Submit claims and check claim status
Use Stedi to send 837P (professional) Health Care Claims to payers. You can also check the status of existing claims in real time.
Some payers require enrollment before you can start sending them claims.
Enable clearinghouse
Before you can send claims, you must enable the Stedi clearinghouse in your account. Go to EDI Settings and click Enable Stedi Clearinghouse.
Stedi automatically configures the necessary settings to send test and production claims and receive 277 and 835 payer responses.
Submit claims
Call one of the following endpoints to send 837 professional claims:
- Professional Claims to send requests in JSON
- Professional Claims Raw X12 to send requests in X12 EDI
The endpoint returns a synchronous response from Stedi in JSON format. Later, the payer will respond with a 277 Claim Acknowledgement.
Headers
When constructing the request, you must include the following Stedi-specific information in headers:
- API Key: Generate an API key to use for authentication.
- Content Type: Set to
application/json. - Stedi Partnership ID: Set this to
local-clearinghousefor production claims orlocal-clearinghouse-testfor test claims. - Transaction Setting ID: Set this to
005010X222A1-837, unless support has specifically instructed you to use a different value.
Body
The information you submit for a claim depends on your use case. Refer to the Professional Claims endpoint for a complete list of fields. However, all claims require the following high-level information:
| Information | Description |
|---|---|
tradingPartnerServiceId | This is the Payer ID. Visit the Payer Network for a complete list. You can also use the same payer IDs you used for CHC eligibility checks. |
tradingPartnerName | This is the payer’s business name, like Cigna or Aetna. |
submitter object | Information about the entity submitting the healthcare claim. This can be either an individual or an organization, such as a doctor, hospital, or insurance company. |
receiver object | Information about the payer, such as an insurance company or government agency. |
subscriber and/or dependent objects | Information about the patient who received the medical services. |
claimInformation object | Information about the claim, such as the patient control number, claim charge amount, and place of service code. It also includes information about each individual service line included in the claim. |
billing object | Information about the billing provider, such as the NPI, taxonomy code, and organization name. |
Identify service lines
A claim can contain multiple service lines. Since the payer may accept, reject, or pay a subset of those lines, you can receive an 835 response that references a patientControlNumber, but only pertains to some of the service lines.
Therefore, even though it is technically an optional field, we strongly recommend including the provider control number as a unique identifier for each service line in your claim submission. This value appears in the 835 response as the lineItemControlNumber, allowing you to correlate the 835 response to the specific service lines from the original claim.
Sample request
The following example sends a professional claim.
Test claims
To send test claims:
- Set the
Stedi-Partnership-Idheader tolocal-clearinghouse-test. Stedi processes your payload as a test claim and doesn’t send it to the payer. - Set the
Stedi-Transaction-Setting-Idheader to005010X222A1-837. - Set the
usageIndicatorfield in the test claim toT. This allows you to filter for test claims on the Transactions page in the Stedi app.
Note that you will receive a 277 Claim Acknowledgment in response to test claims, allowing you to test your workflow end to end, but you will not receive a test 835 (ERA) response.
Check claim status
You may need to check the status of a claim if you don’t receive a 277 acknowledgment or 835 ERA response from the payer within your expected timeframe. You may also want to check the status of a claim submitted by another entity. For example, a billing agency may want to check the status of a claim submitted by their customer, who is a provider.
Call one of the following endpoints to send a 276 Claim Status Request:
- Claim Status to send requests in JSON
- Claim Status Raw X12 to send requests in X12 EDI
The endpoint returns a synchronous response from the payer in JSON format, containing information about the referenced claims and their current status.
View submitted claims
You can view the files that Stedi sends and receives in the Files page of the Stedi app.
On the Transactions page, you can review and filter claims by Usage - production or test.
Download 1500 claim form
Stedi automatically generates a PDF 1500 claim form for each claim you submit. You can download the form on the transaction details page for the claim in the Stedi app.
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