{ "components": { "schemas": { "ClaimPaymentEnrollmentProcess": { "description": "Details about the enrollment process for Electronic Remittance Advice (ERAs).", "properties": { "requestedEffectiveDate": { "$ref": "#/components/schemas/RequestedEffectiveDate", "description": "Whether this payer supports specifying a requested effective date for transaction enrollments.\n - If set to `SUPPORTED`, Stedi will process [transaction enrollment requests](https://www.stedi.com/docs/healthcare/api-reference/post-enrollment-create-enrollment) for this payer according to their specified `requestedEffectiveDate`.\n - This property is only returned when Stedi can determine whether the payer supports requested effective dates." }, "supportedAggregationPreferences": { "description": "Aggregation types this payer supports for 835 Electronic Remittance Advice (ERA) transactions. Payers can aggregate by the provider's NPI, tax ID (TIN), or both.\n - You can use this information to specify an `aggregationPreference` when submitting ERA enrollment requests.\n - This property is only returned when Stedi can determine the payer's supported aggregation types.", "items": { "$ref": "#/components/schemas/SupportedAggregationType" }, "type": "array" }, "timeframe": { "$ref": "#/components/schemas/EnrollmentProcessTimeframe" }, "type": { "$ref": "#/components/schemas/EnrollmentProcessType" } }, "type": "object" }, "ClaimStatusInquiryEnrollmentProcess": { "description": "Details about the enrollment process for real-time claim status requests.", "properties": { "requestedEffectiveDate": { "$ref": "#/components/schemas/RequestedEffectiveDate", "description": "Whether this payer supports specifying a requested effective date for transaction enrollments.\n - If set to `SUPPORTED`, Stedi will process [transaction enrollment requests](https://www.stedi.com/docs/healthcare/api-reference/post-enrollment-create-enrollment) for this payer according to their specified `requestedEffectiveDate`.\n - This property is only returned when Stedi can determine whether the payer supports requested effective dates." }, "timeframe": { "$ref": "#/components/schemas/EnrollmentProcessTimeframe" }, "type": { "$ref": "#/components/schemas/EnrollmentProcessType" } }, "type": "object" }, "CoordinationOfBenefitsEnrollmentProcess": { "description": "Details about the enrollment process for coordination of benefits (COB) checks.", "properties": { "requestedEffectiveDate": { "$ref": "#/components/schemas/RequestedEffectiveDate", "description": "Whether this payer supports specifying a requested effective date for transaction enrollments.\n - If set to `SUPPORTED`, Stedi will process [transaction enrollment requests](https://www.stedi.com/docs/healthcare/api-reference/post-enrollment-create-enrollment) for this payer according to their specified `requestedEffectiveDate`.\n - This property is only returned when Stedi can determine whether the payer supports requested effective dates." }, "timeframe": { "$ref": "#/components/schemas/EnrollmentProcessTimeframe" }, "type": { "$ref": "#/components/schemas/EnrollmentProcessType" } }, "type": "object" }, "CoverageType": { "description": "The types of insurance coverage that a payer can provide. Used to indicate whether a payer supports transactions for medical coverage, dental coverage, vision coverage, or a combination of these.", "enum": [ "medical", "dental", "vision" ], "type": "string" }, "DentalClaimEnrollmentProcess": { "description": "Details about the enrollment process for dental claim submission.", "properties": { "requestedEffectiveDate": { "$ref": "#/components/schemas/RequestedEffectiveDate", "description": "Whether this payer supports specifying a requested effective date for transaction enrollments.\n - If set to `SUPPORTED`, Stedi will process [transaction enrollment requests](https://www.stedi.com/docs/healthcare/api-reference/post-enrollment-create-enrollment) for this payer according to their specified `requestedEffectiveDate`.\n - This property is only returned when Stedi can determine whether the payer supports requested effective dates." }, "timeframe": { "$ref": "#/components/schemas/EnrollmentProcessTimeframe" }, "type": { "$ref": "#/components/schemas/EnrollmentProcessType" } }, "type": "object" }, "EligibilityInquiryEnrollmentProcess": { "description": "Details about the enrollment process for eligibility checks.", "properties": { "requestedEffectiveDate": { "$ref": "#/components/schemas/RequestedEffectiveDate", "description": "Whether this payer supports specifying a requested effective date for transaction enrollments.\n - If set to `SUPPORTED`, Stedi will process [transaction enrollment requests](https://www.stedi.com/docs/healthcare/api-reference/post-enrollment-create-enrollment) for this payer according to their specified `requestedEffectiveDate`.\n - This property is only returned when Stedi can determine whether the payer supports requested effective dates." }, "timeframe": { "$ref": "#/components/schemas/EnrollmentProcessTimeframe" }, "type": { "$ref": "#/components/schemas/EnrollmentProcessType" } }, "type": "object" }, "EnrollmentInfo": { "description": "Information about enrollment requirements for the payer", "properties": { "ptanRequired": { "description": "Whether a PTAN (Provider Transaction Access Number) is required for transaction enrollment.\n\nThe Provider Transaction Access Number (PTAN) is a Medicare-issued number given to providers upon enrollment with Medicare. This number is usually six digits and is assigned based on the type of service and the location of the provider. Upon enrollment, Medicare Administrating Contracting (MAC) providers should receive their assigned PTAN number in their approval letter.", "type": "boolean" }, "transactionEnrollmentProcesses": { "$ref": "#/components/schemas/TransactionEnrollmentProcesses", "description": "Enrollment details for specific transaction types.\n\nStedi only returns this object when information about the enrollment process is available for one or more transaction types. When this object isn't included in the response, it **doesn't** mean no transaction types require enrollment. Refer to the `transactionSupport` object for details about which transaction types require enrollment." } }, "type": "object" }, "EnrollmentProcessTimeframe": { "description": "Stedi's expected timeframe for completing the transaction enrollment process. `INSTANT` indicates that the enrollment will be in `LIVE` status within minutes of submitting the request.", "enum": [ "INSTANT", "HOURS", "DAYS", "WEEKS", "OVER_4_WEEKS" ], "type": "string" }, "EnrollmentProcessType": { "description": "Whether transaction enrollment is single or multi-step.\n - `ONE_CLICK` indicates that once you submit the transaction enrollment request, Stedi can complete the rest of the enrollment process without any further action from you.\n - `MULTI_STEP` indicates that you must complete additional steps to finish the enrollment process. Customer support will reach out with clear instructions explaining how to complete any remaining steps.", "enum": [ "ONE_CLICK", "MULTI_STEP" ], "type": "string" }, "GetPayerRecordResponseContent": { "properties": { "payer": { "$ref": "#/components/schemas/PayerRecord", "description": "The payer record matching the provided Stedi payer ID. The record includes the payer's display name and aliases as well as supported transaction types and details about the payer's [transaction enrollment](https://www.stedi.com/docs/healthcare/transaction-enrollment) process." } }, "required": [ "payer" ], "type": "object" }, "InstitutionalClaimEnrollmentProcess": { "description": "Details about the enrollment process for institutional claim submission.", "properties": { "requestedEffectiveDate": { "$ref": "#/components/schemas/RequestedEffectiveDate", "description": "Whether this payer supports specifying a requested effective date for transaction enrollments.\n - If set to `SUPPORTED`, Stedi will process [transaction enrollment requests](https://www.stedi.com/docs/healthcare/api-reference/post-enrollment-create-enrollment) for this payer according to their specified `requestedEffectiveDate`.\n - This property is only returned when Stedi can determine whether the payer supports requested effective dates." }, "timeframe": { "$ref": "#/components/schemas/EnrollmentProcessTimeframe" }, "type": { "$ref": "#/components/schemas/EnrollmentProcessType" } }, "type": "object" }, "InternalFailureExceptionResponseContent": { "description": "The server response when an unexpected error occurred while processing request.", "properties": { "code": { "description": "Error classification code", "type": "string" }, "message": { "description": "Human-readable error message", "type": "string" } }, "required": [ "message" ], "type": "object" }, "ListPayerRecordsCsvOutputPayload": { "description": "All supported payer records in CSV format. The first row contains the header with field names, and subsequent rows contain the payer data.\n\nTo render this data as a CSV file, you must save it to a file with a `.csv` extension.", "type": "string" }, "ListPayerRecordsResponseContent": { "description": "Common output structure for list operations with pagination support.", "properties": { "items": { "description": "Payers that Stedi supports for each transaction type. Results are returned in alphabetical order of the Stedi ID.", "items": { "$ref": "#/components/schemas/PayerRecord" }, "type": "array" }, "nextPageToken": { "description": "Token that you can supply in subsequent requests to retrieve the next page of results. If not returned, there are no more results.", "maxLength": 1024, "minLength": 1, "type": "string" } }, "required": [ "items" ], "type": "object" }, "Matches": { "description": "Shows which properties in the payer record match the search query. This information helps you understand why Stedi returned this payer and which parts of the payer record matched the search terms. It's also especially useful for debugging search queries and building user interfaces that display matching text.\n- Matching text is wrapped in `` HTML tags for highlighting.\n- This object only contains properties with matching text. For example, if none of the payer's aliases matched the search query, this object will not include the `aliases` property.", "properties": { "aliases": { "description": "The parts of the payer's aliases that match the search query. Each alias that contains matching text is included as a separate entry, with matching portions wrapped in `` tags. For example, searching for `XYZ` might return: [`XYZ123`, `ABCXYZ`].", "items": { "type": "string" }, "type": "array" }, "displayName": { "description": "The part of the payer's display name that matched the search query. For example, searching for `Blue` might return: `Blue Cross Blue Shield`.", "type": "string" }, "names": { "description": "The parts of the payer's other names that match the search query. Each name that contains matching text is included as a separate entry, with matching portions wrapped in `` tags. For example, searching for `Health` might return: [`Community Health Plan`, `Health Partners`].", "items": { "type": "string" }, "type": "array" }, "primaryPayerId": { "description": "The part of the primary payer ID that matched the search query. For example, if you search for '12345', the results for a payer with primary payer ID `12345ABC` would return: `12345ABC`.", "type": "string" }, "stediId": { "description": "The part of the payer's Stedi payer ID that matched the search query. Stedi payer IDs only support exact substring matching (no prefix or fuzzy matching). For example, if you search for `KRP`, the results for a payer with Stedi payer ID 'KRPCH' would be: `KRPCH`.", "type": "string" } }, "type": "object" }, "NotSupportedBreakdown": { "properties": { "total": { "description": "Total number of matching payers that don't support this transaction type.", "minimum": 0, "type": "integer" } }, "required": [ "total" ], "type": "object" }, "OperatingStateCode": { "description": "US state codes, territories, or `NATIONAL` indicating the geographic regions where a payer operates. When set to `NATIONAL`, the payer operates throughout the entire United States.", "enum": [ "AL", "AK", "AZ", "AR", "CA", "CO", "CT", "DE", "FL", "GA", "HI", "ID", "IL", "IN", "IA", "KS", "KY", "LA", "ME", "MD", "MA", "MI", "MN", "MS", "MO", "MT", "NE", "NV", "NH", "NJ", "NM", "NY", "NC", "ND", "OH", "OK", "OR", "PA", "RI", "SC", "SD", "TN", "TX", "UT", "VT", "VA", "WA", "WV", "WI", "WY", "DC", "PR", "VI", "GU", "AS", "MP", "NATIONAL" ], "type": "string" }, "PayerRecord": { "properties": { "aliases": { "description": "Alternative IDs associated with a payer. If a payer changes their `primaryPayerId`, aliases allow you to continue sending transactions to the payer using the old ID uninterrupted.", "items": { "type": "string" }, "type": "array" }, "avatarUrl": { "description": "A URL pointing to an image file (`.png`, `.jpeg`, or `.jpg`) with the payer's logo. This is the same logo Stedi displays in the [Payer Network](https://www.stedi.com/healthcare/network). You can use this property to display payer logos in your system or application.\n\nThis property is only returned when a payer logo is available.", "type": "string" }, "conciseName": { "description": "A shorter version of the payer's display name for use in dense UI views. This property is only returned when a concise name is available for the payer.", "type": "string" }, "coverageTypes": { "description": "A list of insurance coverage types that indicates whether this payer supports transactions for medical coverage, dental coverage, vision coverage, or a combination of these. For example: `[\"medical\"]` or `[\"medical\", \"dental\", \"vision\"]`.\n\nWhen this array isn't in the response, it means Stedi hasn't classified the payer's coverage types yet, **not** that the payer doesn't support any coverage types.", "items": { "$ref": "#/components/schemas/CoverageType" }, "type": "array" }, "displayName": { "description": "The payer's business name, such as Cigna or Aetna. This is the name most commonly used to identify the payer.", "type": "string" }, "employerIdentificationNumbers": { "description": "Employer Identification Numbers (EINs) associated with this payer.", "items": { "description": "A valid Employer Identification Number (EIN) in the format XX-XXXXXXX", "pattern": "^[0-9]{2}-[0-9]{7}$", "type": "string" }, "type": "array" }, "enrollment": { "$ref": "#/components/schemas/EnrollmentInfo", "description": "Details about the [transaction enrollment process](https://www.stedi.com/docs/healthcare/transaction-enrollment) for this payer, if available. This object may not be returned for some payers." }, "names": { "description": "Alternative names associated with a payer. These additional names help you search for and identify payers using the name most familiar to your organization.", "items": { "type": "string" }, "type": "array" }, "operatingStates": { "description": "A list of US state codes, territories, or `NATIONAL` that indicates the geographic regions where this payer operates. For example: `[\"CA\", \"OR\"]` for a regional payer, or `[\"NATIONAL\"]` for a payer that operates throughout the entire United States.\n\nWhen this array isn't in the response, it means Stedi hasn't classified the payer's operating states yet.", "items": { "$ref": "#/components/schemas/OperatingStateCode" }, "type": "array" }, "parentPayerGroupId": { "description": "The payer's parent payer group entity. This is metadata Stedi uses internally. It doesn't necessarily relate to the payer's enrollment process or other capabilities.", "type": "string" }, "primaryPayerId": { "description": "The most commonly used ID for a payer. This value often corresponds to the name the payer uses internally and provides to patients on member ID cards.", "type": "string" }, "stediId": { "description": "A unique ID that Stedi assigned to this payer and uses internally for routing requests. This ID will not change even if the `primaryPayerId` is updated.", "type": "string" }, "transactionSupport": { "$ref": "#/components/schemas/TransactionSupport" }, "urls": { "$ref": "#/components/schemas/PayerUrls", "description": "URLs associated with this payer, such as their website. This object is only returned when URL information is available for the payer." } }, "required": [ "aliases", "displayName", "names", "primaryPayerId", "stediId", "transactionSupport" ], "type": "object" }, "PayerUrls": { "description": "URLs associated with a payer.", "properties": { "website": { "description": "The payer's website URL.", "type": "string" } }, "type": "object" }, "ProfessionalClaimEnrollmentProcess": { "description": "Details about the enrollment process for professional claim submission.", "properties": { "requestedEffectiveDate": { "$ref": "#/components/schemas/RequestedEffectiveDate", "description": "Whether this payer supports specifying a requested effective date for transaction enrollments.\n - If set to `SUPPORTED`, Stedi will process [transaction enrollment requests](https://www.stedi.com/docs/healthcare/api-reference/post-enrollment-create-enrollment) for this payer according to their specified `requestedEffectiveDate`.\n - This property is only returned when Stedi can determine whether the payer supports requested effective dates." }, "timeframe": { "$ref": "#/components/schemas/EnrollmentProcessTimeframe" }, "type": { "$ref": "#/components/schemas/EnrollmentProcessType" } }, "type": "object" }, "RequestedEffectiveDate": { "description": "Whether a payer supports specifying a requested effective date for transaction enrollments.", "enum": [ "SUPPORTED", "NOT_SUPPORTED" ], "type": "string" }, "ResourceNotFoundExceptionResponseContent": { "description": "The server response when the specified resource cannot be found after an API request passes authentication and authorization.", "properties": { "code": { "description": "Error classification code", "type": "string" }, "message": { "description": "Human-readable error message", "type": "string" } }, "required": [ "message" ], "type": "object" }, "SearchPayerRecord": { "properties": { "aliases": { "description": "Alternative IDs associated with a payer. If a payer changes their `primaryPayerId`, aliases allow you to continue sending transactions to the payer using the old ID uninterrupted.", "items": { "type": "string" }, "type": "array" }, "avatarUrl": { "description": "A URL pointing to an image file (`.png`, `.jpeg`, or `.jpg`) with the payer's logo. This is the same logo Stedi displays in the [Payer Network](https://www.stedi.com/healthcare/network). You can use this property to display payer logos in your system or application.\n\nThis property is only returned when a payer logo is available.", "type": "string" }, "conciseName": { "description": "A shorter version of the payer's display name for use in dense UI views. This property is only returned when a concise name is available for the payer.", "type": "string" }, "coverageTypes": { "description": "A list of insurance coverage types that indicates whether this payer supports transactions for medical coverage, dental coverage, vision coverage, or a combination of these. For example: `[\"medical\"]` or `[\"medical\", \"dental\", \"vision\"]`.\n\nWhen this array isn't in the response, it means Stedi hasn't classified the payer's coverage types yet, **not** that the payer doesn't support any coverage types.", "items": { "$ref": "#/components/schemas/CoverageType" }, "type": "array" }, "displayName": { "description": "The payer's business name, such as Cigna or Aetna. This is the name most commonly used to identify the payer.", "type": "string" }, "employerIdentificationNumbers": { "description": "Employer Identification Numbers (EINs) associated with this payer.", "items": { "description": "A valid Employer Identification Number (EIN) in the format XX-XXXXXXX", "pattern": "^[0-9]{2}-[0-9]{7}$", "type": "string" }, "type": "array" }, "enrollment": { "$ref": "#/components/schemas/EnrollmentInfo", "description": "Details about the [transaction enrollment process](https://www.stedi.com/docs/healthcare/transaction-enrollment) for this payer, if available. This object may not be returned for some payers." }, "names": { "description": "Alternative names associated with a payer. These additional names help you search for and identify payers using the name most familiar to your organization.", "items": { "type": "string" }, "type": "array" }, "operatingStates": { "description": "A list of US state codes, territories, or `NATIONAL` that indicates the geographic regions where this payer operates. For example: `[\"CA\", \"OR\"]` for a regional payer, or `[\"NATIONAL\"]` for a payer that operates throughout the entire United States.\n\nWhen this array isn't in the response, it means Stedi hasn't classified the payer's operating states yet.", "items": { "$ref": "#/components/schemas/OperatingStateCode" }, "type": "array" }, "parentPayerGroupId": { "description": "The payer's parent payer group entity. This is metadata Stedi uses internally. It doesn't necessarily relate to the payer's enrollment process or other capabilities.", "type": "string" }, "primaryPayerId": { "description": "The most commonly used ID for a payer. This value often corresponds to the name the payer uses internally and provides to patients on member ID cards.", "type": "string" }, "stediId": { "description": "A unique ID that Stedi assigned to this payer and uses internally for routing requests. This ID will not change even if the `primaryPayerId` is updated.", "type": "string" }, "transactionSupport": { "$ref": "#/components/schemas/SearchPayerTransactionSupport" }, "urls": { "$ref": "#/components/schemas/PayerUrls", "description": "URLs associated with this payer, such as their website. This object is only returned when URL information is available for the payer." } }, "required": [ "aliases", "displayName", "names", "primaryPayerId", "stediId", "transactionSupport" ], "type": "object" }, "SearchPayerTransactionSupport": { "description": "Whether the following transaction types are supported: 270 eligibility checks, 276/277 claim status requests, 837 claims (professional, dental, institutional), 835 ERAs (claim payments), 275 unsolicited claim attachments, and coordination of benefits checks.\n\nIf the value is `ENROLLMENT_REQUIRED`, Stedi supports the transaction type, but you must [enroll with the payer](https://www.stedi.com/docs/healthcare/supported-payers#enrollment) first.", "properties": { "claimPayment": { "$ref": "#/components/schemas/TransactionSupportValue", "description": "Whether you can receive 835 Electronic Remittance Advice (ERA) transactions from this payer." }, "claimStatus": { "$ref": "#/components/schemas/TransactionSupportValue", "description": "Whether you can send 276 claim status requests to this payer." }, "coordinationOfBenefits": { "$ref": "#/components/schemas/TransactionSupportValue", "description": "Coordination of Benefits (COB) support." }, "dentalClaimSubmission": { "$ref": "#/components/schemas/TransactionSupportValue", "description": "Whether you can send 837D dental claims to this payer." }, "eligibilityCheck": { "$ref": "#/components/schemas/TransactionSupportValue", "description": "Whether you can send 270 eligibility checks to this payer." }, "institutionalClaimSubmission": { "$ref": "#/components/schemas/TransactionSupportValue", "description": "Whether you can send 837I institutional claims to this payer." }, "professionalClaimSubmission": { "$ref": "#/components/schemas/TransactionSupportValue", "description": "Whether you can send 837P professional claims to this payer." }, "unsolicitedClaimAttachment": { "$ref": "#/components/schemas/TransactionSupportValue", "description": "Whether you can send unsolicited claim attachments to this payer." } }, "required": [ "claimPayment", "claimStatus", "coordinationOfBenefits", "dentalClaimSubmission", "eligibilityCheck", "institutionalClaimSubmission", "professionalClaimSubmission", "unsolicitedClaimAttachment" ], "type": "object" }, "SearchPayersResponseContent": { "description": "Authenticated output — see `SearchPayers`.", "properties": { "items": { "description": "Matching payers sorted by relevance, with the most relevant matches listed first.", "items": { "$ref": "#/components/schemas/SearchResult" }, "type": "array" }, "nextPageToken": { "description": "Token that you can supply in subsequent requests to retrieve the next page of results. If not returned, there are no more results.", "maxLength": 1024, "minLength": 1, "type": "string" }, "stats": { "$ref": "#/components/schemas/SearchResultsStats", "description": "Statistics about the search results, including the total number of payers matching the search query and the number of payers supported per transaction type." } }, "required": [ "items", "stats" ], "type": "object" }, "SearchResult": { "properties": { "matches": { "$ref": "#/components/schemas/Matches", "description": "Shows which properties in the payer record match the search query. This information helps you understand why Stedi returned this payer and which parts of the payer record matched the search terms. It's also especially useful for debugging search queries and building user interfaces that display matching text.\n- Matching text is wrapped in `` HTML tags for highlighting.\n- This object only contains properties with matching text. For example, if none of the payer's aliases matched the search query, this object will not include the `aliases` property." }, "payer": { "$ref": "#/components/schemas/SearchPayerRecord", "description": "A payer record matching the search query." }, "score": { "deprecated": true, "description": "A relevance score indicating how well this payer matched the search query. Higher scores are better matches. The minimum score is 0.", "format": "double", "type": "number" } }, "required": [ "payer", "score" ], "type": "object" }, "SearchResultsStats": { "properties": { "total": { "description": "Total number of payers matching the search query.", "minimum": 0, "type": "integer" }, "transactionSupport": { "$ref": "#/components/schemas/TransactionSupportStats", "deprecated": true, "description": "Number of matching payers supported per transaction type.\n\nThe categories for each transaction type are mutually exclusive. For example, to calculate the total number of payers that support eligibility checks, regardless of whether enrollment is required, you must add the `supported` and `enrollmentRequired` counts together.\n\n**DEPRECATED**\nThis shape is deprecated since 2025-06-24: Use the `transactionSupportCounts` property instead." }, "transactionSupportCounts": { "$ref": "#/components/schemas/TransactionSupportCounts", "description": "Number of matching payers for each supported transaction type.\n\nTo get the total number of payers that support each transaction type, with additional detail on whether enrollment is required, use `supported.total` instead." } }, "required": [ "total", "transactionSupport", "transactionSupportCounts" ], "type": "object" }, "SupportedAggregationType": { "description": "Aggregation types a payer supports for 835 Electronic Remittance Advice (ERA) transactions. Payers can aggregate by the provider's NPI, tax ID (TIN), or both.\n\nYou can use this information to specify an `aggregationPreference` when submitting ERA enrollment requests.", "enum": [ "NPI", "TIN" ], "type": "string" }, "SupportedBreakdown": { "properties": { "enrollmentNotRequired": { "description": "Number of matching payers that support this transaction type and don't require transaction enrollment.", "minimum": 0, "type": "integer" }, "enrollmentRequired": { "description": "Number of matching payers that support this transaction type and require [transaction enrollment](https://www.stedi.com/docs/healthcare/transaction-enrollment).", "minimum": 0, "type": "integer" }, "total": { "description": "Total number of matching payers that support this transaction type (`enrollmentRequired` + `enrollmentNotRequired`).", "minimum": 0, "type": "integer" } }, "required": [ "enrollmentNotRequired", "enrollmentRequired", "total" ], "type": "object" }, "TransactionEnrollmentProcesses": { "description": "Information about the transaction enrollment requirements and expected timeframes for each transaction type.", "properties": { "claimPayment": { "$ref": "#/components/schemas/ClaimPaymentEnrollmentProcess", "description": "Details about the enrollment process for Electronic Remittance Advice (ERAs) with this payer." }, "claimStatusInquiry": { "$ref": "#/components/schemas/ClaimStatusInquiryEnrollmentProcess", "description": "Details about the enrollment process for real-time claim status requests with this payer." }, "coordinationOfBenefits": { "$ref": "#/components/schemas/CoordinationOfBenefitsEnrollmentProcess", "description": "Details about the enrollment process for coordination of benefits (COB) checks with this payer." }, "dentalClaim": { "$ref": "#/components/schemas/DentalClaimEnrollmentProcess", "description": "Details about the enrollment process for dental claim submission with this payer." }, "eligibilityInquiry": { "$ref": "#/components/schemas/EligibilityInquiryEnrollmentProcess", "description": "Details about the enrollment process for eligibility checks with this payer." }, "institutionalClaim": { "$ref": "#/components/schemas/InstitutionalClaimEnrollmentProcess", "description": "Details about the enrollment process for institutional claim submission with this payer." }, "professionalClaim": { "$ref": "#/components/schemas/ProfessionalClaimEnrollmentProcess", "description": "Details about the enrollment process for professional claim submission with this payer." }, "unsolicitedClaimAttachment": { "$ref": "#/components/schemas/UnsolicitedClaimAttachmentEnrollmentProcess", "description": "Details about the enrollment process for unsolicited claim attachments with this payer." } }, "type": "object" }, "TransactionFilterValue": { "description": "Transaction support filter values. When multiple transaction filters are specified, they are combined with AND logic (payers must satisfy **all** criteria).", "enum": [ "SUPPORTED", "NOT_SUPPORTED", "ENROLLMENT_REQUIRED", "EITHER" ], "type": "string" }, "TransactionSupport": { "description": "Whether the following transaction types are supported: 270 eligibility checks, 276 claim status requests, 837 professional claims, and 835 ERAs (claim payments). If the value is `ENROLLMENT_REQUIRED`, Stedi supports the transaction type, but you must [enroll with the payer](https://www.stedi.com/docs/healthcare/supported-payers#enrollment) first.", "properties": { "claimPayment": { "$ref": "#/components/schemas/TransactionSupportValue", "description": "Whether you can receive 835 Electronic Remittance Advice (ERA) transactions from this payer." }, "claimStatus": { "$ref": "#/components/schemas/TransactionSupportValue", "description": "Whether you can send 276 claim status requests to this payer." }, "claimSubmission": { "$ref": "#/components/schemas/TransactionSupportValue", "deprecated": true, "description": "Whether you can send 837 professional claims to this payer.\nThis shape is deprecated since 2024-11-13: This `claimSubmission` property is deprecated and will be removed in a future release. Instead, use the `professionalClaimSubmission` property." }, "coordinationOfBenefits": { "$ref": "#/components/schemas/TransactionSupportValue", "description": "Coordination of Benefits (COB) support." }, "dentalClaimSubmission": { "$ref": "#/components/schemas/TransactionSupportValue", "description": "Whether you can send 837D dental claims to this payer." }, "eligibilityCheck": { "$ref": "#/components/schemas/TransactionSupportValue", "description": "Whether you can send 270 eligibility checks to this payer." }, "institutionalClaimSubmission": { "$ref": "#/components/schemas/TransactionSupportValue", "description": "Whether you can send 837I institutional claims to this payer." }, "professionalClaimSubmission": { "$ref": "#/components/schemas/TransactionSupportValue", "description": "Whether you can send 837P professional claims to this payer." }, "unsolicitedClaimAttachment": { "$ref": "#/components/schemas/TransactionSupportValue", "description": "Whether you can send unsolicited claim attachments to this payer." } }, "required": [ "claimPayment", "claimStatus", "claimSubmission", "coordinationOfBenefits", "dentalClaimSubmission", "eligibilityCheck", "institutionalClaimSubmission", "professionalClaimSubmission", "unsolicitedClaimAttachment" ], "type": "object" }, "TransactionSupportCounts": { "properties": { "claimPayment": { "$ref": "#/components/schemas/TransactionSupportCountsItem", "description": "Number of matching payers that support 835 Electronic Remittance Advices (ERAs)." }, "claimStatus": { "$ref": "#/components/schemas/TransactionSupportCountsItem", "description": "Number of matching payers that support 276/277 real-time claim status." }, "coordinationOfBenefits": { "$ref": "#/components/schemas/TransactionSupportCountsItem", "description": "Number of matching payers that support 270/271 coordination of benefits (COB) checks." }, "dentalClaimSubmission": { "$ref": "#/components/schemas/TransactionSupportCountsItem", "description": "Number of matching payers that support 837D dental claims." }, "eligibilityCheck": { "$ref": "#/components/schemas/TransactionSupportCountsItem", "description": "Number of matching payers that support 270/271 eligibility checks." }, "institutionalClaimSubmission": { "$ref": "#/components/schemas/TransactionSupportCountsItem", "description": "Number of matching payers that support 837I institutional claims." }, "professionalClaimSubmission": { "$ref": "#/components/schemas/TransactionSupportCountsItem", "description": "Number of matching payers that support 837P professional claims." }, "unsolicitedClaimAttachment": { "$ref": "#/components/schemas/TransactionSupportCountsItem", "description": "Number of matching payers that support 275 unsolicited claim attachments." } }, "required": [ "claimPayment", "claimStatus", "coordinationOfBenefits", "dentalClaimSubmission", "eligibilityCheck", "institutionalClaimSubmission", "professionalClaimSubmission", "unsolicitedClaimAttachment" ], "type": "object" }, "TransactionSupportCountsItem": { "properties": { "notSupported": { "$ref": "#/components/schemas/NotSupportedBreakdown", "description": "Number of matching payers that don't support this transaction type." }, "supported": { "$ref": "#/components/schemas/SupportedBreakdown", "description": "Number of matching payers that support this transaction type, broken down by enrollment requirements." } }, "required": [ "notSupported", "supported" ], "type": "object" }, "TransactionSupportStats": { "properties": { "claimPayment": { "$ref": "#/components/schemas/TransactionSupportStatsItem", "description": "Number of matching payers that support 835 Electronic Remittance Advices (ERAs)." }, "claimStatus": { "$ref": "#/components/schemas/TransactionSupportStatsItem", "description": "Number of matching payers that support 276/277 real-time claim status." }, "coordinationOfBenefits": { "$ref": "#/components/schemas/TransactionSupportStatsItem", "description": "Number of matching payers that support 270/271 coordination of benefits (COB) checks." }, "dentalClaimSubmission": { "$ref": "#/components/schemas/TransactionSupportStatsItem", "description": "Number of matching payers that support 837D dental claims." }, "eligibilityCheck": { "$ref": "#/components/schemas/TransactionSupportStatsItem", "description": "Number of matching payers that support 270/271 eligibility checks." }, "institutionalClaimSubmission": { "$ref": "#/components/schemas/TransactionSupportStatsItem", "description": "Number of matching payers that support 837I institutional claims." }, "professionalClaimSubmission": { "$ref": "#/components/schemas/TransactionSupportStatsItem", "description": "Number of matching payers that support 837P professional claims." }, "unsolicitedClaimAttachment": { "$ref": "#/components/schemas/TransactionSupportStatsItem", "description": "Number of matching payers that support 275 unsolicited claim attachments." } }, "required": [ "claimPayment", "claimStatus", "coordinationOfBenefits", "dentalClaimSubmission", "eligibilityCheck", "institutionalClaimSubmission", "professionalClaimSubmission", "unsolicitedClaimAttachment" ], "type": "object" }, "TransactionSupportStatsItem": { "properties": { "enrollmentRequired": { "description": "Number of matching payers that require [transaction enrollment](https://www.stedi.com/docs/healthcare/transaction-enrollment) for this transaction type.", "minimum": 0, "type": "integer" }, "notSupported": { "description": "Number of matching payers that don't support this transaction type.", "minimum": 0, "type": "integer" }, "supported": { "description": "Number of matching payers that support this transaction type.", "minimum": 0, "type": "integer" } }, "required": [ "enrollmentRequired", "notSupported", "supported" ], "type": "object" }, "TransactionSupportValue": { "enum": [ "SUPPORTED", "NOT_SUPPORTED", "ENROLLMENT_REQUIRED" ], "type": "string" }, "UnauthorizedExceptionResponseContent": { "description": "The server response when the authorizer failed to authenticate the caller.", "properties": { "code": { "description": "Error classification code", "type": "string" }, "message": { "description": "Human-readable error message", "type": "string" } }, "required": [ "message" ], "type": "object" }, "UnsolicitedClaimAttachmentEnrollmentProcess": { "description": "Details about the enrollment process for unsolicited claim attachments.", "properties": { "requestedEffectiveDate": { "$ref": "#/components/schemas/RequestedEffectiveDate", "description": "Whether this payer supports specifying a requested effective date for transaction enrollments.\n - If set to `SUPPORTED`, Stedi will process [transaction enrollment requests](https://www.stedi.com/docs/healthcare/api-reference/post-enrollment-create-enrollment) for this payer according to their specified `requestedEffectiveDate`.\n - This property is only returned when Stedi can determine whether the payer supports requested effective dates." }, "timeframe": { "$ref": "#/components/schemas/EnrollmentProcessTimeframe" }, "type": { "$ref": "#/components/schemas/EnrollmentProcessType" } }, "type": "object" }, "ValidationExceptionField": { "description": "Describes one specific validation failure for an input member.", "properties": { "message": { "description": "A detailed description of the validation failure.", "type": "string" }, "path": { "description": "A JSONPointer expression to the structure member whose value failed to satisfy the modeled constraints.", "type": "string" } }, "required": [ "message", "path" ], "type": "object" }, "ValidationExceptionResponseContent": { "description": "A standard error for input validation failures.\nThis should be thrown by services when a member of the input structure\nfalls outside of the modeled or documented constraints.", "properties": { "fieldList": { "description": "A list of specific failures encountered while validating the input.\nA member can appear in this list more than once if it failed to satisfy multiple constraints.", "items": { "$ref": "#/components/schemas/ValidationExceptionField" }, "type": "array" }, "message": { "description": "A summary of the validation failure.", "type": "string" } }, "required": [ "message" ], "type": "object" } }, "securitySchemes": { "httpApiKeyAuth": { "description": "A [Stedi API Key](https://portal.stedi.com/app/settings/api-keys) for authentication.", "in": "header", "name": "Authorization", "type": "apiKey" } } }, "info": { "contact": { "email": "healthcare@stedi.com" }, "license": { "name": "Proprietary", "url": "https://stedi.com" }, "title": "Stedi Payers", "version": "2024-04-01" }, "openapi": "3.1.0", "paths": { "/payer/{stediId}": { "get": { "description": "Retrieve a single payer record by its Stedi payer ID.", "operationId": "GetPayerRecord", "parameters": [ { "description": "The Stedi payer ID, a unique identifier Stedi assigns to each payer that will never change. You can find the Stedi payer ID for any supported payer in the [Payer Network](https://www.stedi.com/healthcare/network).\n\nThis must be the Stedi payer ID - querying with the primary payer ID or payer ID aliases isn't supported.", "examples": { "GetPayerRecord_example1": { "description": "", "summary": "Retrieve payer record", "value": "QDTRP" } }, "in": "path", "name": "stediId", "required": true, "schema": { "description": "The Stedi payer ID, a unique identifier Stedi assigns to each payer that will never change. You can find the Stedi payer ID for any supported payer in the [Payer Network](https://www.stedi.com/healthcare/network).\n\nThis must be the Stedi payer ID - querying with the primary payer ID or payer ID aliases isn't supported.", "pattern": "^[A-Z]{5}$", "type": "string" } } ], "responses": { "200": { "content": { "application/json": { "examples": { "GetPayerRecord_example1": { "description": "", "summary": "Retrieve payer record", "value": { "payer": { "aliases": [ "00420", "13123", "1584", "4714", "95655", "MEDGL", "MEDGLD", "MEDIGOLD" ], "avatarUrl": "https://prod-payer-avatars.payers.us.stedi.com/YKHRB/avatar.png?v=1766600157693", "coverageTypes": [ "dental", "medical" ], "displayName": "Trinity Health Plan", "enrollment": { "ptanRequired": false, "transactionEnrollmentProcesses": { "claimPayment": { "requestedEffectiveDate": "NOT_SUPPORTED", "supportedAggregationPreferences": [ "NPI", "TIN" ], "timeframe": "DAYS", "type": "ONE_CLICK" } } }, "names": [ "MediGold", "Medigold Health Plans", "Mount Carmel Health Plan", "Mount Carmel MediGold", "Trinity Health Plan of Michigan" ], "operatingStates": [ "ID", "IA", "MI", "NY", "OH" ], "parentPayerGroupId": "GTRSH", "primaryPayerId": "95655", "stediId": "YKHRB", "transactionSupport": { "claimPayment": "ENROLLMENT_REQUIRED", "claimStatus": "SUPPORTED", "claimSubmission": "SUPPORTED", "coordinationOfBenefits": "NOT_SUPPORTED", "dentalClaimSubmission": "NOT_SUPPORTED", "eligibilityCheck": "SUPPORTED", "institutionalClaimSubmission": "SUPPORTED", "professionalClaimSubmission": "SUPPORTED", "unsolicitedClaimAttachment": "NOT_SUPPORTED" }, "urls": { "website": "https://www.thpmedicare.org" } } } } }, "schema": { "$ref": "#/components/schemas/GetPayerRecordResponseContent" } } }, "description": "GetPayerRecord 200 response" }, "400": { "content": { "application/json": { "schema": { "$ref": "#/components/schemas/ValidationExceptionResponseContent" } } }, "description": "ValidationException 400 response" }, "401": { "content": { "application/json": { "schema": { "$ref": "#/components/schemas/UnauthorizedExceptionResponseContent" } } }, "description": "UnauthorizedException 401 response" }, "404": { "content": { "application/json": { "schema": { "$ref": "#/components/schemas/ResourceNotFoundExceptionResponseContent" } } }, "description": "ResourceNotFoundException 404 response" }, "500": { "content": { "application/json": { "schema": { "$ref": "#/components/schemas/InternalFailureExceptionResponseContent" } } }, "description": "InternalFailureException 500 response" } } } }, "/payers": { "get": { "description": "List Stedi's supported payers in JSON format", "operationId": "ListPayerRecords", "parameters": [ { "description": "The maximum number of elements to return per page. If not set, Stedi returns all payers in a single response (no pagination).", "examples": { "ListPayerRecords_example1": { "description": "", "summary": "List payers with pagination", "value": 100 } }, "in": "query", "name": "pageSize", "schema": { "description": "The maximum number of elements to return per page. If not set, Stedi returns all payers in a single response (no pagination).", "minimum": 10, "type": "integer" } }, { "description": "The `nextPageToken` value from a previous response. You can use this to get the next page of results. If not set, Stedi returns the first page of results.", "in": "query", "name": "pageToken", "schema": { "description": "The `nextPageToken` value from a previous response. You can use this to get the next page of results. If not set, Stedi returns the first page of results.", "maxLength": 1024, "minLength": 1, "type": "string" } } ], "responses": { "200": { "content": { "application/json": { "examples": { "ListPayerRecords_example1": { "description": "", "summary": "List payers with pagination", "value": { "items": [ { "aliases": [ "00420", "13123", "1584", "4714", "95655", "MEDGL", "MEDGLD", "MEDIGOLD" ], "avatarUrl": "https://prod-payer-avatars.payers.us.stedi.com/YKHRB/avatar.png?v=1766600157693", "coverageTypes": [ "dental", "medical" ], "displayName": "Trinity Health Plan", "enrollment": { "ptanRequired": false, "transactionEnrollmentProcesses": { "claimPayment": { "requestedEffectiveDate": "NOT_SUPPORTED", "supportedAggregationPreferences": [ "NPI", "TIN" ], "timeframe": "DAYS", "type": "ONE_CLICK" } } }, "names": [ "MediGold", "Medigold Health Plans", "Mount Carmel Health Plan", "Mount Carmel MediGold", "Trinity Health Plan of Michigan" ], "operatingStates": [ "ID", "IA", "MI", "NY", "OH" ], "parentPayerGroupId": "GTRSH", "primaryPayerId": "95655", "stediId": "YKHRB", "transactionSupport": { "claimPayment": "ENROLLMENT_REQUIRED", "claimStatus": "SUPPORTED", "claimSubmission": "SUPPORTED", "coordinationOfBenefits": "NOT_SUPPORTED", "dentalClaimSubmission": "NOT_SUPPORTED", "eligibilityCheck": "SUPPORTED", "institutionalClaimSubmission": "SUPPORTED", "professionalClaimSubmission": "SUPPORTED", "unsolicitedClaimAttachment": "NOT_SUPPORTED" }, "urls": { "website": "https://www.thpmedicare.org" } } ], "nextPageToken": "yrZ3we9982etYlMgmw==" } } }, "schema": { "$ref": "#/components/schemas/ListPayerRecordsResponseContent" } } }, "description": "ListPayerRecords 200 response" }, "400": { "content": { "application/json": { "schema": { "$ref": "#/components/schemas/ValidationExceptionResponseContent" } } }, "description": "ValidationException 400 response" }, "404": { "content": { "application/json": { "schema": { "$ref": "#/components/schemas/ResourceNotFoundExceptionResponseContent" } } }, "description": "ResourceNotFoundException 404 response" }, "500": { "content": { "application/json": { "schema": { "$ref": "#/components/schemas/InternalFailureExceptionResponseContent" } } }, "description": "InternalFailureException 500 response" } } } }, "/payers/csv": { "get": { "description": "List Stedi's supported payers in CSV format", "operationId": "ListPayerRecordsCsv", "responses": { "200": { "content": { "text/plain": { "examples": { "ListPayerRecordsCsv_example1": { "description": "", "summary": "List payers", "value": "\"StediId\",\"PrimaryPayerId\",\"DisplayName\",\"Names\",\"Aliases\",\"EligibilityInquiry\",\"EligibilityInquiryEnrollmentRequired\",\"EligibilityInquiryEnrollmentType\",\"EligibilityInquiryEnrollmentTimeframe\",\"EligibilityInquiryEnrollmentRequestedEffectiveDate\",\"ClaimStatusInquiry\",\"ClaimStatusInquiryEnrollmentRequired\",\"ClaimStatusInquiryEnrollmentType\",\"ClaimStatusInquiryEnrollmentTimeframe\",\"ClaimStatusInquiryEnrollmentRequestedEffectiveDate\",\"ProfessionalClaim\",\"ProfessionalClaimEnrollmentRequired\",\"ProfessionalClaimEnrollmentType\",\"ProfessionalClaimEnrollmentTimeframe\",\"ProfessionalClaimEnrollmentRequestedEffectiveDate\",\"InstitutionalClaim\",\"InstitutionalClaimEnrollmentRequired\",\"InstitutionalClaimEnrollmentType\",\"InstitutionalClaimEnrollmentTimeframe\",\"InstitutionalClaimEnrollmentRequestedEffectiveDate\",\"DentalClaim\",\"DentalClaimEnrollmentRequired\",\"DentalClaimEnrollmentType\",\"DentalClaimEnrollmentTimeframe\",\"DentalClaimEnrollmentRequestedEffectiveDate\",\"ClaimPaymentAdvice\",\"ClaimPaymentAdviceEnrollmentRequired\",\"ClaimPaymentEnrollmentType\",\"ClaimPaymentEnrollmentTimeframe\",\"ClaimPaymentEnrollmentSupportedAggregationPreferences\",\"ClaimPaymentEnrollmentRequestedEffectiveDate\",\"CoordinationOfBenefits\",\"CoordinationOfBenefitsEnrollmentRequired\",\"CoordinationOfBenefitsEnrollmentType\",\"CoordinationOfBenefitsEnrollmentTimeframe\",\"CoordinationOfBenefitsEnrollmentRequestedEffectiveDate\",\"ClaimAttachmentsSupport\",\"ClaimAttachmentsSupportEnrollmentRequired\",\"ClaimAttachmentEnrollmentType\",\"ClaimAttachmentEnrollmentTimeframe\",\"ClaimAttachmentEnrollmentRequestedEffectiveDate\",\"EmployerIdentificationNumbers\",\"CoverageTypes\",\"OperatingStates\",\"PtanRequired\",\"ParentPayerGroupId\",\"WebsiteUrl\"\n\"YKHRB\",\"95655\",\"Trinity Health Plan\",\"MediGold|Medigold Health Plans|Mount Carmel Health Plan|Mount Carmel MediGold|Trinity Health Plan of Michigan\",\"00420|13123|1584|4714|95655|MEDGL|MEDGLD|MEDIGOLD\",\"true\",\"false\",\"\",\"\",\"\",\"true\",\"false\",\"\",\"\",\"\",\"true\",\"false\",\"\",\"\",\"\",\"true\",\"false\",\"\",\"\",\"\",\"false\",\"false\",\"\",\"\",\"\",\"true\",\"true\",\"ONE_CLICK\",\"DAYS\",\"NPI|TIN\",\"NOT_SUPPORTED\",\"false\",\"false\",\"\",\"\",\"\",\"false\",\"false\",\"\",\"\",\"\",\"\",\"dental|medical\",\"ID|IA|MI|NY|OH\",\"false\",\"GTRSH\",\"https://www.thpmedicare.org\"" } }, "schema": { "$ref": "#/components/schemas/ListPayerRecordsCsvOutputPayload" } } }, "description": "ListPayerRecordsCsv 200 response", "headers": { "Content-Type": { "description": "Content type for CSV data", "schema": { "description": "Content type for CSV data", "type": "string" } } } }, "400": { "content": { "application/json": { "schema": { "$ref": "#/components/schemas/ValidationExceptionResponseContent" } } }, "description": "ValidationException 400 response" }, "404": { "content": { "application/json": { "schema": { "$ref": "#/components/schemas/ResourceNotFoundExceptionResponseContent" } } }, "description": "ResourceNotFoundException 404 response" }, "500": { "content": { "application/json": { "schema": { "$ref": "#/components/schemas/InternalFailureExceptionResponseContent" } } }, "description": "InternalFailureException 500 response" } } } }, "/payers/search": { "get": { "description": "Search for payers by name, ID, or alias.", "operationId": "SearchPayers", "parameters": [ { "description": "The maximum number of elements to return in a page. If not specified, the default is 20.", "in": "query", "name": "pageSize", "schema": { "description": "The maximum number of elements to return in a page. If not specified, the default is 20.", "maximum": 100, "minimum": 10, "type": "integer" } }, { "description": "An opaque token returned by a previous call to this endpoint in the `nextPageToken` property. You can use it to request the next page of results. If not specified, Stedi returns the first page of results.", "in": "query", "name": "pageToken", "schema": { "description": "An opaque token returned by a previous call to this endpoint in the `nextPageToken` property. You can use it to request the next page of results. If not specified, Stedi returns the first page of results.", "maxLength": 1024, "minLength": 1, "type": "string" } }, { "description": "The query Stedi will use to search the Payer Network database. You can supply a payer's name, ID, or alias. The query is case-insensitive, and fuzzy matching is supported. For example, `cig`, `62308`, and `SX071` all return Cigna in the results. If not provided, the other search options are used to conduct the search.", "examples": { "SearchPayers_example1": { "description": "", "summary": "Search for query string", "value": "Blue Cross" }, "SearchPayers_example2": { "description": "", "summary": "Search with multiple filters", "value": "Blue Cross" } }, "in": "query", "name": "query", "schema": { "description": "The query Stedi will use to search the Payer Network database. You can supply a payer's name, ID, or alias. The query is case-insensitive, and fuzzy matching is supported. For example, `cig`, `62308`, and `SX071` all return Cigna in the results. If not provided, the other search options are used to conduct the search.", "maxLength": 200, "type": "string" } }, { "description": "Filter for matching payers with the specified 270 eligibility checks support. When combined with other transaction filters, payers must satisfy **all** specified criteria to be included in results.", "examples": { "SearchPayers_example2": { "description": "", "summary": "Search with multiple filters", "value": "SUPPORTED" } }, "in": "query", "name": "eligibilityCheck", "schema": { "$ref": "#/components/schemas/TransactionFilterValue" } }, { "description": "Filter for matching payers with the specified 276/277 real-time claim status checks support. When combined with other transaction filters, payers must satisfy **all** specified criteria to be included in results.", "examples": { "SearchPayers_example2": { "description": "", "summary": "Search with multiple filters", "value": "SUPPORTED" } }, "in": "query", "name": "claimStatus", "schema": { "$ref": "#/components/schemas/TransactionFilterValue" } }, { "description": "Filter for matching payers with the specified 837 professional claims support. When combined with other transaction filters, payers must satisfy **all** specified criteria to be included in results.", "in": "query", "name": "professionalClaimSubmission", "schema": { "$ref": "#/components/schemas/TransactionFilterValue" } }, { "description": "Filter for matching payers with the specified 837 dental claims support. When combined with other transaction filters, payers must satisfy **all** specified criteria to be included in results.", "in": "query", "name": "dentalClaimSubmission", "schema": { "$ref": "#/components/schemas/TransactionFilterValue" } }, { "description": "Filter for matching payers with the specified 837 institutional claims support. When combined with other transaction filters, payers must satisfy **all** specified criteria to be included in results.", "in": "query", "name": "institutionalClaimSubmission", "schema": { "$ref": "#/components/schemas/TransactionFilterValue" } }, { "description": "Filter for matching payers with the specified 835 Electronic Remittance Advice (ERA) support. When combined with other transaction filters, payers must satisfy **all** specified criteria to be included in results.", "in": "query", "name": "claimPayment", "schema": { "$ref": "#/components/schemas/TransactionFilterValue" } }, { "description": "Filter for matching payers with the specified coordination of benefits (COB) checks support. When combined with other transaction filters, payers must satisfy **all** specified criteria to be included in results.", "in": "query", "name": "coordinationOfBenefits", "schema": { "$ref": "#/components/schemas/TransactionFilterValue" } }, { "description": "Filter for matching payers with the specified unsolicited 275 claim attachments support. When combined with other transaction filters, payers must satisfy **all** specified criteria to be included in results.", "in": "query", "name": "unsolicitedClaimAttachment", "schema": { "$ref": "#/components/schemas/TransactionFilterValue" } }, { "description": "Filter for matching payers that support transactions for **all** of the specified coverage types. For example, setting this array to `[\"medical\", \"dental\"]` returns only payers who provide both medical and dental coverage.\n\nThe results also exclude payers without coverage type classifications in Stedi's database.", "explode": true, "in": "query", "name": "coverageTypes", "schema": { "description": "Filter for matching payers that support transactions for **all** of the specified coverage types. For example, setting this array to `[\"medical\", \"dental\"]` returns only payers who provide both medical and dental coverage.\n\nThe results also exclude payers without coverage type classifications in Stedi's database.", "items": { "$ref": "#/components/schemas/CoverageType" }, "type": "array" }, "style": "form" }, { "description": "Filter for matching payers that operate in **all** of the specified states. For example, setting this array to `[\"CA\", \"OR\"]` returns only payers that operate in both California and Oregon, and setting it to `[\"NATIONAL\"]` returns payers that operate throughout the entire United States.\n\nThe results also exclude payers without operating state classifications in Stedi's database.", "explode": true, "in": "query", "name": "operatingStates", "schema": { "description": "Filter for matching payers that operate in **all** of the specified states. For example, setting this array to `[\"CA\", \"OR\"]` returns only payers that operate in both California and Oregon, and setting it to `[\"NATIONAL\"]` returns payers that operate throughout the entire United States.\n\nThe results also exclude payers without operating state classifications in Stedi's database.", "items": { "$ref": "#/components/schemas/OperatingStateCode" }, "type": "array" }, "style": "form" } ], "responses": { "200": { "content": { "application/json": { "examples": { "SearchPayers_example1": { "description": "", "summary": "Search for query string", "value": { "items": [ { "matches": { "names": [ "Highmark Blue Cross Blue Shield", "Highmark Blue Cross Blue Shield Pennsylvania", "Highmark Blue Cross Blue Shield Pennsylvania Professional", "Highmark Blue Shield", "Keystone Health Plan West - Community Blue HMO" ] }, "payer": { "aliases": [ "10046", "100900", "10264", "10524", "2413", "54771", "95462", "PABCBS", "PABLS", "SB865", "SB865MA", "SZXAY" ], "avatarUrl": "https://prod-payer-avatars.payers.us.stedi.com/GUFCO/avatar.png?v=1763077235241", "conciseName": "Highmark PA", "coverageTypes": [ "dental", "medical", "vision" ], "displayName": "Highmark of Pennsylvania", "enrollment": { "ptanRequired": false, "transactionEnrollmentProcesses": { "claimPayment": { "requestedEffectiveDate": "NOT_SUPPORTED", "supportedAggregationPreferences": [ "NPI", "TIN" ], "timeframe": "DAYS", "type": "ONE_CLICK" }, "claimStatusInquiry": { "timeframe": "DAYS", "type": "ONE_CLICK" } } }, "names": [ "Highmark Blue Cross Blue Shield", "Highmark Blue Cross Blue Shield Pennsylvania", "Highmark Blue Cross Blue Shield Pennsylvania Professional", "Highmark Blue Shield", "Keystone Health Plan West - Community Blue HMO", "First Priority Life Insurance Company (FPLIC) Out-of-Area Claims", "Highmark of Pennsylvania - Medicare Advantage" ], "operatingStates": [ "PA" ], "parentPayerGroupId": "QOSPQ", "primaryPayerId": "54771", "stediId": "GUFCO", "transactionSupport": { "claimPayment": "ENROLLMENT_REQUIRED", "claimStatus": "ENROLLMENT_REQUIRED", "coordinationOfBenefits": "SUPPORTED", "dentalClaimSubmission": "NOT_SUPPORTED", "eligibilityCheck": "ENROLLMENT_REQUIRED", "institutionalClaimSubmission": "NOT_SUPPORTED", "professionalClaimSubmission": "SUPPORTED", "unsolicitedClaimAttachment": "NOT_SUPPORTED" } }, "score": 2314894167593451500 } ], "stats": { "total": 142, "transactionSupport": { "claimPayment": { "enrollmentRequired": 113, "notSupported": 29, "supported": 0 }, "claimStatus": { "enrollmentRequired": 3, "notSupported": 55, "supported": 84 }, "coordinationOfBenefits": { "enrollmentRequired": 0, "notSupported": 114, "supported": 28 }, "dentalClaimSubmission": { "enrollmentRequired": 2, "notSupported": 95, "supported": 45 }, "eligibilityCheck": { "enrollmentRequired": 5, "notSupported": 33, "supported": 104 }, "institutionalClaimSubmission": { "enrollmentRequired": 10, "notSupported": 30, "supported": 102 }, "professionalClaimSubmission": { "enrollmentRequired": 9, "notSupported": 16, "supported": 117 }, "unsolicitedClaimAttachment": { "enrollmentRequired": 0, "notSupported": 109, "supported": 33 } }, "transactionSupportCounts": { "claimPayment": { "notSupported": { "total": 29 }, "supported": { "enrollmentNotRequired": 0, "enrollmentRequired": 113, "total": 113 } }, "claimStatus": { "notSupported": { "total": 55 }, "supported": { "enrollmentNotRequired": 84, "enrollmentRequired": 3, "total": 87 } }, "coordinationOfBenefits": { "notSupported": { "total": 114 }, "supported": { "enrollmentNotRequired": 28, "enrollmentRequired": 0, "total": 28 } }, "dentalClaimSubmission": { "notSupported": { "total": 95 }, "supported": { "enrollmentNotRequired": 45, "enrollmentRequired": 2, "total": 47 } }, "eligibilityCheck": { "notSupported": { "total": 33 }, "supported": { "enrollmentNotRequired": 104, "enrollmentRequired": 5, "total": 109 } }, "institutionalClaimSubmission": { "notSupported": { "total": 30 }, "supported": { "enrollmentNotRequired": 102, "enrollmentRequired": 10, "total": 112 } }, "professionalClaimSubmission": { "notSupported": { "total": 16 }, "supported": { "enrollmentNotRequired": 117, "enrollmentRequired": 9, "total": 126 } }, "unsolicitedClaimAttachment": { "notSupported": { "total": 109 }, "supported": { "enrollmentNotRequired": 33, "enrollmentRequired": 0, "total": 33 } } } } } }, "SearchPayers_example2": { "description": "", "summary": "Search with multiple filters", "value": { "items": [ { "matches": { "aliases": [ "BCSNC" ], "displayName": "Blue Cross NC", "names": [ "Blue Cross Blue Shield North Carolina", "Blue Cross Blue Shield of North Carolina", "Blue Cross NC - Medicare Advantage", "Blue Cross NC – Dental Blue" ], "primaryPayerId": "BCSNC" }, "payer": { "aliases": [ "BCSNC", "10383", "12B23", "1411", "560894904", "61472", "61473", "7472", "7514", "7814", "NCBCBS", "NCBLS", "NCPNHP", "SB810", "SB810MA" ], "avatarUrl": "https://prod-payer-avatars.payers.us.stedi.com/UPICO/avatar.png?v=1765912707668", "coverageTypes": [ "dental", "medical", "vision" ], "displayName": "Blue Cross NC", "employerIdentificationNumbers": [ "56-0894904" ], "enrollment": { "ptanRequired": false, "transactionEnrollmentProcesses": { "claimPayment": { "requestedEffectiveDate": "SUPPORTED", "supportedAggregationPreferences": [ "TIN" ], "timeframe": "DAYS", "type": "MULTI_STEP" } } }, "names": [ "Blue Cross Blue Shield North Carolina", "Blue Cross Blue Shield of North Carolina", "Blue Cross NC - Medicare Advantage", "Blue Cross NC – Dental Blue", "Partners National Health Plans of North Carolina Inc" ], "operatingStates": [ "NC" ], "parentPayerGroupId": "OVWIG", "primaryPayerId": "BCSNC", "stediId": "UPICO", "transactionSupport": { "claimPayment": "ENROLLMENT_REQUIRED", "claimStatus": "SUPPORTED", "coordinationOfBenefits": "SUPPORTED", "dentalClaimSubmission": "SUPPORTED", "eligibilityCheck": "SUPPORTED", "institutionalClaimSubmission": "SUPPORTED", "professionalClaimSubmission": "SUPPORTED", "unsolicitedClaimAttachment": "NOT_SUPPORTED" }, "urls": { "website": "https://www.bluecrossnc.com" } }, "score": 2314894167592927000 } ], "stats": { "total": 83, "transactionSupport": { "claimPayment": { "enrollmentRequired": 77, "notSupported": 6, "supported": 0 }, "claimStatus": { "enrollmentRequired": 0, "notSupported": 0, "supported": 83 }, "coordinationOfBenefits": { "enrollmentRequired": 0, "notSupported": 57, "supported": 26 }, "dentalClaimSubmission": { "enrollmentRequired": 2, "notSupported": 41, "supported": 40 }, "eligibilityCheck": { "enrollmentRequired": 0, "notSupported": 0, "supported": 83 }, "institutionalClaimSubmission": { "enrollmentRequired": 5, "notSupported": 3, "supported": 75 }, "professionalClaimSubmission": { "enrollmentRequired": 5, "notSupported": 3, "supported": 75 }, "unsolicitedClaimAttachment": { "enrollmentRequired": 0, "notSupported": 57, "supported": 26 } }, "transactionSupportCounts": { "claimPayment": { "notSupported": { "total": 6 }, "supported": { "enrollmentNotRequired": 0, "enrollmentRequired": 77, "total": 77 } }, "claimStatus": { "notSupported": { "total": 0 }, "supported": { "enrollmentNotRequired": 83, "enrollmentRequired": 0, "total": 83 } }, "coordinationOfBenefits": { "notSupported": { "total": 57 }, "supported": { "enrollmentNotRequired": 26, "enrollmentRequired": 0, "total": 26 } }, "dentalClaimSubmission": { "notSupported": { "total": 41 }, "supported": { "enrollmentNotRequired": 40, "enrollmentRequired": 2, "total": 42 } }, "eligibilityCheck": { "notSupported": { "total": 0 }, "supported": { "enrollmentNotRequired": 83, "enrollmentRequired": 0, "total": 83 } }, "institutionalClaimSubmission": { "notSupported": { "total": 3 }, "supported": { "enrollmentNotRequired": 75, "enrollmentRequired": 5, "total": 80 } }, "professionalClaimSubmission": { "notSupported": { "total": 3 }, "supported": { "enrollmentNotRequired": 75, "enrollmentRequired": 5, "total": 80 } }, "unsolicitedClaimAttachment": { "notSupported": { "total": 57 }, "supported": { "enrollmentNotRequired": 26, "enrollmentRequired": 0, "total": 26 } } } } } } }, "schema": { "$ref": "#/components/schemas/SearchPayersResponseContent" } } }, "description": "SearchPayers 200 response" }, "400": { "content": { "application/json": { "schema": { "$ref": "#/components/schemas/ValidationExceptionResponseContent" } } }, "description": "ValidationException 400 response" }, "401": { "content": { "application/json": { "schema": { "$ref": "#/components/schemas/UnauthorizedExceptionResponseContent" } } }, "description": "UnauthorizedException 401 response" }, "404": { "content": { "application/json": { "schema": { "$ref": "#/components/schemas/ResourceNotFoundExceptionResponseContent" } } }, "description": "ResourceNotFoundException 404 response" }, "500": { "content": { "application/json": { "schema": { "$ref": "#/components/schemas/InternalFailureExceptionResponseContent" } } }, "description": "InternalFailureException 500 response" } } } } }, "security": [ { "httpApiKeyAuth": [] } ], "servers": [ { "description": "Production", "url": "https://payers.us.stedi.com/2024-04-01" } ], "tags": [], "x-stedi": { "lifecycle": "general_availability", "product": "payers", "public": true } }