Check claim status

You may need to check a claim's status when you don't receive a 277CA claim acknowledgment or 835 Electronic Remittance Advice (ERA) from the payer within your expected timeframe.

You can run real-time claim status checks to determine whether a payer is still processing a claim or if it's been rejected or denied.

Run a claim status check

To submit a 276/277 real-time claim status check:

1. Go to the Create claim status check page.
2. Enter the required information. We strongly recommend reviewing our best practices for submitting claim status requests. Supplying too much information or a too narrow/broad date of services range can negatively affect the results.
3. Click Submit.

Stedi displays the claim status response on the next page. If the payer finds a matching claim, the response includes the claim's status and (if applicable) one or more rejection messages indicating the reason(s) for rejection. When the claim status check returns more than one matching claim, you can toggle between them using the dropdown at the top left of the page.

The claim status response also includes information about the attached claim, including key identifiers (such as the Patient Control Number), service details, billed amount, and paid amount (if applicable). However, it doesn't include all details from the original claim and any associated 835 Electronic Remittance Advice (ERAs). For example, if you need a detailed breakdown of payments and adjustments, you must check the related ERA.

Claim status checks aren't listed on the Transactions page. You can only review the response immediately after submitting the request. If you need to know the status of the same claim later, you must run a new claim status check.

Best practices

We recommend following these best practices when checking claim status.

Supply a date of services range

Supply a date range that is at least plus or minus 7 days from the date of the services listed in the claim. The payer may have stored a different date for the encounter than the one in your records, so providing a date range increases the likelihood that the payer will find a match.

We also recommend keeping the dates of service range to 30 days or less. Some payers may reject requests with a date range that is too wide.

Don't provide too much information

Providing too much information in a claim status request can negatively affect the results. That's why we recommend first sending a base request with only the following information.

You will eventually learn payer-specific nuances and can adjust your approach accordingly. For example, some payers may have better success rates when you include the claim number.

Recommended base request

We recommend starting with the following fields in your claim status request.

Form fields	Description
Trading partner service ID	You must specify the payer. Choose the payer from the dropdown. Start typing to filter the list.
Providers	The provider information from the original claim. To start, provide only the NPI, Organization name, and Provider type fields.
Subscriber	The subscriber information from the original claim. To start, provide only the First name, Last name, Date of birth, Gender, and Member ID fields. You'll need to click Select fields to add the Gender field to the form.
Dependent	The dependent information from the original claim. To start, provide only the First name, Last name, Date of birth, and Gender fields. You'll need to click Select fields to add the Dependent fields to the form. If the patient is the subscriber, don't include this information.
Encounter	The encounter information from the original claim. To start, provide only the Beginning date of service and End date of service fields. Remember that you should provide a date range that is plus or minus 7 days from the date of service listed in the claim for best results.

If this base request fails to return results, try adding in other information like the provider's Electronic Transmitter Identification Number (ETIN) or the Trading partner claim number.

Claims submitted by other providers

You likely won't be able to check the status of a claim submitted by a different provider organization or by the patient themselves, even if you have all of the details about the claim.

Payers generally only allow a provider organization to check the status of the claims they submitted. They impose these access controls to protect plan member privacy and confidential commercial data.

Claims older than 18 months

Payers often archive claims older than 18 months, but this varies by payer. If you try to check the status of a claim from several years ago, the payer may return an error even if the information you submit matches a real historical claim.