Use Stedi to send 837P Health Care Claims to payers and receive responses, including the 277 Claim Acknowledgement, 835 Electronic Remittance Advice (ERA), and 999 Implementation Acknowledgment.

Send claims Stedi

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Send a Claim

When you call the Professional Claims endpoint:

  • Stedi automatically maps CHC payer IDs to our payer IDs.
  • Stedi translates the JSON to the X12 EDI 837 format and delivers it to the payer.

The endpoint returns a synchronous response from Stedi in JSON format. Later, the payer will respond with a 277 Claim Acknowledgement.

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Supported payers

Review our list of supported payers for claims.

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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.
  • Response Type: Controls the shape of the response payload. Set to change-beta to return a payload matching the CHC Professional Claims V3 format.

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Body

The JSON payload in the body must conform to the CHC Professional Claims V3 format.

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Line item control number

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 recommend including the lineItemControlNumber as a unique identifier for each line. This value allows you to correlate the 835 response to the specific service lines from the original the claim.

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Sample request

The following example sends a professional claim.

curl --request POST \
  --url https://healthcare.us.stedi.com/2024-04-01/change/medicalnetwork/professionalclaims/v3/submission \
  --header 'Authorization: <api-key>' \
  --header 'Content-Type: application/json' \
  --header 'Stedi-Partnership-Id: <stedi-partnership-id>' \
  --header 'Stedi-Response-Type: change-beta' \
  --header 'Stedi-Transaction-Setting-Id: <stedi-transaction-setting-id>' \
  --data '{
  "controlNumber": "555123",
  "tradingPartnerServiceId": "6400",
  "submitter": {
    "organizationName": "Test Data Health Services, Inc.",
    "contactInformation": {
      "name": "Test Data Health Services, Inc.",
      "phoneNumber": "5552223333"
    }
  },
  "receiver": {
    "organizationName": "Cigna"
  },
  "subscriber": {
    "memberId": "U7777788888",
    "paymentResponsibilityLevelCode": "P",
    "subscriberGroupName": "Cigna",
    "firstName": "John",
    "lastName": "Anon",
    "gender": "M",
    "dateOfBirth": "20000101",
    "groupNumber": "3335555",
    "address": {
      "address1": "2222 Random St",
      "city": "New York",
      "state": "NY",
      "postalCode": "100130000"
    }
  },
  "billing": {
    "providerType": "BillingProvider",
    "npi": "1235600834",
    "employerId": "832675429",
    "taxonomyCode": "2084P0800X",
    "organizationName": "Therapy Associates",
    "address": {
      "address1": "123 Some St",
      "address2": "Floor 1",
      "city": "New York",
      "state": "NY",
      "postalCode": "100130000"
    },
    "contactInformation": {
      "name": "Test Data Health Services, Inc.",
      "phoneNumber": "5553334444"
    }
  },
  "claimInformation": {
    "claimFilingCode": "CI",
    "patientControlNumber": "22266555",
    "claimChargeAmount": "109.20",
    "placeOfServiceCode": "02",
    "claimFrequencyCode": "1",
    "signatureIndicator": "Y",
    "planParticipationCode": "A",
    "benefitsAssignmentCertificationIndicator": "Y",
    "releaseInformationCode": "Y",
    "healthCareCodeInformation": [
      {
        "diagnosisTypeCode": "ABK",
        "diagnosisCode": "F1111"
      }
    ],
    "serviceFacilityLocation": {
      "organizationName": "Smith Associates",
      "address": {
        "address1": "1234 Other St",
        "city": "New York",
        "state": "NY",
        "postalCode": "100130000"
      },
      "npi": "4541648844"

    },
    "serviceLines": [
      {
        "serviceDate": "20240101",
        "professionalService": {
          "procedureIdentifier": "HC",
          "procedureCode": "90837",
          "procedureModifiers": [
            "95"
          ],
          "lineItemChargeAmount": "109.20",
          "measurementUnit": "UN",
          "serviceUnitCount": "1",
          "compositeDiagnosisCodePointers": {
            "diagnosisCodePointers": [
              "1"
            ]
          }
        },
        "renderingProvider": {
          "providerType": "RenderingProvider",
          "npi": "4541648844",
          "taxonomyCode": "111YP2000X",
          "firstName": "Jane",
          "lastName": "Smith"
        }
      }
    ]
  },
  "tradingPartnerName": "Cigna"
}'

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View and filter files

You can view the files that Stedi sends and receives in the Files page of the Stedi app.

Stedi marks claims you send through the API as production files by default. You can specify that a claim contains test data by setting the usageIndicator field to T. On the Transactions page, you can then review and filter claims by Usage - production or test.

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Supported payers

Review our list of supported payers for claims.

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Provider enrollment

You can begin sending claims for many payers immediately. However, there is a subset of payers that require enrollment before they will accept claims. This typically involves submitting information about the provider that will send claims to the payer, including the provider’s name, tax ID, NPI, billing address, and contact information.

The list of supported payers includes information about which payers require enrollment. Submit payers to our enrollment form, and we can help you complete the enrollment process for them as needed.

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Stedi payer errors

Error messagePossible causes and resolutions
Payer is not configured for {transaction type}. Please contact Stedi support to resolve.Stedi does not yet support this transaction type for this payer, or there is a mis-mapping of payer IDs. Contact us with the name of the payer, and we’ll investigate the issue.
Payer connection does not support {transaction type}. Please contact Stedi support to discuss connectivity options.Stedi has a connection to this payer, but it doesn’t currently support this functionality (real-time eligibility or claim submission). Contact us for a timeline on enabling it.
Payer is not configured. Please check our published payer list or contact Stedi support to resolve.Stedi doesn’t recognize the payer ID you provided. Double-check the Payer ID in the Stedi Payer Network, or contact us with the name of the payer, and we will help you determine the correct payer ID.
Payer is not supported. Please contact Stedi support to discuss connectivity options.Stedi doesn’t yet have connectivity to this payer. We’re likely already working on it - contact us for details about the connectivity timeline.

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