POST
/
change
/
medicalnetwork
/
professionalclaims
/
v3
/
submission
cURL
curl --request POST \
  --url https://healthcare.us.stedi.com/2024-04-01/change/medicalnetwork/professionalclaims/v3/submission \
  --header 'Authorization: <api-key>' \
  --header 'Content-Type: application/json' \
  --data '{
  "usageIndicator": "T",
  "tradingPartnerServiceId": "6400",
  "submitter": {
    "organizationName": "Test Data Health Services, Inc.",
    "submitterIdentification": "<YOUR-SUBMITTER-ID>",
    "contactInformation": {
      "name": "Test Data Health Services, Inc.",
      "phoneNumber": "5552223333"
    }
  },
  "receiver": {
    "organizationName": "Cigna"
  },
  "subscriber": {
    "memberId": "U7777788888",
    "paymentResponsibilityLevelCode": "P",
    "subscriberGroupName": "Cigna",
    "firstName": "John",
    "lastName": "Anon",
    "gender": "M",
    "dateOfBirth": "20000101",
    "groupNumber": "3335555",
    "address": {
      "address1": "2222 Random St",
      "city": "A City",
      "state": "NY",
      "postalCode": "123450000"
    }
  },
  "billing": {
    "providerType": "BillingProvider",
    "npi": "1999999984",
    "employerId": "123456789",
    "taxonomyCode": "2084P0800X",
    "organizationName": "Therapy Associates",
    "address": {
      "address1": "123 Some St",
      "address2": "Floor 1",
      "city": "A City",
      "state": "NY",
      "postalCode": "123450000"
    },
    "contactInformation": {
      "name": "Test Data Health Services, Inc.",
      "phoneNumber": "5553334444"
    }
  },
  "claimInformation": {
    "claimFilingCode": "CI",
    "patientControlNumber": "<YOUR-CLAIM-ID>",
    "claimChargeAmount": "109.20",
    "placeOfServiceCode": "02",
    "claimFrequencyCode": "1",
    "signatureIndicator": "Y",
    "planParticipationCode": "A",
    "benefitsAssignmentCertificationIndicator": "Y",
    "releaseInformationCode": "Y",
    "healthCareCodeInformation": [
      {
        "diagnosisTypeCode": "ABK",
        "diagnosisCode": "F1111"
      }
    ],
    "serviceFacilityLocation": {
      "organizationName": "Smith Associates",
      "address": {
        "address1": "1234 Other St",
        "city": "A City",
        "state": "NY",
        "postalCode": "123450000"
      },
      "npi": "1999999984"
    },
    "serviceLines": [
      {
        "serviceDate": "20240101",
        "professionalService": {
          "procedureIdentifier": "HC",
          "procedureCode": "90837",
          "procedureModifiers": [
            "95"
          ],
          "lineItemChargeAmount": "109.20",
          "measurementUnit": "UN",
          "serviceUnitCount": "1",
          "compositeDiagnosisCodePointers": {
            "diagnosisCodePointers": [
              "1"
            ]
          }
        },
        "providerControlNumber": "111222333",
        "renderingProvider": {
          "providerType": "RenderingProvider",
          "npi": "1999999984",
          "taxonomyCode": "111YP2000X",
          "firstName": "Jane",
          "lastName": "Smith"
        }
      }
    ]
  },
  "tradingPartnerName": "Cigna"
}'
{
  "status": "SUCCESS",
  "controlNumber": "555123",
  "tradingPartnerServiceId": "6400",
  "claimReference": {
    "correlationId": "01HTCX97F6XS6F2K22D4KD59TK",
    "patientControlNumber": "22266555",
    "timeOfResponse": "2024-04-01T13:23:54.255Z",
    "payerID": "6400",
    "formatVersion": "5010",
    "rhclaimNumber": "01HTCX97F6XS6F2K22D4KD59TK",
    "serviceLines": [
      {
        "lineItemControlNumber": "111222333"
      }
    ]
  },
  "httpStatusCode": "200 OK",
  "meta": {
    "traceId": "a7f7c912-77f7-489d-96fc-c4ab3b5c33fc"
  },
  "payer": {
    "payerName": "Cigna",
    "payerID": "6400"
  }
}
This endpoint sends 837P professional claims to payers.
  1. Call this endpoint with a JSON payload.
  2. Stedi translates your request to the X12 837 EDI format and sends it to the payer.
  3. The endpoint returns a response from Stedi in JSON format containing information about the claim you submitted and whether the submission was successful.
Visit Submit professional claims for a full how-to guide.

​
CMS-1500 Claim Form PDF

When you submit a professional claim, Stedi automatically generates a 1500 claim form PDF. If you plan to send these PDFs to payers or retain them for your records, we strongly recommend reviewing the CMS-1500 claim form PDF documentation to learn how to structure claim submissions for optimal generation, the correct printer settings for generated PDFs, and general best practices.

Authorizations

​
Authorization
string
header
required

A Stedi API Key for authentication.

Headers

​
Stedi-Transaction-Setting-Id
string

The outbound transaction setting ID. This option only needs to be specified if a non-default release of the Professional Claims guide needs to be used.

Body

application/json

Response

ClaimsSubmission 200 response

The response is of type object.