Submit claims

You can submit professional, dental, and institutional claims through the Stedi portal:

• Electronic claims: You submit through the Stedi portal. Stedi submits your claim to the payer electronically.
• Paper claims: You submit through the Stedi portal with the receiver ID set to PAPER (Print and Mail - All Payers). Stedi prints and mails the claim to the payer on your behalf.

Electronic claims

You can submit professional claims through our interactive claim form or by uploading X12 EDI claim data. There's no interactive claim form for dental and institutional claims, but you can submit them by uploading X12 EDI claim data.

Claim form (professional only)

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: Open the Claims menu and select + Submit professional claim.

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.
EDI mode	Select whether you want to submit a Production or Test claim. Production claims are sent to the payer. Test claims aren't sent to the payer. Stedi validates them and displays them in the portal so you can get familiar with Stedi's claim processing workflow. Stedi responds to test claims with a 277CA claim acknowledgment, but you won't receive an 835 Electronic Remittance Advice (ERA).
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.

Later, you'll also see related claim responses, such as 277CA claim acknowledgments and 835 Electronic Remittance Advice (ERAs).

X12 EDI upload

You can submit professional, dental, and institutional claims through the Stedi portal in X12 EDI format. Claim data must adhere to the following X12 HIPAA claim specifications:

• 837 Claim: Professional (X222A1)
• 837 Claim: Institutional (X223A2)
• 837 Claim: Dental (X224A2)

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)

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.

Paper claims

Some payers require claims to be submitted on paper rather than electronically. Instead of mailing these claims yourself, you can send the claim information to Stedi using an electronic submission workflow with the receiver ID set to PAPER (Print and Mail - All Payers). Stedi then handles printing and mailing the claim to the designated payer on your behalf.

You can submit the following claim types as paper claims:

• Professional: Through the CMS-1500 form or X12 EDI upload
• Institutional: Through X12 EDI upload

Limitations

Paper claims have the following limitations:

• No dental claims: 837D dental claims (ADA form) aren't supported for paper submission.
• No paper attachments: You can't submit paper attachments today by setting the receiver ID to PAPER.
• Limited acknowledgments: You'll receive 277CA claim acknowledgments indicating when Stedi has forwarded the claim for printing. Additional status updates (such as when the claim is printed, mailed, or returned as undeliverable) aren't currently available.
• ERAs typically unavailable: Payers that require paper claim submission usually don't support Electronic Remittance Advice (ERAs). Instead, they typically mail an Explanation of Benefits (EOB) back to the provider.

Transaction enrollment

Transaction enrollment isn't required for paper claim submission. However, you may still need enrollment for Electronic Remittance Advice (ERAs) if the payer supports them.

Note that payers that require paper claim submission usually don't support ERAs:

• HIPAA covered entity health plans are required to send ERAs electronically.
• Other health plans may use different formats and communication channels for both claim submissions and remittances.

Paper receiver ID

Stedi uses a special payer ID to route claim submissions for printing and mailing: PAPER (Print and Mail - All Payers). You'll submit this as the receiver ID in the claim submission.

For paper claims, it's the receiver ID that determines whether a claim is printed and mailed or sent electronically:

Name	Location	Description
Receiver ID	CMS-1500 UI: Send section X12 EDI: Loop 1000B (Receiver Name) NM109	Controls the delivery method.
Payer ID	CMS-1500 UI: Stedi payer dropdown X12 EDI: Loop 2010BB (Payer Name) NM109	Identifies the destination payer.

When the receiver ID is set to PAPER (or By mail is selected in the CMS-1500 form), Stedi bypasses the traditional electronic submission flow and uses the mail-to payer name and mailing address to print and mail a paper claim to the payer.

You'll still set the payer ID to the destination payer's ID or alias, if available in the Stedi Payer Network. However, you can also set the payer ID to PAPER when you need to send paper claims to payers outside of the electronic network.

For example, you can set the receiver ID to PAPER while keeping the payer ID as CIGNA. This tells Stedi to print and mail the claim to Cigna.

Submit through CMS-1500 form

You can submit professional paper claims through the CMS-1500 form. Within the form, configure these paper-specific settings:

1. In the Send section, select By mail. This expands the UI to show additional fields for the mail-to payer name and payer address.

2. In the Stedi payer dropdown:

   • If the payer exists in Stedi's Payer Network, select it from the 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.

3. In the Postage address section:

   • Update the Mail-to payer name if necessary. This becomes the addressee on the physical envelope.
   • Fill in the Payer address fields with the complete mailing address where the claim should be sent.

After you submit the claim, Stedi will use the paper payer ID and the mailing address you provided to route the claim for printing and mailing.

Submit through X12 EDI upload

You can submit professional paper claims through X12 EDI upload. Construct an X12 EDI claim as you normally would. Then, add the following information.

Location	Elements
Loop 1000B (Receiver Name)	Set the following paper-specific elements: NM103: The actual payer name, such as Cigna. NM109: Set to PAPER. This is what tells Stedi to bypass the typical electronic submission flow and instead route this claim to be printed and mailed.
Loop 2010BB (Payer Name)	Set the following paper-specific elements: NM103: The mail-to payer name. This is what should be listed on the physical envelope. This information may be different from 1000B NM103. NM109: Set this to the destination payer's ID or alias, if available in the Stedi Payer Network. If you're sending claims to payers outside the Payer Network, set this to PAPER. N301: The first line of the street address. This typically contains the building number and street name. N302: The second line of the street address. This is optional, and typically contains the apartment or suite number, if relevant. N401: The city name. N402: The state or province code. Only required when the city is in the United States and Canada. N403: The postal zone or zip code. Exclude punctuation and spaces.

After you submit the claim, Stedi will use the paper payer ID and the mailing address you provided to route the claim for printing and mailing.

Example: Professional paper claim

The following example uses:

• The paper payer ID PAPER in Loop 1000B (Receiver Name) NM109.
• Cigna's payer ID from the Stedi Payer Network in Loop 2010BB (Payer Name) NM109.

ISA...~
GS...~
ST*837*0001*005010X222A1~
...

NM1*40*2*CIGNA*****46*PAPER~                             // Paper payer ID
NM1*PR*2*CIGNA*****PI*62308~                             // Name and payer ID
N3*123 Example Street*STE 100~                           // Mailing address
N4*Mountain View*CA*940433706~

...
SE...~
GE...~
IEA...~

Example: Payer not in Stedi's network

The following example uses:

• The paper payer ID PAPER in Loop 1000B (Receiver Name) NM109.
• The paper payer ID PAPER in Loop 2010BB (Payer Name) NM109. This allows you to submit paper claims to payers outside of the Stedi Payer Network.

ISA...~
GS...~
ST*837*0001*005010X222A1~
...

NM1*40*2*ACME Employer LLC*****46*PAPER~ // Paper payer ID
NM1*PR*2*ACME Employer LLC*****PI*PAPER~ // Name and paper payer ID
N3*987 Example Street*STE 200~           // Mailing address
N4*Philadelphia*PA*19192~

...
SE...~
GE...~
IEA...~

Paper claim responses

After you submit a paper claim through the portal, the portal displays a confirmation message with the submitted claim details. Then, Stedi returns a 277CA claim acknowledgment with category code A1 (Acknowledgment/Receipt) and status code 19 (Acknowledged) to indicate that Stedi received the claim and forwarded it to the print-and-mail vendor. This is not confirmation that the claim has been printed or mailed.

Since payers that require paper claims typically don't support ERAs, you'll usually receive a paper Explanation of Benefits (EOB) in the mail instead of an 835 Electronic Remittance Advice (ERA).

Download CMS-1500 PDF

Stedi automatically generates a PDF CMS-1500 claim form for submitted professional claims.

You can download a PDF version of professional claims in the CMS-1500 format from both the timeline view and the claim's detail page.

1. From the claims view, click a professional claim to open its timeline.

2. Do one of the following:

   • From the timeline view, hover over the claim and click Download CMS-1500 claim PDF.
   • Open the claim's detail page and click Download CMS-1500 claim PDF.

3. In the download menu, choose whether to Include CMS-1500 form background. This option is checked by default.

   The National Uniform Claim Committee (NUCC) and CMS provide exact specifications for blank CMS-1500 forms, including paper size and ink color. Many provider offices are accustomed to using these pre-printed forms, and their Practice Management System (PMS) applications are designed to print claim data onto them. Generating PDFs with no background allows you to print the claim data directly onto official pre-printed forms.

4. Click Confirm download. The PDF downloads to your computer.

Payers have strict requirements for submitted CMS-1500 claim forms. If you plan to send generated PDFs to payers or retain them for your records, we strongly recommend visiting CMS-1500 Claim Form PDF for information about the correct printer settings for generated PDFs and general best practices.