POST
/
change
/
medicalnetwork
/
institutionalclaims
/
v1
/
submission
curl --request POST \
  --url https://healthcare.us.stedi.com/2024-04-01/change/medicalnetwork/institutionalclaims/v1/submission \
  --header 'Authorization: <api-key>' \
  --header 'Content-Type: application/json' \
  --data '{
  "usageIndicator": "T",
  "tradingPartnerName": "UnitedHealthcare",
  "tradingPartnerServiceId": "87726",
  "submitter": {
    "organizationName": "Test Facility",
    "contactInformation": {
      "name": "Test Facility",
      "phoneNumber": "2225551234"
    },
    "taxId": "123456789"
  },
  "receiver": {
    "organizationName": "UnitedHealthcare"
  },
  "subscriber": {
    "memberId": "98765",
    "paymentResponsibilityLevelCode": "P",
    "firstName": "JANE",
    "lastName": "DOE",
    "groupNumber": "67890"
  },
  "claimInformation": {
    "claimFilingCode": "ZZ",
    "patientControlNumber": "<YOUR-PATIENT-ID>",
    "claimChargeAmount": "500.00",
    "placeOfServiceCode": "11",
    "claimFrequencyCode": "0",
    "planParticipationCode": "C",
    "benefitsAssignmentCertificationIndicator": "Y",
    "releaseInformationCode": "Y",
    "principalDiagnosis": {
      "qualifierCode": "ABK",
      "principalDiagnosisCode": "R45851"
    },
    "serviceLines": [
      {
        "assignedNumber": "0",
        "serviceDate": "20241015",
        "serviceDateEnd": "20241015",
        "lineItemControlNumber": "111222333",
        "institutionalService": {
          "serviceLineRevenueCode": "90",
          "lineItemChargeAmount": "500.00",
          "measurementUnit": "UN",
          "serviceUnitCount": "1",
          "procedureIdentifier": "HC",
          "procedureCode": "H0001"
        }
      }
    ],
    "claimCodeInformation": {
      "admissionTypeCode": "3",
      "admissionSourceCode": "9",
      "patientStatusCode": "30"
    },
    "claimDateInformation": {
      "admissionDateAndHour": "202409091000",
      "statementBeginDate": "20241015",
      "statementEndDate": "20241015"
    }
  },
  "providers": [
    {
      "providerType": "BillingProvider",
      "npi": "1999999976",
      "employerId": "123456789",
      "organizationName": "Test Facility",
      "address": {
        "address1": "123 Mulberry Street",
        "city": "Seattle",
        "state": "WA",
        "postalCode": "111135272"
      },
      "contactInformation": {
        "name": "Test Facility",
        "phoneNumber": "2065551234"
      }
    },
    {
      "providerType": "AttendingProvider",
      "npi": "1999999976",
      "firstName": "Doctor",
      "lastName": "Provider",
      "contactInformation": {
        "name": "name"
      }
    }
  ]
}'
{
  "status": "SUCCESS",
  "controlNumber": "123456789",
  "tradingPartnerServiceId": "87726",
  "claimReference": {
    "correlationId": "01JABEX6DPF4FCT2J0Y0SGFCY8",
    "patientControlNumber": "00001111222233334444",
    "timeOfResponse": "2024-10-16T20:04:32.962Z",
    "formatVersion": "5010",
    "claimType": "INST",
    "rhClaimNumber": "01JABEX6DPF4FCT2J0Y0SGFCY8"
  },
  "httpStatusCode": "200 OK",
  "payer": {
    "payerName": "UnitedHealthcare",
    "payerID": "87726"
  },
  "meta": {
    "traceId": "a742ab42-a6f3-4232-a88c-197d341afdbe"
  }
}

This endpoint sends 837I (institutional) claims to payers. Visit Submit institutional claims for a full how-to guide.

  • 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.
submitter objectInformation about the entity submitting the healthcare claim. This is an organization, such as a hospital or other treatment center.
receiver objectInformation about the entity responsible for the payment of the claim, 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 claim filing code (identifies the type of claim), claim charge amount, and place of service code. It also includes information about each individual service line included in the claim.
Billing providerYou must supply information about the billing provider in either the providers or billing object. This includes the provider’s NPI, name, and other information.

​
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.lineItemControlNumber 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. We strongly recommend setting the lineItemControlNumber to a ULID or other unique identifier for each service line. We recommend using a ULID instead of a UUID because the property has a max of 30 characters.

​
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 Institutional Claims guide.

Body

application/json

Response

200
application/json
InstitutionalClaimsSubmission 200 response

The response is of type object.