Healthcare
- Payers
- Enrollments
- Eligibility checks
- Claim submission
- Claim status
- Remittances
EDI platform
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- Transactions
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- Mappings
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Institutional Claims
This endpoint sends 837I (institutional) claims to payers. Visit Submit institutional claims for a full how-to guide.
- 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 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.
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. | |
submitter object | Information about the entity submitting the healthcare claim. This is an organization, such as a hospital or other treatment center. | |
receiver object | Information about the entity responsible for the payment of the claim, 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 claim filing code (identifies the type of claim), claim charge amount, and place of service code. It also includes information about each individual service line included in the claim. | |
| Billing provider | You must supply information about the billing provider in either the providers or billing object. This includes the provider’s NPI, name, and other information. |
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.
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.lineItemControlNumber 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. We strongly recommend setting the lineItemControlNumber to a ULID or other unique identifier for each service line. We recommend using a ULID instead of a UUID because the property has a max of 30 characters.
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 Institutional 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 is an organization, such as a hospital or other treatment center.
The business name of the institution submitting the claim.
60The 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, EIN/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.
2 - 80The full name of the person or office.
60The 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.
256The fax number.
The email address.
This shape is deprecated.
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.
60The receiver's Electronic Transmitter Identification Number (ETIN), as assigned by the payer. This may be the same as the payer's TIN, but it can also be another unique identifier. We strongly recommend including this property in your request.
2 - 80The 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 subscriber for the claim submission - include their information here and omit the
dependentobject from the request. - You can only 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 payer's level of responsibility for paying this claim. Can be set to A - Payer Responsibility Four, B - Payer Responsibility Five, C - Payer Responsibility Six, D - Payer Responsibility Seven, E - Payer Responsibility Eight, F - Payer Responsibility Nine, G - Payer Responsibility Ten, H - Payer Responsibility Eleven, P - Primary, S - Secondary, T Tertiary, or U - Unknown (only use in payer-to-payer COB claims).
A, B, C, D, E, F, G, H, P, S, T, U The subscriber's first name. Can be up to 35 characters.
35The subscriber's last name. Can be up to 60 characters.
60The member ID for the subscriber's insurance policy.
2 - 80Deprecated. Use the memberId property instead.
This shape is deprecated.
The subscriber's Social Security Number. This must be a string of exactly nine numbers with no separators. For example, 123456789.
The subscriber's middle name or initial. Can be up to 25 characters.
25The subscriber's name suffix, such as Jr. or III. Can be up to 10 characters.
10Code identifying the gender. Can be set to F - Female, M - Male, or U - Unknown.
F, M, U The subscriber's date of birth, formatted as YYYYMMDD.
Deprecated. This shape is deprecated.
50The subscriber's health plan group number.
50The subscriber's address. Every claim must include address 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.
55The city name.
30The second line of the street address. This typically contains the apartment or suite number.
55The state or province code. Only required when the city is in the Unites States and Canada.
2The postal zone or zip code. Exclude punctuation and spaces.
3 - 15Use the alpha-2 country codes from Part 1 of ISO 3166.
2 - 3Use the country subdivision codes from Part 2 of ISO 3166.
1 - 3Information 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 claimChargeAmount, 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.
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 An identifier you assign to the claim. It can be up to 20 characters. 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).)
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.
2Code specifying the frequency of the claim. Not all payers allow all codes. Can be set to 1 - Original claim submission, 2 - Interim – First Claim, 3 - Interim – Continuing Claim, 4 - Interim – Last Claim, 7 - Replacement, 8 - Void, and 9 - Final Claim for a Home Health PPS Episode.
1Code indicating whether the provider accepts assignment. This refers to whether the provider accepts assignment and/or has a participation agreement with the destination payer. It does not indicate whether the patient has assigned benefits to the provider. Can be set to A - Assigned, B - Assignment Accepted on Clinical Lab Services Only, or C - Not Assigned. Choose A when the provider accepts assignment and/or has a participation agreement with the destination payer, OR the provider does not accept assignment and/or have a participation agreement, but is advising the payer to adjudicate this specific claim under the participating provider benefits allowed under certain plans.
A, B, C A code indicating whether the patient or an authorized person has authorized the plan to remit payment directly to the provider. Use W when the patient refuses to assign benefits. Can be set to N - No, Y - Yes, or W - Not Applicable.
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 Dates and times related to the claim. For example, when the patient was discharged from the hospital.
The beginning date of the statement, formatted as YYYYMMDD.
The ending date of the statement, formatted as YYYYMMDD.
When the patient was admitted to the hospital or facility. This property is required on inpatient claims. Can be expressed as a date and time (YYYYMMDDHHMM) or a single date (YYYYMMDD).
The time the patient was discharged from the hospital or facility. This property is required on final inpatient claims. Can be expressed as a time in format HHMM.
The date the repricer received the claim, expressed as YYYYMMDD. Required when a repricer is passing the claim onto the payer.
This is the diagnosis for the condition determined to be primarily responsible for admission of the patient into the health facility for care.
Code identifying the type of diagnosis code used. Can be set to ABK - International Classification of Diseases Clinical Modification Principal Diagnosis or BK - International Classification of Diseases Clinical Modification (ICD-9-CM) Principal Diagnosis. Note that ICD-9 is deprecated and cannot be used in new claims.
ABK, BK The principal diagnosis code for the patient. It must be a valid code from the appropriate coding system. Do not submit the decimal for ICD codes; the decimal 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.
30Indicates whether the principal diagnosis was present on admission. Can be set to N - No (onset did NOT occur prior to admission to the hospital), Y - Yes (onset occurred prior to admission to the hospital), U - Unknown, or W - Not Applicable.
N, Y, U, W 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.
Stedi assigns this value automatically. It's a unique number identifying the service line within the claim. This shape is deprecated.
6Either a single date of service or the beginning of a range of service dates, formatted as YYYYMMDD. If a range is provided, the end date should be provided in serviceDateEnd. This property is required on outpatient service lines where a drug is not being billed and the Statement Covers Period is greater than one day. It's also required when a drug is being billed and the payer's adjudication is known to be impacted by the drug duration or the date the prescription was written. In cases where a drug is being billed on a service line, this property may be used to indicate the date the prescription was written (or otherwise communicated by the prescriber if not written). It may also be used to indicate the beginning of the duration for which the drug supply will be used by the patient. The difference in dates, including both the begin and end dates, are the days supply of the drug. Example: 20000101-20000107 (1/1/00 to 1/7/00) is used for a 7 day supply where the first day of the drug used by the patient is 1/1/00. In the event a drug is administered on less than a daily basis (for example, every other day) the date range would include the entire period during which the drug was supplied, including the last day the drug was used. Example: 20000101-20000108 (1/1/00 to 1/8/00) is used for an 8 days supply where the prescription is written for Q48 (every 48 hours), four doses of the drug are dispensed and the first dose is used on 1/1/00.
The end of a range of service dates, formatted as YYYYMMDD. If you include this property, you must also include serviceDate to indicate the beginning of the range.
The amount of the service tax or surcharge, formatted as a decimal. Required when a service tax or surcharge applies to the service being reported. The claimInformation.serviceLines.institutionalService.lineItemChargeAmount must include the amount you report here.
The amount of the facility tax or surcharge, formatted as a decimal. Required when a facility tax applies to the service being reported. The claimInformation.serviceLines.institutionalService.lineItemChargeAmount must include the amount you report here.
To provide additional information for comment or special instruction. Required when the TPO/repricer needs to forward additional information to the payer.
80A 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. We strongly recommend setting this property for every service line within the claim. We also recommend using a ULID instead of a UUID because payers are only required to store up to 30 characters for this value.
50Required when a repricing (pricing) organization needs to have an identifying number on the service line in their submission to their payer organization.
50A free-form description to clarify information about the service line. You can use this to further describe the service/product/supply reported in the service line or for non-specific procedure codes. Non-specific procedure codes may include descriptors such as 'Not Otherwise Classified (NOC)', 'Unlisted', 'Unspecified', 'Other', 'Prescription Drug: Generic', 'Prescription Drug, Brand Name', or 'Miscellaneous'.
80Required when a repricing (pricing) organization needs to have an identifying number on an adjusted service line in their submission to their payer organization. Providers shouldn't complete this property.
50Another way to provide additional information for comment or special instruction - same as thirdPartyOrganizationNotes. Required when the TPO/repricer needs to forward additional information to the payer.
80Includes 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.
2 - 80The amount paid for this service line, expressed as a decimal. Zero (0) is an acceptable value.
Code identifying the type of procedureCode. Can be set to ER - Jurisdiction Specific Procedure and Supply Codes, HC - Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes, HP - Health Insurance Prospective Payment System (HIPPS) Skilled Nursing Facility Rate Code, IV - Home Infusion EDI Coalition (HIEC) Product/Service Code, or WK - Advanced Billing Concepts (ABC) Codes. Note that ABC codes are deprecated and shouldn't be used in new claims. Visit Claims code lists for a complete list and usage guidelines.
ER, HC, HP, IV, WK The procedure code.
48A modifier that conveys special circumstances related to the performance of the service.
The revenue code for the service line.
48A description of the procedure identified in procedureCode.
80The number of paid units from the remittance advice. 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 LX assigned number of the service line into which this service line is bundled. It's only used to bundle service lines.
The date the claim was paid, formatted as YYYYMMDD.
The remaining amount (as determined by the provider) to be paid after the other payer identified in the otherPayerPrimaryIdentifier property has adjudicated the claim. Expressed as a decimal. Only used in claims submitted by providers - not in payer-to-payer coordination of benefits (COB). Don't include this if you already provided claimInformation.otherSubscriberInformation.remainingPatientLiability for the claim.
Adjustment reason codes and amounts as needed for the service line. You can include up to five of these objects within claimInformation.serviceLines.lineAdjudicationInformation.claimAdjustmentInformation.
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 adjustment reason, amount, and quantity. You can include up to six of these objects to describe a single adjustmentGroupCode.
Information about the provider who delivered the medical services or non-surgical procedures in this service line. Include this object when the rendering provider is different than the provider listed in the claim's attending object AND when state or federal regulatory requirements call for a combined claim. A combined claim includes both facility and professional components, such as a Medicaid clinic bill or a critical access hospital claim.
The type of provider. Set to the type that matches this object's name.
BillingProvider, AttendingProvider, ReferringProvider, RenderingProvider The provider's National Provider Identifier (NPI). The NPI is a unique, 10-digit identification number assigned to healthcare providers according to HIPAA standards.
The type of identifier used in secondaryIdentifier. Can be set to 0B - State License Number, 1G - Provider UPIN Number, G2 - Provider Commercial Number, or LU - Location Number. Note that UPIN is deprecated and should not be used.
0B, 1G, G2, LU The identifier specified in secondaryIdentifierQualifierCode.
50This shape is deprecated.
50This shape is deprecated.
50This shape is deprecated.
50This shape is deprecated.
50This shape is deprecated.
50This shape is deprecated.
The provider's first name. Can be up to 35 characters.
35The provider's last name, when the provider is an individual. Can be up to 60 characters. Either this property or organizationName is required.
60The provider's middle name or initial. Can be up to 25 characters.
25The provider's suffix, such as Jr. or Sr. Can be up to 10 characters.
10The provider's business name. Can be up to 60 characters. Either this property or lastName is required.
60This shape is deprecated.
The first line of the street address. This typically contains the building number and street name.
55The city name.
30The second line of the street address. This typically contains the apartment or suite number.
55The state or province code. Only required when the city is in the Unites States and Canada.
2The postal zone or zip code. Exclude punctuation and spaces.
3 - 15Use the alpha-2 country codes from Part 1 of ISO 3166.
2 - 3Use the country subdivision codes from Part 2 of ISO 3166.
1 - 3This shape is deprecated.
The full name of the person or office.
60The 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.
256The fax number.
The email address.
This shape is deprecated.
Additional identifiers for the provider. You can set qualifier to 2U - Payer Identification Number.
Information about the provider who referred the patient for care. Include this object only when the referring provider is different than the provider listed in the attending object.
The type of provider. Set to the type that matches this object's name.
BillingProvider, AttendingProvider, ReferringProvider, RenderingProvider The provider's National Provider Identifier (NPI). The NPI is a unique, 10-digit identification number assigned to healthcare providers according to HIPAA standards.
The type of identifier used in secondaryIdentifier. Can be set to 0B - State License Number, 1G - Provider UPIN Number, G2 - Provider Commercial Number, or LU - Location Number. Note that UPIN is deprecated and should not be used.
0B, 1G, G2, LU The identifier specified in secondaryIdentifierQualifierCode.
50This shape is deprecated.
50This shape is deprecated.
50This shape is deprecated.
50This shape is deprecated.
50This shape is deprecated.
50This shape is deprecated.
The provider's first name. Can be up to 35 characters.
35The provider's last name, when the provider is an individual. Can be up to 60 characters. Either this property or organizationName is required.
60The provider's middle name or initial. Can be up to 25 characters.
25The provider's suffix, such as Jr. or Sr. Can be up to 10 characters.
10The provider's business name. Can be up to 60 characters. Either this property or lastName is required.
60This shape is deprecated.
The first line of the street address. This typically contains the building number and street name.
55The city name.
30The second line of the street address. This typically contains the apartment or suite number.
55The state or province code. Only required when the city is in the Unites States and Canada.
2The postal zone or zip code. Exclude punctuation and spaces.
3 - 15Use the alpha-2 country codes from Part 1 of ISO 3166.
2 - 3Use the country subdivision codes from Part 2 of ISO 3166.
1 - 3This shape is deprecated.
The full name of the person or office.
60The 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.
256The fax number.
The email address.
This shape is deprecated.
Additional identifiers for the provider. You can set qualifier to 2U - Payer Identification Number.
This shape is deprecated.
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, 08 - Plan of Treatment or CT - Certification. Visit Claims code lists for a complete list.
03, 04, 05, 06, 07, 08, 09, 10, 11, 13, 15, 21, A3, A4, AM, AS, B2, B3, B4, BR, BS, BT, CB, CK, CT, D2, DA, DB, DG, DJ, DS, EB, HC, HR, I5, IR, LA, M1, MT, NN, OB, OC, OD, OE, OX, OZ, P4, P5, PE, PN, PO, PQ, PY, PZ, RB, RR, RT, RX, SG, V5, XP 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. Required when the attachmentTransmissionCode = BM, EL, EM, FX, or FT.
2 - 80Required when an authorization number is assigned by the payer or UMO and the services on this claim were preauthorized. The UMO (Utilization Management Organization) is generally the entity empowered to decide the outcome of a health services review or the owner of the information. This value applies to the entire claim unless overridden within a specific service line.
50Required when a referral number is assigned by the payer or Utilization Management Organization (UMO) and a referral is involved. This value applies to the entire claim unless overridden within a specific service line.
50An identifier the payer previously assigned to the claim. Required when the claimFrequencyCode indicates this claim is a replacement or void to a previously adjudicated claim.
50Required when the repricer believes this information is necessary. Providers should not complete this property.
50Required when claim involves a Food and Drug Administration (FDA) assigned investigational device exemption (IDE) number. When more than one IDE applies, you must split into separate claims.
50The identifier assigned by clearinghouse, van, etc. when they need to assign their own unique claim number. Providers should not complete this property. This shape is deprecated.
Required when the provider needs to identify the actual medical record of the patient for this episode of care.
50Required when it is necessary to identify claims that are atypical in ways such as content, purpose, and/or payment. For example, claims made as the result of a demonstration or a clinical trial.
50Code indicating the type of service authorization exception. Visit Claims code lists for a complete list.
1, 2, 3, 4, 5, 6, 7 Required when the services reported on this claim are related to an auto accident and the accident occurred in a country or location that has a state, province, or sub-country code.
50Required when an external Peer Review Organization assigns an Approval Number to services deemed medically necessary by that organization.
50The adjusted repriced claim reference number. Required when the repricer believes this information is necessary. Providers should not complete this property.
50Details about the service line, including the procedure code and the line item charge amount.
The identifying number for the product or service. Visit the National Uniform Billing Committee (NUBC) Codes documentation for a complete list.
48The amount charged for the service line, expressed as a decimal. This should include the provider's base charge and any applicable tax amounts reported within the service line.
The unit of measurement for the service. Can be set to DA - Days or UN - Unit.
DA, UN The number of units of service provided. 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.
15Code identifying the type of procedureCode. Can be set to ER - Jurisdiction Specific Procedure and Supply Codes, HC - Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes, HP - Health Insurance Prospective Payment System (HIPPS) Skilled Nursing Facility Rate Code, IV - Home Infusion EDI Coalition (HIEC) Product/Service Code, or WK - Advanced Billing Concepts (ABC) Codes. Note that ABC codes are deprecated and shouldn't be used in new claims. Visit Claims code lists for more information.
ER, HC, HP, IV, WK The procedure code.
A modifier that conveys special circumstances related to the performance of the service.
The description of the procedure identified in procedureCode.
The non-covered service amount, expressed as a decimal. This property isn't intended for sending claims to secondary insurance after receiving a remittance from the original payer. It's used when a provider wants to report that they performed an uncovered service for a patient, but they aren't asking for payment. For example, a cosmetic procedure that isn't covered by the patient's health plan.
Additional information or documentation required for the service line.
Code indicating the title or contents of a document, report or supporting item. For example, 08 - Plan of Treatment or CT - Certification. Visit Claims code lists for a complete list.
03, 04, 05, 06, 07, 08, 09, 10, 11, 13, 15, 21, A3, A4, AM, AS, B2, B3, B4, BR, BS, BT, CB, CK, CT, D2, DA, DB, DG, DJ, DS, EB, HC, HR, I5, IR, LA, M1, MT, NN, OB, OC, OD, OE, OX, OZ, P4, P5, PE, PN, PO, PQ, PY, PZ, RB, RR, RT, RX, SG, V5, XP Code indicating the method by which the attachment was transmitted. 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. Required when the attachmentTransmissionCode = BM, EL, EM, FX, or FT.
This shape is deprecated.
Additional identifiers for the service line. We strongly recommend setting the providerControlNumber property for each service line within the claim.
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. We strongly recommend setting this property for every service line within the claim. We also recommend using a ULID instead of a UUID because payers are only required to store up to 30 characters for this value.
This shape is deprecated.
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 Code identifying the type of procedureCode. Can be set to ER - Jurisdiction Specific Procedure and Supply Codes, HC - Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes, HP - Health Insurance Prospective Payment System (HIPPS) Skilled Nursing Facility Rate Code, IV - Home Infusion EDI Coalition (HIEC) Product/Service Code, or WK - Advanced Billing Concepts (ABC) Codes. Note that ABC codes are deprecated and shouldn't be used in new claims. Visit Claims code lists for more information.
ER, HC, HP, IV, WK 48The unit of measurement for the service. Can be set to DA - Days or UN - Unit.
DA, UN T1, T2, T3, T4, T5, T6 1, 2, 3, 4, 5 Code specifying the exception reason for consideration of out-of-network health care services. Can be set to 1 - Non-Network Professional Provider in Network Hospital, 2 - Emergency Care, 3 - Services or Specialist not in Network, 4 - Out-of-Service Area, 5 - State Mandates, or 6 - Other.
1, 2, 3, 4, 5, 6 Report drugs and biologics related to the service line. Required when government regulation mandates that prescribed drugs and biologics are reported with NDC numbers or when when the provider or submitter chooses to report NDC numbers to enhance the claim reporting or adjudication processes.
The National Drug Code (NDC) number for the drug or biologic. This is a unique number that identifies the drug or biologic, including the labeler code, product code, and package code. The NDC number must be formatted as 5-4-2, with hyphens separating the three parts. For example, 12345-6789-01.
48The number of units of the drug or biologic, formtted as a decimal.
Code identifying the unit of measure for the drug or biologic. Can be set to F2 - International Unit, GR - Gram, ME - Milligram, ML - Milliliter, or UN - Unit.
F2, GR, ME, ML, UN The sequence number assigned to the drug or biologic. Required when the provided medication involves the compounding of two or more drugs being reported and there is no prescription number. The link sequence number is a provider-assigned number unique to this claim. Its purpose is to enable the receiver to piece together the components of the compound. Note that you can set either this property or pharmacyPrescriptionNumber, but not both.
50The prescription number assigned by the pharmacy. Required when dispensing of the drug has been done with an assigned prescription number. In cases where a compound drug is being billed, the components of the compound will all have the same prescription number. Payers receiving the claim can relate all the components by matching the prescription number. Note that you can set either this property or linkSequenceNumber, but not both.
50This shape is deprecated.
2 - 80Code identifying the type of procedureCode. Can be set to ER - Jurisdiction Specific Procedure and Supply Codes, HC - Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes, HP - Health Insurance Prospective Payment System (HIPPS) Skilled Nursing Facility Rate Code, IV - Home Infusion EDI Coalition (HIEC) Product/Service Code, or WK - Advanced Billing Concepts (ABC) Codes. Note that ABC codes are deprecated and shouldn't be used in new claims. Visit Claims code lists for a complete list and usage guidelines.
ER, HC, HP, IV, WK 4880Code 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 adjustment reason, amount, and quantity. You can include up to six of these objects to describe a single adjustmentGroupCode.
Information about the individual with primary responsibility for performing the surgical procedure(s) listed in the service line. Required when a surgical procedure code is listed.
The physician's last name. Can be up to 60 characters.
60The physician's business name. Can be up to 60 characters.
60The type of identifier used in secondaryIdentifier. Can be set to 0B - State License Number, 1G - Provider UPIN Number, G2 - Provider Commercial Number, or LU - Location Number. Note that UPIN is deprecated and should not be used.
0B, 1G, G2, LU The identifier specified in identificationQualififerCode.
The physician's first name. Can be up to 35 characters.
35The physician's middle name or initial. Can be up to 25 characters.
25The physician's name suffix, such as Jr. or III. Can be up to 10 characters.
10Information about the individual who performed a secondary surgical procedure or assisted the operatingPhysician. Required when another operating physician is involved in the surgical procedures listed in the service line.
The physician's last name. Can be up to 60 characters.
60The physician's business name. Can be up to 60 characters.
60The type of identifier used in secondaryIdentifier. Can be set to 0B - State License Number, 1G - Provider UPIN Number, G2 - Provider Commercial Number, or LU - Location Number. Note that UPIN is deprecated and should not be used.
0B, 1G, G2, LU The identifier specified in identificationQualififerCode.
The physician's first name. Can be up to 35 characters.
35The physician's middle name or initial. Can be up to 25 characters.
25The physician's name suffix, such as Jr. or III. Can be up to 10 characters.
10Information about the pricing or repricing of the service line. This information should only be completed by repricers.
The pricing methodology code. Visit Claims code lists for a complete list.
00, 01, 02, 03, 04, 05, 06, 07, 08, 09, 10, 11, 12, 13, 14 The allowed amount, expressed as a decimal.
The savings amount, expressed as a decimal.
The organization identification number.
The pricing rate associated with per diem or flat rate pricing, expressed as a decimal.
The approved DRG code.
The approved DRG amount, expressed as a decimal.
The approved revenue code.
The approved service units or inpatient days. Can be set to DA - Days or UN - Unit.
DA, UN The approved service units or inpatient days. 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. 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. Can be set to 1 - Non-Network Professional Provider in Network Hospital, 2 - Emergency Care, 3 - Services or Specialist not in Network, 4 - Out-of-Service Area, 5 - State Mandates, or 6 - Other.
1, 2, 3, 4, 5, 6 Code identifying the type of product or service ID used. Can be set to ER - Jurisdiction Specific Procedure and Supply Codes, HC - Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes, HP - Health Insurance Prospective Payment System (HIPPS) Skilled Nursing Facility Rate Code, IV - Home Infusion EDI Coalition (HIEC) Product/Service Code, or WK - Advanced Billing Concepts (ABC) Codes. Note that ABC codes are deprecated and should not be used in new claims. If you provide this property, you must also provide repricedApprovedHCPCSCode Visit Claims code lists for a complete list and additional usage notes.
ER, HC, HP, IV, WK The approved procedure code. If you provide this property, you must also include productOrServiceIDQualifier.
Supply information specific to hospital claims, such as the priority of the admission.
The code indicating the priority of the admission.
1Code indicating patient status as of the 'statement covers through date'.
1 - 2Code indicating the source of the admission.
The agency claim number for this transaction. Used when services included in this claim are part of a property and casualty claim. This property is typically not used by Stedi customers.
This shape is deprecated.
This shape is deprecated.
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 This shape is deprecated.
The total estimated amount the patient must pay for the services listed in this claim. Expressed as a decimal, such as 20.50. This includes any co-payments, co-insurance, or other costs.
Used to send additional data specifically requested by the payer. Not commonly used.
To communicate special instructions regarding claim billing. Required when the provider judges the information is needed to substantiate the medical treatment and cannot be provided elsewhere in the request. Can be up to 80 characters.
80Free-form information to substantiate the medical treatment that isn't provided elsewhere in the claim submission. Also used to provide narrative information from the forms Home Health Certification and Plan of Treatment or Medical Update and Patient Information, as needed to substantiate home health services. You can provide up to 10 strings in this array.
Goals, Rehabilitation Potential, or Discharge Plans
Diagnosis Description
Allergies
Durable Medical Equipment (DME) and Supplies
Medications
Nutritional Requirements
Orders for Disciplines and Treatments
Functional Limitations, Reason Homebound, or Both
Reasons Patient Leaves Home
Times and Reasons Patient Not at Home
Unusual Home, Social Environment, or Both
Safety Measures
Supplementary Plan of Treatment
Updated Information
This shape is deprecated.
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 01 - Diagnosis Related Group (DRG), 02 - Per Diem, 03 - Variable Per Diem, 04 - Flat, 05 - Capitated, 06 - Percent, or 09 - Other.
01, 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.
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, 08 - Plan of Treatment or CT - Certification. Visit Claims code lists for a complete list.
03, 04, 05, 06, 07, 08, 09, 10, 11, 13, 15, 21, A3, A4, AM, AS, B2, B3, B4, BR, BS, BT, CB, CK, CT, D2, DA, DB, DG, DJ, DS, EB, HC, HR, I5, IR, LA, M1, MT, NN, OB, OC, OD, OE, OX, OZ, P4, P5, PE, PN, PO, PQ, PY, PZ, RB, RR, RT, RX, SG, V5, XP 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. Required when the attachmentTransmissionCode = BM, EL, EM, FX, or FT.
2 - 80Required when an authorization number is assigned by the payer or UMO and the services on this claim were preauthorized. The UMO (Utilization Management Organization) is generally the entity empowered to decide the outcome of a health services review or the owner of the information. This value applies to the entire claim unless overridden within a specific service line.
50Required when a referral number is assigned by the payer or Utilization Management Organization (UMO) and a referral is involved. This value applies to the entire claim unless overridden within a specific service line.
50An identifier the payer previously assigned to the claim. Required when the claimFrequencyCode indicates this claim is a replacement or void to a previously adjudicated claim.
50Required when the repricer believes this information is necessary. Providers should not complete this property.
50Required when claim involves a Food and Drug Administration (FDA) assigned investigational device exemption (IDE) number. When more than one IDE applies, you must split into separate claims.
50The identifier assigned by clearinghouse, van, etc. when they need to assign their own unique claim number. Providers should not complete this property. This shape is deprecated.
Required when the provider needs to identify the actual medical record of the patient for this episode of care.
50Required when it is necessary to identify claims that are atypical in ways such as content, purpose, and/or payment. For example, claims made as the result of a demonstration or a clinical trial.
50Code indicating the type of service authorization exception. Visit Claims code lists for a complete list.
1, 2, 3, 4, 5, 6, 7 Required when the services reported on this claim are related to an auto accident and the accident occurred in a country or location that has a state, province, or sub-country code.
50Required when an external Peer Review Organization assigns an Approval Number to services deemed medically necessary by that organization.
50The adjusted repriced claim reference number. Required when the repricer believes this information is necessary. Providers should not complete this property.
50Indicates the condition of the patient for EPSDT referral situations. Can be set to AV - Available-Not Used, NU - Not Used, S2 - Under Treatment, ST - New Services Requested. Uset AV when the patient refused a referral. Use S2 when the patient is currently under treatment for the referred diagnostic or corrective health problem. Use ST when the patient is referred to another provider for diagnostic or corrective treatment for at least one health problem identified during an initial or periodic screening service (not including dental referrals) OR the patient is scheduled for another appointment with the screening provider for diagnostic or corrective treatment for at least one health problem identified during an initial or periodic screening service (not including dental referrals).
AV, NU, S2, ST The diagnosis for which the patient sought medical care. This may be different from the principal diagnosis.
Code identifying the type of admitting diagnosis code used. Can be set to ABJ - International Classification of Diseases Clinical Modification (ICD-10-CM) Admitting Diagnosis or BJ - International Classification of Diseases Clinical Modification (ICD-9-CM) Admitting Diagnosis. Note that ICD-9 is deprecated and cannot be used in new claims.
ABJ, BJ The admitting diagnosis code for the patient. It must be a valid code from the appropriate coding system. Do not submit the decimal for ICD codes; the decimal 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.
30The diagnosis for which the patient visited an outpatient provider. Required when the claim involves outpatient visits. This may be different from the principal diagnosis.
Code identifying the type of reason for visit code used. Can be set to APR - International Classification of Diseases Clinical Modification Patient's Reason for Visit or PR - International Classification of Diseases Clinical Modification Patient's Reason for Visit. Note that ICD-9 is deprecated and cannot be used in new claims.
APR, PR The patient's reason for visit code. It must be a valid code from the appropriate coding system. Do not submit the decimal for ICD codes; the decimal 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.
30Diagnosis codes to describe the patient's condition. Required when an external Cause of Injury is needed to describe an injury, poisoning, or adverse effect. Note that to fully describe an injury using ICD-10-CM, it will be necessary to report a series of 3 external cause of injury codes. Refer to the ICD-10-CM Official Guidelines for Coding and Reporting.
Code identifying the type of external cause of injury code used. Can be set to ABN - International Classification of Diseases Clinical Modification External Cause of Injury Code or BN - International Classification of Diseases Clinical Modification External Cause of Injury Code. Note that ICD-9 is deprecated and cannot be used in new claims.
ABN, BN The external cause of injury code(s) for the patient. These must be valid codes from the appropriate coding system. Do not submit the decimal for ICD codes; the decimal is implied.
30Indicates whether the external cause of injury was present on admission. Can be set to N - No (onset did NOT occur prior to admission to the hospital), Y - Yes (onset occurred prior to admission to the hospital), U - Unknown, or W - Not Applicable.
N, U, Y, W Diagnosis related group (DRG) code. Required when an inpatient hospital is under DRG contract with a payer and the contract requires the provider to identify the DRG to the payer.
The diagnosis related group code.
30Additional diagnosis codes relevant to the claim. Required when other condition(s) coexist or develop(s) subsequently during the patient's treatment. You can provide up to two codes in this array. Do not submit the decimal for ICD codes; the decimal 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.
The procedure code for the primary procedure performed on the patient. Required on inpatient claims when a procedure was performed.
Code identifying the type of procedure code used. Can be set to BBR - International Classification of Diseases Clinical Modification (ICD-10-PCS) Principal Procedure Codes, BR - International Classification of Diseases Clinical Modification (ICD-9-CM) Principal Procedure Codes, or CAH - Advanced Billing Concepts (ABC) Codes. Note that ICD-9 and ABC codes are deprecated and cannot be used in new claims.
BBR, BR, CAH The principal procedure code for the patient. It must be a valid code from the appropriate coding system. Do not submit the decimal for ICD codes; the decimal is implied.
30The date when the procedure was performed, formatted as YYYYMMDD.
Required on inpatient claims when additional procedures must be reported. You can provide up to two objects in this array.
Required when there is an Occurrence Span Code that applies to this claim. You can provide up to two objects in this array.
Required when there is a Value Code that applies to this claim. You can provide up to two objects in this array.
Required when there is a Occurrence Code that applies to this claim. You can provide up to two objects in this array.
Required when Home Health Agencies need to report Plan of Treatment information under various payer contracts. You can provide up to two objects in this array.
Required when there is a Condition Code that applies to this claim. You can provide up to two objects in this array.
Specifies pricing or repricing information about a claim. Required when this information is deemed necessary by the repricer. For capitated encounters, pricing or repricing information is usually not applicable and is provided to qualify other information within the claim.
The pricing methodology code. Visit Claims code lists for a complete list.
00, 01, 02, 03, 04, 05, 06, 07, 08, 09, 10, 11, 12, 13, 14 The allowed amount, expressed as a decimal.
The savings amount, expressed as a decimal.
The organization identification number.
The pricing rate associated with per diem or flat rate pricing, expressed as a decimal.
The approved DRG code.
The approved DRG amount, expressed as a decimal.
The approved revenue code.
The approved service units or inpatient days. Can be set to DA - Days or UN - Unit.
DA, UN The approved service units or inpatient days. 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. 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. Can be set to 1 - Non-Network Professional Provider in Network Hospital, 2 - Emergency Care, 3 - Services or Specialist not in Network, 4 - Out-of-Service Area, 5 - State Mandates, or 6 - Other.
1, 2, 3, 4, 5, 6 Code identifying the type of product or service ID used. Can be set to ER - Jurisdiction Specific Procedure and Supply Codes, HC - Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes, HP - Health Insurance Prospective Payment System (HIPPS) Skilled Nursing Facility Rate Code, IV - Home Infusion EDI Coalition (HIEC) Product/Service Code, or WK - Advanced Billing Concepts (ABC) Codes. Note that ABC codes are deprecated and should not be used in new claims. If you provide this property, you must also provide repricedApprovedHCPCSCode Visit Claims code lists for a complete list and additional usage notes.
ER, HC, HP, IV, WK The approved procedure code. If you provide this property, you must also include productOrServiceIDQualifier.
The service facility location. Required when the location of healthcare services is different from the billing provider's address. When an organization's healthcare provider's NPI is provided to identify the service location, the organization healthcare provider must be external to the entity identified as the billing provider (for example, a reference lab). The service location can't be a component or subpart of the billing provider entity.
The business name of the laboratory or facility.
The location where services were rendered. If this was in an 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' or 'Exit near Mile marker 265 on Interstate 80'.
The first line of the street address. This typically contains the building number and street name.
55The city name.
30The second line of the street address. This typically contains the apartment or suite number.
55The state or province code. Only required when the city is in the Unites States and Canada.
2The postal zone or zip code. Exclude punctuation and spaces.
3 - 15Use the alpha-2 country codes from Part 1 of ISO 3166.
2 - 3Use the country subdivision codes from Part 2 of ISO 3166.
1 - 3Code identifying the type of secondary identification. Can be set to 0B - State License Number, G2 - Provider Commercial Number, or LU - Location Number.
0B, G2, LU The identifier specified in secondaryIdentifierQualifierCode.
50The service facility location's National Provider Identifier (NPI). Required when the service location to be identified has an NPI and is not a component or subpart of the billing provider.
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. This will almost always be P - Primary. However, 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 Medicare first as P and then bill the commercial 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 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, DS, FI, HM, LM, MA, MB, MC, OF, TV, VA, WC, ZZ 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, Y - Yes, or W - Not Applicable. Use W when the patient refuses to assign benefits.
N, Y, W 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 last name (when the subscriber is an individual) or the name of the organization (when the subscriber is an organization).
Code identifying the type of identifier used for the other insured. Can be set to II - Standard Unique Health Identifier for each Individual in the United States or MI - Member Identification Number. Note that II is deprecated and should not be used in new claims.
II, MI The identifier specified in otherInsuredIdentifierTypeCode.
The subscriber's first name.
The subscriber's middle name or initial.
The subscriber's name suffix, such as Jr or III.
The subscriber's social security number (SSN). This must be a string of exactly nine numbers with no separators.
The subscriber's address. 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.
55The city name.
30The second line of the street address. This typically contains the apartment or suite number.
55The state or province code. Only required when the city is in the Unites States and Canada.
2The postal zone or zip code. Exclude punctuation and spaces.
3 - 15Use the alpha-2 country codes from Part 1 of ISO 3166.
2 - 3Use the country subdivision codes from Part 2 of ISO 3166.
1 - 3This shape is deprecated.
Details about the other payer.
The business name of the other payer.
Code specifying the type of identifier used for the other payer. Can be set to PI - Payor Identification or XV - Centers for Medicare and Medicaid Services PlanID. Use XV when reporting Health Plan ID (HPID) or Other Entity Identifier (OEID).
PI, XV The identifier specified in otherPayerIdentifierTypeCode.
This shape is deprecated.
The address of the other payer. 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.
55The city name.
30The second line of the street address. This typically contains the apartment or suite number.
55The state or province code. Only required when the city is in the Unites States and Canada.
2The postal zone or zip code. Exclude punctuation and spaces.
3 - 15Use the alpha-2 country codes from Part 1 of ISO 3166.
2 - 3Use the country subdivision codes from Part 2 of ISO 3166.
1 - 3Additional identification number for the other payer. The qualifier property can be set to 2U - Payer Identification Number, EI - Employer's Identification Number, FY - Claim Office Number, or NF - National Addociation of Insurance Commissioners (NAIC) Code.
The code qualifying the type of identifier.
The identifier specified in qualifier.
The other payer's prior authorization number. Required when this payer has assigned a prior authorization number to this claim.
The other payer's referral number. Required when this payer has assigned a referral number to this claim.
Required when the claim is being sent in the payer-to-payer COB model, AND the destination payer is secondary to the payer identified in this object, AND the payer identified in this object re-adjudicated the claim. Can be set to Y - Yes.
The other payer's claim control number for this claim.
The policy number for the subscriber's health plan.
The group number for the subscriber's health plan.
The name of the subscriber's health plan.
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.
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. Required when the other payer adjudicated the claim and provided claim level information only or when the other payer adjudicated the claim, and the provider received a paper remittance advice, and the provider does not have the ability to report line item information. Don't include this property if you're specifying remaining patient liability at the service line level.
Required when the destination payer's cost avoidance policy allows providers to bypass claim submission to the otherwise prior payer identified in otherPayerName. The amount must equal the total claim charge amount you reported in claimInformation.claimChargeAmount.
Claim-level data related to the adjudication of Medicare inpatient claims. Required when inpatient adjudication information is reported in the remittance advice or when you need to report remark codes.
The number of covered days, expressed as a decimal.
The number of lifetime psychiatric days, expressed as a decimal.
The Diagnosis Related Group (DRG) amount, expressed as a decimal.
The claim payment remark code. Refer to the X12 Remittance Advice Remark Codes for a complete list. You can include up to four codes in this array.
The disproportionate share amount, expressed as a decimal.
The Medicare Secondary Payer (MSP) pass-through amount, expressed as a decimal.
The Prospective Payment System (PPS) capital amount, expressed as a decimal.
The Prospective Payment System (PPS) capital, disproportionate share, hospital Diagnosis Related Group (DRG) amount. Expressed as a decimal.
The Prospective Payment System (PPS) capital, hospital specific portion, Diagnosis Related Group (DRG) amount. Expressed as a decimal.
The prospective Payment System (PPS) capital, disproportionate share, hospital Diagnosis Related Group (DRG) amount. Expressed as a decimal.
The old capital amount, expressed as a decimal.
The Prospective Payment System (PPS) capital Indirect Medical Education (IME) claim amount, expressed as a decimal.
The hospital specific Diagnosis Related Group (DRG) amount, expressed as a decimal.
The number of cost report days, expressed as a decimal.
The federal specific Diagnosis Related Group (DRG) amount, expressed as a decimal.
The Prospective Payment System (PPS) capital outlier amount, expressed as a decimal.
The indirect teaching amount, expressed as a decimal.
The professional component amount billed but not payable, expressed as a decimal.
The capital exception amount, expressed as a decimal.
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.
The End-Stage Renal Disease (ESRD) payment amount, expressed as a decimal.
The professional component amount billed but not payable, expressed as a decimal.
Supply adjustment reason codes and amounts as needed. Required when the claim has been adjudicated by the payer identified in this loop, and the claim has claim level adjustment information. Submitters must 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, the paper values must be converted to standard Claim Adjustment Reason Codes. You can include up to five claimLevelAdjustments 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 adjustment reason, amount, and quantity. You can include up to six of these objects to describe a single adjustmentGroupCode.
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.
The units of service being adjusted, expressed as a decimal.
Information regarding the other payer's attending provider. The attending provider is the provider who is primarily responsible for the care of the patient.
The provider's identifier. The qualifier can be set to OB - State License Number, 1G - Provider UPIN Number, G2 - Provider Commercial Number, or LU - Location Number. Note that UPIN numbers are deprecated and should not be used in new claims.
The code qualifying the type of identifier.
The identifier specified in qualifier.
Information regarding the other payer's operating physician. The operating physician is the provider who performed the procedure.
The qualifier can be set to OB - State License Number, 1G - Provider UPIN Number, G2 - Provider Commercial Number, or LU - Location Number. Note that UPIN numbers are deprecated and should not be used in new claims.
The code qualifying the type of identifier.
The identifier specified in qualifier.
Information regarding the other payer's other operating physician. The other operating physician is the provider who performed a secondary surgical procedure or assisted the otherPayerOperatingPhysician.
The physician's identifier. The qualifier can be set to OB - State License Number, 1G - Provider UPIN Number, G2 - Provider Commercial Number, or LU - Location Number. Note that UPIN numbers are deprecated and should not be used in new claims.
The code qualifying the type of identifier.
The identifier specified in qualifier.
Information regarding the other payer's service facility location. This is where the service was performed.
The facility's identifier. The qualifier can be set to OB - State License Number, G2 - Provider Commercial Number, or LU - Location Number.
The code qualifying the type of identifier.
The identifier specified in qualifier.
Information regarding the other payer's rendering provider. The rendering provider is the provider who performed the service or non-surgical procedure.
The provider's identifier. The qualifier can be set to OB - State License Number, 1G - Provider UPIN Number, G2 - Provider Commercial Number, or LU - Location Number. Note that UPIN numbers are deprecated and should not be used in new claims.
The code qualifying the type of identifier.
The identifier specified in qualifier.
Information regarding the other payer's referring provider. This is the provider who sent the patient to another provider for services.
The provider's identifier. The qualifier can be set to OB - State License Number, 1G - Provider UPIN Number, or G2 - Provider Commercial Number. Note that UPIN numbers are deprecated and should not be used in new claims.
The code qualifying the type of identifier.
The identifier specified in qualifier.
Information regarding the other payer's billing provider.
The provider's identifier. The qualifier can be set to G2 - Provider Commercial Number or LU - Location Number. Note that UPIN numbers are deprecated and should not be used in new claims.
The code qualifying the type of identifier.
The identifier specified in qualifier.
Required on Early & Periodic Screening, Diagnosis, and Treatment (EPSDT) claims when the screening service is being billed in this claim.
Code indicating whether an EPSDT referral was given to the patient. Can be set to N - No or Y - Yes.
N, Y Code indicating the patient's status. Set to AV when the patient refused the referral. Set to NU when you set certificationConditionCodeAppliesIndicator to N. Set to S2 when the patient is currently under treatment for the referred diagnostic or corrective health problem. Set to ST when either the patient is referred to another provider for diagnostic or corrective treatment for at least one health problem identified during an initial or periodic screening service (not including dental referrals) or the patient is scheduled for another appointment with the screening provider for diagnostic or corrective treatment for at least one health problem identified during an initial or periodic screening service (not including dental referrals).
AV, NU, S2, ST A nine-digit number that uniquely identifies the transaction. You must use exactly nine numbers in this property - letters or other types of characters return an error. Stedi autogenerates a control number for you if you don't set one.
9Dependent who received the medical care associated with the claim. When 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.
3560Code identifying the gender. Can be set to F - Female, M - Male, or U - Unknown.
F, M, U 01, 19, 20, 39, 40, 53, G8 2510The first line of the street address. This typically contains the building number and street name.
55The city name.
30The second line of the street address. This typically contains the apartment or suite number.
55The state or province code. Only required when the city is in the Unites States and Canada.
2The postal zone or zip code. Exclude punctuation and spaces.
3 - 15Use the alpha-2 country codes from Part 1 of ISO 3166.
2 - 3Use the country subdivision codes from Part 2 of ISO 3166.
1 - 3Another way to send information for each provider relevant to the claim. This object overwrites the information you send in the billing, referring, rendering, and attending objects. Note that your request must include information about the billing provider either here or within the billing object.
BillingProvider, AttendingProvider, ReferringProvider, RenderingProvider The National Provider Identifier (NPI) of the provider. The NPI is a unique, 10-digit identification number assigned to healthcare providers according to HIPAA standards. Note that this is required for billing providers that have an NPI assigned.
The type of identifier used in secondaryIdentifier. Can be set to 0B - State License Number, 1G - Provider UPIN Number, G2 - Provider Commercial Number, or LU - Location Number. Note that UPIN is deprecated and should not be used.
0B, 1G, G2, LU The identifier referenced by secondaryIdentificationQualifierCode. For example, if secondaryIdentificationQualifierCode is set to 0B, this property should be the provider's state license number.
The provider's employer ID, also known as an EIN or TIN. Must be a string of exactly nine numbers with no separators. Only applies to the billing provider.
The provider's taxnonomy code, a unique 10-character code that designates their classification and specialization. Only applies to the attending provider.
10The provider's first name. Can be up to 35 characters.
35The provider's last name. Can be up to 60 characters.
60The provider's middle name or initial. Can be up to 25 characters.
25The provider's name suffix, such as Jr. or III. Can be up to 10 characters.
10The provider's business name, when the provider is not an individual. Can be up to 60 characters.
60The provider's business address. Only applies to the billing provider.
The first line of the street address. This typically contains the building number and street name.
55The city name.
30The second line of the street address. This typically contains the apartment or suite number.
55The state or province code. Only required when the city is in the Unites States and Canada.
2The postal zone or zip code. Exclude punctuation and spaces.
3 - 15Use the alpha-2 country codes from Part 1 of ISO 3166.
2 - 3Use the country subdivision codes from Part 2 of ISO 3166.
1 - 3The provider's contact information. Only applies to the billing provider. You must include at least one communication method (phone, fax, or email) in this object.
The full name of the person or office.
60The 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.
256The fax number.
The email address.
This shape is deprecated.
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 business name of the organization to which the payment should be made.
60The type of identification code used to identify the organization. Can be set to PI - Payer Identification or XV - Centers for Medicare and Medicaid Services PlanID. Use XV when reporting the Health Plan ID (HPID) or Other Entity Identifier (OEID).
PI, XV The identification code specified by the identificationCodeQualifier.
2 - 80The payer tax identification number (TIN). This is a unique number assigned to the payer by the IRS.
50Specify the location of the named party.
The first line of the street address. This typically contains the building number and street name.
55The city name.
30The second line of the street address. This typically contains the apartment or suite number.
55The state or province code. Only required when the city is in the Unites States and Canada.
2The postal zone or zip code. Exclude punctuation and spaces.
3 - 15Use the alpha-2 country codes from Part 1 of ISO 3166.
2 - 3Use the country subdivision codes from Part 2 of ISO 3166.
1 - 3The payer identification number. You should only include this information when the identificationCodeQualifier is set to XV - Centers for Medicare and Medicaid Services PlanID.
50The Claim Office Number.
50The National Association of Insurance Commisioners (NAIC) code. This is the five-digit identifier assigned to each insurance company.
Use when the address for payment is different than that of the billing provider for this claim.
The address information.
The first line of the street address. This typically contains the building number and street name.
55The city name.
30The second line of the street address. This typically contains the apartment or suite number.
55The state or province code. Only required when the city is in the Unites States and Canada.
2The postal zone or zip code. Exclude punctuation and spaces.
3 - 15Use the alpha-2 country codes from Part 1 of ISO 3166.
2 - 3Use the country subdivision codes from Part 2 of ISO 3166.
1 - 3Code identifying the type of entity. Can be set to 2 - Non-Person Entity.
2 Information about the individual with primary responsibility for performing the surgical procedure(s) listed in the claim. Required when a surgical procedure code is listed on the claim. Use this object for operating physicians that apply to the entire claim.
The physician's last name. Can be up to 60 characters.
60The physician's business name. Can be up to 60 characters.
60The type of identifier used in secondaryIdentifier. Can be set to 0B - State License Number, 1G - Provider UPIN Number, G2 - Provider Commercial Number, or LU - Location Number. Note that UPIN is deprecated and should not be used.
0B, 1G, G2, LU The identifier specified in identificationQualififerCode.
The physician's first name. Can be up to 35 characters.
35The physician's middle name or initial. Can be up to 25 characters.
25The physician's name suffix, such as Jr. or III. Can be up to 10 characters.
10Information about any other operating physician involved in the surgical procedures listed in the claim. Required when another operating physician is involved in the surgical procedures listed in the claim. Use this object for physicians that apply to the entire claim.
The physician's last name. Can be up to 60 characters.
60The physician's business name. Can be up to 60 characters.
60The type of identifier used in secondaryIdentifier. Can be set to 0B - State License Number, 1G - Provider UPIN Number, G2 - Provider Commercial Number, or LU - Location Number. Note that UPIN is deprecated and should not be used.
0B, 1G, G2, LU The identifier specified in identificationQualififerCode.
The physician's first name. Can be up to 35 characters.
35The physician's middle name or initial. Can be up to 25 characters.
25The physician's name suffix, such as Jr. or III. Can be up to 10 characters.
10Address information for the entity responsible for payment of the claim, listed in the receiver object.
The first line of the street address. This typically contains the building number and street name.
55The city name.
30The second line of the street address. This typically contains the apartment or suite number.
55The state or province code. Only required when the city is in the Unites States and Canada.
2The postal zone or zip code. Exclude punctuation and spaces.
3 - 15Use the alpha-2 country codes from Part 1 of ISO 3166.
2 - 3Use the country subdivision codes from Part 2 of ISO 3166.
1 - 3Whether 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 desginate a claim as test data.
Information 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. Note that the provider's 10-digit National Provider Identifier (NPI) is also required, if one is assigned.
The type of provider. Set to BillingProvider.
BillingProvider, AttendingProvider, ReferringProvider, RenderingProvider The provider's employer ID, also known as an EIN or TIN. Must be a string of exactly nine numbers with no separators.
50The provider's address.
The first line of the street address. This typically contains the building number and street name.
55The city name.
30The second line of the street address. This typically contains the apartment or suite number.
55The state or province code. Only required when the city is in the Unites States and Canada.
2The postal zone or zip code. Exclude punctuation and spaces.
3 - 15Use the alpha-2 country codes from Part 1 of ISO 3166.
2 - 3Use the country subdivision codes from Part 2 of ISO 3166.
1 - 3The provider's National Provider Identifier (NPI). The NPI is a unique, 10-digit identification number assigned to healthcare providers according to HIPAA standards.
The type of identifier used in secondaryIdentifier. Can be set to 0B - State License Number, 1G - Provider UPIN Number, G2 - Provider Commercial Number, or LU - Location Number. Note that UPIN is deprecated and should not be used.
0B, 1G, G2, LU The identifier specified in secondaryIdentifierQualifierCode.
50This shape is deprecated.
50This shape is deprecated.
50This shape is deprecated.
50This shape is deprecated.
50The provider's taxnonomy code, a unique 10-character code that designates their classification and specialization.
10The provider's first name. Can be up to 35 characters.
35The provider's last name, when the provider is an individual. Can be up to 60 characters. Either this property or organizationName is required.
60The provider's middle name or initial. Can be up to 25 characters.
25The provider's suffix, such as Jr. or Sr. Can be up to 10 characters.
10The provider's business name, when the provider is not an individual. Can be up to 60 characters.
60The provider's contact information.You must include at least one communication method (phone, fax, or email) in this object.
The full name of the person or office.
60The 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.
256The fax number.
The email address.
This shape is deprecated.
Information about the provider who referred the patient for care. Include this object only when the referring provider is different than the provider listed in the attending object. Use this object for providers that apply to the entire claim.
Set to ReferringProvider.
The provider's last name. Can be up:: 60 characters.
60The provider's National Provider Identifier (NPI). The NPI is a unique, 10-digit identification number assigned to healthcare providers according to HIPAA standards.
The type of identifier used in secondaryIdentifier. Can be set to 0B - State License Number, 1G - Provider UPIN Number, or G2 - Provider Commercial Number. Note that UPIN is deprecated and should not be used.
0B, 1G, G2 The identifier specified in secondaryIdentifierQualifierCode.
This shape is deprecated.
This shape is deprecated.
This shape is deprecated.
This shape is deprecated.
This shape is deprecated.
This shape is deprecated.
10The provider's first name. Can be up to 35 characters.
35The provider's middle name or initial. Can be up to 25 characters.
25The provider's name suffix, such as Jr. or III. Can be up to 10 characters.
10The provider's business name. Can be up to 60 characters.
60This shape is deprecated.
The first line of the street address. This typically contains the building number and street name.
55The city name.
30The second line of the street address. This typically contains the apartment or suite number.
55The state or province code. Only required when the city is in the Unites States and Canada.
2The postal zone or zip code. Exclude punctuation and spaces.
3 - 15Use the alpha-2 country codes from Part 1 of ISO 3166.
2 - 3Use the country subdivision codes from Part 2 of ISO 3166.
1 - 3This shape is deprecated.
The full name of the person or office.
60The 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.
256The fax number.
The email address.
This shape is deprecated.
Information about the provider who delivered the medical services or non-surgical procecures listed in the claim. Include this object when the rendering provider is different than the provider listed in the attending object AND when state or federal regulatory requirements call for a combined claim. A combined claim includes both facility and professional components, such as a Medicaid clinic bill or a critical access hospital claim. Use this object for providers that apply to the entire claim.
Set to RenderingProvider.
The provider's last name. Can be up to 60 characters.
60The provider's National Provider Identifier (NPI). The NPI is a unique, 10-digit identification number assigned to healthcare providers according to HIPAA standards.
The type of identifier used in secondaryIdentifier. Can be set to 0B - State License Number, 1G - Provider UPIN Number, G2 - Provider Commercial Number, or LU - Location Number. Note that UPIN is deprecated and should not be used.
0B, 1G, G2, LU The identifier specified in the secondaryIdentificationQualifierCode.
This shape is deprecated.
The provider's commercial number. This shape is deprecated.
The provider's location number. This shape is deprecated.
The provider's state license number. This shape is deprecated.
This shape is deprecated.
This shape is deprecated.
10The provider's first name. Can be up to 35 characters.
35The provider's middle name or initial. Can be up to 25 characters.
25The provider's name suffix, such as Jr. or III. Can be up to 10 characters.
10The provider's business name. Can be up to 60 characters.
60This shape is deprecated.
The first line of the street address. This typically contains the building number and street name.
55The city name.
30The second line of the street address. This typically contains the apartment or suite number.
55The state or province code. Only required when the city is in the Unites States and Canada.
2The postal zone or zip code. Exclude punctuation and spaces.
3 - 15Use the alpha-2 country codes from Part 1 of ISO 3166.
2 - 3Use the country subdivision codes from Part 2 of ISO 3166.
1 - 3This shape is deprecated.
The full name of the person or office.
60The 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.
256The fax number.
The email address.
This shape is deprecated.
Information about the individual who has overall responsibility for the patient's medical care and treatment reported in the claim. This object is required when the claim contains any services other than non-scheduled transportation claims.
Set to AttendingProvider.
The National Provider Identifier (NPI) of the supervising provider. The NPI is a unique, 10-digit identification number assigned to healthcare providers according to HIPAA standards.
The type of identifier used in secondaryIdentifier. Can be set to 0B - State License Number, 1G - Provider UPIN Number, G2 - Provider Commercial Number, or LU - Location Number. Note that UPIN is deprecated and should not be used.
0B, 1G, G2, LU The identifier referenced by secondaryIdentificationQualifierCode. For example, if secondaryIdentificationQualifierCode is set to 0B, this property should be the provider's state license number.
This shape is deprecated.
The provider's taxnonomy code, a unique 10-character code that designates their classification and specialization. Only applies to the attending provider.
10The provider's first name. Can be up to 35 characters.
35The provider's last name. Can be up to 60 characters. This is required when the provider is an individual.
60The provider's middle name or initial. Can be up to 25 characters.
25The provider's name suffix, such as Jr. or III. Can be up to 10 characters.
10The provider's business name. This is required when the provider is not an individual. Can be up to 60 characters.
60This shape is deprecated.
The first line of the street address. This typically contains the building number and street name.
55The city name.
30The second line of the street address. This typically contains the apartment or suite number.
55The state or province code. Only required when the city is in the Unites States and Canada.
2The postal zone or zip code. Exclude punctuation and spaces.
3 - 15Use the alpha-2 country codes from Part 1 of ISO 3166.
2 - 3Use the country subdivision codes from Part 2 of ISO 3166.
1 - 3This shape is deprecated.
The full name of the person or office.
60The 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.
256The fax number.
The email address.
This shape is deprecated.
This is the payer's business name, like Cigna or Aetna.
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 X12 EDI version Stedi used to generate the claim for the payer. This is always 5010.
The type of claim, always INST.
A tracking number Stedi assigns to the claim. This is the same as the correlationId.
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.
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