download.

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Correlate responses with original claim

You can use the patientControlNumber from the original claim to correlate it with the 277 and 835 responses.

• In the 277 response, this number is returned as the patientAccountNumber
• In the 835 response, this number is returned as the patientControlNumber

You can further use the value passed in passed in the original claim’s claimInformation.serviceLines.providerControlNumber, if provided. A claim can contain multiple service lines, so this approach is especially useful for correlating the 835 response to specific service lines from the original claim.

• In the 277 response, this value coresponses to the tradingPartnerClaimNumber or the clearinghouseTraceNumber.
• In the 835 response, this value corresponds to the lineItemControlNumber.