Submit claims

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

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:

Field	Instructions and Notes
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.

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.