Professional Claims Raw X12

This endpoint sends 837P (professional) claims to payers in raw X12 EDI format. This is ideal if you have an existing system that generates X12 EDI files and you want to send them through Stedi’s API.

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

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Send test claims

All claims you submit through this endpoint are sent to the payer as production claims unless you explicitly designate them as test data.

To send test claims, set the usageIndicator field in the test claim to T. This allows you to filter for test claims on the Transactions page in the Stedi app.

Note that you will receive a 277 Claim Acknowledgment in response to test claims, allowing you to test your workflow end to end, but you will not receive a test 835 (ERA) response.

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Identify service lines

A claim can contain multiple service lines. Since the payer may accept, reject, or pay a subset of those lines, you can receive an 835 response that references a patientControlNumber, but only pertains to some of the service lines.

However, the claimInformation.serviceLines.providerControlNumber serves as a unique identifier for each service line in your claim submission. This value appears in the 277CA and 835 ERA responses as the lineItemControlNumber, allowing you to correlate these responses to specific service lines from the original claim. If you don’t set the providerControlNumber for a service line, Stedi uses a random UUID.

Stedi returns service line identifiers in the claimReference.serviceLines object of the synchronous API response.

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Character restrictions

Only use the following characters as delimiters: ~, *, : and ^. The X12 format doesn’t support using escape sequences, so you can’t include delimiters or special characters as part of the request data. Stedi returns a 400 error if you include restricted characters as anything other than delimiters in the request.

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Enhanced validation

You can optionally set the Stedi-Validation header to snip for enhanced validation on your claim submission.

Enhanced validation uses hundreds of additional edits (the industry term for validation rules) to increase claim acceptance rates. These include Strategic National Implementation Process (SNIP) validations. Stedi also automatically fixes common errors and monitors payer rejections to proactively build out new rules.