POST
/
change
/
medicalnetwork
/
professionalclaims
/
v3
/
raw-x12-submission
curl --request POST \
  --url https://healthcare.us.stedi.com/2024-04-01/change/medicalnetwork/professionalclaims/v3/raw-x12-submission \
  --header 'Authorization: <api-key>' \
  --header 'Content-Type: application/json' \
  --data '{
  "x12": "ISA*00*          *00*          *ZZ*001690149382   *ZZ*STEDITEST      *240630*0847*^*00501*000000001*0*T*>~GS*HC*001690149382*STEDITEST*20240630*084744*000000001*X*005010X222A1~ST*837*0001*005010X222A1~BHT*0019*00*01J1M588QT2TAV2N093GNJ998T*20240630*0847*CH~NM1*41*2*Test Data Health Services, Inc.*****46*123567890~PER*IC*Test Data Health Services, Inc.*TE*5552223333~NM1*40*2*Cigna*****46*60054~HL*1**20*1~PRV*BI*PXC*2084P0800X~NM1*85*2*Therapy Associates*****XX*1999999984~N3*123 Some St*Floor 1~N4*A City*NY*123450000~REF*EI*832675429~PER*IC*Test Data Health Services, Inc.*TE*5553334444~HL*2*1*22*0~SBR*P*18*3335555******CI~NM1*IL*1*Anon*John****MI*U7777788888~N3*2222 Random St~N4*A City*NY*123450000~DMG*D8*20000101*M~NM1*PR*2*Cigna*****PI*60054~CLM*22266555*109.0***02>B>1*Y*A*Y*Y~HI*ABK>F1111~NM1*82*1*Smith*Jane****XX*1999999984~PRV*PE*PXC*111YP2000X~NM1*77*2*Smith Associates*****XX*1999999984~N3*1234 Other St~N4*A City*NY*123450000~LX*1~SV1*HC>90837>95*109.2*UN*1.0***1~DTP*472*D8*20240101~SE*30*0001~GE*1*000000001~IEA*1*000000001~"
}'
{
  "status": "SUCCESS",
  "controlNumber": "000000001",
  "tradingPartnerServiceId": "60054",
  "claimReference": {
    "correlationId": "01J1M588QT2TAV2N093GNJ998T",
    "patientControlNumber": "22266555",
    "timeOfResponse": "2024-07-10T22:05:32.203Z",
    "payerId": "60054",
    "formatVersion": "5010",
    "rhclaimNumber": "01J1M588QT2TAV2N093GNJ998T",
    "serviceLines": [
      {
        "lineItemControlNumber": "111222333"
      }
    ]
  },
  "httpStatusCode": "200 OK",
  "meta": {
    "traceId": "b727b8e7-1f00-4011-bc6e-e41444d406d8"
  },
  "payer": {
    "payerName": "Cigna",
    "payerId": "60054"
  }
}

This endpoint sends 837P (professional) claims 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.

  • Call this endpoint with a payload in 837 X12 EDI format.
  • Stedi validates the EDI and sends the claim 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.

​
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 patient control number, but only pertains to some of the service lines.

However, the line item control number serves as a unique identifier for each service line in your claim submission. You can set the line item control number in Loop 2400 REF02, when REF01 = 6R. The line item control number 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 line item control number for a service line, Stedi uses a random UUID.

Stedi returns service line identifiers in the claimReference.serviceLines object of the synchronous API response.

​
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.

​
Enhanced validation

You can optionally set the Stedi-Validation header to snip for enhanced validation on your claim submission.

Enhanced validation uses hundreds of additional edits (the industry term for validation rules) to increase claim acceptance rates. These include Strategic National Implementation Process (SNIP) validations. Stedi also automatically fixes common errors and monitors payer rejections to proactively build out new rules.

There is an additional cost per claim submission when you use enhanced validation. Please reach out to support for access and pricing information.

​
CMS-1500 Claim Form PDF

When you submit a claim, Stedi automatically generates a 1500 claim form PDF. Please review the behaviors and recommendations in the CMS-1500 claim form PDF documentation if you plan to send the generated PDFs to payers or retain them for your records.

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.

​
Stedi-Validation
string

Set to snip for enhanced validation on this claim. Enhanced validation uses hundreds of additional 'edits' (the industry term for validation rules) to increase claims acceptance rates. Stedi also monitors your 277 rejections to proactively build rules based on previous failures. When possible, Stedi automatically fixes common errors (such as invalid date/time formats and character encoding issues) before sending the claim, reducing payer rejections. There is an additional cost per claim submission when you use enhanced validation. Please reach out to support for access and pricing information.

Body

application/json

Response

200
application/json
ClaimsRawX12Submission 200 response

The response is of type object.