Format and submit claims

After setting up SFTP, you're ready to start submitting 837 claims and unsolicited 275 claim attachments.

Before sending claims

You may need to complete the following steps before sending claims.

Transaction enrollment is the process of registering a provider to exchange specific healthcare transactions with a payer. Some payers require enrollment before allowing providers to submit 837 claims through a new clearinghouse.

You can check whether a specific payer requires transaction enrollment for 837 claims in the Payer Network or through the Payers API.

To enroll, complete the following steps:

Create a provider record with the information required for enrollment. If you already have a record for the provider, you can skip this step. Stedi portal | API endpoint
Submit an enrollment request for the claim type. Stedi portal | API endpoint

For most payers that require enrollment for claim submission, enrolling through Stedi won't impact your ability to send transactions to your original clearinghouse. Only a few payers require the 837 claim to be sent to the same clearinghouse as the 835 ERA enrollment. For any questions on payer nuances, contact Stedi's support team.

Best practices

Leverage batch enrollments when onboarding new provider groups or many providers at a time.
For ERAs, you can only be enrolled through one clearinghouse at a time per payer per provider. When your ERA enrollment is accepted through Stedi, you'll stop receiving ERAs through the previous clearinghouse. Every other transaction type accepts enrollment through more than one clearinghouse.

Coordination of benefits check

We recommend running a coordination of benefits (COB) check to ensure you submit claims to the correct payer. COB checks can help you determine:

If a patient is covered by more than one health plan
Whether coverage overlap requires coordination of benefits
Each payer's responsibility for payment (primacy) in coordination of benefits scenarios

Visit Coordination of benefits (COB) checks for more information.

Test claims

You can submit test claims through SFTP to validate your integration without sending claims to payers. Stedi offers two workflows:

Test payer-specific edits: Submit test claims to any payer and receive test 999 Implementation Acknowledgments and 277CA claim acknowledgments from Stedi.
Generate a test ERA: Submit test claims to the Stedi Test Payer and receive test 999s, test 277CAs, and a test 835 ERA from Stedi.

Visit Test claim workflows for details.

Format X12 EDI files

You must drop claims and claim attachments into the to-stedi directory in X12 EDI format. Stedi validates the claims and routes them to the appropriate clearinghouse based on the ISA15 Interchange Usage Indicator element and the SFTP user type.

ISA validation

Stedi validates the ISA envelope to ensure ISA08 (Interchange Receiver ID) and ISA15 (Interchange Usage Indicator Code) match your SFTP user type and the intended clearinghouse. If the values don't match, Stedi rejects the interchange with a TA1 Interchange Acknowledgment.

In the TA1 rejection, TA105 (Interchange Note Code) can be set to:

008 (Invalid Interchange Receiver ID) when ISA08 doesn't match the intended clearinghouse
020 (Invalid Test Indicator Value) when ISA15 doesn't match the SFTP user type

The following table shows which combinations are permitted:

SFTP user type	ISA15	ISA08	Behavior
Test	`T`	`STEDITEST`	Accept
Prod	`P`	`STEDI`	Accept
Test	`T`	`STEDI`	Reject - `TA105` set to `008`
Test	`P`	`STEDI`	Reject - `TA105` set to `020`
Test	`P`	`STEDITEST`	Reject - `TA105` set to `020`
Prod	`P`	`STEDITEST`	Reject - `TA105` set to `008`
Prod	`T`	`STEDI`	Reject - `TA105` set to `020`
Prod	`T`	`STEDITEST`	Reject - `TA105` set to `020`

The following example shows a TA1 rejection that resulted from sending a test claim through a production SFTP user.

ISA*00*          *00*          *ZZ*STEDI          *ZZ*111222333444   *260602*2054*^*00501*000000050*0*T*`~
TA1*000000135*260527*1518*R*020~
IEA*0*000000050~

837 claims

Claims must adhere to the following X12 HIPAA claim specifications:

We recommend submitting one claim per file to make troubleshooting easier. However, an EDI Interchange can contain multiple transactions, so you can submit multiple claims within a single file if needed. Regardless of how many claims you submit in a file, Stedi processes each claim individually and returns each claim response as a separate file.

Required elements

You must populate all required claim information according to the X12 HIPAA specification. You can submit any valid values in the ISA and GS envelope with a few exceptions listed in the following table.

You must set the following elements to specific values:

Data	Location	Instructions
Interchange Receiver ID	`ISA08`	Set to `STEDITEST` for test claims or `STEDI` for production claims.
Interchange Usage Indicator	`ISA15`	Set to `T` for test claims or `P` for production claims. You must use a test SFTP user to submit test claims and a production SFTP user to submit production claims.
Group Control Number	`GS06`	Include a unique value for each claim so you can correlate error 999 Implementation Acknowledgments with the original claim submission. Without a unique `GS06`, you won't be able to determine which claim was rejected.
Implementation Guide Version Name	`ST03`	Set to the appropriate value for the claim type: • Professional: `005010X222A1` • Institutional: `005010X223A2` • Dental: `005010X224A2`
Payer ID	`Loop 2010BB NM109`	Submit a payer identifier listed in the Payer Network so Stedi can route the claim to the correct payer. This identifier must be a payer ID or payer ID alias. You must include leading `0` characters - for example, use `00540` for SISCO, not `540`.
Patient Control Number	`CLM01`	We recommend including a unique value for each claim. This value is returned in both the 277CA and 835 ERA responses, so you can use it to correlate responses with the original claim.

If your system requires you to send unique values in the ISA and GS envelope, you can find suggested configurations for each transaction type on the SFTP setup page under ISA settings.

The following example shows a professional claim in X12 EDI format. ISA15 is set to P, as this is a production claim.

ISA*00*          *00*          *ZZ*401576130024   *ZZ*STEDI          *260213*2039*^*00501*000000123*0*P*>~
GS*HC*574183004559*STEDI*20260213*203918*39*X*005010X222A1~
ST*837*0001*005010X222A1~
BHT*0019*00*01KHCBK84E40QQYJVXA5VVXG54*20260213*2038*CH~
NM1*41*2*Data Health Services*****46*123435~
PER*IC**TE*5552223333~
NM1*40*2*AETNA*****46*60054~
HL*1**20*1~
PRV*BI*PXC*2084P0800X~
NM1*85*2*Billing Provider Name*****XX*1999999984~
N3*123 Some St*Floor 1~
N4*A City*NY*123450000~
REF*EI*123456789~
PER*IC*Data Health Services*TE*5553334444~
HL*2*1*22*0~
SBR*P*18*3335555******CI~
NM1*IL*1*Doe*John****MI*123456789~
N3*123 Some St~
N4*Somewhere*VA*123450000~
DMG*D8*20000101*M~
NM1*PR*2*AETNA*****PI*60054~
CLM*123456789*109.2***02>B>1*Y*A*Y*Y~
HI*ABK>F1111~
NM1*77*2*Service Facility Name~
N3*1234 Other St~
N4*A City*NY*123450000~
LX*1~
SV1*HC>90837>95*109.2*UN*1***1~
DTP*472*D8*20240101~
REF*6R*111222333~
SE*29*0001~
GE*1*39~
IEA*1*000000123~

Claim identifier

Loop 2300 REF02 (Claim Identifier for Transmission Intermediaries) has different usage rules depending on your role:

Providers: Don't include Loop 2300 REF02 when REF01 = D9 in your claim submission. It's reserved for clearinghouses and intermediaries. You can use Loop 2300 CLM01 (Patient Control Number) to correlate claims with responses instead.
Clearinghouses and intermediaries: You can optionally include REF*D9 in your 837 submissions. Stedi always returns this value in Loop 2200D REF*D9 of 277CA claim acknowledgments, allowing you to match these responses to the claim.

Bulk claims

You can submit multiple claims in the same 837 transaction by including multiple instances of the following loops:

Loop 2000A (Billing Provider)
Loop 2000B (Subscriber)
Loop 2300 (Claim Information) - You can submit up to 1,000 claim loops in each 837 transaction

After submission, Stedi separates your bulk 837 transaction into individual claims and sends each claim separately to the payer. This includes multiple claims going to the same payer - Stedi sends all claims within a bulk submission individually to maintain consistency.

The following example would produce 12 separate claims (2 x 3 x 2 = 12):

837 transaction contains information for two billing providers (2x Loop 2000A)
Each billing provider has three subscribers (3x Loop 2000B)
Each subscriber has two claims (2x Loop 2300)

By default, Stedi returns one 999 Implementation Acknowledgment when one or more transactions in the bulk 837 fail validation. 999s for fully accepted bulk transactions are opt-in only - visit Monitor for 999 rejections for details.

Then, you'll typically receive separate 277CA claim acknowledgments for each claim. Note that Stedi sends accepted claims to the payer, even if other claims within the batch fail our validation. You should monitor for 277CA rejections and resubmit those claims accordingly.

Each claim also receives its own test ERA from Stedi's test clearinghouse if the payer was STEDI. Visit Test claim workflows for complete instructions on sending test claims and receiving test responses.

You'll be billed per claim submitted, not per bulk 837 transaction. For example, if you submit a bulk 837 transaction with 10 claims, you'll be billed for 10 claims.

275 claim attachments

You can submit unsolicited claim attachments through SFTP. Unsolicited attachments are sent proactively with the claim without a prior payer request. If a payer sends a Request for Additional Information (277 RFA), you cannot submit the requested attachments through Stedi.

Before you can submit an attachment, you must first submit a claim that references the attachment(s) in the appropriate location. Visit Claim attachments for complete instructions.

Claim attachments must adhere to the 275 Patient Information (X210) X12 HIPAA specification.

Required elements

You must set the following elements to specific values:

Data	Location	Instructions
Interchange Usage Indicator	`ISA15`	Set to `T` for test attachments or `P` for production attachments. You must use a test SFTP user to submit test attachments and a production SFTP user to submit production attachments.
Implementation Guide Version Name	`ST03`	Set to `005010X210` for all 275 claim attachments.
Payer ID	`Loop 1000A NM109`	Submit a payer identifier listed in the Payer Network so Stedi can route the attachment to the correct payer. This identifier must be a payer ID or payer ID alias. You must include leading `0` characters - for example, use `00540` for SISCO, not `540`.
Attachment Control Number	`Loop 2000A TRN02`	This value must match the value you submitted in the claim's `PWK06` element. This is how Stedi and the payer match the attachment with the claim.

The following example shows a 275 claim attachment in X12 EDI format. ISA15 is set to T, as this is a test attachment.

ISA*00*          *00*          *ZZ*STEDI          *ZZ*CIGNA          *250227*2140*^*00501*000000001*0*T*>~
GS*PI*STEDI*CIGNA*20250227*214016*1*X*005010X210~
ST*275*1001*005010X210~
BGN*11*0001*20060915~
NM1*PR*2*CIGNA*****XV*62308~
NM1*41*2*XYZ SERVICES*****46*1999999976~
NM1*1P*2*THE HOSPITAL*****XX*3999000B01~
NX1*1P~
N3*123 Main~
N4*Miami*FL*11111~
NM1*QC*1*DOE*JOHN*J***MI*987654320~
REF*EJ*DOE123~
REF*EA*AAAAA12345~
DTP*472*D8*20060812~
LX*1~
TRN*2*11122233344~
STC*R4>18626-2>>LOI~
DTP*368*D8*20060915~
CAT*AE*TX~
EFI*05~
BIN*8*U3RlZGk=~
SE*20*1001~
GE*1*1~
IEA*1*000000001~

Size limits

We recommend limiting attachments to 64MB each, but some payers may have different size requirements. When in doubt, check the payer's documentation to determine their specific limits. This limit is per attachment file - you can submit multiple attachment files in each 275 transaction.

Paper claims

Some payers require claims to be submitted on paper rather than electronically. When you send a claim and optional attachments through SFTP with paper-specific routing information, Stedi handles printing and mailing the claim to the payer on your behalf.

For paper claims with attachments, you must submit both the 837 claim and 275 attachment in the same X12 interchange.

Visit Submit paper claims for complete requirements and examples.

Send claims and attachments

Drop claim and attachment files into the to-stedi directory. Stedi automatically validates the data and then routes each transaction to the appropriate clearinghouse (test or production).

Stedi deletes files from the to-stedi directory after processing them to avoid duplicate submissions.

We strongly recommend monitoring for 999 rejections that indicate Stedi rejected at least one transaction in the file. Otherwise, your submissions may silently fail.

Format and submit claims

On this page