Professional Claims (837P) Raw X12

Submit an 837P professional claim in raw X12 EDI format

POST /change/medicalnetwork/professionalclaims/v3/raw-x12-submission

This endpoint is ideal if you have an existing system that generates X12 EDI files and you want to send them through Stedi.

1. Call this endpoint with a payload in 837 X12 EDI format.
2. Stedi validates the EDI and sends the claim to the payer.
3. The endpoint returns a response from Stedi in JSON format containing information about the claim you submitted and whether the submission was successful.

Claim identifier

Loop 2300 REF02 (Claim Identifier for Transmission Intermediaries) has different usage rules depending on your role:

• Providers: Don't include Loop 2300 REF02 when REF01 = D9 in your claim submission. It's reserved for clearinghouses and intermediaries. You can use Loop 2300 CLM01 (Patient Control Number) to correlate claims with responses instead.
• Clearinghouses and intermediaries: You can optionally include REF*D9 in your 837 submissions. Stedi always returns this value in Loop 2200D REF*D9 of 277CA claim acknowledgments, allowing you to match these responses to the claim.

CMS-1500 Claim Form PDF

When you submit a professional claim, Stedi automatically generates a 1500 claim form PDF. If you plan to send these PDFs to payers or retain them for your records, we strongly recommend reviewing the CMS-1500 claim form PDF documentation to learn how to structure claim submissions for optimal generation, the correct printer settings for generated PDFs, and general best practices.

Authorizations

Authorization · Required Header

A Stedi API Key for authentication. Supports both test and production API keys.

Headers

Idempotency-Key · String Length : 1 - 255

A unique string to identify this request to the server. The key can be up to 255 characters. You can safely retry requests with the same idempotency key within 24 hours of making the first request. This prevents you from sending duplicate claims due to network errors or other intermittent failures. Learn more.

Body

application/json

x12 · String Required

Response

application/json

claimReference · Object

Information about the claim.

controlNumber · String

An identifier for the transaction.

editResponses · Array of Objects

Currently not used.

editStatus · String Deprecated

This shape is deprecated: Currently not used.

errors · Array of Objects

Errors resulting from claim edits. You must review and fix these errors before resubmitting.

failure · Object

Currently not used.

httpStatusCode · String

Stedi can return the following status codes:

• 200: Stedi successfully generated the X12 EDI claim format required by the payer. It does not indicate whether the payer has accepted the claim - the payer will respond later with a 277CA containing this information. Learn more about 277CAs.
• 400: The request contains one or more problems with the claim data. Examples include missing required fields, invalid values, or incorrect data types. The response includes a message describing the problem.
• 403: The request is not permitted, such as using a test API key to submit a production transaction.

Possible values

200 OK

400 BAD_REQUEST

403 FORBIDDEN

meta · Object

Metadata from Stedi about the request.

payer · Object

Information about the payer for the submitted claim.

status · String

The status of the claim submission.

tradingPartnerServiceId · String

An ID for the payer you identified in the original claim. 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.

warnings · Array of Objects

A list of warnings. Currently not used.

x12 · String

A 277CA claim acknowledgment acceptance or rejection from Stedi in X12 EDI format. It indicates whether the claim has passed Stedi's claim edits.

When the claim fails one or more edits, the 277CA contains STC segments with information about each error. These are the same error codes that appear in the errors array.

Note that this 277CA only indicates whether Stedi has accepted or rejected the claim submission. You may receive additional 277CA acceptances or rejections as the claim is routed to the payer.

Request

curl --request POST \
  --url "https://healthcare.us.stedi.com/2024-04-01/change/medicalnetwork/professionalclaims/v3/raw-x12-submission" \
  --header "Authorization: <api_key>" \
  --header "Content-Type: application/json" \
  --data '{
    "x12": "ISA*00*          *00*          *ZZ*574183004559   *ZZ*STEDITEST      *260213*2039*^*00501*000000039*0*T*>~GS*HC*574183004559*STEDITEST*20260213*203918*39*X*005010X222A1~ST*837*0001*005010X222A1~BHT*0019*00*01KHCBK84E40QQYJVXA5VVXG54*20260213*2038*CH~NM1*41*2*Test Data Health Services, Inc.*****46*123435~PER*IC**TE*5552223333~NM1*40*2*Cigna*****46*62308~HL*1**20*1~PRV*BI*PXC*2084P0800X~NM1*85*2*Therapy Associates*****XX*1999999984~N3*123 Some St*Floor 1~N4*A City*NY*123450000~REF*EI*123456789~PER*IC*Test Data Health Services, Inc.*TE*5553334444~HL*2*1*22*0~SBR*P*18*3335555******CI~NM1*IL*1*Anon*John****MI*U7777788888~N3*2222 Random St~N4*A City*NY*123450000~DMG*D8*20000101*M~NM1*PR*2*Cigna*****PI*62308~CLM*123456789*109.2***02>B>1*Y*A*Y*Y~HI*ABK>F1111~NM1*77*2*Smith Associates~N3*1234 Other St~N4*A City*NY*123450000~LX*1~SV1*HC>90837>95*109.2*UN*1***1~DTP*472*D8*20240101~REF*6R*111222333~SE*29*0001~GE*1*39~IEA*1*000000039~"
  }'

Response

{
  "claimReference": {
    "correlationId": "01J1M588QT2TAV2N093GNJ998T",
    "formatVersion": "5010",
    "patientControlNumber": "22266555",
    "payerId": "60054",
    "rhclaimNumber": "01J1M588QT2TAV2N093GNJ998T",
    "serviceLines": [
      {
        "lineItemControlNumber": "111222333"
      }
    ],
    "timeOfResponse": "2024-07-10T22:05:32.203Z"
  },
  "controlNumber": "000000001",
  "httpStatusCode": "200 OK",
  "meta": {
    "traceId": "b727b8e7-1f00-4011-bc6e-e41444d406d8"
  },
  "payer": {
    "payerId": "60054",
    "payerName": "Cigna"
  },
  "status": "SUCCESS",
  "tradingPartnerServiceId": "60054",
  "x12": "ISA*00*          *00*          *ZZ*STEDITEST      *ZZ*574183004559   *260213*1951*^*00501*980180479*0*T*>~GS*HN*STEDITEST*574183004559*20260213*195151*1*X*005010X214~ST*277*0001*005010X214~BHT*0085*08*01KHC8YJE8EY6A5HFR00Z5H305*20260213*195151*TH~HL*1**20*1~NM1*AY*2*STEDI INC*****46*117151744~TRN*1*01KHC8YJE8EY6A5HFR00Z5H305~DTP*050*D8*20260213~DTP*009*D8*20260213~HL*2*1*21*1~NM1*41*2*Test Data Health Services, Inc.*****46*123456~TRN*2*01KHC8Y4HNP0GVQ5NSVTPZBC0F~STC*A0>17>AY*20260213*WQ*109.2~QTY*90*1~AMT*YU*109.2~HL*3*2*19*1~NM1*85*2*Therapy Associates*****XX*1234567890~TRN*1*0~REF*TJ*123456789~QTY*QA*1~AMT*YU*109.2~HL*4*3*PT*0~NM1*QC*1*Anon*John****MI*U7777788888~TRN*2*111222333~STC*A1>20*20260213*WQ*109.2~DTP*472*RD8*20240101-20240101~SE*25*0001~GE*1*1~IEA*1*980180479~"
}