Stedi Claim submission API
The Claim submission API from Stedi — 8 operation(s) for claim submission.
Stedi Claim submission API is one of 25 APIs that Stedi publishes on the APIs.io network, described by a machine-readable OpenAPI specification.
Tagged areas include Claim Submission. The published artifact set on APIs.io includes an OpenAPI specification, API documentation, and an API reference.
This API exposes 8 operations across 8 paths, and defines 349 schemas. It is described by OpenAPI 3.2.0, at version 2024-04-01.
Requests are made against 2 base URLs: https://healthcare.us.stedi.com/2024-04-01, https://healthcare.us.stedi.com/2026-06-01.
8 operations
8 paths
349 schemas
2 GET6 POST
Metadata
The identity and technical contract details declared by the specification.
Authentication & Security 1
Stedi Claim submission API declares
1 security scheme
for authenticating requests.
An API key is passed in the header as Authorization (httpApiKeyAuth).
By default, every request must be authenticated.
httpApiKeyAuth— A [Stedi API Key](https://portal.stedi.com/app/settings/api-keys) for authentication.
Paths & Operations 8
Across 8 paths, the API surfaces 8 operations — 2 GET, 6 POST. Each is listed below with its method, path, parameters, and response codes.
Claim submission 8
POST
/change/medicalnetwork/institutionalclaims/v1/raw-x12-submission
Submit an 837I institutional claim in raw X12 EDI format
POST
/change/medicalnetwork/institutionalclaims/v1/submission
Submit an 837I institutional claim in JSON format
POST
/change/medicalnetwork/professionalclaims/v3/raw-x12-submission
Submit an 837P professional claim in raw X12 EDI format
POST
/change/medicalnetwork/professionalclaims/v3/submission
Submit an 837P professional claim in JSON format
POST
/dental-claims/raw-x12-submission
Submit an 837D dental claim in raw X12 EDI format
POST
/dental-claims/submission
Submit an 837D dental claim in JSON format
GET
/export/pdf
Retrieve a Stedi generatedCMS-1500 Claim Form PDF for a submitted 837P (professional) claim by business identifier
GET
/export/{transactionId}/1500/pdf
Retrieve the generated CMS-1500 Claim Form PDF for a submitted 837P professional claim
Schemas 349
The contract defines 349 schemas that model the data the API accepts and returns. The most detailed are ClaimInformation (41 properties), InstitutionalClaimInformation (40 properties), ServiceLine (38 properties), DentalClaimInformation (30 properties). Each schema is shown below with its type and property counts.
DentalClaimContractInformation
object
Required when the submitter is contractually obligated to supply this information on post-adjudicated claims.
6 properties
1 required
CertificationTypeCode
string
Code indicating the type of certification. Can be set to I - Initial, R - Renewal, or S - Revised.
DentalContractTypeCode
string
A code identifying the type of contract. Can be set to 02 - Per Diem, 03 - Variable Per Diem, 04 - Flat, 05 - Capitated, 06 - Percent, or 09 - Other.
MaximumResponseSizeExceeded
object
3 properties
InstitutionalPayer
object
Information about the payer for the submitted claim.
2 properties
PatientConditionCode
string
A code indicating the nature of a patient's condition.
ServiceUnavailableExceptionResponseContent
object
The server is temporarily unavailable.
2 properties
1 required
ClaimFilingIndicatorCode
string
A code identifying the type of claim. For example DS - Disability. Use OF when submitting Medicare Part D claims. Use ZZ when you don't know the type of insura…
FamilyPlanningIndicator
string
Code indicating whether the service was related to family planning. Can be set to Y - Yes.
OtherProcedureInformation
object
3 properties
2 required
CodeCategory
string
Identifies the category to which the conditionCode applies. Can be set to E1 - Spectacle Lenses, E2 - Contact Lenses, or E3 - Spectacle Frames.
DentalServiceLineSupervisingProvider
object
11 properties
PayToAddressName
object
Use to specify an address for payment that is different from the billing provider's physical address. This is relevant when the provider expects to receive pap…
2 properties
2 required
Subscriber
object
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 busi…
16 properties
OtherDiagnosisInformationQualifierCode
string
Code identifying the type of diagnosis code used. Can be set to ABF - International Classification of Diseases Clinical Modification (ICD-10-CM) or BF - Intern…
InstitutionalServiceAuthorizationExceptionCode
string
Code indicating the type of service authorization exception. Visit [Claims code lists](https://www.stedi.com/docs/healthcare/claims-code-listsservice-authoriza…
EpsdtIndicator
string
Code indicating whether there was EPSDT involvement in the service. Can be set to Y - Yes. EPSDT is a program that provides comprehensive and preventive health…
CopayStatusCode
string
Code indicating whether co-payment requirements were met. Can be set to O - Copay exempt.
ServiceLineReferringProviderIdentificationQualifierCode
string
The type of identifier used in secondaryIdentifier. Can be set to 0B - State License Number, 1G - Provider UPIN Number, or G2 - Provider Commercial Number. Not…
OtherDiagnosisInformation
object
3 properties
2 required
PatientConditionInformationVision
object
Required on vision claims involving replacement lenses or frames when this information is known to impact reimbursement. .
3 properties
3 required
ClaimIdentifier
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…
ServiceLineResponseIdentifier
object
1 property
OtherPayerAttendingProvider
object
Information regarding the other payer's attending provider. The attending provider is the provider who is primarily responsible for the care of the patient.
1 property
1 required
PredeterminationOfBenefits
object
2 properties
1 required
InstitutionalMeasurementUnitCode
string
Code identifying the unit of measure for the drug or biologic. Can be set to F2 - International Unit, GR - Gram, ME - Milligram, ML - Milliliter, or UN - Unit.
PatientReasonForVisitQualifierCode
string
Code identifying the type of reason for visit code used. Can be set to APR - International Classification of Diseases Clinical Modification Patient's Reason fo…
ProfessionalService
object
Information about the service rendered.
13 properties
6 required
SubscriberGender
string
Identifies the subscriber's gender. Can be set to F - Female, M - Male, or U - Unknown. This property is required if the subscriber is an individual. You shoul…
OtherSubscriberInformationBenefitsAssignmentCertificationIndicator
string
Code indicating whether or not the insured has authorized the plan to remit payment directly to the provider. Can be set to N - No (Payment should go to the pa…
ClaimsServiceLineRenderingProvider
object
22 properties
ClaimServiceFacilityLocationSecondaryIdentifierItem
object
3 properties
2 required
DentalLineAdjudicationInformationServiceIdQualifier
string
ContactInformationOrderingProvider
object
5 properties
1 required
ServiceFacilityLocationSecondaryIdentifierItem
object
3 properties
2 required
DentalLineAdjudicationInformation
object
Includes service line adjudication information for coordination of benefits between the initial payers of a health care claim and all subsequent payers.
11 properties
6 required
DurableMedicalEquipmentCertification
object
Required when a Durable Medical Equipment Regional Carrier Certificate of Medical Necessity (DMERC CMN) or a DMERC Information Form (DIF) or Oxygen Therapy Cer…
2 properties
2 required
ClaimPricingInformationProductOrServiceIDQualifier
string
Code identifying the type of product or service ID used. Can be set to ER - Jurisdiction Specific Procedure and Supply Codes, HC - Health Care Financing Admini…
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 la…
14 properties
ClaimsHealthCareInformation
object
2 properties
2 required
BillingProviderType
string
Defines the billing provider type.
OperatingPhysician
object
8 properties
1 required
ConditionIndicatorCode
string
A second code indicating the condition of the certificate. Can be set to 38 - Certification signed by the physician is on file at the supplier's office or ZV -…
OccurrenceInformation
object
2 properties
2 required
DrugIdentification
object
To report prescribed drugs and biologics.
6 properties
4 required
InstitutionalOtherPayerReferringProvider
object
Information regarding the other payer's referring provider. This is the provider who sent the patient to another provider for services.
1 property
1 required
ClaimsExceptionCode
string
Code specifying the exception reason for consideration of out-of-network health care services. This is the reason generated by the third-party health organizat…
InstitutionalClaimInformation
object
Information about the healthcare claim. Note that the objects and properties marked as required are required for all claims, while others are conditionally req…
40 properties
12 required
AccessDeniedExceptionResponseContent
object
The server response for authorization failure.
2 properties
1 required
ExportPDF400ErrorResponseContent
InstitutionalServiceFacilityLocation
object
The service facility location. Required when the location of healthcare services is different from the billing provider's address. - When an organization's hea…
5 properties
2 required
DurableMedicalEquipmentCertificateOfMedicalNecessityAttachmentTransmissionCode
string
Code indicating the timing, transmission method, or format by which attachments will be sent. Required when the actual attachment is maintained by an attachmen…
InstitutionalOtherPayerIdentifierTypeCode
string
Code specifying the type of identifier used for the other payer. Can be set to PI - Payor Identification or XV - Centers for Medicare and Medicaid Services Pla…
OtherPayerRenderingProvider
object
Information about the rendering provider.
2 properties
1 required
OtherSubscriberInformationInsuranceTypeCode
string
Code identifying the type of insurance policy within a specific insurance program. Visit [Claims code lists](https://www.stedi.com/docs/healthcare/claims-code-…
Receiver
object
The entity responsible for the payment of the claim, such as an insurance company or government agency.
2 properties
1 required
PurchasedServiceInformation
object
Specify information about services that were purchased. Required on non-vision service lines when adjudication is known to be impacted by the charge amount for…
2 properties
2 required
ClaimsError
object
5 properties
ReleaseOfInformationCode
string
Code indicating whether the provider has on file a signed statement by the patient authorizing the release of medical data to other organizations. Can be set t…
ClaimInformationBenefitsAssignmentCertificationIndicator
string
A code indicating whether the patient or an authorized person has authorized the plan to remit payment directly to the provider. Use W when the patient refuses…
DentalPlanParticipationCode
string
CertificationConditionCodeAppliesIndicator
string
Code indicating whether an EPSDT referral was given to the patient. Can be set to N - No or Y - Yes.
SignatureIndicator
string
Indicates whether the provider's signature is on file. Can be set to N - No or Y - Yes.
PayToPlan
object
Use for subrogation payment requests. If you include this information, you must also set the claimInformation.otherSubscriberInformation.payerPaidAmount to the…
7 properties
5 required
DentalContractInformationContractTypeCode
string
Code indicating the type of contract. Can be set to 02 - Per Diem, 03 - Variable Per Diem, 04 - Flat, 05 - Capitated, 06 - Percent, or 09 - Other.
OtherSubscriberName
object
The person or entity who is the primary policyholder for the other payer's health plan.
9 properties
4 required
InstitutionalSubmitter
object
The entity submitting the healthcare claim. This is an organization, such as a hospital or other treatment center.
3 properties
3 required
PricingMethodologyCode
string
Code indicating the pricing or repricing methodology. Visit [Claims code lists](https://www.stedi.com/docs/healthcare/claims-code-listspricing-methodology-code…
ClaimInformationRelatedCausesCodeItem
string
Code identifying an accompanying cause of an illness, injury or an accident. Can be set to AA - Auto Accident, EM - Employment, or OA - Other Accident.
OtherInsuredQualifier
string
Code identifying the type of entity. Can be set to 1 - Person or 2 - Non-Person Entity.
AccessDeniedException
object
The server response for authorization failure.
2 properties
1 required
InstitutionalClaimsSubmissionResponseContent
object
13 properties
DentalClaimDateInformation
object
4 properties
DentalServiceLineAssistantSurgeon
object
11 properties
ReportInformation
object
4 properties
2 required
InstitutionalOtherInsuredQualifier
string
Code identifying the type of entity. Can be set to 1 - Person or 2 - Non-Person Entity.
PriorAuthorization
object
2 properties
1 required
SpinalManipulationServiceInformation
object
Information about a chiropractic service rendered to the patient. Required on chiropractic claims involving spinal manipulation when the information is known t…
3 properties
1 required
MedicareInpatientAdjudication
object
19 properties
1 required
TradingPartnerSecondaryIdentifiers
object
Secondary identifiers for the payer. You can include up to three properties in this object.
4 properties
MeasurementReferenceIdentificationCode
string
Code identifying the type of measurement. Can be set to OG - Original or TR - Test Results.
ClaimsSubmissionRequestContent
object
20 properties
6 required
InstitutionalRendering
object
Information about the provider who delivered the medical services or non-surgical procedures listed in the claim. This must be an individual, not an organizati…
17 properties
1 required
DiagnosisRelatedGroupInformation
object
1 property
1 required
InstitutionalServiceLineReferenceInformation
Additional identifiers for the service line. We strongly recommend setting the providerControlNumber property for each service line within the claim.
InstitutionalReferenceIdentification
object
2 properties
2 required
SpecialProgramCode
string
Code indicating the Special Program under which the services rendered to the patient were performed. Used for Medicaid claims only. Can be set to 02 - Physical…
ServiceLineOrderingProviderSecondaryIdentifierItem
object
3 properties
2 required
InstitutionalLineAdjudicationInformation
object
12 properties
5 required
DentalServiceLineDateInformation
object
Identify specific dates related to the service rendered.
6 properties
PrimaryIdentifierTypeCode
string
Code identifying the type of identifier. Can be set to PI - Payor Identification or XV - Centers for Medicare/Medicaid Services PlanID. Use code value XV when…
PrincipalProcedureInformationQualifierCode
string
Code identifying the type of procedure code used. Can be set to BBR - International Classification of Diseases Clinical Modification (ICD-10-PCS) Principal Pro…
DependentGender
string
Code indiciating the patient's gender. Can be set to F - Female, M - Male, or U - Unknown. You should set this property to U when the patient declines to answe…
InstitutionalReferring
object
Information about the provider who referred the patient for care. - Include this object only when the referring provider is different than the provider listed…
17 properties
1 required
DentalOtherSubscriberName
object
The person or entity who is the primary policyholder for the other payer's health plan.
9 properties
4 required
InstitutionalClaimsRawX12SubmissionResponseContent
object
13 properties
OtherPayerBillingProviderIdentifierItem
object
3 properties
2 required
AssistantSurgeon
object
Information about the assistant surgeon who rendered the care. Use this object when the rendering providers provided these services in the role of the assistan…
12 properties
2 required
PDFError
object
2 properties
InstitutionalBilling
object
Information about the billing provider. The following information is required: - An address that is a physical location such as the office where care is delive…
17 properties
2 required
InstitutionalClaimFilingIndicatorCode
string
ClaimsPayer
object
Information about the payer for the submitted claim.
3 properties
DentalReceiver
object
The entity responsible for the payment of the claim, such as an insurance company or government agency.
1 property
1 required
OtherPayerReferringProvider
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 speci…
1 property
1 required
ClaimPricingRepricingInformation
object
Repricing information to be completed by repricers, not providers. For capitated encounters, pricing or repricing information usually is not applicable and is…
10 properties
2 required
DelayReasonCode
string
Code indicating the reason for the delay in claim submission. Visit [Claims code lists](https://www.stedi.com/docs/healthcare/claims-code-listsdelay-reason-cod…
InternalFailureExceptionResponseContent
object
The server response when an unexpected error occurred while processing request.
2 properties
1 required
OtherProcedureInformationQualifierCode
string
DentalServiceLinePricingRepricingInformation
object
Repricing information about the line item. This information is completed by repricers, not providers. For capitated encounters, pricing or repricing informatio…
12 properties
2 required
ExportPDF404ErrorResponseContent
ClaimsRawX12SubmissionResponseContent
object
13 properties
InstitutionalOtherPayerRenderingProvider
object
Information regarding the other payer's rendering provider. The rendering provider is the provider who performed the service or non-surgical procedure.
1 property
1 required
RequestChangedExceptionResponseContent
object
Exception returned when a request uses an idempotency key that was previously used with different request parameters.
2 properties
1 required
AmbulanceTransportReasonCode
string
Code indicating the reason for ambulance transport. For example, A - Patient was transported to nearest facility for care of symptoms, complaints, or both. Vis…
OtherPayerReferringProviderIdentifierItem
object
3 properties
2 required
AmbulanceCertificationConditionCodesItem
string
Code indicating the condition of the patient at the time of transport. You can provide up to five codes. Visit [Claims code lists](https://www.stedi.com/docs/h…
InstitutionalClaimInformationBenefitsAssignmentCertificationIndicator
string
InstitutionalRelationshipToSubscriberCode
string
Identifies the relationship of the patient to the subscriber. Can be set to 01 - Spouse, 19 - Child, 20 - Employee, 21 - Unknown, 39 - Organ Donor, 40 - Cadave…
DentalClaimsRawX12SubmissionResponseContent
object
13 properties
PDFData
object
2 properties
ClaimsAddress
object
7 properties
2 required
OtherDiagnosisInformationPresentOnAdmissionIndicator
string
InstitutionalProvidersObject
object
13 properties
1 required
MeasurementUnitCode
string
Code identifying the unit of measurement. Can be set to F2 - International Unit, GR - Gram, ME - Milligram, ML - Milliliter, or UN - Unit.
OtherInsuredIdentifierTypeCode
string
Code identifying the type of identifier. Can be set to II - Standard Unique Health Identifier for each individual in the United States or MI - Member Identific…
AdmittingDiagnosis
object
2 properties
2 required
ThrottlingExceptionResponseContent
object
The server response when usage plan or account-level throttling limits exceeded.
2 properties
1 required
InstitutionalDelayReasonCode
string
Code indicating the reason for the delay in claim submission. Visit [Claims code lists](https://www.stedi.com/docs/healthcare/claims-code-listsdelay-reason-cod…
RepricedApprovedServiceUnitCode
string
The approved service units or inpatient days. Can be set to DA - Days or UN - Unit.
InstitutionalClaimAdjustment
object
2 properties
1 required
OtherPayerOperatingPhysician
object
Information regarding the other payer's operating physician. The operating physician is the provider who performed the procedure.
1 property
1 required
InstitutionalClaimsRawX12SubmissionRequestContent
object
1 property
1 required
DentalServiceLineServiceFacilityLocation
object
6 properties
1 required
ServiceLineSupplementalInformationAttachmentReportTypeCode
string
Code indicating the title or contents of a document, report or supporting item. For example, 08 - Plan of Treatment or CT - Certification. Visit [Claims code l…
ReferringProviderType
string
Defines the referring provider type.
InstitutionalReceiver
object
The entity responsible for the payment of the claim, such as an insurance company or government agency.
3 properties
1 required
MedicareOutpatientAdjudication
object
Claim-level data related to the adjudication of Medicare claims not related to an inpatient setting. Required when outpatient adjudication information is repor…
5 properties
OtherPayerBillingProviderEntityTypeQualifier
string
Code identifying the type of entity. Can be set to 1 - Person or 2 - Non-Person Entity.
ConditionInformation
object
HI
1 property
1 required
DentalServiceLine
object
16 properties
1 required
ClaimReference
object
Information about the claim.
11 properties
Dependent
object
Dependent who received the medical care associated with the claim. - If the dependent has their own member ID for the health plan, you should include the depen…
11 properties
5 required
ClaimNote
object
Comments or special instructions related to the claim. Contains information required to substantiate the medical treatment that isn't provided elsewhere in the…
5 properties
ConditionIndicatorDurableMedicalEquipmentCertificationConditionIndicator
string
Code indicating whether there is a certification. Can be set to N - No or Y - Yes.
LineAdjudicationInformationServiceIdQualifier
string
Code identifying the type of procedureCode. Visit [Claims code lists](https://www.stedi.com/docs/healthcare/claims-code-listscomposite-medical-procedure-produc…
DentalClaimsRawX12SubmissionRequestContent
object
1 property
1 required
DentalServiceIdQualifier
string
PrincipalDiagnosisQualifierCode
string
Code identifying the type of diagnosis code used. Can be set to ABK - International Classification of Diseases Clinical Modification Principal Diagnosis or BK…
RenderingSecondaryIdentificationQualifierCode
string
The type of identifier used in secondaryIdentifier. Can be set to 0B - State License Number, 1G - Provider UPIN Number, G2 - Provider Commercial Number, or LU…
InstitutionalClaimsExceptionCode
string
Code specifying the exception reason for consideration of out-of-network health care services. Can be set to 1 - Non-Network Professional Provider in Network H…
RelationshipToSubscriberCode
string
Identifies the relationship of the patient to the subscriber. Can be set to 01 - Spouse, 19 - Child, 20 - Employee, 21 - Unknown, 39 - Organ Donor, 40 - Cadave…
ServiceFacilityLocationSecondaryIdentificationQualifierCode
string
Code identifying the type of secondary identification. Can be set to 0B - State License Number, G2 - Provider Commercial Number, or LU - Location Number.
OtherPayerServiceFacilityLocationSecondaryIdentifierItem
object
3 properties
2 required
PayToPlanName
object
Use for subrogation payment requests. If you include this information, you must also set the claimInformation.otherSubscriberInformation.payerPaidAmount to the…
8 properties
4 required
PatientReasonForVisit
object
2 properties
2 required
ProsthesisCrownOrInlayCode
string
Code indicating the placement status for the dental work. Can be set to I - Initial Placement or R - Replacement. When set to R, you must include either the pr…
CompositeDiagnosisCodePointers
object
Diagnosis code pointers in order of importance to this service line. These pointers are an index to the ICD-10-CM codes you included in the claimInformation.he…
1 property
1 required
ClaimServiceFacilityLocation
object
Required when the location for the service is different from the billing provider's address. The purpose of this object is to identify specifically where the s…
7 properties
2 required
ClaimInformation
object
Information about the healthcare claim. Note that the objects and properties marked as required are required for all claims, while others are conditionally req…
41 properties
11 required
AttachmentReportTypeCode
string
Code indicating the title or contents of a document, report or supporting item. For example, 08 - Plan of Treatment or CT - Certification. Visit [Claims code l…
OrthodonticTotalMonthsOfTreatment
object
3 properties
ClaimsRawX12SubmissionRequestContent
object
1 property
1 required
InstitutionalClaimReference
object
Information about the claim.
10 properties
OtherPayerSupervisingProvider
object
Information about the supervising provider.
1 property
1 required
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 physic…
16 properties
InstitutionalOtherPayerBillingProvider
object
Information regarding the other payer's billing provider.
1 property
1 required
DurableMedicalEquipmentService
object
Information about durable medical equipment. For example, the rental and purchase price information.
4 properties
4 required
ExportPDF403ErrorResponseContent
InstitutionalOtherInsuredIdentifierTypeCode
string
Code identifying the type of identifier used for the other insured. Can be set to II - Standard Unique Health Identifier for each Individual in the United Stat…
ServiceLineReferringProviderSecondaryIdentifierItem
object
3 properties
2 required
ClaimsProvider
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 physic…
16 properties
1 required
SubscriberInsuranceTypeCode
string
Identifies the type of insurance policy within a specific insurance program. Visit [Claims code lists](https://www.stedi.com/docs/healthcare/claims-code-listsi…
ClaimContractInformation
object
Required when the submitter is contractually obligated to supply this information on post-adjudicated claims.
6 properties
1 required
DrugIdentificationServiceIdQualifier
string
Code indicating the source of the drug code or product number. Visit [Claims code lists](https://www.stedi.com/docs/healthcare/claims-code-listsdrug-identifica…
ConflictExceptionResponseContent
object
The request conflicts with the current state of the resource.
1 property
1 required
InstitutionalResponseMeta
object
Metadata from Stedi about the request.
5 properties
Failure
object
Currently not used.
2 properties
ClaimsServiceLineSupervisingProvider
object
22 properties
InstitutionalContactInformation
object
5 properties
1 required
DentalService
object
9 properties
2 required
DentalSpecialProgramCode
string
Code indicating the Special Program under which the services rendered to the patient were performed. Used for Medicaid claims only. Can be set to 01 - Early &…
OperatingPhysicianIdentificationQualifierCode
string
The type of identifier used in secondaryIdentifier. Can be set to 0B - State License Number, 1G - Provider UPIN Number, G2 - Provider Commercial Number, or LU…
ResourceNotFoundExceptionResponseContent
object
The server response when the specified resource cannot be found after an API request passes authentication and authorization.
2 properties
1 required
ClaimPricingInformation
object
15 properties
2 required
InstitutionalReportInformation
object
4 properties
2 required
ToothStatusCode
string
Can be set to E - To Be Extracted, M - Missing.
ResourceNotFoundException
object
The server response when the specified resource cannot be found after an API request passes authentication and authorization.
2 properties
1 required
OtherPayerSupervisingProviderIdentifierItem
object
3 properties
2 required
DentalSubscriber
object
The person or entity who is the primary policyholder for the health plan or a dependent with their own member ID. - When a dependent has a unique, payer-assign…
15 properties
DentalServiceLineReferenceInformation
object
Additional identifiers for the service line.
5 properties
LineAdjudicationInformation
object
Includes service line adjudication information for coordination of benefits between the initial payers of a health care claim and all subsequent payers.
11 properties
6 required
ContractInformation
object
Required when the submitter is contractually obligated to supply this information on post-adjudicated claims.
6 properties
1 required
ContactInformationSubscriberDependent
object
Only use this object for payer administrative contacts on property and casualty claims. Otherwise, you shoudn't include contact information here. If you includ…
5 properties
1 required
InstitutionalIndividualRelationshipCode
string
DentalClaimInformation
object
30 properties
8 required
OtherPayerEntityTypeQualifier
string
PlaceOfServiceCode
string
Code identifying the type of facility where the services were or may be performed.
ValidationException
object
A standard error for input validation failures. This should be thrown by services when a member of the input structure falls outside of the modeled or document…
2 properties
1 required
ReleaseInformationCode
string
Indicates whether the provider has on file a signed statement by the patient authorizing the release of medical data to other organizations. Can be set to Y -…
ValidationExceptionField
object
Describes one specific validation failure for an input member.
2 properties
2 required
InstitutionalReportInformationAttachmentTransmissionCode
string
Code identifying the method by which the provider's report is attached. Can be set to AA - Available on Request at Provider Site, BM - By Mail, EL - Electronic…
EditResponse
object
Currently not used.
13 properties
DentalReportInformation
object
4 properties
2 required
OtherPayerOtherOperatingPhysician
object
Information regarding the other payer's other operating physician. The other operating physician is the provider who performed a secondary surgical procedure o…
1 property
1 required
DentalAttachmentReportTypeCode
string
Code indicating the title or contents of a document, report or supporting item. For example, B4 - Referral Form or DA - Dental Models. Visit [Claims code lists…
ServiceLineDateInformation
object
Identify specific dates related to the service rendered.
10 properties
ToothStatus
object
2 properties
2 required
OccurrenceSpanInformation
object
3 properties
3 required
ClaimAdjustmentDetails
object
The adjustment reason codes and amounts. You can include up to six objects in this array to describe a single adjustment group code.
3 properties
2 required
EpsdtReferral
object
Required on Early & Periodic Screening, Diagnosis, and Treatment (EPSDT) claims when the screening service is being billed in this claim.
2 properties
2 required
ExternalCauseOfInjuryQualifierCode
string
Code identifying the type of external cause of injury code used. Can be set to ABN - International Classification of Diseases Clinical Modification External Ca…
PrincipalDiagnosisPresentOnAdmissionIndicator
string
Indicates whether the principal diagnosis was present on admission. Can be set to N - No (onset did NOT occur prior to admission to the hospital), Y - Yes (ons…
ServiceLineProviderPurchasedService
object
22 properties
PatientConditionInformationVisionConditionCodesItem
string
Code indicating the reason for the vision services. Visit [Claims code lists](https://www.stedi.com/docs/healthcare/claims-code-listsvision-condition-codes) fo…
InstitutionalOtherSubscriberInformation
object
Required when other payers are known to potentially be involved in paying on this claim. This object contains information about other health plans under which…
23 properties
7 required
DentalContractInformation
object
Required when the submitter is contractually obligated to supply this information on post-adjudicated claims.
6 properties
1 required
ServiceLine
object
38 properties
2 required
InstitutionalDependent
object
9 properties
5 required
ServiceLinePurchasedServiceProviderSecondaryIdentifierItem
object
3 properties
2 required
InstitutionalServiceLineReferringProvider
object
Information about the provider who referred the patient for care. - Include this object only when the referring provider is different than the provider listed…
18 properties
DentalHealthCareInformation
object
2 properties
2 required
EpsdtReferralConditionCodesItem
string
InstitutionalOtherPayerServiceFacilityLocation
object
Information regarding the other payer's service facility location. This is where the service was performed.
1 property
1 required
PayToAddressNameEntityTypeQualifier
string
Code identifying the type of entity. Can be set to 2 - Non-Person Entity.
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 speci…
13 properties
ResponseMeta
object
Metadata from Stedi about the request.
5 properties
FrequencyCode
string
Code indicating the frequency at which the rental equipment is billed. Can be set to 1 - weekly, 4 - monthly, or 6 - daily.
PayToPlanNameIdentificationCodeQualifier
string
The type of identification code used to identify the organization. Can be set to PI - Payer Identification or XV - Centers for Medicare and Medicaid Services P…
OtherSubscriberInformationPaymentResponsibilityLevelCode
string
Code identifying the payer's level of responsibility for paying this claim. Visit [Claims code lists](https://www.stedi.com/docs/healthcare/claims-code-listspa…
ClaimAdjustment
object
2 properties
2 required
OtherSubscriberInformation
object
21 properties
7 required
PolicyComplianceCode
string
ServiceLineSupervisingProviderSecondaryIdentifierItem
object
3 properties
2 required
Submitter
object
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 sub…
6 properties
1 required
ClaimsContactInformation
object
You must include at least one communication method (phone, fax, or email) in this object.
5 properties
SubscriberPaymentResponsibilityLevelCode
string
Code identifying the payer's level of responsibility for paying this claim. Visit [Claims code lists](https://www.stedi.com/docs/healthcare/claims-code-listspa…
InstitutionalClaimAdjustmentDetails
object
3 properties
2 required
OtherPayerIdentifierTypeCode
string
Code designating the type of identifier. Can be set to PI - Payor Identification or XV - Centers for Medicare/Medicaid Services PlanID. Use code value XV when…
OtherPayerAssistantSurgeon
object
Information about the assistant surgeon.
2 properties
2 required
InstitutionalOtherSubscriberInformationPaymentResponsibilityLevelCode
string
ServiceLineSupplementalInformationAttachmentTransmissionCode
string
Code indicating the method by which the attachment was transmitted. Can be set to AA - Available on Request at Provider Site, BM - By Mail, EL - Electronically…
ExternalCauseOfInjury
object
3 properties
2 required
InstitutionalSubscriber
object
The person or entity who is the primary policyholder for the health plan or a dependent with their own member ID. - When a dependent has a unique, payer-assign…
14 properties
1 required
InstitutionalSubmitterContactInformation
object
5 properties
InstitutionalClaimDateInformation
object
Dates and times related to the claim. For example, when the patient was discharged from the hospital.
5 properties
2 required
ToothSurfaceCode
string
ClaimFrequencyCode
string
Identify the type of claim. Can be set to: 1 - indicates an original claim, 7 - Indicates the new claim is a replacement or correction, 8 - Indicates the claim…
ToothInformation
object
2 properties
1 required
ServiceLineRenderingProviderSecondaryIdentifierItem
object
3 properties
2 required
ClaimContractInformationContractTypeCode
string
A code identifying the type of contract. Can be set to 01 - Diagnosis Related Group (DRG), 02 - Per Diem, 03 - Variable Per Diem, 04 - Flat, 05 - Capitated, 06…
InstitutionalClaimsSubmissionRequestContent
object
21 properties
5 required
OtherPayerRenderingProviderEntityTypeQualifier
string
Code identifying the type of entity. Can be set to 1 - Person or 2 - Non-Person Entity.
EmergencyIndicator
string
Code indicating whether the service was related to an emergency. Can be set to Y - Yes. An emergency is when the patient requires immediate medical interventio…
ClaimsDiagnosisTypeCode
string
Code indicating the specific industry code list. Can be set to ABK - International Classification of Diseases Clinical Modification (ICD-10-CM) Principal Diagn…
InstitutionalError
object
5 properties
FormTypeCode
string
Code indicating the type of form. Can be set to AS - Form Type Code or UT - Centers for Medicare and Medicaid Services (CMS) Durable Medical Equipment Regional…
Measurements
object
3 properties
3 required
Attending
object
Information about the individual who has overall responsibility for the patient's medical care and treatment reported in the claim. This information is require…
13 properties
InstitutionalServiceLineSupplementalInformation
object
4 properties
2 required
ClaimsIndividualRelationshipCode
string
Code identifying the relationship to the person insured. Visit [Claims code lists](https://www.stedi.com/docs/healthcare/claims-code-listsindividual-relationsh…
InstitutionalDrugIdentification
object
5 properties
3 required
AdmittingDiagnosisQualifierCode
string
Code identifying the type of admitting diagnosis code used. Can be set to ABJ - International Classification of Diseases Clinical Modification (ICD-10-CM) Admi…
ValueInformation
object
2 properties
2 required
ConditionIndicatorDurableMedicalEquipment
object
Required when a Durable Medical Equipment Regional Carrier Certificate of Medical Necessity (DMERC CMN) or a DMERC Information Form (DIF), or Oxygen Therapy Ce…
3 properties
2 required
ClaimSupplementalInformation
object
Additional information or documentation required for the claim. This is where you can include information about [attachments](https://www.stedi.com/docs/health…
16 properties
LinePricingInformation
object
14 properties
2 required
InstitutionalMeasurementUnit
string
The unit of measurement for the service. Can be set to DA - Days or UN - Unit.
DentalMedicareOutpatientAdjudication
object
Claim-level data related to the adjudication of Medicare claims not related to an inpatient setting. Required when outpatient adjudication information is repor…
4 properties
OtherPayerName
object
Details about the other payer.
10 properties
3 required
MissingParameter
object
Returned when a required parameter is missing from the request.
3 properties
AdjustmentGroupCode
string
Code identifying the general category of payment adjustment. Can be set to CO - Contractual Obligations, CR - Correction and Reversals, OA - Other Adjustments,…
OtherPayerAssistantSurgeonIdentifierItem
object
3 properties
2 required
AmbulanceTransportInformation
object
Information about the ambulance service provided to the patient.
5 properties
2 required
ExportPDFResponseContent
object
2 properties
AmbulanceCertificationCertificationConditionIndicator
string
Code indicating whether there is an ambulance certification.
InstitutionalSubscriberPaymentResponsibilityLevelCode
string
The payer's level of responsibility for paying this claim. Can be set to A - Payer Responsibility Four, B - Payer Responsibility Five, C - Payer Responsibility…
GenderWithUnknown
string
InstitutionalProcedureIdentifier
string
Code identifying the type of procedureCode. If you set this property, you must also set procedureCode. Can be set to ER - Jurisdiction Specific Procedure and S…
FormIdentification
object
Use this object to attach standardized supplemental information to the claim when required by the payer. One example is payer documentation requirements for ho…
3 properties
2 required
AmbulanceCertification
object
Required when the claim involves ambulance transport services.
2 properties
2 required
DentalDiagnosisTypeCode
string
Code indicating the specific industry code list. Can be set to ABK - International Classification of Diseases Clinical Modification (ICD-10-CM) Principal Diagn…
ExternalCauseOfInjuryPresentOnAdmissionIndicator
string
Indicates whether the external cause of injury was present on admission. Can be set to N - No (onset did NOT occur prior to admission to the hospital), Y - Yes…
ClaimFilingCode
string
A code identifying the type of claim. For example DS - Disability. - Use OF when submitting Medicare Part D claims. - Use ZZ when you don't know the type of in…
OtherPayerServiceFacilityLocation
object
1 property
1 required
DurableMedicalEquipmentCertificateOfMedicalNecessity
object
Required on claims that include a Durable Medical Equipment Regional Carrier (DMERC) Certificate of Medical Necessity (CMN).
1 property
1 required
InstitutionalProviderType
string
ConditionIndicator
string
Code indicating the condition of the certificate. Can be set to 38 - Certification signed by the physician is on file at the supplier's office or ZV - Replacem…
ClaimInformationConditionCodesItem
string
PlanParticipationCode
string
Code indicating whether the provider accepts assignment. This refers to whether the provider accepts assignment and/or has a participation agreement with the d…
MeasurementUnit
string
Code identifying the unit of measurement. Can be set to MJ - Minutes or UN - Unit. Minutes is required for anesthesia services. Note that anesthesia time is co…
GetPDF1500OutputPayload
string
A base64 encoded string of the CMS-1500 Claim Form PDF. To render the PDF, you must decode the base64 string and save it to a file with a .pdf extension.
InstitutionalOtherSubscriberName
object
10 properties
4 required
SecondaryIdentifierTypeCode
string
Code identifying the type of secondary identifier. Can be set to 2U - Payer Identification Number, FY - Claim Office Number, or NF - National Association of In…
InstitutionalServiceLineRenderingProvider
object
Information about the provider who delivered the medical services or non-surgical procedures in this service line. This must be an individual, not an organizat…
18 properties
PrincipalDiagnosis
object
3 properties
2 required
ReportInformationAttachmentTransmissionCode
string
Code identifying the method by which the provider's report is attached. Can be set to AA - Available on Request at Provider Site, BM - By Mail, EL - Electronic…
DentalMeasurementUnitCode
string
HttpStatusCode
string
Stedi can return the following status codes: - 200: Stedi successfully generated the X12 EDI claim format required by the payer. It does not indicate whether t…
DentalClaimSupplementalInformation
object
Additional information or documentation required for the claim. This is where you can include information about [attachments](https://www.stedi.com/docs/health…
10 properties
InstitutionalOtherSubscriberInformationBenefitsAssignmentCertificationIndicator
string
OtherPayerBillingProvider
object
Information about the billing provider.
2 properties
2 required
InstitutionalServiceLineDateInformation
object
4 properties
ReportInformationAttachmentReportTypeCode
string
Code indicating the title or contents of a document, report or supporting item. For example, 08 - Plan of Treatment or CT - Certification. Visit [Claims code l…
RenderingProviderType
string
Defines the rendering provider type.
InstitutionalClaimIdentifier
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…
ServiceLineReferenceInformation
object
Additional identifiers for the service line.
8 properties
InstitutionalClaimSupplementalInformationServiceLine
object
Additional information or documentation required for the claim. This is where you can include information about [attachments](https://www.stedi.com/docs/health…
14 properties
InstitutionalService
object
9 properties
4 required
GatewayTimeoutExceptionResponseContent
object
The server response for a gateway timeout error.
2 properties
1 required
DentalServiceLineRenderingProvider
object
11 properties
1 required
NoTransactionsFound
object
3 properties
RejectReasonCode
string
ClaimsServiceLineReferringProvider
object
22 properties
ContractInformationContractTypeCode
string
Code indicating the type of contract. Can be set to 01 - Diagnosis Related Group (DRG), 02 - Per Diem, 03 - Variable Per Diem, 04 - Flat, 05 - Capitated, 06 -…
InstitutionalServiceLine
object
26 properties
1 required
RequestSubscriberDependentAddress
object
The patient's address. Every claim must include this information in either the subscriber (when the patient is the subscriber) or dependent (when the patient i…
7 properties
2 required
InstitutionalConditionInformation
object
1 property
1 required
InstitutionalAddress
object
7 properties
2 required
Ordering
object
Deprecated; please use claimInformation.serviceLines[].orderingProvider instead.
20 properties
DentalDependent
object
Dependent who received the medical care associated with the claim. - If the dependent has their own member ID for the health plan, you should include the depen…
10 properties
5 required
LineAdjudicationInformationProductOrServiceIDQualifier
string
Code identifying the type of procedureCode. Can be set to ER - Jurisdiction Specific Procedure and Supply Codes, HC - Health Care Financing Administration Comm…
PregnancyIndicator
string
Code indicating whether the patient is pregnant. Can be set to Y - Yes.
PrincipalProcedureInformation
object
3 properties
2 required
ServiceLineOrderingProvider
object
22 properties
DentalOtherSubscriberInformation
object
21 properties
6 required
ClaimCodeInformation
object
Supply information specific to hospital claims, such as the priority of the admission.
3 properties
2 required
DentalClaimsSubmissionResponseContent
object
13 properties
Billing
object
Information about the billing provider. - You must provide an address that is a physical location such as the office where care is delivered or an administrati…
19 properties
QuestionResponseCode
string
Code indicating a yes or no condition response to the question. Can be set to N - No, W - Not Applicable, or Y - Yes.
InstitutionalAdjustmentGroupCode
string
Code identifying the general category of payment adjustment. Can be set to CO - Contractual Obligations, CR - Correction and Reversals, OA - Other adjustments,…
OtherPayerRenderingProviderIdentifierItem
object
3 properties
2 required
InstitutionalOtherPayerName
object
11 properties
3 required
ValidationExceptionResponseContent
object
A standard error for input validation failures. Thrown when a member of the input structure falls outside of the modeled or documented constraints.
2 properties
1 required
DentalOtherPayerName
object
Details about the other payer.
11 properties
3 required
ClaimsWarning
object
Warnings indicate issues that may cause some payers to reject the claim. Stedi doesn’t reject claims with warnings only - a response with warnings but no error…
2 properties
LineAdjustmentInformation
object
11 properties
7 required
ClaimNotes
object
Free-form information to substantiate the medical treatment that isn't provided elsewhere in the claim submission. Also used to provide narrative information f…
15 properties
ClaimDateInformation
object
You must provide at least one date related to the claim. For example, the date on which the patient was admitted to the hospital.
18 properties
ReferringSecondaryIdentificationQualifierCode
string
The type of identifier used in secondaryIdentifier. Can be set to 0B - State License Number, 1G - Provider UPIN Number, or G2 - Provider Commercial Number. Not…
OtherPayerSecondaryIdentifierItem
object
3 properties
2 required
InstitutionalClaimSupplementalInformation
object
Additional information or documentation required for the claim. This is where you can include information about [attachments](https://www.stedi.com/docs/health…
14 properties
PatientConditionInformationVisionCertificationConditionIndicator
string
Code indicating whether there is a certification. Can be set to N - No or Y - Yes.
ClaimsSubmissionResponseContent
object
13 properties
SupportingDocumentation
object
Use to provide information in response to a coded questionnaire document.
5 properties
1 required
MeasurementQualifier
string
Code identifying the specific measurement. Can be set to HT - Height, R1 - Hemoglobin, R2 - Hematocrit, R3 - Epoetin Starting Dosage, or R4 - Creatinine.
ServiceAuthorizationExceptionCode
string
Code indicating the reason for the service authorization exception. Visit [Claims code lists](https://www.stedi.com/docs/healthcare/claims-code-listsservice-au…
DentalClaimsSubmissionRequestContent
object
18 properties
6 required
ProcedureIdentifier
string
Code identifying the specific industry code list used for the procedureCode. Visit [Claims code lists](https://www.stedi.com/docs/healthcare/claims-code-listsc…
ServiceLineServiceFacilityLocation
object
Required when the location for the service is different from the billing provider's address. The purpose of this object is to identify specifically where the s…
7 properties
2 required
Specification
The full machine-readable OpenAPI contract behind this narrative.
Source
More from Stedi 12
Other APIs Stedi publishes across the network.
Stedi Claim acknowledgments API
Stedi Claim Attachments API
Stedi Coordination of benefits API
Stedi Documents API
Stedi Enrollments API
Stedi Events API
Stedi Executions API
Stedi Fragments API
Stedi Insurance discovery API
Stedi Partnerships API
Stedi Payer API
Stedi Payers API
#Claim Submission
Where this information came from
This is an independent, third-party profile of Stedi Claim submission API, published by API Evangelist. We do not operate, host, resell, or support these APIs, and we are not affiliated with or endorsed by the company unless stated above. Everything here is built from publicly available information — the company's own site, developer portal, documentation, public repositories, and the specifications it publishes for public use. Nothing is obtained by breaching a system, defeating an access control, or using credentials.
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