Supported payers
You can only submit transactions to supported payers, which means the payer is listed in Stedi's Payer Network. Stedi supports thousands of medical and dental payers, so most practices find that all their major payers are already in the network.
What does "supported" mean?
When a payer is in the network, it means you can transact with them through Stedi. However, you'll also need to check:
- Whether the transaction types you want to send or receive are listed as "supported" for the payer. For example, if the Payer Network says real-time claim status checks aren't supported, you won't be able to send real-time claim status transactions to that payer through Stedi.
- Whether the payer requires transaction enrollment to exchange the particular transaction. Transaction enrollment is the process of registering with the payer. This is always required for Electronic Remittance Advice (ERAs). It's required less often for other transaction types, like claims and eligibility checks, but there are exceptions. For example, the Centers for Medicare and Medicaid Services (CMS) requires enrollment for eligibility checks.
What if my payer isn't available?
If a payer you need isn't in the network, contact us to request that we add them. We're continuously expanding our network.
Find payer details
The Payer Network shows details about each supported payer.
To check details for a specific payer:
-
Go to the Payer Network.
-
Search for the payer by name and click a result to review its details.
You can find the following details in the Payer Network:
Payer IDs
When submitting claims and other transactions as EDI files, you'll need to include the payer ID for routing.
You must include leading 0 characters in payer IDs. For example, use 00540
for SISCO, not 540.
The Payer Network includes the following types of IDs:
- Primary payer ID (recommended): This is the most commonly used ID for a payer and most often corresponds to the name the payer uses internally and provides to patients on member ID cards. When you don't already have a payer ID for a particular payer, we recommend using the primary payer ID.
- Stedi payer ID: This is a unique identifier Stedi assigns to each payer. This ID will not change, even if the payer updates their primary payer ID. For X12 EDI file submissions, you can use either the Stedi payer ID or the primary payer ID.
- Payer ID aliases: These are alternative IDs associated with a payer. If a payer changes their primary payer ID, payer ID aliases ensure that you can still find the payer and continue sending transactions uninterrupted. Some payers also have different payer IDs for different plans. Payer ID aliases ensure that requests using these IDs are routed to the same payer.
Other names
The Payer Network includes other names for many payers. These additional names help you search for and identify payers using the name most familiar to your organization. For example, "Eaton Benefits Ohio" is an alternative associated with "Cigna" - searching for either name returns the same payer within the database.
Coverage types
You can determine which payers support medical use cases, dental use cases, vision use cases, or all three. Coverage types only apply to batch and real-time eligibility checks.
For example, Aetna's Coverage types in the network are Dental, Medical, and Vision. That means you can submit eligibility checks for medical, dental, and vision services to Aetna.
Operating states
The payer details page shows Operating states that list where the payer sells insurance plans.
Operating states can differ from where the payer is headquartered or where your patients live. For example, if a company is headquartered in Washington (WA), an employee in their Georgia office could still have Premera WA coverage. In this case, WA is the operating state because that's where the plan is sold.
Some payers may show NATIONAL, indicating they operate throughout the entire United States.
Transactions and enrollment
The payer's details page shows which transaction types are supported for that payer. Under each transaction, Stedi includes text explaining whether the transaction is supported and whether transaction enrollment is required.
If transaction enrollment is required, you'll need to complete that process before you can exchange that transaction type with the payer.
Ask the Stedi Agent
You can chat with the Stedi Agent to get information about supported payers. To use it, you must be at least an Operator role within your Stedi account.
To start chatting with the Stedi Agent:
- Go to the Chats page in the Stedi portal.
- Click New chat and select Payer Finder.
- Type your question in the chat window and press Enter. For example, you could ask "What is the payer ID for Aetna?" or "Does Cigna support dental eligibility checks?" You can also ask more complex questions, like "Which payers support dental eligibility checks and require transaction enrollment?" Talk to Stedi Agent like you would a human support agent.
- Ask follow-up questions as needed. You can ask multiple questions about different payers in the same chat.
The Stedi Agent will respond to your questions and display its answers in the chat window.
Payer errors
Stedi returns the following error messages when a payer is not supported or enrolled properly.
| Error message | Possible causes and resolutions |
|---|---|
Payer is not configured for {transaction type}. Please contact Stedi support to resolve. | Stedi does not yet support this transaction type for this payer, or there is a mis-mapping of payer IDs. Contact us with the name of the payer, and we'll investigate the issue. |
Payer connection does not support {transaction type}. Please contact Stedi support to discuss connectivity options. | Stedi has a connection to this payer, but it doesn't currently support this functionality (real-time eligibility or claim submission). Contact us for a timeline on enabling it. |
Payer is not configured. Please check our published payer list or contact Stedi support to resolve. | Stedi doesn't recognize the payer ID you provided. Double-check the payer ID in the Stedi Payer Network, or contact us with the name of the payer, and we will help you determine the correct payer ID. |
Payer is not supported. Please contact Stedi support to discuss connectivity options. | Stedi doesn't yet have connectivity to this payer. We're likely already working on it - contact us for details about the connectivity timeline. |