Claims processing

Submit healthcare claims, send attachments, check claim status, and receive electronic remittances using developer-friendly APIs

Claims Overview

99213 - Outpatient visit

• Amount: $109.20
• Units: 3
• Payer: Cigna
• Provider: Smiths Associates

Patient Name: Jane S Doe
Patient ID: U1234567890
Services rendered: May 14th
Claim created: May 16th
Claim accepted: May 22nd
Claim paid: May 22nd

Claim validation

Stedi's database of edits and repairs mean fewer payer rejections and faster payments.

New claim edits weekly

Our edits cover all SNIP Types. Check our changelog for the latest. Request a new edit.

Track outstanding claims

Keep providers informed with claim acknowledgments and real-time claim status updates.

Ingest ERAs

Automatically ingest electronic remittances (ERAs) to reconcile payments faster.

“Stedi's 835 ERA transaction enhancements have been a game-changer for our workflow. It's made our payment processing smoother and more efficient – especially as we scale up.”

— Alisha Foster

How it works

Integrate with a modern, developer-friendly API

Claim submission

Submit Professional (837P), Dental (837D), and Institutional (837I) claims to thousands of payers. Stedi creates a HIPAA-compliant transaction, applies enhanced edits, and sends it to the right payer.

Submit paper CMS-1500 and UB-04 claims using the same APIs, SFTP, and portal UIs used for electronic claims. Stedi prints and mails the claim to the payer for you.

Example Code: Claim Submission

fetch(
"https://healthcare.us.stedi.com/2024-04-01/change/medicalnetwork/professionalclaims/v3/submission",
  {
    controlNumber: "123456789",
    tradingPartnerServiceId: "6400",
    submitter: {
      organizationName: "Doctors LLC",
      contactInformation:
        {
          name: "Doctors LLC",
          phoneNumber: "5552221212"
        },
    },
    receiver:
      {
        organizationName: "Cigna"
      },
    subscriber: {},
    providers: [],
    claimInformation: {
      serviceLines: [{}]
    },
  }
).then((response) => response.json());

Claim Declined Example

Claim Code: 36415 - Routine venipuncture

fetch(
"https://healthcare.us.stedi.com/2024-04-01/change/medicalnetwork/claimstatus/v2",
  {
    controlNumber: "000000001",
    tradingPartnerServiceId: "UHC",
    encounter: {
      beginningDateOfService: "20240322",
      endDateOfService: "20240322",
      trackingNumber: "1234AAA",
    },
    providers:[
      {
        providerType: "BillingProvider",
        organizationName: "Doctors LLC",
        npi: "1234567890",
      }
    ],
    subscriber: {
      memberId: "0000000000",
      firstName: "Jane",
      lastName: "Doe",
      dateOfBirth: "19891002",
    },
  }
).then((response) => response.json());

Real-time claim status

Check any claim’s status in seconds with our JSON-based Claim Status API or the Stedi portal.

Electronic remittance advice (ERAs)

Receive ERAs automatically through Stedi webhooks or periodically poll for new transactions. Browse, filter, and review ERAs in the Stedi portal, or pull them through our API.

Example Code: ERAs

{
  "transactions": [
    {
      "controlNumber": "1003",
      "productionDate": "20240324",
      "receiverIdentifier": "55555500",
      "financialInformation": {
        "transactionHandlingCode": "I",
        "totalActualProviderPaymentAmount": "109.2",
        "creditOrDebitFlagCode": "C",
        "paymentMethodCode": "ACH",
        "paymentFormatCode": "CCP",
        "payerIdentifier": "1111666666",
        "checkIssueOrEFTEffectiveDate": "20240327",
        "senderAccountDetails": {},
        "receiverAccountDetails": {}
      },
      "payer": {},
      "payee": {},
      "detailInfo": [],
    }
  ],
  "meta": {}
}

Claim attachments

Programmatically upload PDFs and images to Stedi. Then send 275 claim attachments for 837P, 837D, and 837I claims.

Built-in claim validation

Stedi validates every claim against a database of edits and repairs, catching – and where possible fixing – errors before they reach the payer.

Edits Overview

Our edits cover all SNIP Types, including payer-specific SNIP Type 7 edits. We ship new edits weekly. See our changelog for the latest.

Validation Error Example

1 validation error

{
  "errors": [
    {
      "code": "33",
      "description": "Invalid Place of Service code. The submitted place of service code, A5, is invalid. Correct and resubmit.",
      "followupAction": "Please Correct and Resubmit"
    }
  ]
}

Manage claims in the Stedi portal

The Stedi portal includes a dedicated claims view where you can track claim submissions, check processing status, and review transaction history. Each claim shows its current processing status: Submitted, Received, Accepted, or Rejected.

Test integrations

Submit professional claims through a digital version of the CMS-1500 claim form. Download auto-generated CMS-1500 PDFs through the Stedi portal or API.

“We submitted claims three days after signing, and the support is excellent in quality and timeliness of response. For example, Stedi's team—including their CEO—regularly resolves our engineers’ issues within minutes. This used to take months or just never happen at all with our previous vendor.”

— Craig Micon

Connect to thousands of payers

Our growing set of payers provide broad, reliable connectivity.

Automatic failover

Stedi dynamically routes traffic to the most reliable connection, eliminating single points of failure, providing redundant connections.

Start processing claims today

Start free with a sandbox account. Upgrade to production when you're ready. There are no monthly minimums or setup fees. You only pay for the transactions you use.