Real-Time Claim Status (276/277) Raw X12

This endpoint sends 276 Claim Status requests to payers in raw X12 EDI format. This is ideal if you have an existing system that generates X12 EDI files and you want to send them through Stedi’s API.

• Call this endpoint with a payload in 276 X12 EDI format.
• Stedi validates the EDI and sends the status request to the payer.
• The endpoint returns a synchronous 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.

Best practices

We recommend the following best practices to increase your chances of receiving status information.

Supply a date of services range

Supply a date range that is at least plus or minus 7 days from the date of the services listed in the claim. 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.

We also recommend keeping the dates of service range to 30 days or less. Some payers may reject requests with a date range that is too wide.

Don’t provide too much information

Providing too much information in a claim status request can negatively affect the results. That’s why we recommend first sending a request with only the following information:

• Loop 2100C: NM109 (National Provider Identifier) and NM103 (Provider Last Name or Organization Name)
• Loop 2000D or 2000E: DMG02 (Subscriber/Patient Birth Date)
• Loop 2100B: NM1 (Information Receiver Name)
• Loop 2100D: NM103 (Subscriber Last Name), NM103 (Subscriber First Name), and NM109 (Member Identification Number)
• Loop 2200D: DTP03 (Claim Service Period) that is plus or minus 7 days from the date of service listed in the claim
• Loop 2200D or 2200E: TRN (Claim Status Tracking Number)

If this base request fails to return results, try adding in other information like Loop 2200D REF02 (Payer Claim Control Number).

You will eventually learn payer-specific nuances and can build logic in your system to supply additional information to specific payers. For example, some payers may have better success rates when you include the claim number.

Character restrictions

Only use the following characters as delimiters: ~, *, : and ^. The X12 format doesn’t support using escape sequences, so you can’t include delimiters or special characters as part of the request data. Stedi returns a 400 error if you include restricted characters as anything other than delimiters in the request.

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

Basic character set

The X12 Basic character set includes uppercase letters, digits, space, and some special characters. Lowercase letters and special language characters like ñ are not included.

The following special characters are included:

Extended character set

The Extended character set includes the characters listed in Basic, plus lowercase letters and additional special characters, such as @.

The following additional special characters are included:

Payer limitations

Payers generally only allow a provider organization to check the status of the claims they submitted. This means that you likely won’t be able to check the status of a claim submitted by a different provider organization or by the patient themselves, even if you have all of the details about the claim. Payers impose these access controls to protect plan member privacy and confidential commercial data.

Payers also often archive claims older than 18 months, but this varies by payer. If you try to check the status of a claim from several years ago, the payer may return an error even if the information you submit matches a real historical claim.

Timeout

Requests to payers typically time out at 1 minute, though Stedi’s API can keep connections open longer than that if needed.

Authorizations

Authorization

string

header

required

A Stedi API Key for authentication.

Body

application/json

x12

string

required

Response

200

application/json

ClaimStatusRawX12 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.

Show child attributes

payer.organizationName

string

The payer's organization name. For example UNITEDHEALTHCARE.

payer.payerIdentification

string

The payer's identification number. This is the tradingPartnerServiceId.

payer.centersForMedicareAndMedicaidServicePlanId

string

The payer's Health Plan ID (HPID) or Other Entity Identifier (OEID).

payer.contactInformation

object

Show child attributes

payer.contactInformation.name

string

The payer contact name.

payer.contactInformation.electronicDataInterChangeAccessNumber

string

The payer's Electronic Data Interchange Access number.

payer.contactInformation.email

string

The payer's email address.

payer.contactInformation.fax

string

The payer's fax number, without separators. For example, 5551123345 for 555-112-3345

payer.contactInformation.phone

string

The payer's telephone number. Phone numbers are formatted as AAABBBCCCC, where AAA represents the area code, BBB represents the telephone number prefix, and CCCC represents the telephone number. Phone numbers are provided without separators, such as dashes or parentheses. For example, 5551123345 for 555-112-3345.

payer.contactInformation.phoneExtension

string

The payer's telephone extension.

providers

object[]

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

Show child attributes

providers.providerType

enum<string>

required

Identifies the type of provider related to the referenced healthcare claim.

Available options:

BillingProvider,

ServiceProvider

providers.organizationName

string

The provider's organization name.

Required string length: 1 - 60

providers.firstName

string

The provider's first name.

Required string length: 1 - 35

providers.lastName

string

The provider's last name.

Required string length: 1 - 60

providers.npi

string

The National Provider Identification (NPI) number.

Required string length: 2 - 80

providers.spn

string

deprecated

The service provider number. This shape is deprecated.

Required string length: 2 - 80

providers.tin

string

Required string length: 2 - 80

providers.taxId

string

The Taxpayer Identification Number (TIN).

Required string length: 2 - 80

providers.etin

string

The Electronic Transmitter Identification Number (ETIN).

Required string length: 2 - 80

subscriber

object

Information about the subscriber listed in the referenced claim.

Show child attributes

subscriber.memberId

string

required

The subscriber's insurance member ID. This is the unique identifier for the subscriber on the insurance policy.

Required string length: 2 - 80

subscriber.firstName

string

required

The subscriber's first name as specified on their policy.

Required string length: 1 - 35

subscriber.lastName

string

required

The subscriber's last name as specified on their policy. The subscriber can be an individual or a business entity.

Required string length: 1 - 60

subscriber.gender

enum<string>

A code indicating the subscriber's gender.

Available options:

M,

F,

U

subscriber.dateOfBirth

string

The subscriber's date of birth, formatted as YYYYMMDD.

subscriber.groupNumber

string

The group number associated with the subscriber's insurance policy.

Required string length: 1 - 50

dependent

object

Information about the dependent listed in the referenced claim.

Show child attributes

dependent.firstName

string

required

The dependent's first name as specified on their insurance policy.

Required string length: 1 - 35

dependent.lastName

string

required

The dependent's last name as specified on their insurance policy.

Required string length: 1 - 60

dependent.gender

enum<string>

A code indicating the dependent's gender.

Available options:

M,

F,

U

dependent.dateOfBirth

string

The dependent's date of birth, formatted as YYYYMMDD.

dependent.groupNumber

string

The group number associated with the subscriber and dependent's insurance policy.

Required string length: 1 - 50

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.

Information about the claim and its status.

Show child attributes

claims.claimStatus

object

The status, required action, and paid information of a claim or service line.

Show child attributes

claims.claimStatus.statusCategoryCode

string

The status category code. Visit Claim Status Category Codes in the official X12 documentation for a complete list.

claims.claimStatus.statusCategoryCodeValue

string

The description of the statusCategoryCode.

claims.claimStatus.statusCode

string

The status code used to identify the status of an entire claim or a service line. For example, 20 - Accepted for Processing.

This is either a Health Care Claim Status Code or a National Council for Prescription Drug Programs (NCPDP) Reject/Payment Code, when the status is related to pharmacy claims.

Visit [Claim Status Codes](Health Care Claim Status Code in the official X12 documentation or the NCPDP website for a complete list of codes and their values.

claims.claimStatus.statusCodeValue

string

The description of the statusCode.

claims.claimStatus.entityCode

string

Code identifying the organizational entity, physical location, property, or individual associated with the statusCode. For example 1G - Oncology Center.

claims.claimStatus.entity

string

The description of the entityCode. For example, Home Health Care.

claims.claimStatus.effectiveDate

string

The date the claim was placed in this status by the payer's adjudication process. Formatted as YYYYMMDD.

claims.claimStatus.submittedAmount

string

The total charges submitted for the claim. The total claim charge may change from the submitted claim total charge based on claims processing instructions, such as claim splitting. Some payers may not store the original submitted charge. Some HMO encounters supply zero as the amount of original charges.

claims.claimStatus.amountPaid

string

The total amount paid for the claim. May be zero when no payment is being made. Some payers can provide the adjudicated payment amount before they issue the remittance.

claims.claimStatus.paidDate

string

This is the date of denial or approval for the claim, formatted as YYYYMMDD. This date may or may not be the same as the issue date of the check, EFT, or non-payment remittance. Some payers can provide this date before they issue the remittance.

claims.claimStatus.checkIssueDate

string

The date the payer issued the check for payment, formatted as YYYYMMDD. This may also contain a non-payment remittance advice date, if available from the payer.

claims.claimStatus.checkNumber

string

The check identification number or electronic funds transfer (EFT) trace number. This number is used to track the payment. This may also contain a non-payment remittance advice Trace Number (835 or paper), if available from the payer.

claims.claimStatus.trackingNumber

string

This is the trace or reference number of the original claim status request.

claims.claimStatus.claimServiceDate

string

Either a single date (formatted as YYYYMMDD) or a range of dates (formatted as YYYYMMDD-YYYYMMDD) identifying the period of service related to the claim. This property is derived from the service level dates.

claims.claimStatus.tradingPartnerClaimNumber

string

An identifier for the claim, assigned by the payer.

claims.claimStatus.patientAccountNumber

string

The patient account number provided by the service provider in the original claim. You can use this value to correlate the claim status response to the original claim.

claims.claimStatus.clearingHouseClaimNumber

string

The claim number provided by the clearinghouse.

claims.serviceDetails

object[]

Information about specific service lines and their status.

Show child attributes

claims.serviceDetails.service

object

Information about a service line listed in the referenced claim.

Show child attributes

claims.serviceDetails.service.serviceIdQualifierCode

enum<string>

A code identifying the type/source of the procedureId. Visit Check claim status for a complete list.

Available options:

AD,

ER,

HC,

HP,

IV,

N4,

NU,

WK

claims.serviceDetails.service.serviceIdQualifier

string

The definition of the serviceIdQualifierCode. For example, American Dental Association Codes.

claims.serviceDetails.service.procedureId

string

Identifying number for product or service.

claims.serviceDetails.service.submittedAmount

string

The amount submitted for the service line, expressed as a decimal. For example, 100.00. This is the line item total on the current claim service status.

claims.serviceDetails.service.amountPaid

string

The amount paid for the service line, expressed as a decimal. For example, 100.00.

claims.serviceDetails.service.revenueCode

string

The National Uniform Billing Committee revenue code.

claims.serviceDetails.service.submittedUnits

string

The number of units of service submitted.

claims.serviceDetails.status

object[]

Information about the status, required action, and paid information of a service line.

Information about the status, required action, and paid information of a service line.

Show child attributes

claims.serviceDetails.status.statusCategoryCode

string

The category code for the status. Visit Claim Status Category Codes in the official X12 documentation for a complete list.

claims.serviceDetails.status.statusCategoryCodeValue

string

The description of the statusCategoryCode.

claims.serviceDetails.status.statusCode

string

The status code used to identify the status of an entire service line. This is either a Health Care Claim Status Code or a National Council for Prescription Drug Programs Reject/Payment Code, when the status is related to pharmacy claims.

claims.serviceDetails.status.statusCodeValue

string

The description of the statusCode.

claims.serviceDetails.status.entityCode

string

The code identifying the organizational entity, physical location, property, or individual associated with the statusCode. For example, 4H - Emergency Department.

claims.serviceDetails.status.entity

string

The description of the entityCode. For example, Public Health Service Facility.

claims.serviceDetails.status.effectiveDate

string

The date the service line was placed in this status by the payer's adjudication process. Formatted as YYYYMMDD.

reassociationKey

string

The control number for the transaction.

errorResponse

object

Show child attributes

errorResponse.code

string

errorResponse.description

string

errorResponse.transactionIdentifier

object

Show child attributes

errorResponse.transactionIdentifier.customerTransactionId

string

errorResponse.transactionIdentifier.transactionId

string

errorResponse.errors

object[]

Show child attributes

errorResponse.errors.field

string

The attribute that caused the error.

errorResponse.errors.value

string

The value that caused the error.

errorResponse.errors.code

string

The error code.

errorResponse.errors.description

string

The description of the error code.

errorResponse.errors.location

string

Where the error occurred within the request syntax. If this is a network or system error, there is no location attribute.

errorResponse.errors.followupAction

string

Follow-up actions to correct the error.

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.

Show child attributes

meta.submitterId

string

The submitter ID assigned to this request.

meta.senderId

string

The sender ID assigned to this request.

meta.billerId

string

The biller ID assigned to this request.

meta.traceId

string

The unique ID assigned to this request within Stedi.

meta.applicationMode

string

Identifies where this request can be found for support.