slug: stedi provider: Stedi generated_by: planning/capability-mapping/scripts/classify_capabilities.py model: claude-opus-5 frame: - Healthcare Providers min_confidence: 0.7 capability_model: source: https://github.com/vincentmakes/turbo-ea-capabilities license: CC-BY-4.0 attribution: Turbo EA Capabilities by Vincent Verdet — Turbo EA, https://github.com/vincentmakes/turbo-ea-capabilities, CC BY 4.0 notice: NOTICE edge_count: 14 edges: - tag: Claim submission spec_file: stedi-claim-submission-api-openapi.yml capability_id: BC-2870.30 capability_id_l1: BC-2870 capability_name: Claim Production & Submission confidence: 0.95 evidence: POST /change/medicalnetwork/professionalclaims/v3/submission ClaimsSubmission; POST /dental-claims/submission; GET /export/{transactionId}/1500/pdf reason: Operations submit professional, institutional and dental claims (837) to payers through a clearinghouse and export CMS-1500 forms — claim production and submission in the provider revenue cycle. - tag: Real-time eligibility check spec_file: stedi-real-time-eligibility-check-api-openapi.yml capability_id: BC-2800.30 capability_id_l1: BC-2800 capability_name: Eligibility & Benefits Verification confidence: 0.93 evidence: POST /change/medicalnetwork/eligibility/v3 EligibilityCheck, schemas BenefitsDateInformation, InsuranceTypeCode, InPlanNetworkIndicatorCode reason: 270/271 real-time eligibility and benefits inquiry against payer coverage is precisely Eligibility & Benefits Verification; no other reading fits. - tag: Batch eligibility check spec_file: stedi-batch-eligibility-check-api-openapi.yml capability_id: BC-2800.30 capability_id_l1: BC-2800 capability_name: Eligibility & Benefits Verification confidence: 0.92 evidence: POST /eligibility-manager/batch-eligibility BatchEligibilityChecks; schemas InsuranceTypeCode, BenefitsDateInformation, InPlanNetworkIndicatorCode, EligibilityCheckDependentError reason: Operations perform batched payer eligibility/benefits inquiries (X12 270/271) with insurance type, network indicator and benefits date schemas — squarely insurance coverage and benefits verification prior to service. - tag: Eligibility Check spec_file: stedi-eligibility-check-api-openapi.yml capability_id: BC-2800.30 capability_id_l1: BC-2800 capability_name: Eligibility & Benefits Verification confidence: 0.9 evidence: 'POST /eligibility-check; vendor: "verify eligibility ... eligibility checks (270/271)"' reason: The single operation performs an insurance eligibility/benefits inquiry (X12 270/271), which is exactly Eligibility & Benefits Verification. - tag: Claim Attachments spec_file: stedi-claim-attachments-api-openapi.yml capability_id: BC-2870.30 capability_id_l1: BC-2870 capability_name: Claim Production & Submission confidence: 0.85 evidence: POST /claim-attachments/raw-x12-submission SubmitClaimAttachmentRawX12; schema ClaimAttachmentReference reason: Submission of supporting documentation attached to healthcare claims via the clearinghouse — part of producing and submitting claims to payers. - tag: Enrollments spec_file: stedi-enrollments-api-openapi.yml capability_id: BC-2890.50 capability_id_l1: BC-2890 capability_name: Provider Enrolment Management confidence: 0.85 evidence: CreateEnrollment / ListEnrollments; "manages provider enrollments with healthcare payers ... tracks enrollment status, provider details"; schemas EnrolledProviderInput, EnrolledPayerInput reason: Operations create and track provider enrolments with payers, matching Provider Enrolment Management. - tag: Insurance discovery spec_file: stedi-insurance-discovery-api-openapi.yml capability_id: BC-2800.30 capability_id_l1: BC-2800 capability_name: Eligibility & Benefits Verification confidence: 0.85 evidence: POST /insurance-discovery/check/v1 InsuranceDiscoveryCheck; schemas InsuranceTypeCode, BenefitsDateInformation, InPlanNetworkIndicatorCode reason: Discovers a patient's active insurance coverage and benefits, which is coverage/benefits verification ahead of service delivery. - tag: Real-time claim status spec_file: stedi-real-time-claim-status-api-openapi.yml capability_id: BC-2870.30 capability_id_l1: BC-2870 capability_name: Claim Production & Submission confidence: 0.85 evidence: POST /change/medicalnetwork/claimstatus/v2 ClaimStatus, schemas ClaimStatusRequestContent, StatusRequestProvider, Claim reason: 276/277 claim status inquiry to payers is claim status tracking within claim production and submission. Could arguably touch denials management, but the surface is status inquiry only. - tag: Claim acknowledgments spec_file: stedi-claim-acknowledgments-api-openapi.yml capability_id: BC-2870.30 capability_id_l1: BC-2870 capability_name: Claim Production & Submission confidence: 0.8 evidence: GET /change/medicalnetwork/reports/v2/{transactionId}/277 ConvertReport277; schemas ReportsClaimAcknowledgmentResponse, ClaimLevelStatus, ServiceClaimStatus reason: Retrieval of 277 claim acknowledgment/status reports for submitted claims, i.e. status tracking of claims submitted to payers. Could arguably touch denial triage, but the surface is acknowledgment/status of submissions. - tag: Providers spec_file: stedi-providers-api-openapi.yml capability_id: BC-2890.50 capability_id_l1: BC-2890 capability_name: Provider Enrolment Management confidence: 0.78 evidence: '"The Stedi Enrollment Service manages provider enrollments with healthcare payers... provider details" with CreateProvider / UpdateProvider / ListProviders operations and ProviderSummary, TaxIdType, ProviderContact schemas' reason: The tag's operations maintain provider records inside an enrollment service whose stated purpose is enrolling providers with healthcare payers, which is Provider Enrolment Management. Slight ambiguity because the operations themselves are plain provider CRUD (could be read as master data), hence not top confidence. - tag: Eligibility PDF spec_file: stedi-eligibility-pdf-api-openapi.yml capability_id: BC-2800.30 capability_id_l1: BC-2800 capability_name: Eligibility & Benefits Verification confidence: 0.75 evidence: GET /eligibility-manager/eligibility-checks/{eligibilityCheckId}/pdf GetEligibilityCheckPdf reason: Renders the result of an eligibility check as a document; it is a presentation facet of eligibility and benefits verification rather than a separate capability. - tag: Remittances spec_file: stedi-remittances-api-openapi.yml capability_id: BC-2870.50 capability_id_l1: BC-2870 capability_name: Cash Posting & Payer Reconciliation confidence: 0.72 evidence: GET /electronic-remittance-advice/{transactionId}/pdf GetElectronicRemittanceAdvicePdf; schemas ClaimPaymentAdviceResponse, PaymentAndRemitReassociationDetails, ProviderAdjustments reason: '835 electronic remittance advice retrieval delivers payer payment/adjudication detail used for posting and reconciliation against expected reimbursement. Some ambiguity: the operations only fetch/convert the remittance rather than post cash, so confidence is moderate.' - tag: Coordination of benefits spec_file: stedi-coordination-of-benefits-api-openapi.yml capability_id: BC-2800.30 capability_id_l1: BC-2800 capability_name: Eligibility & Benefits Verification confidence: 0.7 evidence: POST /coordination-of-benefits CoordinationOfBenefits; schemas COBPlanDateInformation, COBResponseBenefitsInformationCode, EligibilityCheckError reason: Discovers other/primary coverage and benefits information for a patient, reusing eligibility-check schemas — i.e. verification of insurance coverage and benefits. Some ambiguity as COB also feeds claim billing order, hence moderate confidence. - tag: Documents spec_file: stedi-documents-api-openapi.yml capability_id: BC-2890.50 capability_id_l1: BC-2890 capability_name: Provider Enrolment Management confidence: 0.7 evidence: DELETE /documents/{documentId} DeleteEnrollmentDocument; CreateEnrollmentDocumentDownloadResponseContent; "The Stedi Enrollment Service manages provider enrollments with healthcare payers" reason: Although the operations are file delete/download, the operationIds and schemas identify them as enrollment documents within the provider-payer enrollment service, i.e. supporting provider enrolment. Confidence tempered because the surface is document handling only. recovered_from: healthcare-vertical-edges.json