Professional Claims (837P) JSON

Submit an 837P professional claim in JSON format

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

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.

Minimum length: 1

submitter · object · required

The entity submitting the healthcare claim. This can be either an individual or an organization, such as a doctor, hospital, or insurance company. You must submit at least organizationName or lastName properties and the contactInformation object. If you don't supply the submitterIdentification property, Stedi uses the value from billing.npi in the request.

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receiver · object · required

The entity responsible for the payment of the claim, such as an insurance company or government agency.

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subscriber · object · required

The person or entity who is the primary policyholder for the health plan or a dependent with their own member ID. The subscriber can be an individual or a business entity.

• 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 dependent object from the request. Stedi treats the subscriber as an individual when the request doesn't contain a value for the subscriber.organizationName property.
• You must set the dateOfBirth and gender properties when the subscriber is the patient. 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. You can either include both properties or neither within a single request.

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claimInformation · object · required

Information 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 patient's diagnosis codes in the healthCareCodeInformation object, 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.

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billing · object · required

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.
• If the billing provider has an NPI, you must include it in the npi property. If the billing provider does not have an NPI, you must include either the commercialNumber or the locationNumber for identification. Some payers may require the npi and either the commercialNumber or the locationNumber as a secondary identifier.

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controlNumber · string

Not currently used.

dependent · object

Dependent who received the medical care associated with the claim. Note that if 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.

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providers · object[] · deprecated

Please set all providers individually by type. For example, Referring. This shape is deprecated.

Required array length: 1 - 2147483647 elements

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payToAddress · object

Use when the address for payment is different than that of the billing provider for this claim.

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payToPlan · object

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.

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payerAddress · object

The payer's address. Some payers use this for internal routing. Only provide this address if the payer explicitly requires it.

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usageIndicator · string

Whether you want to send a test or production claim. This property also allows you to filter claims in the Stedi portal by production or test data. By default, this property is set to P for production data. Use T to designate a claim as test data.

referring · object

Information about the provider who directed the patient to the rendering provider for care. For example, a primary care physician may refer patients to a specialist. Use when the referring provider applies to the entire claim, not just a specific service line.

This should be an individual, not an organization, and you should supply at least the provider's lastName and an identifier, which is typically the npi.

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rendering · object

Information about the person or company (laboratory or other facility) who rendered the care. Use this object for all types of rendering providers including laboratories. When a substitute provider (locum tenens) was used, enter that provider's information here.

• Use when the provider applies to the entire claim or to at least one service line. For example, if a claim had two service lines with two different rendering providers, you would include the provider for the first service line here and leave the claimInformation.serviceLines.renderingProvider object for that service line blank. Then, you would specify the second provider in the appropriate service line's claimInformation.serviceLines.renderingProvider object.
• You can omit this object when the rendering provider is the same as the billing provider. In that case, you would include the provider's information in the billing object and leave this object blank.

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ordering · object · deprecated

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supervising · object

The entity responsible for overseeing the rendering provider and the care reported in this claim. Applies when the rendering provider is supervised by a physician. Use when the provider applies to the entire claim, not just a specific service line.

This should be an individual, not an organization, and you should supply at least the provider's lastName and an identifier, which is typically the npi.

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tradingPartnerName · string

This is the payer's business name, like Cigna or Aetna.

claimIdentifier · enum<string>

A code specifying the type of transaction. Defaults to CH if not provided.

• 31: Only for use by state Medicaid agencies performing post payment recovery.
• CH: Use when the transaction contains only fee for service claims or claims with at least one chargeable line item. Also use when it's not clear whether a transaction contains claims or capitated encounters, or if the transaction contains a mix of claims and capitated encounters.
• RP: Use for capitated encounters. Also use when the transaction is being sent to an entity for purposes other than adjudication of a claim. For example, when you're sending the claim to a state health agency that is using the claim for health data reporting purposes.

Available options:

31,

CH,

RP

Response

200

application/json

ClaimsSubmission 200 response

status · string

The status of the claim submission.

controlNumber · string

An identifier for the transaction.

tradingPartnerServiceId · string

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.

claimReference · object

Information about the claim.

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errors · object[]

A list of errors. Currently not used.

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warnings · object[]

A list of warnings.

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httpStatusCode · enum<string>

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.

Available options:

200 OK,

400 BAD_REQUEST

meta · object

Metadata from Stedi about the request.

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editStatus · string

Currently not used.

editResponses · object[]

Currently not used.

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payer · object

Information about the payer for the submitted claim.

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failure · object

Currently not used.

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