Real-Time Claim Status
This endpoint sends real-time 276 Claim Status requests to payers. You can use it to quickly check the status of an existing claim.
- Call this endpoint with a JSON payload.
- Stedi translates the JSON to the X12 276 EDI format and sends it to the payer.
- The endpoint returns a synchronous response from the payer in JSON format. The response contains information about the referenced claim and its current status.
Character restrictions
Don’t include the following characters in your request data: ~, *, : and ^. They are reserved for delimiters in the resulting X12 EDI transaction, and X12 doesn’t support using escape sequences to represent delimiters or special characters. Stedi returns a 400 error if you include these restricted characters in your request.
Conditional requirements
Note that objects marked as required are required for all requests, while others are conditionally required depending on the circumstances. When you include a conditionally required object, you must include all of its required properties.
For example, you must always include the subscriber object in your request, but you only need to include the serviceLineInformation object when you want to request the status for a specific service line.
Payer limitations
Payers generally only allow a provider organization to check the status of the claims they submitted. This means that 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 impose these access controls to protect plan member privacy and confidential commercial data.
Payers also 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.
Finally, we 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.
Timeout
Requests to payers typically time out at 1 minute, though Stedi’s API can keep connections open longer than that if needed.
Authorizations
A Stedi API Key for authentication.
Body
An integer used to identify the transaction. It does not need to be globally unique. It is returned in the response as controlNumber.
9This is the Payer ID. Visit the Payer Network for a complete list. You can send requests using the Primary Payer ID, the Stedi Payer ID, or any alias listed in the payer record.
2 - 80Information about the billing and/or service providers related to the referenced claim. For each provider, you must set the providerType and one of the following identifiers: npi, taxId, or etin. When the providerType = BillingProvider, you must provide the provider's etin.
Information about the subscriber listed in the referenced claim.
This is the payer name, such as Cigna or Aetna.
Information about the dependent listed in the referenced claim.
Information about the referenced claim.
Identify a service line listed in the referenced claim. Used to request status for a specific service line.
Response
The control number the payer provided in the claim status response. This is used to identify the transaction.
An ID for the payer you identified in the original claim status request. This value may differ from the tradingPartnerServiceId you submitted in the original request because it reflects the payer's internal concept of their ID, not necessarily the ID Stedi uses to route requests to this payer.
Information about the payer listed in the referenced claim.
Information about the provider making the claim status request.
Information about the subscriber listed in the referenced claim.
Information about the dependent listed in the referenced claim.
The status information for the claim referenced in the original claim status request.
The control number for the transaction.
The status of the entire claim.
The acknowledgment code in the 999 Implementation Acknowledgment, an EDI file generated by the payer to acknowledge receipt of the claim status request. It indicates whether the claim status request was accepted or rejected due to errors in the EDI request syntax.
The syntax error code in the 999 Implementation Acknowledgment. It indicates the type of error (if present) in the EDI request syntax. Visit IK502 in the Implementation Acknowledgment specification for a complete list.
The raw X12 response from the payer.
Metadata about the response.
Was this page helpful?