Submit professional claims

Use Stedi to send 837P (Professional) claims to payers. You can also check the status of existing claims in real time.

Stedi automatically configures the necessary settings to send test and production claims and receive 277 and 835 responses from payers.

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Submit claims manually

Manual claim submission can be useful for testing, QA, and debugging your pipeline. You can submit 837P professional claims manually through the Create manual claim page in the Stedi app.

The in-app form is adapted from the National Uniform Claim Committee (NUCC) 1500 Claim Form. As you build the claim, Stedi validates provider NPIs, diagnosis codes, and other key information to reduce payer rejections. You can also review a live preview of the autogenerated JSON payload for the Professional Claims API to understand how the form relates to the request structure.

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Submit claims through the API

Call one of the following endpoints to submit 837 professional claims:

• Professional Claims to send requests in JSON
• Professional Claims Raw X12 to send requests in X12 EDI

The endpoint returns a synchronous response from Stedi in JSON format. Later, the payer will respond with a Claim Acknowledgment (277CA).

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Headers

When constructing the request, you must include the following information in HTTP headers:

• Authorization: Generate an API key to use for authentication.
• Content-Type: Set to application/json.

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Enhanced validation

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

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

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Body

The information you submit for a claim depends on your use case. Refer to the Professional Claims endpoint for a complete list of properties. However, all claims require the following high-level information:

Information	Description
tradingPartnerServiceId	This is the Payer ID. Visit the Payer Network for a complete list.
tradingPartnerName	This is the payer’s business name, like Cigna or Aetna.
submitter object	Information about the entity submitting the healthcare claim. This can be either an individual or an organization, such as a doctor, hospital, or insurance company.
receiver object	Information about the payer, such as an insurance company or government agency.
subscriber and/or dependent objects	Information about the patient who received the medical services. Note that if a dependent has their own, unique member ID for their health plan, you should submit their information in the subscriber object and omit the dependent object from the request. You can check whether the dependent has a unique member ID by submitting an Eligibility Check to the payer for the dependent. The payer will return the member ID in the dependents.memberId field, if present.
claimInformation object	Information about the claim, such as the patient control number, claim charge amount, and place of service code. It also includes information about each individual service line included in the claim.
billing object	Information about the billing provider, such as the NPI, taxonomy code, and organization name.

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Identify service lines

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

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

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

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Sample request

The following example sends a professional claim.

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Test claims

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

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

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

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Cancel or resubmit claims

You may need to resubmit claims for several reasons, including changes to the patient’s coverage, errors in the original claim’s information, or appealing a denied claim. You may also need to cancel duplicate claims or claims that were submitted in error.

We recommend the following for resubmitting or canceling claims:

• Correct or replace claims: Set claimInformation.claimFrequencyCode to 7 - Replacement of Prior Claim. We also recommend setting a new, unique patientControlNumber. The payer includes this value in their 835 ERA response, allowing you to easily correlate that response with your resubmission.
• Cancel claims : Set claimInformation.claimFrequencyCode to 8 - Void/Cancel of Prior Claim.

In both cases, identify the original claim by setting claimInformation.claimSupplementalInformation.claimControlNumber to the Payer Claim Control Number (sometimes called the ICN). This is different from the patientControlNumber you sent in the claim and the Stedi-generated controlNumber returned in the API response. You can retrieve the Payer Claim Control Number from one of the payer’s 277 responses under the key transactions.payers.claimStatusTransactions.claimStatusDetails.patientClaimStatusDetails.claims.claimStatus.tradingPartnerClaimNumber.

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View submitted claims

You can view the files that Stedi sends and receives in the Files page of the Stedi app.

On the Transactions page, you can review and filter claims by Usage - production or test. Click any claim submission to review its details, including the full request and response payload, processing events, and a link to download the auto-generated 1500 Claim Form PDF.

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Download 1500 claim form

Stedi automatically generates a PDF 1500 claim form for each claim you submit. You can download the form on the transaction details page for the claim in the Stedi app.