Submit professional claims - Manual

You can submit professional claims manually 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 acknowledgments 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 professional 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 either CMS-1500 form or 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 professional claims

You can submit professional claims either through our interactive claim form or by uploading X12 EDI claim data.

CMS-1500 claim form

The CMS-1500 form only supports submitting claims to the patient's primary health plan, though you can include information about secondary or tertiary payers if required. To submit claims directly to secondary or tertiary payers, use X12 EDI upload, API, or SFTP instead.

To submit a professional claim: Go to the claims view, click Submit claim, and select CMS-1500 form from the dropdown.

The submission form is based on the CMS-1500 Claim Form.

Enter the required information for your professional claim. Notably:

Form section	Instructions and Notes
Send	Select whether you want to send the claim Electronically or By mail. Electronically: The claim is transformed into an X12 EDI transaction and routed electronically to the payer. By mail: Select this option when you want to send a paper claim to the payer. When you select this option: If the payer exists in Stedi's Payer Network, select it from the Stedi payer dropdown. If the payer is not in the network, check I'm sending to a payer not found in Stedi's network. Stedi automatically populates the dropdown with the Print and Mail - All Payers option. Additional fields appear in the Postage address section where you must enter the mail-to payer name (the addressee on the physical envelope) and the payer's mailing address (where the claim will be sent).
Stedi payer	Select a Payer from the dropdown list. Start typing to filter the list.
Patient account number	We strongly recommend submitting a unique value in Box 26 (Patient acccount number). The identifier should be more complex than a simple sequential number and should be hard to guess. The payer returns this value in related transactions, such as the 277CA and 835 ERA, so you can correlate responses and real-time claim status checks with the original claim. Keep it 17 characters or less. Some payers cut off values longer than 17 characters in ERAs and claim acknowledgments, which makes it hard to match them with the original claim. Use alphanumeric characters only. Avoid special characters, as many payers don't handle them properly. Use random strings. Formats with patient initials or the date of service in them can create duplicates.
Line item control numbers	The line item control number is an identifier for each service line in Box 24 (Service lines) that you can use correlate the original claim with the 835 ERA. By default, Stedi automatically assigns line item control numbers for each service line. To set your own identifiers, click the Set manual line item control numbers in the service lines table. Line item control numbers must be 30 characters or less and unique within the claim. Note that Stedi will automatically reuse the same line item control numbers if you resubmit this claim through the CMS-1500 form.
Attachments	Submit claim-level attachments in Box 19b (Claim attachments) and service-line attachments in Box 24 (Service lines). Note that you can't add attachments to claims that were already submitted through the portal. To include attachments for those, resubmit the claim with the attachments. Click + Add attachment (claim-level) or Add attachment, note or NDC codes (service-line) to specify the details for an attachment. Choose the appropriate Report type for each attachment. Choose the appropriate Transmission code. If you plan to upload an attachment file, set this to EL (EDI). If you plan to submit the attachment through another method, such as directly through the payer's portal, set this to the appropriate code. Either enter the Attachment control number or click Upload file to select the file you want to attach. Supported file types are JPG, PDF, PNG, or TIFF. Each attachment should be 10 MB or less to comply with most payer requirements. You can add up to 10 attachment files at the claim level and up to 10 attachment files for each service line. If you included attachment files, Stedi automatically generates the required attachment control numbers for you.
Secondary or tertiary or payer details	Select an option in Box 11d (Is there another health benefit plan?). Select Yes when submitting a coordination of benefits (COB) claim. Box 9 (Other insured) appears where you can enter the other payer's information. In Box 9, Click + Other insured to add multiple plans (up to two additional plans for secondary and tertiary coverage). Each other insured card includes: Box 9: Other Insured's Name (required) and Member ID Number (required) Box 9a: Other Insured's Policy or Group Number Box 9d: Insurance Plan Name or Program Name Additional details: Click to expand and enter Other Payer (required), Payer Responsibility Sequence Number Code (required), Other Insured Relationship to Insured (required), and additional optional fields. Select No when the patient is covered by a single health plan.

When you're finished, click Submit claim. Stedi validates the claim and submits it to the payer. It will appear on the claims view within a few minutes.

X12 EDI upload

Your X12 EDI claim data must adhere to the 837 Claim: Professional (X222A1) 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 your claim requires attachments, you can include them through either submission method:

• CMS-1500 form: Add claim-level attachments in Box 19b and service-line attachments in Box 24. You can upload files directly or enter attachment control numbers.
• X12 EDI upload: Include the PWK segment in Loop 2300 (claim-level) or Loop 2400 (service-line) with elements PWK01, PWK02, and PWK06 to identify the attachment.

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 and download the auto-generated CMS-1500 claim form PDF.

CMS-1500 claim form PDF

When you submit a professional claim, Stedi automatically generates a CMS-1500 claim form PDF. Visit CMS-1500 claim form PDF for instructions about how to download, correct printer settings, and general best practices.