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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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 patient control number, but only pertains to some of the service lines.

However, the line item control number serves as a unique identifier for each service line in your claim submission. You can set the line item control number in Loop 2400 REF02, when REF01 = 6R. The line item control number 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 line item control number 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.

Only use the X12 Basic and Extended character sets in request data. Using characters outside these sets may cause validation and HTTP 400 errors.

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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.

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NUCC 1500 Claim Form PDF

Stedi automatically generates a 1500 claim form PDF for each professional claim. You can download the form on the transaction details page in Stedi or retrieve it through the NUCC 1500 Claim Form PDF endpoint.

If you plan to send these PDFs to payers or retain them for your records, we recommend:

• Ensuring that your claim data is within the maximum length for 1500 claim form fields. Many claim form fields have lower maximum lengths than the corresponding properties in the claim request, and Stedi truncates the claim data as needed to fit the PDF. We especially recommend using USPS abbreviations to avoid truncated addresses.
• Putting all street address line data into N301, ensuring that you adhere to the claim form length constraints. Some NUCC 1500 items contain address fields that can only be mapped to a single address line.