Healthcare
- Payers
- Transaction enrollment
- Eligibility checks
- Coordination of benefits
- Claim submission
- Claim status
- Remittances
EDI platform
- Transaction
- Interchange
- File execution
- Fragments
- Mappings
- Events
Dental Claims
curl --request POST \
--url https://healthcare.us.stedi.com/2024-04-01/dental-claims/submission \
--header 'Authorization: <api-key>' \
--header 'Content-Type: application/json' \
--data '{
"usageIndicator": "T",
"tradingPartnerServiceId": "52133",
"tradingPartnerName": "United HealthCare Dental",
"subscriber": {
"paymentResponsibilityLevelCode": "P",
"memberId": "123412345",
"firstName": "John",
"lastName": "Doe",
"groupNumber": "1234567890",
"gender": "F",
"address": {
"address1": "1234 Some St",
"city": "Buckeye",
"state": "AZ",
"postalCode": "85326"
},
"dateOfBirth": "20180615"
},
"submitter": {
"organizationName": "ABA Inc",
"submitterIdentification": "123456789",
"contactInformation": {
"phoneNumber": "3131234567",
"name": "BILLING DEPARTMENT"
}
},
"rendering": {
"npi": "1234567893",
"taxonomyCode": "106S00000X",
"providerType": "RenderingProvider",
"lastName": "Doe",
"firstName": "Jane"
},
"receiver": {
"organizationName": "United HealthCare Dental"
},
"payerAddress": {
"address1": "PO Box 7000",
"city": "Camden",
"state": "SC",
"postalCode": "29000"
},
"claimInformation": {
"signatureIndicator": "Y",
"toothStatus": [
{
"toothNumber": "3",
"toothStatusCode": "E"
}
],
"serviceLines": [
{
"serviceDate": "20230428",
"renderingProvider": {
"npi": "1234567893",
"taxonomyCode": "122300000X",
"lastName": "Doe",
"firstName": "Jane"
},
"providerControlNumber": "a0UDo000000dd2dMAA",
"dentalService": {
"procedureCode": "D7140",
"lineItemChargeAmount": "832.00",
"placeOfServiceCode": "12",
"oralCavityDesignationCode": [
"1",
"2"
],
"prosthesisCrownOrInlayCode": "I",
"procedureCount": 2,
"compositeDiagnosisCodePointers": {
"diagnosisCodePointers": [
"1"
]
}
},
"teethInformation": [
{
"toothCode": "3",
"toothSurface": [
"M",
"O"
]
}
]
}
],
"serviceFacilityLocation": {
"phoneNumber": "3131234567",
"organizationName": "ABA Inc",
"npi": "1234567893",
"address": {
"address1": "ABA Inc 123 Some St",
"city": "Denver",
"state": "CO",
"postalCode": "802383100"
}
},
"releaseInformationCode": "Y",
"planParticipationCode": "A",
"placeOfServiceCode": "12",
"patientControlNumber": "0000112233",
"healthCareCodeInformation": [
{
"diagnosisTypeCode": "ABK",
"diagnosisCode": "K081"
}
],
"claimSupplementalInformation": {
"priorAuthorizationNumber": "20231010012345678"
},
"claimFrequencyCode": "1",
"claimFilingCode": "FI",
"claimChargeAmount": "832.00",
"benefitsAssignmentCertificationIndicator": "Y"
},
"billing": {
"taxonomyCode": "106S00000X",
"providerType": "BillingProvider",
"organizationName": "ABA Inc",
"npi": "1999999992",
"employerId": "123456789",
"contactInformation": {
"phoneNumber": "3134893157",
"name": "ABA Inc"
},
"address": {
"address1": "ABA Inc 123 Some St",
"city": "Denver",
"state": "CO",
"postalCode": "802383000"
}
}
}'{
"status": "SUCCESS",
"controlNumber": "1",
"tradingPartnerServiceId": "52133",
"claimReference": {
"correlationId": "01JDQMX92Q1T561BH8NKX750TQ",
"patientControlNumber": "0U1LBRS4",
"timeOfResponse": "2024-11-27T20:27:27.077Z",
"payerId": "52133",
"formatVersion": "5010",
"rhclaimNumber": "01JDQMX92Q1T561BH8NKX750TQ",
"serviceLines": [
{
"lineItemControlNumber": "a0UDo000000dd2dMAA"
}
]
},
"httpStatusCode": "200 OK",
"meta": {
"traceId": "9b491769-052e-4738-93d6-e0b5f6d83f53"
},
"payer": {
"payerName": "United HealthCare Dental",
"payerId": "52133"
}
}This endpoint sends 837D (dental) claims to payers.
- Call this endpoint with a JSON payload.
- Stedi translates your request to the X12 837 EDI format and sends it 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.
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 property in the test claim body 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.
Basic claim submission
The content of your claim submission depends on your use case and the payer’s requirements. However, a basic claim submission includes the following information in the request body:
| Information | Description |
|---|---|
tradingPartnerServiceId | This is the Payer ID. Visit the Payer Network for a complete list. |
tradingPartnerName | This is the payer’s business name, like Cigna or Aetna. |
submitter object | Information about the entity submitting the healthcare claim. This can be either an individual or an organization, such as a doctor, hospital, or insurance company. |
receiver object | Information about the payer, such as an insurance company or government agency. |
subscriber and/or dependent objects | Information about the patient who received the medical services. Note that if a dependent has their own, unique member ID for their health plan, you should submit their information in the subscriber object and omit the dependent object from the request. You can check whether the dependent has a unique member ID by submitting an Eligibility Check to the payer for the dependent. The payer will return the member ID in the dependents.memberId field, if present. |
claimInformation object | Information about the claim, such as the patient control number, claim charge amount, and place of service code. It also includes information about each individual service line included in the claim. |
billing object | Information about the billing provider, such as the NPI, taxonomy code, and organization name. |
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.
Only use the X12 Basic and Extended character sets in request data. Using characters outside these sets may cause validation and HTTP 400 errors.
The X12 Basic character set includes uppercase letters, digits, space, and some special characters. Lowercase letters and special language characters like ñ are not included.
The following special characters are included:
The Extended character set includes the characters listed in Basic, plus lowercase letters and additional special characters, such as @.
The following additional special characters are included:
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.
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 supervising object when the rendering provider is supervised by a physician.
Authorizations
A Stedi API Key for authentication.
Headers
The outbound transaction setting ID. This option only needs to be specified if you're using a non-default release of the Dental Claims guide.
Body
This 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.
The entity submitting the healthcare claim. This can be either an individual or an organization, such as a doctor, hospital, or insurance company. You must submit at least organizationName or lastName properties and the contactInformation object. If you don't supply the submitterIdentification property, Stedi uses the value from billing.npi in the request.
Contact information for the person or office handling administrative communications regarding the claim. You can include a maximum of two objects in this array.
The full name of the person or office.
The phone number, formatted as AAABBBCCCC, where AAA represents the area code, BBB is the telephone number prefix, and CCCC is the telephone number. The phone number should only include the digits 0 to 9. Don't include separators, such as dashes, and don't include long distance access numbers, such as 1. For example, you would format the phone number 123-456-7890 as 1234567890.
The fax number.
The email address.
The phone extension, if applicable.
The business name of the organization submitting the claim.
The last name of the individual submitting the claim.
The first name of the individual submitting the claim.
The middle name or initial of the individual submitting the claim.
The submitter's Electronic Transmitter Identification Number (ETIN), as assigned by the payer. For some payers, this may be the same as the submitter's NPI or TIN, but it can also be another unique identifier. Payers can refer to this identifier as the Provider Number, Submitter ID, Submitter Identifier, Submitter Primary Number, Sender Code, Certified Contracted Provider ID, and other names.
If you don't provide this property, Stedi uses the billing provider's NPI from billing.npi property.
The entity responsible for the payment of the claim, such as an insurance company or government agency.
The business name of the payer receiving the claim, such as Aetna or Cigna.
1Information about the billing provider. For tax identification, you must include either the provider's Social Security Number (SSN) or their Employer Identification Number (EIN), but not both.
Set to BillingProvider.
The billing provider's National Provider Identifier (NPI).
The billing provider's Social Security Number. Must be a string of exactly nine numbers with no separators. If you include this value, you cannot include the employerId.
The billing provider's Employer Identification Number. Typically a string of exactly nine numbers with no separators, unless otherwise instructed by the payer. If you include this value, you cannot include the ssn.
The billing provider's state license number.
Deprecated; do not use. This shape is deprecated.
Code from the National Uniform Claims Committee Health Care Provider Taxonomy Code Set. This identifies the billing provider's type and/or area of specialty.
10The billing provider's first name, if the provider is an individual.
The provider's last name, if the provider is an individual.
The provider's middle name or initial, if the provider is an individual.
The provider's name suffix, such as Jr. or III.
The provider's business name.
The billing provider's address. For United States addresses, you must include the full nine-digit zip code with no separators, such as 100031502. If you don't know the full zip code, you can find it using the USPS ZIP Code Lookup tool.
The first line of the street address. This typically contains the building number and street name.
The city name.
The second line of the street address. This typically contains the apartment or suite number.
The state or province code. Only required when the city is in the Unites States and Canada.
The postal zone or zip code. Exclude punctuation and spaces.
Use the alpha-2 country codes from Part 1 of ISO 3166.
Use the country subdivision codes from Part 2 of ISO 3166.
Contact information for the billing provider. You can include a maximum of two objects in this array.
The full name of the person or office.
The phone number, formatted as AAABBBCCCC, where AAA represents the area code, BBB is the telephone number prefix, and CCCC is the telephone number. The phone number should only include the digits 0 to 9. Don't include separators, such as dashes, and don't include long distance access numbers, such as 1. For example, you would format the phone number 123-456-7890 as 1234567890.
The fax number.
The email address.
The phone extension, if applicable.
The person or entity who is the primary policyholder for the health plan or a dependent with their own member ID.
- When a dependent has a unique, payer-assigned member ID, treat them as the
subscriberfor the claim submission - include their information here and omit thedependentobject from the request. Note that the subscriber can be an individual or a business entity. Stedi treats the subscriber as an individual when the request doesn't contain a value for thesubscriber.organizationNameproperty. - You must set the
dateOfBirthandgenderproperties when the subscriber is the patient. Stedi determines that the subscriber is the patient when thedependentobject is not included in the request. - If either
dateOfBirthorgenderis set, you must include both properties. You can either include both properties or neither within a single request.
The member ID for the subscriber's insurance policy. This property is required if the subscriber is an individual.
2 - 80The subscriber's Social Security Number. This must be a string of exactly nine numbers with no separators. For example, send 111002222 instead of 111-00-2222.
Code identifying the insurance carrier's level of responsibility for a payment of a claim. Stedi sets this property to P - Primary by default.
You only need to include this property when you need to submit codes other than P. This can happen when the patient has multiple insurance policies. For example, if a patient is covered by both Medicare and an employer-sponsored commercial plan, you could bill the commercial plan first as P and then bill the Medicare payer second as S. Visit Claims code lists for a complete list of possible codes.
A, B, C, D, E, F, G, H, P, S, T, U The business name of the entity submitting the claim. When the subscriber is an organization, you should identify the patient in the dependent object.
Identifies the type of insurance policy within a specific insurance program. Visit Claims code lists for a complete list.
12, 13, 14, 15, 16, 41, 42, 43, 47 The name of the subscriber's health plan. For example, Cigna or Blue Cross Blue Shield.
Provide either this property OR the groupNumber, not both. If groupNumber is set, Stedi ignores this value and uses the value in groupNumber.
The subscriber's first name. This property is recommended when the subscriber is an individual. Some payers reject requests without the firstName property.
The subscriber's last name. This property is required if the subscriber is an individual.
Don't include the subscriber's name suffix, such as Jr. or III. Use the designated suffix property instead.
The subscriber's middle name or initial.
The suffix of the subscriber's name, such as Jr. or Sr. Only include the subscriber's personal name suffix - don't include professional or academic titles, such as M.D. or MBA.
Identifies the subscriber's gender. This property is required when the subscriber is the patient. Can be set to F - Female, M - Male, or U - Unknown.
You should set this property to U when the patient declines to answer or does not identify as male or female. Note that some payers may reject the claim if the patient's gender doesn't match the gender they have recorded in their member records.
M, F, U The subscriber's date of birth. Expressed in format YYYYMMDD. This property is required if the subscriber is an individual.
The subscriber's health plan policy number. You should provide either this property OR the groupNumber, not both.
The subscriber's health plan group number.
- Provide this property OR the
policyNumber, not both. - Provide this property OR the
subscriberGroupName, not both. If this property is set, Stedi ignores thesubscriberGroupNameproperty.
The patient's address. Every claim must include this information in either the subscriber (when the patient is the subscriber) or dependent (when the patient is a dependent) object. You must include at least the address1 and city properties in this object.
The first line of the street address. This typically contains the building number and street name.
The city name.
The second line of the street address. This typically contains the apartment or suite number.
The state or province code. Only required when the city is in the Unites States and Canada.
The postal zone or zip code. Exclude punctuation and spaces.
Use the alpha-2 country codes from Part 1 of ISO 3166.
Use the country subdivision codes from Part 2 of ISO 3166.
Information about the healthcare claim.
Note that the objects and properties marked as required are required for all claims, while others are conditionally required, depending on type of claim and claim circumstances. For example, you must always provide the placeOfServiceCode property, but you only need to provide the otherSubscriberInformation object in coordination of benefits scenarios. When you include a conditionally required object, you must provide all of its required properties.
An identifier you assign to the claim. We strongly recommend submitting a unique value for this property so that you can use it to correlate this claim with responses from the payer, such as the 835 Electronic Remittance Advice (ERA).
1 - 20The total dollar amount charged for the services on this claim, expressed as a decimal. For example, 100.50. This is the total amount before any adjustments or payments. The amount must balance to the sum of the service line charges.
Code identifying the type of facility where the services were or may be performed. Visit Place of Service Codes for a complete list.
01, 02, 03, 04, 05, 06, 07, 08, 09, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 31, 32, 33, 34, 41, 42, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 60, 61, 62, 65, 66, 71, 72, 81, 99 Code specifying the frequency of the claim. Can be set to 1 - Admit thru Discharge Claim, 7 - Replacement of Prior Claim, or 8 - Void/Cancel of Prior Claim. Visit the National Uniform Billing Committee for a complete code list and usage notes.
1, 7, 8 Indicates whether the provider's signature is on file. Can be set to N - No or Y - Yes.
N, Y A code indicating whether the patient or an authorized person has assigned benefits to the provider. Use W when the patient refuses to assign benefits. Can be set to N - No, Y - Yes, or W - Not Applicable (use when patient refuses to assign benefits).
N, W, Y Indicates whether the provider has on file a signed statement by the patient authorizing the release of medical data to other organizations. Can be set to Y - Yes, or I - Informed Consent to Release Medical Information for Conditions or Diagnoses Regulated by Federal Statues. Use I when the provider has not collected a signature AND state or federal laws do not require a signature be collected.
I, Y Information about one or more services rendered to the patient. Each service line must be a unique procedure. Service lines can share the same dates of service if the patient received multiple services on the same day. You can include up to 50 service lines within a single claim.
Information about the service rendered to the patient, including the procedure code, the line item charge amount, and the place of service.
The procedure code.
The total charge amount for the service, including the provider's base charge and any applicable tax or postage. It is acceptable to set this to 0 (zero).
A free form description to clarify the procedure code and any procedure modifiers, as needed.
1 - 80Code identifying the type of facility where the services were or may be performed. Visit Place of Service Codes for a complete list.
Required when the nomenclature associated with the procedure reported in claimInformation.serviceLines.dentalService.procedureCode refers to a quadrant or arch and the area of the oral cavity is not uniquely defined.
- You can include up to five codes per service line.
- You should report individual tooth numbers in one or more
teethInformationobjects.
Code indicating the placement status for the dental work. Can be set to I - Initial Placement or R - Replacement. When set to R, you must include either the priorPlacementDate or estimatedPriorPlacementDate properties within the claimInformation.serviceLines.serviceLineDateInformation object.
I, R The number of procedures performed.
Diagnosis code pointers in order of importance to this service line. These pointers are an index to the ICD-10-CM codes you included in the claimInformation.healthCareCodeInformation object array. The pointer values can be from 1 to 12 (integer numbers).
- You must set at least one pointer for the primary diagnosis. Then, you can add up to three additional pointers (up to four in total).
- The number of pointers cannot exceed the number of diagnosis codes in the
claimInformation.healthCareCodeInformationobject array. For example, if you only supplied one diagnosis code, then the only valid pointer value is 1. - Don't put ICD-10-CM codes here - they belong in
claimInformation.healthCareCodeInformation.
A diagnosis code pointer for this service line.
Modifier codes that clarify or improve the reporting accuracy of the associated procedure code. You can include up to four modifiers in this array. Only include modifier codes when required; otherwise, do not send.
The date the service was rendered (for services performed on a single day), expressed as YYYYMMDD. Do not supply a date here if you are including the serviceLineDateInformation.treatmentStartDate property in the service line.
A unique identifier for this service line within the claim. It appears in the 835 (ERA) response as lineItemControlNumber, allowing you to correlate ERAs to the specific service lines from the original claim. If you don't set this property, Stedi uses a random UUID. Stedi returns service line identifiers in the claimReference.serviceLines.lineItemControlNumber object of the synchronous API response.
Required when the submitter is contractually obligated to supply this information on post-adjudicated claims.
Code indicating the type of contract. Can be set to 02 - Per Diem, 03 - Variable Per Diem, 04 - Flat, 05 - Capitated, 06 - Percent, or 09 - Other.
02, 03, 04, 05, 06, 09 The total dollar amount of the contract, expressed as a decimal. For example, 100.50.
The allowance or charge percent, expressed as a decimal. For example, 0.80.
The contract code. This is an identifier for the contract.
Terms discount percentage, expressed as a decimal, available to the purchaser if an invoice is paid on or before the Terms Discount Due Date.
An additional identifier for the contract. Identifies the revision level of a particular format, program, technique or algorithm.
Identify specific dates related to the service rendered. All properties are single dates formatted as YYYYMMDD.
The exact date when the previous appliance was placed. Either this property or estimatedPriorPlacementDate is required when the claimInformation.serviceLines.dentalService.prosthesisCrownOrInlayCode for this service line is set to R for Replacement.
The estimated date when the previous appliance was placed. Either this property or priorPlacementDate is required when the claimInformation.serviceLines.dentalService.prosthesisCrownOrInlayCode for this service line is set to R for Replacement.
The date the appliance was placed. Required when the orthodontic appliance placement date is different than the date you supplied in claimInformation.claimDateInformation.appliancePlacementDate.
The date the orthodontic appliance was replaced.
The date the treatment began. This may apply to the following scenarios: initial impression or preparation for a crown or denture, reporting initial endontic treatment, or reporting the implant fixture placement. If you include this property, do not include the serviceDate property in this service line.
The date the treatment was completed. If you include this property, do not include the serviceDate property in this service line.
Additional identifiers for the service line.
Prior authorization numbers relevant to this service line. Required when services have been previously authorized and are now being submitted for payment. You can include up to five objects in this array.
The prior authorization number.
This must match the value in claimInformation.otherSubscriberInformation.otherPayerName.otherPayerIdentifier.
The Predetermination of Benefits Identification Numbers relevant to this service line. Required for services that have been previously predetermined and are now being submitted for payment. You can include up to five objects in this array.
The Predetermination of Benefits Identification Number. If you're including the identifier provided by the payer identified in claimInformation.otherSubscriberInformation.otherPayerName, you must also include the otherPayerPrimaryIdentifier property.
The primary identifier of the payer who assigned the predeterminationOfBenefits number. This must match the identifier in the claimInformation.otherSubscriberInformation.otherPayerName.otherPayerIdentifier property.
Required when a repricing (pricing) organization needs to have an identifying number on the service line. Only completed by repricing organizations.
Required when a repricing (pricing) organization needs to have an identifying number on the service line. Only completed by repricing organizations.
Required when this service line involved a referral number that is different than the number reported at the claim level. You can include up to five objects in this array.
Sales tax, formatted as a decimal. When you include this property, the total lineItemChargeAmount for this service line must include this sales tax value.
The amount of the postage, formatted as a decimal. When you include this property, the total lineItemChargeAmount for this service line must include this postage value.
Used to send additional data specifically requested by the payer. Not commonly used.
Repricing information about the line item. This information is completed by repricers, not providers. For capitated encounters, pricing or repricing information usually is not applicable and is provided to qualify other information within the claim.
Code indicating the pricing or repricing methodology. Visit Claims code lists for a complete list.
00, 01, 02, 03, 04, 05, 06, 07, 08, 09, 10, 11, 12, 13, 14 The dollar amount, expressed as a decimal. For example, 100.50.
The dollar amount, expressed as a decimal.
The identifier of the organization that repriced the claim.
The pricing rate associated with per diem or flat rate repricing, expressed as a decimal.
The qualifier for the type of code included in repricedApprovedHCPCSCode. Can be set to AD - American Dental Association Codes.
AD The procedure code for the service that was repriced.
The unit of measure for the service that was repriced. Can be set to UN - Units.
UN The number of units for the service that was repriced, expressed as a decimal. The maximum length for this field is 8 digits excluding the decimal. When a decimal is used, the maximum number of digits allowed to the right of the decimal is three.
Code indicating the rejection message returned from the third party organization. Visit Claims code lists for a complete list.
T1, T2, T3, T4, T5, T6 Code indicating the policy compliance status of the claim. Visit Claims code lists for a complete list.
1, 2, 3, 4, 5 Code specifying the exception reason for consideration of out-of-network health care services. This is the reason generated by the third-party health organization. Visit Claims code lists for a complete list.
1, 2, 3, 4, 5, 6 Information about the provider who rendered the services. This can be a individual or a company (a laboratory or other facility). This is where you should enter the substitute provider's (locum tenens physician) information, if applicable.
Code from the National Uniform Claims Committee Health Care Provider Taxonomy Code Set. This identifies the provider's type and/or area of specialty.
10The National Provider Identifier (NPI) assigned to the provider.
The provider's commercial number.
The provider's location number.
Deprecated; do not use.
The provider's business name.
The provider's first name.
The provider's last name.
The provider's middle name or initial.
The provider's name suffix, such as Jr. or III.
The provider's state license number.
Information about the assistant surgeon who rendered the care. Use this object when the rendering providers provided these services in the role of the assistant surgeon.
This should be an individual, not an organization, and you should supply at least the surgeon's lastName and an identifier, which is typically the npi.
The individual National Provider Identifier (NPI) assigned to the provider.
The provider's commercial number.
The provider's location number.
Deprecated; do not use.
The provider's business name.
The provider's first name.
The provider's last name.
The provider's middle name or initial.
The provider's name suffix, such as Jr. or III.
Code from the National Uniform Claims Committee Health Care Provider Taxonomy Code Set. This identifies the provider's type and/or area of specialty.
10The provider's state license number.
Information about where the services were rendered. This can be healthcare facilities, such as surgical centers or reference labs, OR the patient's address when services were rendered in their home.
The provider's business name.
The organization National Provider Identifier (NPI) assigned to the service facility. Only include this property when the service facility is not a component or subpart of the billing provider. Don't include when the service facility is the patient's home.
The provider's commercial number.
The provider's location number.
Deprecated; do not use.
The first line of the street address. This typically contains the building number and street name.
The city name.
The second line of the street address. This typically contains the apartment or suite number.
The state or province code. Only required when the city is in the Unites States and Canada.
The postal zone or zip code. Exclude punctuation and spaces.
Use the alpha-2 country codes from Part 1 of ISO 3166.
Use the country subdivision codes from Part 2 of ISO 3166.
Information about the provider who oversaw the rendering provider and the care reported in this service line. Include this object when the supervising provider is different than the one listed in the supervising object for the entire claim.
This should be an individual, not an organization, and you should supply at least the provider's lastName and an identifier, which is typically the npi.
The individual National Provider Identifier (NPI) assigned to the provider.
The provider's commercial number.
The provider's location number.
Deprecated; do not use.
The provider's business name.
The provider's first name.
The provider's last name.
The provider's middle name or initial.
The provider's name suffix, such as Jr. or III.
Code from the National Uniform Claims Committee Health Care Provider Taxonomy Code Set. This identifies the provider's type and/or area of specialty.
10The provider's state license number.
Includes service line adjudication information for coordination of benefits between the initial payers of a health care claim and all subsequent payers.
The payer ID for the payer responsible for reimbursement.
The amount paid for this service line, expressed as a decimal. Zero (0) is an acceptable value.
The procedure code.
The number of paid units from the remittance advice. expressed as a decimal. When paid units are not present on the remittance advice, use the original billed units. The maximum length for this property is 8 digits excluding the decimal. When a decimal is used, the maximum number of digits allowed to the right of the decimal is three.
The date the other payer adjudicated or paid the claim, formatted as YYYYMMDD.
Code identifying the the type of product or service ID. Can be set to AD - American Dental Association Codes or ER - Jurisdiction Specific Procedure and Supply Codes.
AD, ER Modifiers that convey special circumstances related to the performance of the service. You can include up to four modifiers in this array.
The meaning of the procedure code.
The LX assigned number of the service line into which this service line is bundled. It's only used to bundle service lines.
Required when the payer made line level adjustments which caused the amount paid to differ from the amount originally charged. You can include up to five objects in this array.
Code identifying the general category of payment adjustment. Can be set to CO - Contractual Obligations, CR - Correction and Reversals, OA - Other Adjustments, PI - Payor Initiated Reductions, or `PR - Patient Responsibility.
CO, CR, OA, PI, PR The amount of the service line that the patient is still responsible for, expressed as a decimal.
Identify a tooth by its number and the surfaces involved in the service.
An American Dental Association CDT Code for the procedures performed on a specific tooth. You can only use this object to report individual teeth. You can't use it to report areas of the oral cavity, such as quadrants or sextants. Areas of the oral cavity are reported in the claimInformation.serviceLines.dentalService.oralCavityDesignation property. You can only include multiples of this object when claimInformation.serviceLines.dentalService.procedureCount is equal to 1. When applicable, you can include this object up to 32 times within a single service line.
Code identifying the area of the tooth that was treated. Can be set to B - Buccal, D- Distal, F- Facial, I- Incisal, L - Lingual, M - Mesial, or O Occlusal.
B, D, F, I, L, M, O A code identifying the type of claim. For example DS - Disability. Use OF when submitting Medicare Part D claims. Use ZZ when you don't know the type of insurance. Visit Claims code lists for a complete list.
11, 12, 13, 14, 15, 16, 17, AM, BL, CH, CI, DS, FI, HM, LM, MA, MB, MC, OF, TV, VA, WC, ZZ The agency claim number for this transaction. Used when services included in this claim are part of a property and casualty claim.
Code identifying an accompanying cause of an illness, injury or an accident. Can be set to AA - Auto Accident, EM - Employment, or OA - Other Accident. You can include up to two codes in this array.
AA, EM, OA A code identifying the state or province in which the automobile accident occurred. Use this code when relatedCausesCode is set to AA.
AA, EM, OA The country code where the accident occurred. Use when relatedCausesCode = AA and the accident occurred in a country other than US or Canada.
Code indicating the reason for the delay in claim submission. Visit Claims code lists for a complete list.
1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 15 The total amount in dollars the patient or their representatives have paid on this claim. For example, 20.50. This includes any co-payments, co-insurance, or other amounts already collected from the patient.
Used to send additional data specifically requested by the payer. Not commonly used.
Used to send additional data specifically requested by the payer. Not commonly used.
Repricing information to be completed by repricers, not providers. For capitated encounters, pricing or repricing information usually is not applicable and is provided to qualify other information within the claim.
Code indicating the pricing or repricing methodology. Visit Claims code lists for a complete list.
00, 01, 02, 03, 04, 05, 06, 07, 08, 09, 10, 11, 12, 13, 14 The dollar amount, expressed as a decimal. For example, 100.50.
The dollar amount, expressed as a decimal.
The identifier of the organization that repriced the claim.
The pricing rate associated with per diem or flat rate repricing, expressed as a decimal.
The code indicating the type of repricing.
The dollar amount, expressed as a decimal.
Code indicating the rejection message returned from the third party organization. Visit Claims code lists for a complete list.
T1, T2, T3, T4, T5, T6 Code indicating the policy compliance. Visit Claims code lists for a complete list.
1, 2, 3, 4, 5 Code specifying the exception reason for consideration of out-of-network health care services. This is the reason generated by the third-party health organization. Visit Claims code lists for a complete list.
1, 2, 3, 4, 5, 6 Required when the location for the service is different from the billing provider's address. The purpose of this object is to identify specifically where the service was rendered. This can be healthcare facilities, such as surgical centers or reference labs, OR the patient's address when services were rendered in their home.
The laboratory or facility name. When services were rendered in the patient's home, we recommend setting this to Residence or something similar.
The address of where services were rendered.
If the service facility location is in an area where there are no street addresses, enter a description of where the service was rendered. For example, 'crossroad of State Road 34 and 45'.
For United States addresses, you must include the full nine-digit zip code with no separators, such as 100031502. If you don't know the full zip code, you can find it using the USPS ZIP Code Lookup tool.
The first line of the street address. This typically contains the building number and street name.
The city name.
The second line of the street address. This typically contains the apartment or suite number.
The state or province code. Only required when the city is in the Unites States and Canada.
The postal zone or zip code. Exclude punctuation and spaces.
Use the alpha-2 country codes from Part 1 of ISO 3166.
Use the country subdivision codes from Part 2 of ISO 3166.
The organization National Provider Identifier (NPI) assigned to the service facility. Only include this property when the service facility is not a component or subpart of the billing provider. Don't include when the service facility is the patient's home.
The full name of the person or office.
The phone number, formatted as AAABBBCCCC, where AAA represents the area code, BBB is the telephone number prefix, and CCCC is the telephone number. The phone number should only include the digits 0 to 9. Don't include separators, such as dashes, and don't include long distance access numbers, such as 1. For example, you would format the phone number 123-456-7890 as 1234567890.
The telephone extension, if applicable. Only submit the numeric extension. For example, don't include data that indicates an extension, such as 'ext.' or 'x-'.
Secondary identifier for the service facility location. Used when another identifier is needed for the claims processor to identify the facility or when the entity is not a healthcare provider and does not have an NPI. The qualifier can be set to OB - State License Number, LU - Location Number, or G2 - Provider Commercial Number. You can include up to three objects in this array.
The code identifying the type of reference number.
The reference number.
The identifier for the other payer who provided this reference number. This is only required when the reference number is provided by the non-destination payer. The value must match the otherPayerName.otherPayerIdentifier property.
Information about orthodontic treatment. Required when the claim contains services related to treatment for orthodontic purposes. You must include one of these properties in this object: monthsCount, monthsRemaining, or treatmentIndicator.
The estimated number of treatment months, expressed as a decimal.
The number of months remaining in the treatment, expressed as a decimal.
The only allowed value is Y, which indicates that services reported in this claim are for orthodontic purposes. Only include this property if you haven't set the monthsCount or monthsRemaining properties.
The status of the teeth involved in the service. Required when the submitter is reporting a missing tooth or a tooth to be extracted in the future. You can include up to 35 objects in this array.
Dates related to services within the claim, including the date an appliance was placed and the date of the accident (if applicable). All dates are single dates formatted as YYYYMMDD unless otherwise noted. All dates apply to all services in the claim unless specifically overridden within an individual service line.
The date of the accident related to this claim. Required when relatedCausesCode is set to AA - Auto Accident or OA - Other Accident. Also required when relatedCausesCode is set to EM - Employment and this claim is the result of an accident.
The date the appliance was placed.
A single service date, expressed as YYYYMMDD or a range of service dates, expressed as YYYYMMDD-YYYYMMDD.
The date the repricing entity received the initial claim. Required when a repricer is passing the claim onto the payer.
Additional information or documentation required for the claim.
Required when there is a paper attachment following this claim, when attachments are sent electronically with the claim, or when the provider deems it necessary to identify additional information that is being held at the provider's office and is available upon request.
Code indicating the title or contents of a document, report or supporting item. For example, B4 - Referral Form or DA - Dental Models. Visit Claims code lists for a complete list.
B4, DA, DG, EB, OZ, P6, RB, RR Code identifying the method by which the provider's report is attached. Can be set to AA - Available on Request at Provider Site, BM - By Mail, EL - Electronically Only, EM - E-Mail, FT - File Transfer, or FX - By Fax.
AA, BM, EL, EM, FT, FX The control number assigned to the attachment.
The Predetermination of Benefits Identification Number assigned by the payer. Required for services that have been previously predetermined and are now being submitted for payment. The identifier you supply here applies to the entire claim.
Required when the claimFrequencyCode indicates this claim is a replacement or void to a previously adjudicated claim.
Required when an authorization number is assigned by the payer or UMO and the services on this claim were preauthorized. This authorization number applies to the payer you listed in the receiver object. If you need to include authorization numbers for other payers, you can include them in claimInformation.otherSubscriberInformation.otherPayerName.otherPayerPriorAuthorizationNumber.
Generally, preauthorization numbers are assigned by the payer or UMO to authorize a service prior to its being performed. The UMO (Utilization Management Organization) is generally the entity empowered to make a decision regarding the outcome of a health services review or the owner of information.
Required when a referral number is assigned by the payer or Utilization Management Organization (UMO) and a referral is involved.
Required when the repricer believes this information is necessary. Providers should not complete this property.
Required when the repricer believes this information is necessary. Providers should not complete this property.
The claim number assigned by clearinghouse, van, etc. Providers should not complete this property.
Code indicating the reason for the service authorization exception. Visit Claims code lists for a complete list.
1, 2, 3, 4, 5, 6, 7 Include comments or special instructions related to the claim. Required when the provider needs to include additional information to substantiate the medical treatment that can't be provided elsewhere in the claim submission. You can include up to five objects in this array.
The code indicating whether the provider accepts assignment in their relationship with the payer. Can be set to A - Assigned or C - Not Assigned. Code A is required when either the provider accepts assignment or has a participation agreement with the payer OR when the provider doesn't accept assignment or have a participation agreement but is advising the payer to adjudicate this specific claim under participating provider benefits allowed in certain plans.
Note that this is not where you should indicate whether the patient has assigned benefits to the provider - you must indicate that in the benefitsAssignmentCertificationIndicator property.
A, C Indicates whether the services reported in this claim were previously determined to be covered by the patient's dental benefits. Can be set to true to indicate predetermination of dental benefits.
Code indicating the Special Program under which the services rendered to the patient were performed. Used for Medicaid claims only. Can be set to 01 - Early & Periodic Screening, Diagnosis and Treatment (EPSDT) or Child Assessment Program (CHAP), 02 - Physically Handicapped Children's Program, 03 - Special Federal Funding, or 05 - Disability. Codes 02, 03, and 05 are used for Medicaid claims only.
01, 02, 03, 05 Required when the submitter is contractually obligated to supply this information on post-adjudicated claims.
A code identifying the type of contract. Can be set to 02 - Per Diem, 03 - Variable Per Diem, 04 - Flat, 05 - Capitated, 06 - Percent, or 09 - Other.
02, 03, 04, 05, 06, 09 The total dollar amount of the contract, expressed as a decimal. For example, 100.50.
The allowance or charge percent, expressed as a decimal. For example, 0.80.
The contract code. This is a unique identifier for the contract.
Terms discount percentage, expressed as a percent, available to the purchaser if an invoice is paid on or before the Terms Discount Due Date.
An additional identifer for the contract. Identifies the revision level of a particular format, program, technique or algorithm.
Details about the patient's healthcare diagnosis. Only required when the diagnosis may have an impact on the adjudication of the claim in cases where specific dental procedures may minimize the risks associated with the connection between the patient's oral and systemic health conditions.
- Don't submit the decimal for ICD codes; the decimal is implied.
- Use
ABKas the type for the principal diagnosis code andABFfor any other diagnosis codes you include. - Use one
ABKcode as the first object, and then you can submit up to 11ABFcodes as needed. If you need to submit more codes than this, you must create additional, separate claims.
Code indicating the specific industry code list. Can be set to ABK - International Classification of Diseases Clinical Modification (ICD-10-CM) Principal Diagnosis or ABF - International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis, TQ Systemized Nomenclature of Dentistry (SNODENT).
ABK, ABF, TQ The diagnosis code. Do not submit the decimal point for ICD codes. The decimal point is implied. Also, do not submit IDC-10 header codes. Header codes exist to group related codes and are not valid for billing. These header codes can change with each new version of ICD-10, so we recommend reviewing your diagnosis codes every year to ensure that they aren't classified as header codes in the most recent version. To determine whether a code is a header code, you can also search the Value Set Authority Center. If the 'Header' property is set, the code is a header code and you shouldn't use it in claim submissions.
Required when other payers are known to potentially be involved in paying on this claim. This object contains information about other health plans under which the patient has coverage. It's used for coordination of benefits scenarios.
Code identifying the insurance carrier's level of responsibility for a payment of a claim. Visit Claims code lists for a complete list. You may need to use other codes if the patient has multiple insurance policies. For example, if a patient is covered by both Medicare and an employer-sponsored commercial plan, you could bill the commercial payer first as P and then bill the Medicare payer second as S.
A, B, C, D, E, F, G, H, P, S, T, U Code identifying the relationship to the person insured. Visit Claims code lists for a complete list.
01, 18, 19, 20, 21, 39, 40, 53, G8 Code indicating whether whether or not the insured has authorized the plan to remit payment directly to the provider. Can be set to N - No, W - Not Applicable, or Y - Yes.
N, W, Y Code indicating whether the provider has on file a signed statement by the patient authorizing the release of medical data to other organizations. Can be set to I - Informed Consent to Release Medical Information or Y - Yes. Code I is required when the provider has not collected a signature AND state or federal laws do not require a signature be collected. Code Y is required when the provider has collected a signature OR when state or federal laws require a signature be collected.
I, Y The person or entity who is the primary policyholder for the other payer's health plan.
Code identifying the type of entity. Can be set to 1 - Person or 2 - Non-Person Entity.
1, 2 The primary policyholder's last name or organizational name. Don't include the primary policyholder's name suffix, such as Jr. or III. Use the designated otherInsuredNameSuffix property instead.
Code identifying the type of identifier. Can be set to II - Standard Unique Health Identifier for each individual in the United States or MI - Member Identification Number. The code MI should be the subscriber's identification number as assigned by the payer, such as their subscriber ID. You should also use MI in claims submitted to the Indian Health Service/Contract Health Services (IHS/CHS) Fiscal Intermediary for the purpose of reporting the Tribe Residency Code (Tribe County State). For IHS/CHS claims, you should also put the SSN in the otherInsuredAdditionalIdentifier property.)
II, MI The identifier you specified in otherInsuredIdentifierTypeCode.
The primary policyholder's first name, if they are an individual.
The primary policyholder's middle name or initial, if they are an individual.
The primary policyholder's name suffix, such as Jr. or III. Only include the subscriber's personal name suffix - don't include professional or academic titles, such as M.D. or MBA.
The other subscriber's address.
The first line of the street address. This typically contains the building number and street name.
The city name.
The second line of the street address. This typically contains the apartment or suite number.
The state or province code. Only required when the city is in the Unites States and Canada.
The postal zone or zip code. Exclude punctuation and spaces.
Use the alpha-2 country codes from Part 1 of ISO 3166.
Use the country subdivision codes from Part 2 of ISO 3166.
The primary policyholder's Social Security Number. The Social Security Number must be a string of exactly nine numbers with no separators. For example 123456789.
Details about the other payer.
The payer's organization name.
Code designating the type of identifier. Can be set to PI - Payor Identification or XV - Centers for Medicare/Medicaid Services PlanID. Use code value XV when reporting Health Plan ID (HPID) or Other Entity Identifier (OEID).
PI, XV The identifier specified in otherPayerIdentifierCode. When sending Line Adjudication Information for this payer, the identifier sent in lineAdjudicationInformation.otherPayerPrimaryIdentifier must match this value.
The payer's address.
The first line of the street address. This typically contains the building number and street name.
The city name.
The second line of the street address. This typically contains the apartment or suite number.
The state or province code. Only required when the city is in the Unites States and Canada.
The postal zone or zip code. Exclude punctuation and spaces.
Use the alpha-2 country codes from Part 1 of ISO 3166.
Use the country subdivision codes from Part 2 of ISO 3166.
The date the other payer adjudicated the claim. Required when this payer has previously adjudicated the claim and you aren’t including a value for LineAdjudicationInformation.adjudicationOrPaymentDate.
An additional identification number to identify the other payer. The qualifier can be set to 2U - Payer Identification Number, EI - Employer Identification Number, FY - Claim Office Number, or NF - National Association of Insurance Commissioners (NAIC) Code.
The code identifying the type of reference number.
The reference number.
The identifier for the other payer who provided this reference number. This is only required when the reference number is provided by the non-destination payer. The value must match the otherPayerName.otherPayerIdentifier property.
The authorization number assigned by this payer.
The referral number assigned by this payer.
The only valid value is true. Required when Required when the claim is being sent in the payer-to-payer COB model AND the destination payer is secondary to this payer AND this payer has re-adjudicated the claim.
The claim control number assigned by this payer.
The authorization number assigned by this payer.
The group or policy number.
The name of the health plan.
Code identifying the type of insurance policy within a specific insurance program. Visit Claims code lists for a complete list.
12, 13, 14, 15, 16, 41, 42, 43, 47 A code identifying the type of claim. For example DS - Disability. Use OF when submitting Medicare Part D claims. Use ZZ when you don't know the type of insurance. Visit Claims code lists for a complete list.
11, 12, 13, 14, 15, 16, 17, AM, BL, CH, CI, DS, FI, HM, LM, MA, MB, MC, OF, TV, VA, WC, ZZ Use this object to report prior payers' claim level adjustments that cause the amount paid to differ from the amount originally charged. Codes and associated amounts must come from either paper remittance advice or 835s (Electronic Remittance Advice) received on the claim. When the information originates from a paper remittance advice that does not use the standard Claim Adjustment Reason Codes, you must convert them to standard Claim Adjustment Reason Codes.
Code identifying the general category of payment adjustment. Can be set to CO - Contractual Obligations, CR - Correction and Reversals, OA - Other Adjustments, PI - Payor Initiated Reductions, or `PR - Patient Responsibility.
CO, CR, OA, PI, PR Code identifying the detailed reason the adjustment was made. Visit the X12 Claim Adjustment Reason Codes for a complete list.
The dollar amount of the adjustment, expressed as a decimal. For example, 100.50.
The units of service being adjusted.
The total amount in dollars the payer has paid on this claim. It is acceptable to set this to 0 (Zero). This is required when you include the payToPlan object, and you should set it to the amount the Medicaid agency actually paid.
Required when the destination payer's cost avoidance policy allows providers to bypass claim submission to the otherwise prior payer identified in otherSubscriberInformation.otherPayerName. The amount must equal the total claim charge amount you reported in claimInformation.claimChargeAmount.
This is the remaining amount (as determined by the provider) to be paid after the other payer identified in the otherPayerName object has adjudicated the claim.
Information about the provider who directed the patient to the rendering provider for care. For example, a primary care physician may refer patients to a specialist.
An identifier for the referring provider. The qualifier can be set to OB - State License Number, 1G - Provider UPIN Number, LU - Location Number, or G2 - Provider Commercial Number. Note that UPIN is deprecated and shouldn't be used for new claims. You can include up to three objects in this array.
The code identifying the type of reference number.
The reference number.
The identifier for the other payer who provided this reference number. This is only required when the reference number is provided by the non-destination payer. The value must match the otherPayerName.otherPayerIdentifier property.
Information about the rendering provider.
Code identifying the type of entity. Can be set to 1 - Person or 2 - Non-Person Entity.
1, 2 An identifier for the provider. The qualifier can be set to OB - State License Number, 1G - Provider UPIN Number, LU - Location Number, or G2 - Provider Commercial Number. Note that UPIN is deprecated and shouldn't be used for new claims. You can include up to three objects in this array.
The code identifying the type of reference number.
The reference number.
The identifier for the other payer who provided this reference number. This is only required when the reference number is provided by the non-destination payer. The value must match the otherPayerName.otherPayerIdentifier property.
Information about the service facility location.
A secondary identifier for the service facility location. The qualifier can be set to OB - State License Number, LU - Location Number, or G2 - Provider Commercial Number. You can include up to three objects in this array.
The code identifying the type of reference number.
The reference number.
The identifier for the other payer who provided this reference number. This is only required when the reference number is provided by the non-destination payer. The value must match the otherPayerName.otherPayerIdentifier property.
Information about the supervising provider.
An identifier for the supervising provider. The qualifier can be set to OB - State License Number, 1G - Provider UPIN Number, LU - Location Number or G2` - Provider Commercial Number. Note that UPIN is deprecated and shouldn't be used for new claims. You can include up to three objects in this array.
The code identifying the type of reference number.
The reference number.
The identifier for the other payer who provided this reference number. This is only required when the reference number is provided by the non-destination payer. The value must match the otherPayerName.otherPayerIdentifier property.
Information about the billing provider.
Code identifying the type of entity. Can be set to 1 - Person or 2 - Non-Person Entity.
1, 2 An identifier for the billing provider. The qualifier can be set to LU - Location Number, or G2 - Provider Commercial Number. You can include up to two objects in this array.
The code identifying the type of reference number.
The reference number.
The identifier for the other payer who provided this reference number. This is only required when the reference number is provided by the non-destination payer. The value must match the otherPayerName.otherPayerIdentifier property.
Claim-level data related to the adjudication of Medicare claims not related to an inpatient setting. Required when outpatient adjudication information is reported in the remittance advice or when you need to report remark codes.
The reimbursement percentage, expressed as a decimal.
The claim Health Care Financing Administration Common Procedural Coding System (HCPCS) payable amount, expressed as a decimal.
The remark code. Visit the X12 Remittance Advice Remark Codes for a complete list. You can include up to five codes in this array.
The professional component amount billed but not payable, expressed as a decimal.
Information about the assistant surgeon.
Code identifying the type of entity. Can be set to 1 - Person or 2 - Non-Person Entity. In practice, you should always set this to 1 - Person.
1, 2 An identifier for the assistant surgeon. The qualifier can be set to OB - State License Number, 1G - Provider UPIN Number, G2 - Commercial Number, or LU - Location Number. Note that UPIN is deprecated and shouldn't be used in new claims. You can include up to three objects in this array.
The code identifying the type of reference number.
The reference number.
The identifier for the other payer who provided this reference number. This is only required when the reference number is provided by the non-destination payer. The value must match the otherPayerName.otherPayerIdentifier property.
This is the payer's business name, like Cigna or Aetna.
Whether you want to send a test or production claim. This property also allows you to filter claims in the Stedi app by production or test data. By default, this property is set to P for production data. Use T to designate a claim as test data.
Use when the address for payment is different than that of the billing provider for this claim.
The first line of the street address. This typically contains the building number and street name.
The city name.
The second line of the street address. This typically contains the apartment or suite number.
The state or province code. Only required when the city is in the Unites States and Canada.
The postal zone or zip code. Exclude punctuation and spaces.
Use the alpha-2 country codes from Part 1 of ISO 3166.
Use the country subdivision codes from Part 2 of ISO 3166.
Use for subrogation payment requests. If you include this information, you must also set the claimInformation.otherSubscriberInformation.payerPaidAmount to the amount the payer (for example, Medicaid) actually paid.
The last name of the individual, or the business name of the pay-to-plan organization.
Code identifying the type of identifier. Can be set to PI - Payor Identification or XV - Centers for Medicare/Medicaid Services PlanID. Use code value XV when reporting Health Plan ID (HPID) or Other Entity Identifier (OEID).
PI, XV The identifier you specified in primaryIdentifierTypeCode.
The address of the pay-to-plan organization.
The first line of the street address. This typically contains the building number and street name.
The city name.
The second line of the street address. This typically contains the apartment or suite number.
The state or province code. Only required when the city is in the Unites States and Canada.
The postal zone or zip code. Exclude punctuation and spaces.
Use the alpha-2 country codes from Part 1 of ISO 3166.
Use the country subdivision codes from Part 2 of ISO 3166.
The Employer Identification Number (EIN). This must be a string of exactly nine numbers with no separators.
9Code identifying the type of secondary identifier. Can be set to 2U - Payer Identification Number, FY - Claim Office Number, or NF - National Association of Insurance Commissioners. You should only set this to 2U when you set the primaryIdentifierTypeCode to XV.
2U, FY, NF The secondary identifier you specified in secondaryIdentifierTypeCode.
The payer's address. Required when the payer address is available and the submitter intends for the claim to be printed on paper at the next EDI location (for example, a clearinghouse).
The first line of the street address. This typically contains the building number and street name.
The city name.
The second line of the street address. This typically contains the apartment or suite number.
The state or province code. Only required when the city is in the Unites States and Canada.
The postal zone or zip code. Exclude punctuation and spaces.
Use the alpha-2 country codes from Part 1 of ISO 3166.
Use the country subdivision codes from Part 2 of ISO 3166.
Dependent who received the medical care associated with the claim. Note that if the dependent has their own member ID for the health plan, you should include the dependent's information in the subscriber object instead. To check whether a dependent has a member ID, submit an Eligibility Check to the payer. The payer returns the dependent's member ID in the dependents.memberId property in the response, if present.
The patient's first name.
The patient's last name. Don't include the patient's name suffix, such as Jr. or III. Use the designated suffix property instead.
Code indiciating the patient's gender. Can be set to F - Female, M - Male, or U - Unknown.
You should set this property to U when the patient declines to answer or does not identify as male or female. Note that some payers may reject the claim if the patient's gender doesn't match the gender they have recorded in their member records.
M, F, U The patient's date of birth, formatted as YYYYMMDD.
Identifies the relationship of the patient to the subscriber. Can be set to 01 - Spouse, 19 - Child, 20 - Employee, 21 - Unknown, 39 - Organ Donor, 40 - Cadaver Donor, 53 - Life Partner, or G8 - Other Relationship.
01, 19, 20, 21, 39, 40, 53, G8 The patient's middle name or initial.
The patient's name suffix, such as Jr. or III. Only include the patient's personal name suffix - don't include professional or academic titles, such as M.D. or MBA.
The patient's Social Security Number. Only used for Property and Casualty claims. The Social Security Number must be a string of exactly nine numbers with no separators. For example 123456789.
The patient's identification number. Only used in Property and Casualty claims.
The patient's address. Every claim must include this information in either the subscriber (when the patient is the subscriber) or dependent (when the patient is a dependent) object. You must include at least the address1 and city properties in this object.
The first line of the street address. This typically contains the building number and street name.
The city name.
The second line of the street address. This typically contains the apartment or suite number.
The state or province code. Only required when the city is in the Unites States and Canada.
The postal zone or zip code. Exclude punctuation and spaces.
Use the alpha-2 country codes from Part 1 of ISO 3166.
Use the country subdivision codes from Part 2 of ISO 3166.
Information about the provider who directed the patient to the rendering provider for care. For example, a primary care physician may refer patients to a specialist. Use when the referring provider applies to the entire claim, not just a specific service line.
This should be an individual, not an organization, and you should supply at least the provider's lastName and an identifier, which is typically the npi.
Set to ReferringProvider.
The individual National Provider Identifier (NPI) assigned to the provider.
The provider's commercial number.
The provider's state license number.
Deprecated; do not use. This shape is deprecated.
This shape is deprecated.
10The provider's first name.
The provider's last name.
The provider's middle name or initial.
The provider's name suffix, such as Jr. or III.
The provider's business name.
This shape is deprecated.
The first line of the street address. This typically contains the building number and street name.
The city name.
The second line of the street address. This typically contains the apartment or suite number.
The state or province code. Only required when the city is in the Unites States and Canada.
The postal zone or zip code. Exclude punctuation and spaces.
Use the alpha-2 country codes from Part 1 of ISO 3166.
Use the country subdivision codes from Part 2 of ISO 3166.
This shape is deprecated.
The full name of the person or office.
The phone number, formatted as AAABBBCCCC, where AAA represents the area code, BBB is the telephone number prefix, and CCCC is the telephone number. The phone number should only include the digits 0 to 9. Don't include separators, such as dashes, and don't include long distance access numbers, such as 1. For example, you would format the phone number 123-456-7890 as 1234567890.
The fax number.
The email address.
The phone extension, if applicable.
Information about the person or company (laboratory or other facility) who rendered the care. Use this object for all types of rendering providers including laboratories. When a substitute provider (locum tenens) was used, enter that provider's information here. Use when the provider applies to the entire claim, not just a specific service line.
Set to RenderingProvider.
The National Provider Identifier (NPI) assigned to the provider.
The provider's commercial number.
The provider's location number.
The provider's state license number.
Deprecated; do not use. This shape is deprecated.
Code from the National Uniform Claims Committee Health Care Provider Taxonomy Code Set. This identifies the provider's type and/or area of specialty.
10The provider's first name, if the provider is an individual.
The provider's last name, if the provider is an individual. You must include either the lastName or organizationName property in this object.
The provider's middle name or initial, if the provider is an individual.
The provider's name suffix, such as Jr. or III.
The provider's business name, if the provider is an organization. You must include either the lastName or organizationName property in this object.
This shape is deprecated.
The first line of the street address. This typically contains the building number and street name.
The city name.
The second line of the street address. This typically contains the apartment or suite number.
The state or province code. Only required when the city is in the Unites States and Canada.
The postal zone or zip code. Exclude punctuation and spaces.
Use the alpha-2 country codes from Part 1 of ISO 3166.
Use the country subdivision codes from Part 2 of ISO 3166.
This shape is deprecated.
The full name of the person or office.
The phone number, formatted as AAABBBCCCC, where AAA represents the area code, BBB is the telephone number prefix, and CCCC is the telephone number. The phone number should only include the digits 0 to 9. Don't include separators, such as dashes, and don't include long distance access numbers, such as 1. For example, you would format the phone number 123-456-7890 as 1234567890.
The fax number.
The email address.
The phone extension, if applicable.
The entity responsible for overseeing the rendering provider and the care reported in this claim. Applies when the rendering provider is supervised by a physician. Use when the provider applies to the entire claim, not just a specific service line.
This should be an individual, not an organization, and you should supply at least the provider's lastName and an identifier, which is typically the npi.
Set to SupervisingProvider.
The individual National Provider Identifier (NPI) assigned to the supervising provider.
This shape is deprecated.
This shape is deprecated.
The commercial number of the supervising provider.
The location number of the supervising provider.
The state license number of the supervising provider.
Deprecated; do not use. This shape is deprecated.
This shape is deprecated.
10The first name of the supervising provider.
The last name of the supervising provider.
The middle name or initial of the supervising provider.
The suffix of the supervising provider's name, such as Jr. or III.
The supervising provider's business name, when the provider is not an individual.
This shape is deprecated.
The first line of the street address. This typically contains the building number and street name.
The city name.
The second line of the street address. This typically contains the apartment or suite number.
The state or province code. Only required when the city is in the Unites States and Canada.
The postal zone or zip code. Exclude punctuation and spaces.
Use the alpha-2 country codes from Part 1 of ISO 3166.
Use the country subdivision codes from Part 2 of ISO 3166.
This shape is deprecated.
The full name of the person or office.
The phone number, formatted as AAABBBCCCC, where AAA represents the area code, BBB is the telephone number prefix, and CCCC is the telephone number. The phone number should only include the digits 0 to 9. Don't include separators, such as dashes, and don't include long distance access numbers, such as 1. For example, you would format the phone number 123-456-7890 as 1234567890.
The fax number.
The email address.
The phone extension, if applicable.
Information about the assistant surgeon who rendered the care. Use this object when the rendering providers provided these services in the role of the assistant surgeon.
This should be an individual, not an organization, and you should supply at least the surgeon's lastName, taxonomyCode, and an identifier, which is typically the npi.
Code from the National Uniform Claims Committee Health Care Provider Taxonomy Code Set. This identifies the provider's type and/or area of specialty. For example, code 1223S0112X is for Oral and Maxillofacial Surgery.
10The assistant surgeon's last name. You must include either the lastName or organizationName property in this object.
The individual National Provider Identifier (NPI) assigned to the surgeon.
The provider's commercial number.
The provider's location number.
The provider's state license number.
Deprecated; do not use. This shape is deprecated.
The assistant surgeon's first name.
The assistant surgeon's middle name or initial.
The assistant surgeon's name suffix, such as Jr. or III.
The first line of the street address. This typically contains the building number and street name.
The city name.
The second line of the street address. This typically contains the apartment or suite number.
The state or province code. Only required when the city is in the Unites States and Canada.
The postal zone or zip code. Exclude punctuation and spaces.
Use the alpha-2 country codes from Part 1 of ISO 3166.
Use the country subdivision codes from Part 2 of ISO 3166.
You must include at least one communication method (phone, fax, or email) in this object.
The full name of the person or office.
The phone number, formatted as AAABBBCCCC, where AAA represents the area code, BBB is the telephone number prefix, and CCCC is the telephone number. The phone number should only include the digits 0 to 9. Don't include separators, such as dashes, and don't include long distance access numbers, such as 1. For example, you would format the phone number 123-456-7890 as 1234567890.
The fax number.
The email address.
The phone extension, if applicable.
Response
The status of the claim submission.
An identifier for the transaction.
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.
Information about the claim.
An identifier Stedi assigns to the claim.
Stedi's ID for the entity that submitted the claim.
A tracking number that Stedi assigns to the claim.
The patientControlNumber from the original request, if supplied. This is a unique identifier that you assign to the claim so you can track the claim and correlate it with responses from the payer.
A timestamp for Stedi's response to the claim submission.
The type of claim, currently not used.
The ID of the payer. This is the same as the tradingPartnerServiceId.
The X12 EDI version Stedi used to generate the claim for the payer. This is always 5010.
A tracking number Stedi assigns to the claim. This is the same as the correlationId.
Contains a unique identifier for each service line, listed in the order the service lines were included in the claim. You can use these identifiers to correlate payer responses to specific service lines.
A unique identifier for the service line, matching the value provided for the claimInformation.serviceLines.providerControlNumber property in the claim submission. If you didn't provide a value for providerControlNumber, this property contains a randomly generated a UUID for the service line.
A list of errors. Currently not used.
The field related to the error.
The value for the data causing the error.
The error code.
The description of the error code.
Recommended followup actions to correct the error.
Where the error is located in the original request.
A 200 response indicates that 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. A 400 response indicates one or more problems with the claim data in the request. Examples include missing required fields, invalid values, or incorrect data types. The response includes a message describing the problem.
200 OK, 400 BAD_REQUEST Metadata from Stedi about the request.
The submitter ID assigned to this request.
The sender ID assigned to this request.
The biller ID assigned to this request.
The file execution ID, a unique identifier assigned to the processed file within the Stedi platform.
Indicates where this request can be found for support.
Currently not used.
Currently not used.
Was this page helpful?
curl --request POST \
--url https://healthcare.us.stedi.com/2024-04-01/dental-claims/submission \
--header 'Authorization: <api-key>' \
--header 'Content-Type: application/json' \
--data '{
"usageIndicator": "T",
"tradingPartnerServiceId": "52133",
"tradingPartnerName": "United HealthCare Dental",
"subscriber": {
"paymentResponsibilityLevelCode": "P",
"memberId": "123412345",
"firstName": "John",
"lastName": "Doe",
"groupNumber": "1234567890",
"gender": "F",
"address": {
"address1": "1234 Some St",
"city": "Buckeye",
"state": "AZ",
"postalCode": "85326"
},
"dateOfBirth": "20180615"
},
"submitter": {
"organizationName": "ABA Inc",
"submitterIdentification": "123456789",
"contactInformation": {
"phoneNumber": "3131234567",
"name": "BILLING DEPARTMENT"
}
},
"rendering": {
"npi": "1234567893",
"taxonomyCode": "106S00000X",
"providerType": "RenderingProvider",
"lastName": "Doe",
"firstName": "Jane"
},
"receiver": {
"organizationName": "United HealthCare Dental"
},
"payerAddress": {
"address1": "PO Box 7000",
"city": "Camden",
"state": "SC",
"postalCode": "29000"
},
"claimInformation": {
"signatureIndicator": "Y",
"toothStatus": [
{
"toothNumber": "3",
"toothStatusCode": "E"
}
],
"serviceLines": [
{
"serviceDate": "20230428",
"renderingProvider": {
"npi": "1234567893",
"taxonomyCode": "122300000X",
"lastName": "Doe",
"firstName": "Jane"
},
"providerControlNumber": "a0UDo000000dd2dMAA",
"dentalService": {
"procedureCode": "D7140",
"lineItemChargeAmount": "832.00",
"placeOfServiceCode": "12",
"oralCavityDesignationCode": [
"1",
"2"
],
"prosthesisCrownOrInlayCode": "I",
"procedureCount": 2,
"compositeDiagnosisCodePointers": {
"diagnosisCodePointers": [
"1"
]
}
},
"teethInformation": [
{
"toothCode": "3",
"toothSurface": [
"M",
"O"
]
}
]
}
],
"serviceFacilityLocation": {
"phoneNumber": "3131234567",
"organizationName": "ABA Inc",
"npi": "1234567893",
"address": {
"address1": "ABA Inc 123 Some St",
"city": "Denver",
"state": "CO",
"postalCode": "802383100"
}
},
"releaseInformationCode": "Y",
"planParticipationCode": "A",
"placeOfServiceCode": "12",
"patientControlNumber": "0000112233",
"healthCareCodeInformation": [
{
"diagnosisTypeCode": "ABK",
"diagnosisCode": "K081"
}
],
"claimSupplementalInformation": {
"priorAuthorizationNumber": "20231010012345678"
},
"claimFrequencyCode": "1",
"claimFilingCode": "FI",
"claimChargeAmount": "832.00",
"benefitsAssignmentCertificationIndicator": "Y"
},
"billing": {
"taxonomyCode": "106S00000X",
"providerType": "BillingProvider",
"organizationName": "ABA Inc",
"npi": "1999999992",
"employerId": "123456789",
"contactInformation": {
"phoneNumber": "3134893157",
"name": "ABA Inc"
},
"address": {
"address1": "ABA Inc 123 Some St",
"city": "Denver",
"state": "CO",
"postalCode": "802383000"
}
}
}'{
"status": "SUCCESS",
"controlNumber": "1",
"tradingPartnerServiceId": "52133",
"claimReference": {
"correlationId": "01JDQMX92Q1T561BH8NKX750TQ",
"patientControlNumber": "0U1LBRS4",
"timeOfResponse": "2024-11-27T20:27:27.077Z",
"payerId": "52133",
"formatVersion": "5010",
"rhclaimNumber": "01JDQMX92Q1T561BH8NKX750TQ",
"serviceLines": [
{
"lineItemControlNumber": "a0UDo000000dd2dMAA"
}
]
},
"httpStatusCode": "200 OK",
"meta": {
"traceId": "9b491769-052e-4738-93d6-e0b5f6d83f53"
},
"payer": {
"payerName": "United HealthCare Dental",
"payerId": "52133"
}
}