Submit institutional claims - Manual

You can submit institutional claims manually in X12 EDI format through the Stedi portal. Manual claim submission is useful for testing, QA, and debugging your pipeline. You can also submit claims through the API, SFTP, or as paper claims.

Once you send a claim, Stedi automatically receives and processes 277CA claim acknowledgment and 835 Electronic Remittance Advice (ERA) responses.

Before sending claims

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

Transaction enrollment

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:

1. 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
2. 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.

Testing

The best way to test institutional claims is by submitting them in test mode through the Stedi portal.

To submit test claims through the Stedi portal:

1. Click your account name in the side navigation and toggle Test mode to ON.
2. Go to the claims view and click Submit claim.
3. Choose Upload raw X12 file from the dropdown.

When you send a test claim, Stedi doesn't send it to the payer. Instead, we apply our full suite of edits and repairs and return a 277CA claim acknowledgment indicating whether the claim was successfully processed.

Visit Test claims workflow to learn more about testing in the Stedi portal.

Submit institutional claims

You can submit institutional claims by uploading an X12 EDI file to the Stedi portal.

X12 EDI upload

Your X12 EDI claim data must adhere to the 837 Claim: Institutional (X223A2) specification.

To manually submit an X12 EDI claim:

1. Go to the claims view.

2. Click Submit claim and select Upload raw X12 file.

3. Do one of the following:

   • Click Upload X12 EDI and select an existing .edi file.
   • Select the transaction type and then paste the X12 EDI content into the text area.

   You can submit multiple claims in a single file, as long as all claims are 837s of the same type and X12 version. Visit Bulk claims for details.

4. Set ISA15 (Interchange Usage Indicator) to T (Test Data) or P (Production Data), accordingly. Production claims are sent to payers. Test claims aren't sent to payers - Stedi's test clearinghouse processes them and returns test 277CA acknowledgments so you can evaluate your claim processing pipeline.

5. Fix any X12 EDI validation errors that appear after adding the claim content. Stedi highlights errors in red and displays the specification for the claim type you selected on the right side of the screen to make it easier to identify and fix issues.

   These validations ensure your claim data conforms to the HIPAA specification. Stedi runs additional claim edits on your claim data after submission.

6. Click Submit claim.

Stedi processes the claim and runs claim edits to identify errors that could lead to a payer rejection. If a claim fails one of Stedi's edits, you'll receive a 277CA claim acknowledgment from Stedi rejecting the claim immediately after submission. This can happen even when the X12 EDI editor showed no errors before submission.

If the claim passes all of Stedi's edits, Stedi submits it to the payer. It will appear on the claims view within a few minutes.

Bulk claims

You can submit multiple claims in a single X12 EDI file, as long as they are all the same claim type (professional, institutional, or dental) and X12 version. 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 - all claims within a bulk submission are sent individually to maintain consistency.

The following example would produce 12 separate claims (2 x 3 x 2 = 12), each shown individually on the claims view:

• 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)

Then, you'll typically receive separate 277CA claim acknowledgments for each claim. Each claim will also receive its own test ERA from Stedi's test clearinghouse if the payer was STEDITEST.

275 claim attachments

If the claim requires attachments, you must include the PWK (Claim Supplemental Information) segment in Loop 2300 to identify the attachment. These elements are PWK01, PWK02, and PWK06.

Visit Claim attachments to learn more.

View submitted claims

In the claims view, you can review and filter every claim in your account. Toggle test mode to ON to review test claims. Click any claim to review its details.