POST
/
change
/
medicalnetwork
/
claimstatus
/
v2
curl --request POST \
  --url https://healthcare.us.stedi.com/2024-04-01/change/medicalnetwork/claimstatus/v2 \
  --header 'Authorization: <api-key>' \
  --header 'Content-Type: application/json' \
  --data '{
  "tradingPartnerServiceId": "3429",
  "controlNumber": "222222222",
  "encounter": {
    "beginningDateOfService": "20240318",
    "endDateOfService": "20240402"
  },
  "providers": [
    {
      "npi": "1999999984",
      "organizationName": "Behavioral Services P.C.",
      "providerType": "BillingProvider"
    }
  ],
  "subscriber": {
    "dateOfBirth": "19000806",
    "firstName": "Jane",
    "lastName": "Doe",
    "memberId": "111222333"
  }
}'
{
  "claims": [
    {
      "claimStatus": {
        "amountPaid": "95.55",
        "claimServiceDate": "20240325",
        "effectiveDate": "20240329",
        "paidDate": "20240329",
        "patientAccountNumber": "3333333",
        "statusCategoryCode": "P5",
        "statusCategoryCodeValue": "Pending/Payer Administrative/System hold",
        "statusCode": "3",
        "statusCodeValue": "Claim has been adjudicated and is awaiting payment cycle.",
        "submittedAmount": "238.44",
        "trackingNumber": "222222222",
        "tradingPartnerClaimNumber": "5332034153-KK"
      },
      "serviceDetails": [
        {
          "service": {
            "amountPaid": "95.55",
            "procedureId": "90837",
            "serviceIdQualifier": "Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes",
            "serviceIdQualifierCode": "HC",
            "submittedAmount": "238.44",
            "submittedUnits": "1"
          },
          "status": [
            {
              "effectiveDate": "20240329",
              "statusCategoryCode": "P5",
              "statusCategoryCodeValue": "Pending/Payer Administrative/System hold",
              "statusCode": "3",
              "statusCodeValue": "Claim has been adjudicated and is awaiting payment cycle."
            }
          ]
        }
      ]
    }
  ],
  "controlNumber": "222222222",
  "meta": {
    "applicationMode": "production",
    "traceId": "bf27223e-46c3-451e-b2b4-46f3f0b6fe3b"
  },
  "payer": {
    "organizationName": "UNITEDHEALTHCARE",
    "payerIdentification": "3429"
  },
  "providers": [
    {
      "organizationName": "Behavioral Services P.C.",
      "providerType": "BillingProvider",
      "taxId": "123456789"
    },
    {
      "npi": "1999999984",
      "organizationName": "Behavioral Services P.C.",
      "providerType": "ServiceProvider"
    }
  ],
  "reassociationKey": "000000001",
  "status": "success",
  "subscriber": {
    "firstName": "JANE",
    "lastName": "DOE",
    "memberId": "111222333"
  },
  "tradingPartnerServiceId": "3429"
}
You may need to submit a 276 real-time claim status request when you don’t receive a 277CA claim acknowledgment or 835 Electronic Remittance Advice (ERA) response from the payer within your expected timeframe.
  1. Call this endpoint with a JSON payload.
  2. Stedi generates the X12 276 EDI transaction and sends it to the payer.
  3. The endpoint returns a synchronous 277 claim status response from the payer in JSON format. The response contains information about the claims matching the criteria you provided in the request and their current status.
The response may contain information about more than one claim, if the payer has multiple claims on file that match the information you provided.
Visit Check claim status for a complete how-to guide.

Authorizations

​
Authorization
string
header
required

A Stedi API Key for authentication.

Body

application/json
​
controlNumber
string
required

An integer used to identify the transaction. It does not need to be globally unique. It is returned in the response as controlNumber.

Required string length: 9
​
tradingPartnerServiceId
string
required

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.

Required string length: 2 - 80
​
providers
object[]
required

Information about the billing and/or service providers related to the referenced claim. For each provider, you must set the providerType and one of the following identifiers: npi, taxId, or etin. - When the providerType = BillingProvider, you must include the provider's etin. - When providerType = ServiceProvider, you must include the npi if the provider has one. Otherwise, include the taxId.

Required array length: 1 - 2147483647 elements
​
subscriber
object
required

Information about the subscriber listed in the referenced claim.

  • You must set both the dateOfBirth and gender properties when the subscriber is the patient unless the gender is unknown. Stedi determines that the subscriber is the patient when the dependent object is not included in the request.
  • If either dateOfBirth or gender is set, you must include both properties unless the gender is unknown.
​
tradingPartnerName
string

This is the payer name, such as Cigna or Aetna.

​
dependent
object

Information about the dependent listed in the referenced claim. You must submit the dependent's firstName, lastName, dateOfBirth, and gender (if known). If the claim set the dependent's gender to U for unknown, you should omit the gender property.

​
encounter
object

Information about the referenced claim or claims for which you want to retrieve status information.

We recommend supplying a date range that is at least plus or minus 7 days from the date of the services listed in the claim, using the beginningDateOfService and endDateOfService properties. The payer may have stored a different date for the encounter than the one in your records, so providing a date range increases the likelihood that the payer will find a match.

​
serviceLineInformation
object
​
serviceLinesInformation
object[]
Minimum length: 1

Response

ClaimStatus 200 response

​
controlNumber
string

The control number the payer provided in the claim status response. This is used to identify the transaction.

​
tradingPartnerServiceId
string

An ID for the payer you identified in the original claim status request. 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.

​
payer
object

Information about the payer listed in the referenced claim.

​
providers
object[]

Information about the billing and/or service providers related to the referenced claim.

​
subscriber
object

Information about the subscriber listed in the referenced claim.

​
dependent
object

Information about the dependent listed in the referenced claim.

​
claims
object[]

The status information for the claim referenced in the original claim status request.

The payer may return multiple claims in the response if they have more than one claim on file that matches the information you provided.

​
reassociationKey
string

The control number for the transaction.

​
errorResponse
object
​
status
string

The status of the entire claim.

​
transactionSetAcknowledgement
string

The acknowledgment code in the 999 Implementation Acknowledgment, an EDI file generated by the payer to acknowledge receipt of the claim status request. It indicates whether the claim status request was accepted or rejected due to errors in the EDI request syntax.

​
implementationTransactionSetSyntaxError
string

The syntax error code in the 999 Implementation Acknowledgment. It indicates the type of error (if present) in the EDI request syntax. Visit IK502 in the Implementation Acknowledgment specification for a complete list.

​
x12
string

The raw X12 response from the payer.

​
meta
object

Metadata about the response.