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)

You can only submit claims to the patient's primary health plan through our interactive CMS-1500 form. You must submit secondary or tertiary claims through 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	You can 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.

When you're finished, click Submit claim. Stedi validates the claim and submits it to the payer. It will appear on the Transactions page as a new 837P Professional Claim.

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 Transactions page.
2. Click Submit claim and choose Upload EDI file from the menu.
3. Do one of the following:
   • Click Upload X12 EDI and select an existing .edi file to add.
   • Select the transaction type and then paste the X12 EDI content into the text area.
4. Configure the settings to send a test or a production claim. 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.
   1. Select either Test or Production in the menu at the top of the text area.
   2. Set ISA15 (Interchange Usage Indicator) to T (Test Data) or P (Production Data), accordingly.
5. Fix any validation errors that appear after adding the claim X12 EDI 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.
6. Click Submit claim to submit the claim to Stedi.

Stedi processes the claim and takes you to the claim's details page. Stedi also displays the claim on the Transactions page.

Download CMS-1500 PDF

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

To download the PDF:

1. Go to the Transactions page and click the claim you want to download.
2. Click Download CMS 1500 claim PDF. You can choose to download it either with or without the CMS-1500 form overlay.

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.