Workers' compensation and automobile claims

Workers' compensation and automobile (auto) claims are a subset of property and casualty claims (P&C). They're required when an injury or illness is related to work or a motor vehicle accident. These claim types are different than standard medical claims because:

They're typically submitted to different payers than the patient's primary insurance, such as state workers' compensation boards or auto insurance companies.
They often require additional information, such as accident details and attachments to support the claim.
They may be subject to different rules and regulations, which can vary by state and payer.

You can submit workers' compensation and auto claims through Stedi's UI, claim submission APIs, and SFTP. Currently, only 837P professional claim transactions are supported.

There is an additional cost to submit these claim types. Contact Stedi customer support for details.

Transaction enrollment

There is no enrollment required for workers' compensation or auto claims. There is also no transaction enrollment required for their associated 835 Electronic Remittance Advice (ERAs).

You can only receive 835 ERAs for workers' compensation claims through the clearinghouse you used for the claim submission. That means you can't split claim submission and ERA receipt between Stedi and another clearinghouse.

Submit claims

You'll submit workers' compensation and auto claims to Stedi the same way you submit standard medical claims.

Stedi portal: From the Transactions page, click Submit claim. You can either:
- Upload EDI file: Submit raw X12 EDI files.
- Submit manually: Complete a virtual CMS-1500 claim form.
SFTP: Upload X12 EDI files to Stedi's SFTP server. Visit SFTP claim submission for details.
API: Submit claims through either of the following endpoints:
- Professional Claims JSON
- Professional Claims Raw X12

You'll provide much of the same information as standard medical claims, such as details about the patient, provider, and amount billed. However, workers' compensation and auto claims have the following additional requirements.

Payer

You must submit the claim to the payer responsible for processing the patient's compensation or auto claim. This is typically a different payer than the one you would use for the patient's standard medical claims. You can find all of Stedi's supported workers' compensation and auto payers in the Payer Network.

You can identify the payer using any Payer ID or alias listed in the Payer Network. When submitting claims, you'll indicate the payer in:

JSON: tradingPartnerServiceId
X12 EDI: Loop 2010BB NM109 (Payer Identifier)

Claim Filing Indicator Code

Set the Claim Filing Indicator Code to WC (Workers' Compensation Health Claim) or AM (Automobile Medical). This is what differentiates the claim from a standard medical claim.

When submitting claims, you'll indicate the Claim Filing Indicator Code in:

JSON: claimInformation.claimFilingCode
X12 EDI: Loop 2000B SBR09 (Claim Filing Indicator Code)

Patient information

The subscriber is the entity that holds the insurance policy, and the patient is the individual who received care. Note that for workers' compensation claims, the subscriber is typically the employer.

You'll submit the subscriber information in:

JSON: subscriber object
X12 EDI: Loop 2000B (Subscriber)

You'll submit the patient's information in:

JSON: dependent object
X12 EDI: Loop 2000C (Patient)

Individual Relationship Code

The Individual Relationship Code indicates the relationship between the patient and the insurance holder.

For all workers' compensation claims and auto claims where the insurer is not the same entity as the patient, leave this empty.
For auto claims where the patient is the insurance holder, set this to 18 (Self).

When required, you'll indicate the Individual Relationship Code in:

JSON: Stedi automatically sets the Individual Relationship Code to 18 in the final X12 EDI transaction to the payer when you include the patient's information in the subscriber object instead of the dependent object. There is no property to set this in JSON.
X12 EDI: Loop 2000B SBR02 (Individual Relationship Code)

Attachments

Many workers' compensation and auto claims require attachments to support the claim. For example, you may need to include an accident report, test results, or medical records. Attachments are sent to the payer as separate 275 transactions that you link to the claim through an attachment control number.

Attachments aren't yet supported for workers' compensation and auto claims submitted through Stedi. You'll need to submit attachments directly to the payer and reference the attachment in your claim submission. Visit Attachments for details.

Additional information

You may need to include additional information in workers' compensation and auto claims that you don't typically include on standard medical claims. For example, you may need to include accident details such as the date, time, and location of the accident.

Review the payer's requirements for these claim types to ensure you include all necessary information.

State board auto-submission

The New York Workers' Compensation Board requires that workers' compensation claims are submitted both to the clearinghouse and directly to their system.

We automatically send a copy of submitted claims to the New York Workers' Compensation Board. You don't need to do anything else to meet this requirement.

Examples

The following examples show claims in both JSON and X12 EDI format.

Workers' compensation

The following examples show a workers' compensation claim:

The Claim Filing Indicator Code is set to WC to indicate that this is a workers' compensation claim.
The Individual Relationship Code is left empty because the subscriber (the employer) is not the same entity as the patient.
The subscriber for most workers' compensation claims is the employer. In JSON, the patient's details are in the dependent object. In X12 EDI, the patient's details are in Loop 2000C PAT (Patient Information).
The claim includes references to an attachment that supports the claim. In JSON, this is the claimSupplementalInformation object because the attachment is relevant for the entire claim. In X12 EDI submissions, this is Loop 2300 PWK (Claim Supplemental Information). Visit Reference attachments in a claim for more details.

 {
   "tradingPartnerServiceId": "WCPAYER",
   "usageIndicator": "T",
   "billing": {
      "address": {
        "address1": "123 Some St",
        "city": "Pittsburgh",
        "postalCode": "12345",
        "state": "VA"
      },
      "contactInformation": {
        "name": "Billing Contact",
        "phoneNumber": "1234567890"
      },
      "employerId": "123456789",
      "npi": "1999999984",
      "organizationName": "Billing Dr Last Name",
      "providerType": "BillingProvider",
      "taxonomyCode": "207QG0300X"
    },
    "claimInformation": {
      "benefitsAssignmentCertificationIndicator": "Y",
      "claimChargeAmount": "2160.00",
      "claimFilingCode": "WC",
      "claimFrequencyCode": "1",
      "healthCareCodeInformation": [
        {
          "diagnosisCode": "G8250",
          "diagnosisTypeCode": "ABK"
        },
        {
          "diagnosisCode": "S24101A",
          "diagnosisTypeCode": "ABF"
        },
        {
          "diagnosisCode": "S060X0A",
          "diagnosisTypeCode": "ABF"
        }
      ],
      "patientControlNumber": "123456",
      "placeOfServiceCode": "11",
      "planParticipationCode": "A",
      "releaseInformationCode": "Y",
      "serviceFacilityLocation": {
        "address": {
          "address1": "Addr 1",
          "city": "City",
          "postalCode": "99999",
          "state": "ST"
        },
        "npi": "1999999984",
        "organizationName": "Facility"
      },
      "serviceLines": [
        {
          "professionalService": {
            "compositeDiagnosisCodePointers": {
              "diagnosisCodePointers": [
                "1",
                "2",
                "3"
              ]
            },
            "lineItemChargeAmount": "2148.00",
            "measurementUnit": "UN",
            "procedureCode": "A4353",
            "procedureIdentifier": "HC",
            "serviceUnitCount": "400.00"
          },
          "providerControlNumber": "111222333444",
          "renderingProvider": {
            "firstName": "James",
            "lastName": "Smith",
            "npi": "1999999984",
            "providerType": "RenderingProvider",
            "taxonomyCode": "111N00000X"
          },
          "serviceDate": "20181219"
        },
        {
          "professionalService": {
            "compositeDiagnosisCodePointers": {
              "diagnosisCodePointers": [
                "1",
                "2",
                "3"
              ]
            },
            "lineItemChargeAmount": "12.00",
            "measurementUnit": "UN",
            "procedureCode": "A9901",
            "procedureIdentifier": "HC",
            "serviceUnitCount": "1.00"
          },
          "providerControlNumber": "5555566667777888",
          "renderingProvider": {
            "firstName": "Preferred",
            "lastName": "Medical Network",
            "npi": "1999999984",
            "providerType": "Supplier",
            "taxonomyCode": "207RG0300X"
          },
          "serviceDate": "20181219"
        }
      ],
      "signatureIndicator": "Y",
      "claimSupplementalInformation": {
          "reportInformation": {
            "attachmentReportTypeCode": "07",
            "attachmentTransmissionCode": "EL",
            "attachmentControlNumber": "12345"
          }
      }     
    },
    "receiver": {
      "organizationName": "WC PAYER"
  },
    "submitter": {
      "contactInformation": {
        "name": "Contact Name",
        "phoneNumber": "1234567890"
      },
      "organizationName": "Submitting Company",
      "submitterIdentification": "44444444"
    },
    "subscriber": {
      "address": {
        "address1": "Addr 1",
        "city": "City",
        "postalCode": "99999",
        "state": "ST"
      },
      "lastName": "EmployerName",
      "memberId": "123456789",
      "paymentResponsibilityLevelCode": "P"
    },
    "dependent": {
      "firstName": "Jane",
      "lastName": "Doe",
      "address": {
        "address1": "Addr 1",
        "city": "City",
        "postalCode": "99999",
        "state": "WA"
      },
      "dateOfBirth": "19900101",
      "gender": "F",
      "relationshipToSubscriberCode": "20"
    }
  }

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" \
  --data '{
    "tradingPartnerServiceId": "WCPAYERID",
    "usageIndicator": "T",
    "billing": {
      "address": {
        "address1": "123 Some St",
        "city": "Pittsburgh",
        "postalCode": "12345",
        "state": "VA"
      },
      "contactInformation": {
        "name": "Billing Contact",
        "phoneNumber": "1234567890"
      },
      "employerId": "123456789",
      "npi": "1999999984",
      "organizationName": "Billing Dr Last Name",
      "providerType": "BillingProvider",
      "taxonomyCode": "207QG0300X"
    },
    "claimInformation": {
      "benefitsAssignmentCertificationIndicator": "Y",
      "claimChargeAmount": "2160.00",
      "claimFilingCode": "WC",
      "claimFrequencyCode": "1",
      "healthCareCodeInformation": [
        {
          "diagnosisCode": "G8250",
          "diagnosisTypeCode": "ABK"
        },
        {
          "diagnosisCode": "S24101A",
          "diagnosisTypeCode": "ABF"
        },
        {
          "diagnosisCode": "S060X0A",
          "diagnosisTypeCode": "ABF"
        }
      ],
      "patientControlNumber": "123456",
      "placeOfServiceCode": "11",
      "planParticipationCode": "A",
      "releaseInformationCode": "Y",
      "serviceFacilityLocation": {
        "address": {
          "address1": "Addr 1",
          "city": "City",
          "postalCode": "99999",
          "state": "ST"
        },
        "npi": "1999999984",
        "organizationName": "Facility"
      },
      "serviceLines": [
        {
          "professionalService": {
            "compositeDiagnosisCodePointers": {
              "diagnosisCodePointers": [
                "1",
                "2",
                "3"
              ]
            },
            "lineItemChargeAmount": "2148.00",
            "measurementUnit": "UN",
            "procedureCode": "A4353",
            "procedureIdentifier": "HC",
            "serviceUnitCount": "400.00"
          },
          "providerControlNumber": "111222333444",
          "renderingProvider": {
            "firstName": "James",
            "lastName": "Smith",
            "npi": "1999999984",
            "providerType": "RenderingProvider",
            "taxonomyCode": "111N00000X"
          },
          "serviceDate": "20181219"
        },
        {
          "professionalService": {
            "compositeDiagnosisCodePointers": {
              "diagnosisCodePointers": [
                "1",
                "2",
                "3"
              ]
            },
            "lineItemChargeAmount": "12.00",
            "measurementUnit": "UN",
            "procedureCode": "A9901",
            "procedureIdentifier": "HC",
            "serviceUnitCount": "1.00"
          },
          "providerControlNumber": "5555566667777888",
          "renderingProvider": {
            "firstName": "Preferred",
            "lastName": "Medical Network",
            "npi": "1999999984",
            "providerType": "Supplier",
            "taxonomyCode": "207RG0300X"
          },
          "serviceDate": "20181219"
        }
      ],
      "signatureIndicator": "Y",
      "claimSupplementalInformation": {
          "reportInformation": {
            "attachmentReportTypeCode": "07",
            "attachmentTransmissionCode": "EL",
            "attachmentControlNumber": "12345"
          }
      }     
    },
    "receiver": {
      "organizationName": "WC PAYER"
    },
    "submitter": {
      "contactInformation": {
        "name": "Contact Name",
        "phoneNumber": "1234567890"
      },
      "organizationName": "Submitting Company",
      "submitterIdentification": "44444444"
    },
    "subscriber": {
      "address": {
       "address1": "Addr 1",
        "city": "City",
        "postalCode": "99999",
        "state": "ST"
      },
      "lastName": "EmployerName",
      "memberId": "123456789",
      "paymentResponsibilityLevelCode": "P"
    },
    "dependent": {
      "firstName": "Jane",
      "lastName": "Doe",
      "address": {
        "address1": "Addr 1",
        "city": "City",
        "postalCode": "99999",
        "state": "WA"
      },
      "dateOfBirth": "19900101",
      "gender": "F",
      "relationshipToSubscriberCode": "20"
    }
  }'

ISA*00*          *00*          *ZZ*311573142P     *ZZ*205367462      *190101*1317*^*00501*000000050*1*T*:~
GS*HC*ISA SENDER ID*205367462*20140522*0926*8*X*005010X222A1~
ST*837*0008*005010X222A1~
BHT*0019*00*8*20190522*0926*CH~
NM1*41*2*SUBMITTING COMPANY*****46*ISA SENDER ID~
PER*IC*CONTACT NAME*TE*1234567890~
NM1*40*2*WORKCOMPEDI*****46*205367462~
HL*1**20*1~
NM1*85*1*BILLING DR LAST NAME* BILLING DR FIRST NAME ****XX*1999999984~
N3*ADDR 1~
N4*CITY*ST*99999~
REF*EI*123456789~
PER*IC*DOCTOR NAME*TE*1234567890~
HL*2*1*22*0~
SBR*P********WC~
NM1*IL*2*EMPLOYER NAME*****MI*123456789~
N3*ADDR 1~
N4*CITY*ST*99999~
NM1*PR*2*WC PAYER*****PI*WCPAYERID~
N3*123 SOME ST~
N4*PITTSBURGH*VA*12345~
HL*3*2*23*0~
PAT*20~
NM1*QC*1*DOE*JANE~
N3*ADDR 1~
N4*CITY*ST*9999~
DMG*D8*19900101*F~
REF*Y4*123456789~
REF*SY*999999999~
CLM*L174065*2160.00***12:B:1*Y*A*Y*Y*P*EM~
DTP*439*D8*20160608~
PWK*OZ*EL***AC*AttachmentName~ 
HI*ABK:G8250*ABF:S24101A*ABF:S060X0A~
HCP*02*1880.00~
NM1*82*1*SMITH*JAMES****XX*1999999984~
PRV*PE*PXC*111N00000X~
NM1*77*2*FACILITY*****XX*FACILITY NPI~
N3*ADDR 1~
N4*CITY*ST*99999~
LX*1~
SV1*HC:A4353:NU::::Intermittent Urinary Catheter*2148.00*UN*400.00***1:2:3~
SV5*HC:A4353*DA*400.00*0*2148.00*4~
DTP*472*D8*20181219~
HCP*02*6808.00~
NM1*DQ*1*Preferred Medical Network~
REF*0B*1750529582~
LX*2~
SV1*HC:A9901:::::DME Dispensing Service Fee*12.00*UN*1.00***1:2:3~
SV5*HC:A9901*DA*1.00*0*12.00*4~
DTP*472*D8*20181219~
HCP*02*60.00~
NM1*DQ*1*Preferred Medical Network~
REF*0B*1750529582~
SE*52*0008~
GE*1*8~
IEA*1*000000050~

curl --request POST \
  --url "https://healthcare.us.stedi.com/2024-04-01/change/medicalnetwork/professionalclaims/v3/raw-x12-submission" \
  --header "Authorization: <api-key>" \
  --header "Content-Type: application/json" \
  --data '{
    "x12": "ISA*00*          *00*          *ZZ*311573142P     *ZZ*205367462      *190101*1317*^*00501*000000050*1*T*:~GS*HC*ISA SENDER ID*205367462*20140522*0926*8*X*005010X222A1~ST*837*0008*005010X222A1~BHT*0019*00*8*20190522*0926*CH~NM1*41*2*SUBMITTING COMPANY*****46*ISA SENDER ID~PER*IC*CONTACT NAME*TE*1234567890~NM1*40*2*WORKCOMPEDI*****46*205367462~HL*1**20*1~NM1*85*1*BILLING DR LAST NAME* BILLING DR FIRST NAME ****XX*1999999984~N3*ADDR 1~N4*CITY*ST*99999~REF*EI*123456789~PER*IC*DOCTOR NAME*TE*1234567890~HL*2*1*22*0~SBR*P********WC~NM1*IL*2*EMPLOYER NAME*****MI*123456789~N3*ADDR 1~N4*CITY*ST*99999~NM1*PR*2*WC PAYER*****PI*WCPAYERID~N3*123 SOME ST~N4*PITTSBURGH*VA*12345~HL*3*2*23*0~PAT*20~NM1*QC*1*DOE*JANE~N3*ADDR 1~N4*CITY*ST*9999~DMG*D8*19900101*F~REF*Y4*123456789~REF*SY*999999999~CLM*L174065*2160.00***12:B:1*Y*A*Y*Y*P*EM~DTP*439*D8*20160608~PWK*OZ*EL***AC*AttachmentName~HI*ABK:G8250*ABF:S24101A*ABF:S060X0A~HCP*02*1880.00~NM1*82*1*SMITH*JAMES****XX*1999999984~PRV*PE*PXC*111N00000X~NM1*77*2*FACILITY*****XX*FACILITY NPI~N3*ADDR 1~N4*CITY*ST*99999~LX*1~SV1*HC:A4353:NU::::Intermittent Urinary Catheter*2148.00*UN*400.00***1:2:3~SV5*HC:A4353*DA*400.00*0*2148.00*4~DTP*472*D8*20181219~HCP*02*6808.00~NM1*DQ*1*Preferred Medical Network~REF*0B*1750529582~LX*2~SV1*HC:A9901:::::DME Dispensing Service Fee*12.00*UN*1.00***1:2:3~SV5*HC:A9901*DA*1.00*0*12.00*4~DTP*472*D8*20181219~HCP*02*60.00~NM1*DQ*1*Preferred Medical Network~REF*0B*1750529582~SE*52*0008~GE*1*8~IEA*1*000000050~"
  }'

Auto

The following examples show an auto claim:

The Claim Filing Indicator Code is set to AM to indicate that this is an auto claim.
The Individual Relationship Code is set to 18 (Self) because the patient is also the subscriber (insurance holder).
The claim includes information about the accident, including:
- The Related Causes Code is set to AA to indicate that the claim is related to an auto accident. This is relatedCausesCode in JSON and Loop 2300 CLM11-01 in X12 EDI.
- The jurisdiction state, which is typically where the accident occurred. This is autoAccidentStateCode in JSON and Loop 2300 CLM11-04 in X12 EDI.
- The date of the accident. This is accidentDate in JSON and Loop 2300 DTP03 in X12 EDI.
The subscriber is the patient. Therefore, this claim doesn't include a dependent object in JSON or Loop 2010CA (Patient) in X12 EDI.

{
 "tradingPartnerServiceId": "AUTOPAYERID",
 "usageIndicator": "T",
 "billing": {
    "address": {
      "address1": "123 Some St",
      "city": "Pittsburgh",
      "postalCode": "12345",
      "state": "VA"
    },
    "contactInformation": {
      "name": "Billing Contact",
      "phoneNumber": "1234567890"
    },
    "employerId": "123456789",
    "npi": "1999999984",
    "organizationName": "Billing Dr Last Name",
    "providerType": "BillingProvider"
  },
  "rendering": {
    "firstName": "John",
    "lastName": "Smith",
    "npi": "1999999984",
    "providerType": "RenderingProvider",
    "taxonomyCode": "207Q00000X"
  },
  "claimInformation": {
    "claimChargeAmount": "1450.00",
    "claimFilingCode": "AM",
    "claimFrequencyCode": "1",
    "patientControlNumber": "AUTO12345",
    "placeOfServiceCode": "12",
    "signatureIndicator": "Y",
    "releaseInformationCode": "Y",
    "planParticipationCode": "A",
    "benefitsAssignmentCertificationIndicator": "Y",
    "patientSignatureSourceCode": true,
    "relatedCausesCode": [
      "AA"
    ],
    "autoAccidentStateCode": "IL",
    "claimDateInformation": {
      "accidentDate": "20251015"
    },
    "claimSupplementalInformation": {
        "reportInformation": {
          "attachmentReportTypeCode": "OZ",
          "attachmentTransmissionCode": "EL",
          "attachmentControlNumber": "12345"
        }
    }, 
     "healthCareCodeInformation": [
      {
        "diagnosisCode": "S12300A",
        "diagnosisTypeCode": "ABK"
      },
      {
        "diagnosisCode": "M25511",
        "diagnosisTypeCode": "ABF"
      }
    ],
    "claimPricingRepricingInformation": {
      "pricingMethodologyCode": "00",
      "repricedAllowedAmount": "1450.00"
    },
    "serviceFacilityLocation": {
      "address": {
        "address1": "123 Main St",
        "city": "City",
        "postalCode": "99999",
        "state": "IL"
      },
      "npi": "1999999984",
      "organizationName": "Auto Health Clinic"
    },
    "serviceLines": [
      {
        "professionalService": {
          "compositeDiagnosisCodePointers": {
            "diagnosisCodePointers": [
              "1"
            ]
          },
          "measurementUnit": "UN",
          "procedureCode": "97110",
          "procedureIdentifier": "HC",
          "procedureModifiers": [
            "GP"
          ],
          "lineItemChargeAmount": "200.00",
          "serviceUnitCount": "1.00",
          "description": "Therapeutic Exercise"
        },
        "providerControlNumber": "111222333444",
        "serviceDate": "20251016"
      },
      {
        "professionalService": {
          "compositeDiagnosisCodePointers": {
            "diagnosisCodePointers": [
              "1"
            ]
          },
          "procedureModifiers": [
            "25"
          ],
          "lineItemChargeAmount": "1250.00",
          "measurementUnit": "UN",
          "procedureCode": "99213",
          "procedureIdentifier": "HC",
          "serviceUnitCount": "1.00",
          "description": "Office Visit"
        },
        "providerControlNumber": "5555566667777888",
        "serviceDate": "20251017"
      }
    ]
  },
  "receiver": {
    "organizationName": "AUTO PAYER"
  },
  "submitter": {
    "contactInformation": {
      "name": "Contact Person",
      "phoneNumber": "1234567890"
    },
    "organizationName": "Auto Billing Services",
    "submitterIdentification": "777777777"
  },
  "subscriber": {
    "address": {
      "address1": "Addr 1",
      "city": "City",
      "postalCode": "99999",
      "state": "ST"
    },
    "firstName": "Jane",
    "lastName": "Doe",
    "memberId": "123456789",
    "dateOfBirth": "19900101",
    "gender": "F",
    "paymentResponsibilityLevelCode": "P"
  }
}

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" \
  --data '{
   "tradingPartnerServiceId": "AUTOPAYERID",
   "usageIndicator": "T",
   "billing": {
      "address": {
        "address1": "123 Some St",
        "city": "Pittsburgh",
        "postalCode": "12345",
        "state": "VA"
      },
      "contactInformation": {
        "name": "Billing Contact",
        "phoneNumber": "1234567890"
      },
      "employerId": "123456789",
      "npi": "1999999984",
      "organizationName": "Billing Dr Last Name",
      "providerType": "BillingProvider"
    },
    "rendering": {
      "firstName": "John",
      "lastName": "Smith",
      "npi": "1999999984",
      "providerType": "RenderingProvider",
      "taxonomyCode": "207Q00000X"
    },
    "claimInformation": {
      "claimChargeAmount": "1450.00",
      "claimFilingCode": "AM",
      "claimFrequencyCode": "1",
      "patientControlNumber": "AUTO12345",
      "placeOfServiceCode": "12",
      "signatureIndicator": "Y",
      "releaseInformationCode": "Y",
      "planParticipationCode": "A",
      "benefitsAssignmentCertificationIndicator": "Y",
      "patientSignatureSourceCode": true,
      "relatedCausesCode": [
        "AA"
      ],
      "autoAccidentStateCode": "IL",
      "claimDateInformation": {
        "accidentDate": "20251015"
      },
      "claimSupplementalInformation": {
          "reportInformation": {
            "attachmentReportTypeCode": "OZ",
            "attachmentTransmissionCode": "EL",
            "attachmentControlNumber": "12345"
          }
      }, 
     "healthCareCodeInformation": [
        {
          "diagnosisCode": "S12300A",
          "diagnosisTypeCode": "ABK"
        },
        {
          "diagnosisCode": "M25511",
          "diagnosisTypeCode": "ABF"
        }
      ],
      "claimPricingRepricingInformation": {
        "pricingMethodologyCode": "00",
        "repricedAllowedAmount": "1450.00"
      },
      "serviceFacilityLocation": {
        "address": {
          "address1": "123 Main St",
          "city": "City",
          "postalCode": "99999",
          "state": "IL"
        },
        "npi": "1999999984",
        "organizationName": "Auto Health Clinic"
      },
      "serviceLines": [
        {
          "professionalService": {
            "compositeDiagnosisCodePointers": {
              "diagnosisCodePointers": [
                "1"
              ]
            },
            "measurementUnit": "UN",
            "procedureCode": "97110",
            "procedureIdentifier": "HC",
            "procedureModifiers": [
              "GP"
            ],
            "lineItemChargeAmount": "200.00",
            "serviceUnitCount": "1.00",
            "description": "Therapeutic Exercise"
          },
          "providerControlNumber": "111222333444",
          "serviceDate": "20251016"
        },
        {
          "professionalService": {
            "compositeDiagnosisCodePointers": {
              "diagnosisCodePointers": [
                "1"
              ]
            },
            "procedureModifiers": [
              "25"
            ],
            "lineItemChargeAmount": "1250.00",
            "measurementUnit": "UN",
            "procedureCode": "99213",
            "procedureIdentifier": "HC",
            "serviceUnitCount": "1.00",
            "description": "Office Visit"
          },
          "providerControlNumber": "5555566667777888",
          "serviceDate": "20251017"
        }
      ]
    },
    "receiver": {
      "organizationName": "AUTO PAYER"
    },
    "submitter": {
      "contactInformation": {
        "name": "Contact Person",
        "phoneNumber": "1234567890"
      },
      "organizationName": "Auto Billing Services",
      "submitterIdentification": "777777777"
    },
    "subscriber": {
      "address": {
        "address1": "Addr 1",
        "city": "City",
        "postalCode": "99999",
        "state": "ST"
      },
      "firstName": "Jane",
      "lastName": "Doe",
      "memberId": "123456789",
      "dateOfBirth": "19900101",
      "gender": "F",
      "paymentResponsibilityLevelCode": "P"
    }
  }'

ISA*00*          *00*          *ZZ*777777777      *ZZ*205367462      *251107*1030*^*00501*000000089*1*T*:~
GS*HC*AUTOCLAIMX12*205367462*20251107*1030*10*X*005010X222A1~
ST*837*0010*005010X222A1~
BHT*0019*00*AUTO12345*20251107*1030*CH~
NM1*41*2*AUTO BILLING SERVICES*****46*777777777~
PER*IC*Contact Person*TE*1234567890~
NM1*40*2*AUTOPAYER*****46*AUTOPAYER~
HL*1**20*1~
NM1*85*1*BILLING DR LAST NAME*****XX*1999999984~
N3*123 SOME ST~
N4*PITTSBURGH*VA*12345~
REF*EI*123456789~
PER*IC*BILLING CONTACT*TE*1234567890~
HL*2*1*22*0~
SBR*P*18*******AM~
NM1*IL*1*DOE*JANE****MI*123456789~
N3*ADDR 1~
N4*CITY*ST*99999~
DMG*D8*19900101*F~
NM1*PR*2*ABC AUTO INSURANCE*****PI*AUTOPAYERID~
N3*123 SOME ST~
N4*PITTSBURGH*VA*12345~
CLM*AUTO12345*1450.00***12:B:1*Y*A*Y*Y*P*AA:::IL~
DTP*439*D8*20251015~
PWK*OZ*EL***AC*12345~
HI*ABK:S12300A*ABF:M25511~
HCP*00*1450.00~
NM1*82*1*SMITH*JOHN****XX*1999999984~
PRV*PE*PXC*207Q00000X~
NM1*77*2*AUTO HEALTH CLINIC*****XX*1999999984~
N3*123 Main St~
N4*City*IL*99999~
LX*1~
SV1*HC:97110:GP::::Therapeutic Exercise*200.00*UN*1***1~
DTP*472*D8*20251016~
REF*6R*111222333444~
LX*2~
SV1*HC:99213:25::::Office Visit*1250.00*UN*1***1~
DTP*472*D8*20251017~
REF*6R*5555566667777888~
SE*39*0010~
GE*1*10~
IEA*1*000000089~

curl --request POST \
  --url "https://healthcare.us.stedi.com/2024-04-01/change/medicalnetwork/professionalclaims/v3/raw-x12-submission" \
  --header "Authorization: <api-key>" \
  --header "Content-Type: application/json" \
  --data '{
    "x12": " ISA*00*          *00*          *ZZ*777777777      *ZZ*205367462      *251107*1030*^*00501*000000089*1*T*:~GS*HC*AUTOCLAIMX12*205367462*20251107*1030*10*X*005010X222A1~ST*837*0010*005010X222A1~BHT*0019*00*AUTO12345*20251107*1030*CH~NM1*41*2*AUTO BILLING SERVICES*****46*777777777~PER*IC*Contact Person*TE*1234567890~NM1*40*2*AUTOPAYER*****46*AUTOPAYER~HL*1**20*1~NM1*85*1*BILLING DR LAST NAME*****XX*1999999984~N3*123 SOME ST~N4*PITTSBURGH*VA*12345~REF*EI*123456789~PER*IC*BILLING CONTACT*TE*1234567890~HL*2*1*22*0~SBR*P*18*******AM~NM1*IL*1*DOE*JANE****MI*123456789~N3*ADDR 1~N4*CITY*ST*99999~DMG*D8*19900101*F~NM1*PR*2*ABC AUTO INSURANCE*****PI*AUTOPAYERID~N3*123 SOME ST~N4*PITTSBURGH*VA*12345~CLM*AUTO12345*1450.00***12:B:1*Y*A*Y*Y*P*AA:::IL~DTP*439*D8*20251015~PWK*OZ*EL***AC*12345~HI*ABK:S12300A*ABF:M25511~HCP*00*1450.00~NM1*82*1*SMITH*JOHN****XX*1999999984~PRV*PE*PXC*207Q00000X~NM1*77*2*AUTO HEALTH CLINIC*****XX*1999999984~N3*123 Main St~N4*City*IL*99999~LX*1~SV1*HC:97110:GP::::Therapeutic Exercise*200.00*UN*1***1~DTP*472*D8*20251016~REF*6R*111222333444~LX*2~SV1*HC:99213:25::::Office Visit*1250.00*UN*1***1~DTP*472*D8*20251017~REF*6R*5555566667777888~SE*39*0010~GE*1*10~IEA*1*000000089~"
  }'

835 Electronic Remittance Advice (ERAs)

Some payers don't support electronic 835 Electronic Remittance Advice (ERA) transactions. You can expect to receive a paper Explanation of Benefits (EOB) from payers if Stedi's Payer Network doesn't list 835 ERA support.

For payers that do support electronic 835 ERAs, you'll always receive them through the clearinghouse you used for the claim submission. That means you can't split claim submission and ERA receipt between Stedi and another clearinghouse.

Visit Acknowledgments and ERAs for details about the kinds of electronic responses you can expect to receive for claims, how to retrieve them, and how to correlate them back to the original claim.

Workers' compensation and automobile claims

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