POST
/
dental-claims
/
submission
curl --request POST \
  --url https://healthcare.us.stedi.com/2024-04-01/dental-claims/submission \
  --header 'Authorization: <api-key>' \
  --header 'Content-Type: application/json' \
  --data '{
  "usageIndicator": "T",
  "tradingPartnerServiceId": "52133",
  "tradingPartnerName": "United HealthCare Dental",
  "subscriber": {
    "paymentResponsibilityLevelCode": "P",
    "memberId": "123412345",
    "firstName": "John",
    "lastName": "Doe",
    "groupNumber": "1234567890",
    "gender": "F",
    "address": {
      "address1": "1234 Some St",
      "city": "Buckeye",
      "state": "AZ",
      "postalCode": "85326"
    },
    "dateOfBirth": "20180615"
  },
  "submitter": {
    "organizationName": "ABA Inc",
    "submitterIdentification": "<YOUR-SUBMITTER-ID",
    "contactInformation": {
      "phoneNumber": "3131234567",
      "name": "BILLING DEPARTMENT"
    }
  },
  "rendering": {
    "npi": "1999999992",
    "taxonomyCode": "106S00000X",
    "providerType": "RenderingProvider",
    "lastName": "Doe",
    "firstName": "Jane"
  },
  "receiver": {
    "organizationName": "United HealthCare Dental"
  },
  "payerAddress": {
    "address1": "PO Box 7000",
    "city": "Camden",
    "state": "SC",
    "postalCode": "29000"
  },
  "claimInformation": {
    "signatureIndicator": "Y",
    "toothStatus": [
      {
        "toothNumber": "3",
        "toothStatusCode": "E"
      }
    ],
    "serviceLines": [
      {
        "serviceDate": "20230428",
        "renderingProvider": {
          "npi": "1999999992",
          "taxonomyCode": "122300000X",
          "lastName": "Doe",
          "firstName": "Jane"
        },
        "providerControlNumber": "a0UDo000000dd2dMAA",
        "dentalService": {
          "procedureCode": "D7140",
          "lineItemChargeAmount": "832.00",
          "placeOfServiceCode": "12",
          "oralCavityDesignationCode": [
            "1",
            "2"
          ],
          "prosthesisCrownOrInlayCode": "I",
          "procedureCount": 2,
          "compositeDiagnosisCodePointers": {
            "diagnosisCodePointers": [
              "1"
            ]
          }
        },
        "teethInformation": [
          {
            "toothCode": "3",
            "toothSurface": [
              "M",
              "O"
            ]
          }
        ]
      }
    ],
    "serviceFacilityLocation": {
      "phoneNumber": "3131234567",
      "organizationName": "ABA Inc",
      "npi": "1999999992",
      "address": {
        "address1": "ABA Inc 123 Some St",
        "city": "Denver",
        "state": "CO",
        "postalCode": "802383100"
      }
    },
    "releaseInformationCode": "Y",
    "planParticipationCode": "A",
    "placeOfServiceCode": "12",
    "patientControlNumber": "<YOUR-PATIENT-ID>",
    "healthCareCodeInformation": [
      {
        "diagnosisTypeCode": "ABK",
        "diagnosisCode": "K081"
      }
    ],
    "claimSupplementalInformation": {
      "priorAuthorizationNumber": "20231010012345678"
    },
    "claimFrequencyCode": "1",
    "claimFilingCode": "FI",
    "claimChargeAmount": "832.00",
    "benefitsAssignmentCertificationIndicator": "Y"
  },
  "billing": {
    "taxonomyCode": "106S00000X",
    "providerType": "BillingProvider",
    "organizationName": "ABA Inc",
    "npi": "1999999992",
    "employerId": "123456789",
    "contactInformation": {
      "phoneNumber": "3134893157",
      "name": "ABA Inc"
    },
    "address": {
      "address1": "ABA Inc 123 Some St",
      "city": "Denver",
      "state": "CO",
      "postalCode": "802383000"
    }
  }
}'
{
  "status": "SUCCESS",
  "controlNumber": "1",
  "tradingPartnerServiceId": "52133",
  "claimReference": {
    "correlationId": "01JDQMX92Q1T561BH8NKX750TQ",
    "patientControlNumber": "0U1LBRS4",
    "timeOfResponse": "2024-11-27T20:27:27.077Z",
    "payerId": "52133",
    "formatVersion": "5010",
    "rhclaimNumber": "01JDQMX92Q1T561BH8NKX750TQ",
    "serviceLines": [
      {
        "lineItemControlNumber": "a0UDo000000dd2dMAA"
      }
    ]
  },
  "httpStatusCode": "200 OK",
  "meta": {
    "traceId": "9b491769-052e-4738-93d6-e0b5f6d83f53"
  },
  "payer": {
    "payerName": "United HealthCare Dental",
    "payerId": "52133"
  }
}

This endpoint sends 837D (dental) claims to payers.

  • Call this endpoint with a JSON payload.
  • Stedi translates your request to the X12 837 EDI format and sends it to the payer.
  • The endpoint returns a response from Stedi in JSON format containing information about the claim you submitted and whether the submission was successful.

​
Send 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 property in the test claim body to T. This allows you to filter for test claims on the Transactions page in the Stedi portal.

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.

​
Basic claim submission

The content of your claim submission depends on your use case and the payer’s requirements. However, a basic claim submission includes the following information in the request body:

InformationDescription
tradingPartnerServiceIdThis is the Payer ID. Visit the Payer Network for a complete list.
tradingPartnerNameThis is the payer’s business name, like Cigna or Aetna.
submitter objectInformation 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 objectInformation about the payer, such as an insurance company or government agency.
subscriber and/or dependent objectsInformation 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 objectInformation 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 objectInformation about the billing provider, such as the NPI, taxonomy code, and organization name.

​
Character restrictions

Don’t include the following characters in your request data: ~, *, : and ^. They are reserved for delimiters in the resulting X12 EDI transaction, and X12 doesn’t support using escape sequences to represent delimiters or special characters. Stedi returns a 400 error if you include these restricted characters in your 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.

​
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.

​
Conditional requirements

Note that objects marked as required are required for all requests, while others are conditionally required depending on the circumstances. When you include a conditionally required object, you must include all of its required properties.

For example, you must always include the subscriber object in your request, but you only need to include the supervising object when the rendering provider is supervised by a physician.

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 you're using a non-default release of the Dental Claims guide.

Body

application/json

Response

200
application/json
DentalClaimsSubmission 200 response

The response is of type object.