openapi: 3.0.3 info: contact: email: healthcare@stedi.com license: name: Proprietary url: https://stedi.com title: Stedi Healthcare Claims Claim acknowledgments Claim submission API version: '2025-03-07' servers: - description: Production url: https://claims.us.stedi.com/2025-03-07 security: - httpApiKeyAuth: [] tags: - name: Claim submission paths: /change/medicalnetwork/institutionalclaims/v1/raw-x12-submission: post: description: Submit an 837I institutional claim in raw X12 EDI format operationId: InstitutionalClaimsRawX12Submission parameters: - description: A unique string to identify this request to the server. The key can be up to 255 characters. You can safely retry requests with the same idempotency key within 24 hours of making the first request. This prevents you from sending duplicate claims due to network errors or other intermittent failures. [Learn more](https://www.stedi.com/docs/api-reference/index#idempotency-keys). in: header name: Idempotency-Key schema: description: A unique string to identify this request to the server. The key can be up to 255 characters. You can safely retry requests with the same idempotency key within 24 hours of making the first request. This prevents you from sending duplicate claims due to network errors or other intermittent failures. [Learn more](https://www.stedi.com/docs/api-reference/index#idempotency-keys). maxLength: 255 minLength: 1 type: string requestBody: content: application/json: examples: InstitutionalClaimsRawX12Submission_example1: description: '' summary: Submit claim value: x12: ISA*00* *00* *ZZ*574183004559 *ZZ*STEDITEST *260213*2004*^*00501*000000035*0*T*>~GS*HC*574183004559*STEDITEST*20260213*200422*35*X*005010X223A2~ST*837*0001*005010X223A2~BHT*0019*00*01KHC9KCMYMA7YSW4K1ZM774ZA*20260213*2003*CH~NM1*41*2*Test Facility*****46*123456789~PER*IC**TE*2225551234~NM1*40*2*UnitedHealthcare*****46*87726~HL*1**20*1~NM1*85*2*Test Facility*****XX*1999999976~N3*123 Mulberry Street~N4*Seattle*WA*111135272~REF*EI*123456789~HL*2*1*22*0~SBR*P*18*******ZZ~NM1*IL*1*DOE*JANE****MI*98765~N3*1234 Some St~N4*Buckeye*AZ*85326~DMG*D8*19000101*F~NM1*PR*2*UnitedHealthcare*****PI*87726~CLM*55556666777888*500***11>A>0**C*Y*Y~DTP*434*RD8*20241015-20241015~DTP*435*DT*202409091000~CL1*3*9*30~HI*ABK>R45851~NM1*71*1*Provider*Doctor****XX*1999999976~LX*1~SV2*0800*HC>H0001*500*UN*1~DTP*472*RD8*20241015-20241015~REF*6R*111222333~SE*28*0001~GE*1*35~IEA*1*000000035~ schema: $ref: '#/components/schemas/InstitutionalClaimsRawX12SubmissionRequestContent' required: true responses: '200': content: application/json: examples: InstitutionalClaimsRawX12Submission_example1: description: '' summary: Submit claim value: claimReference: correlationId: 01J1M588QT2TAV2N093GNJ998T formatVersion: '5010' patientControlNumber: '26403774' payerId: AETNA rhClaimNumber: 01J1M588QT2TAV2N093GNJ998T serviceLines: - lineItemControlNumber: '1' timeOfResponse: '2024-07-10T22:05:32.203Z' controlNumber: '000000001' httpStatusCode: 200 OK meta: traceId: b727b8e7-1f00-4011-bc6e-e41444d406d8 payer: payerID: AETNA payerName: Aetna status: SUCCESS tradingPartnerServiceId: AETNA x12: ISA*00* *00* *ZZ*STEDITEST *ZZ*574183004559 *260213*2001*^*00501*929135779*0*T*>~GS*HN*STEDITEST*574183004559*20260213*200134*1*X*005010X214~ST*277*0001*005010X214~BHT*0085*08*01KHC9GC66KDRVHEJC42Q103EQ*20260213*200134*TH~HL*1**20*1~NM1*AY*2*STEDI INC*****46*117151744~TRN*1*01KHC9GC66KDRVHEJC42Q103EQ~DTP*050*D8*20260213~DTP*009*D8*20260213~HL*2*1*21*1~NM1*41*2*Test Facility*****46*123456789~TRN*2*01KHC9G8FMGZ6CA9TQT704RAMB~STC*A0>17>AY*20260213*WQ*500.0~QTY*90*1~AMT*YU*500.0~HL*3*2*19*1~NM1*85*2*Test Facility*****XX*1999999976~TRN*1*0~REF*TJ*123456789~QTY*QA*1~AMT*YU*500.0~HL*4*3*PT*0~NM1*QC*1*DOE*JANE****MI*98765~TRN*2*12345~STC*A1>20*20260213*WQ*500.0~DTP*472*RD8*20241015-20241015~SE*25*0001~GE*1*1~IEA*1*929135779~ schema: $ref: '#/components/schemas/InstitutionalClaimsRawX12SubmissionResponseContent' description: InstitutionalClaimsRawX12Submission 200 response '400': content: application/json: schema: $ref: '#/components/schemas/ValidationExceptionResponseContent' description: ValidationException 400 response '403': content: application/json: schema: $ref: '#/components/schemas/AccessDeniedExceptionResponseContent' description: AccessDeniedException 403 response '404': content: application/json: schema: $ref: '#/components/schemas/ResourceNotFoundExceptionResponseContent' description: ResourceNotFoundException 404 response '409': content: application/json: schema: $ref: '#/components/schemas/ConflictExceptionResponseContent' description: ConflictException 409 response '422': content: application/json: schema: $ref: '#/components/schemas/RequestChangedExceptionResponseContent' description: RequestChangedException 422 response '429': content: application/json: schema: $ref: '#/components/schemas/ThrottlingExceptionResponseContent' description: ThrottlingException 429 response '500': content: application/json: schema: $ref: '#/components/schemas/InternalFailureExceptionResponseContent' description: InternalFailureException 500 response '503': content: application/json: schema: $ref: '#/components/schemas/ServiceUnavailableExceptionResponseContent' description: ServiceUnavailableException 503 response '504': content: application/json: schema: $ref: '#/components/schemas/GatewayTimeoutExceptionResponseContent' description: GatewayTimeoutException 504 response tags: - Claim submission /change/medicalnetwork/institutionalclaims/v1/submission: post: description: Submit an 837I institutional claim in JSON format operationId: InstitutionalClaimsSubmission parameters: - description: A unique string to identify this request to the server. The key can be up to 255 characters. You can safely retry requests with the same idempotency key within 24 hours of making the first request. This prevents you from sending duplicate claims due to network errors or other intermittent failures. [Learn more](https://www.stedi.com/docs/api-reference/index#idempotency-keys). in: header name: Idempotency-Key schema: description: A unique string to identify this request to the server. The key can be up to 255 characters. You can safely retry requests with the same idempotency key within 24 hours of making the first request. This prevents you from sending duplicate claims due to network errors or other intermittent failures. [Learn more](https://www.stedi.com/docs/api-reference/index#idempotency-keys). maxLength: 255 minLength: 1 type: string requestBody: content: application/json: examples: InstitutionalClaimsSubmission_example1: description: '' summary: Submit claim value: claimInformation: benefitsAssignmentCertificationIndicator: Y claimChargeAmount: '500.00' claimCodeInformation: admissionSourceCode: '9' admissionTypeCode: '3' patientStatusCode: '30' claimDateInformation: admissionDateAndHour: '202409091000' statementBeginDate: '20241015' statementEndDate: '20241015' claimFilingCode: ZZ claimFrequencyCode: '0' patientControlNumber: placeOfServiceCode: '11' planParticipationCode: C principalDiagnosis: principalDiagnosisCode: R45851 qualifierCode: ABK releaseInformationCode: Y serviceLines: - assignedNumber: '0' institutionalService: lineItemChargeAmount: '500.00' measurementUnit: UN procedureCode: H0001 procedureIdentifier: HC serviceLineRevenueCode: 0800 serviceUnitCount: '1' lineItemControlNumber: '111222333' serviceDate: '20241015' serviceDateEnd: '20241015' controlNumber: '123456789' providers: - address: address1: 123 Mulberry Street city: Seattle postalCode: '111135272' state: WA contactInformation: name: Test Facility phoneNumber: '2065551234' employerId: '123456789' npi: '1999999976' organizationName: Test Facility providerType: BillingProvider - contactInformation: name: name firstName: Doctor lastName: Provider npi: '1999999976' providerType: AttendingProvider receiver: organizationName: UnitedHealthcare submitter: contactInformation: name: Test Facility phoneNumber: '2225551234' organizationName: Test Facility taxId: '123456789' subscriber: address: address1: 1234 Some St city: Buckeye postalCode: '85326' state: AZ dateOfBirth: '19000101' firstName: JANE gender: F lastName: DOE memberId: '98765' paymentResponsibilityLevelCode: P tradingPartnerName: UnitedHealthcare tradingPartnerServiceId: '87726' usageIndicator: T schema: $ref: '#/components/schemas/InstitutionalClaimsSubmissionRequestContent' required: true responses: '200': content: application/json: examples: InstitutionalClaimsSubmission_example1: description: '' summary: Submit claim value: claimReference: claimType: INST correlationId: 01JABEX6DPF4FCT2J0Y0SGFCY8 formatVersion: '5010' patientControlNumber: '00001111222233334444' payerId: '87726' rhClaimNumber: 01JABEX6DPF4FCT2J0Y0SGFCY8 serviceLines: - lineItemControlNumber: '111222333' timeOfResponse: '2024-10-16T20:04:32.962Z' controlNumber: '123456789' httpStatusCode: 200 OK meta: traceId: a742ab42-a6f3-4232-a88c-197d341afdbe payer: payerID: '87726' payerName: UnitedHealthcare status: SUCCESS tradingPartnerServiceId: '87726' x12: ISA*00* *00* *ZZ*STEDITEST *ZZ*574183004559 *260213*2001*^*00501*929135779*0*T*>~GS*HN*STEDITEST*574183004559*20260213*200134*1*X*005010X214~ST*277*0001*005010X214~BHT*0085*08*01KHC9GC66KDRVHEJC42Q103EQ*20260213*200134*TH~HL*1**20*1~NM1*AY*2*STEDI INC*****46*117151744~TRN*1*01KHC9GC66KDRVHEJC42Q103EQ~DTP*050*D8*20260213~DTP*009*D8*20260213~HL*2*1*21*1~NM1*41*2*Test Facility*****46*123456789~TRN*2*01KHC9G8FMGZ6CA9TQT704RAMB~STC*A0>17>AY*20260213*WQ*500.0~QTY*90*1~AMT*YU*500.0~HL*3*2*19*1~NM1*85*2*Test Facility*****XX*1999999976~TRN*1*0~REF*TJ*123456789~QTY*QA*1~AMT*YU*500.0~HL*4*3*PT*0~NM1*QC*1*DOE*JANE****MI*98765~TRN*2*12345~STC*A1>20*20260213*WQ*500.0~DTP*472*RD8*20241015-20241015~SE*25*0001~GE*1*1~IEA*1*929135779~ schema: $ref: '#/components/schemas/InstitutionalClaimsSubmissionResponseContent' description: InstitutionalClaimsSubmission 200 response '400': content: application/json: schema: $ref: '#/components/schemas/ValidationExceptionResponseContent' description: ValidationException 400 response '403': content: application/json: schema: $ref: '#/components/schemas/AccessDeniedExceptionResponseContent' description: AccessDeniedException 403 response '404': content: application/json: schema: $ref: '#/components/schemas/ResourceNotFoundExceptionResponseContent' description: ResourceNotFoundException 404 response '409': content: application/json: schema: $ref: '#/components/schemas/ConflictExceptionResponseContent' description: ConflictException 409 response '422': content: application/json: schema: $ref: '#/components/schemas/RequestChangedExceptionResponseContent' description: RequestChangedException 422 response '429': content: application/json: schema: $ref: '#/components/schemas/ThrottlingExceptionResponseContent' description: ThrottlingException 429 response '500': content: application/json: schema: $ref: '#/components/schemas/InternalFailureExceptionResponseContent' description: InternalFailureException 500 response '503': content: application/json: schema: $ref: '#/components/schemas/ServiceUnavailableExceptionResponseContent' description: ServiceUnavailableException 503 response '504': content: application/json: schema: $ref: '#/components/schemas/GatewayTimeoutExceptionResponseContent' description: GatewayTimeoutException 504 response tags: - Claim submission /change/medicalnetwork/professionalclaims/v3/raw-x12-submission: post: description: Submit an 837P professional claim in raw X12 EDI format operationId: ClaimsRawX12Submission parameters: - description: A unique string to identify this request to the server. The key can be up to 255 characters. You can safely retry requests with the same idempotency key within 24 hours of making the first request. This prevents you from sending duplicate claims due to network errors or other intermittent failures. [Learn more](https://www.stedi.com/docs/api-reference/index#idempotency-keys). in: header name: Idempotency-Key schema: description: A unique string to identify this request to the server. The key can be up to 255 characters. You can safely retry requests with the same idempotency key within 24 hours of making the first request. This prevents you from sending duplicate claims due to network errors or other intermittent failures. [Learn more](https://www.stedi.com/docs/api-reference/index#idempotency-keys). maxLength: 255 minLength: 1 type: string requestBody: content: application/json: examples: ClaimsRawX12Submission_example1: description: '' summary: Submit professional claim - X12 EDI value: x12: ISA*00* *00* *ZZ*574183004559 *ZZ*STEDITEST *260213*2039*^*00501*000000039*0*T*>~GS*HC*574183004559*STEDITEST*20260213*203918*39*X*005010X222A1~ST*837*0001*005010X222A1~BHT*0019*00*01KHCBK84E40QQYJVXA5VVXG54*20260213*2038*CH~NM1*41*2*Test Data Health Services, Inc.*****46*123435~PER*IC**TE*5552223333~NM1*40*2*Cigna*****46*6400~HL*1**20*1~PRV*BI*PXC*2084P0800X~NM1*85*2*Therapy Associates*****XX*1999999984~N3*123 Some St*Floor 1~N4*A City*NY*123450000~REF*EI*123456789~PER*IC*Test Data Health Services, Inc.*TE*5553334444~HL*2*1*22*0~SBR*P*18*3335555******CI~NM1*IL*1*Anon*John****MI*U7777788888~N3*2222 Random St~N4*A City*NY*123450000~DMG*D8*20000101*M~NM1*PR*2*Cigna*****PI*6400~CLM*123456789*109.2***02>B>1*Y*A*Y*Y~HI*ABK>F1111~NM1*77*2*Smith Associates~N3*1234 Other St~N4*A City*NY*123450000~LX*1~SV1*HC>90837>95*109.2*UN*1***1~DTP*472*D8*20240101~REF*6R*111222333~SE*29*0001~GE*1*39~IEA*1*000000039~ schema: $ref: '#/components/schemas/ClaimsRawX12SubmissionRequestContent' required: true responses: '200': content: application/json: examples: ClaimsRawX12Submission_example1: description: '' summary: Submit professional claim - X12 EDI value: claimReference: correlationId: 01J1M588QT2TAV2N093GNJ998T formatVersion: '5010' patientControlNumber: '22266555' payerId: '60054' rhclaimNumber: 01J1M588QT2TAV2N093GNJ998T serviceLines: - lineItemControlNumber: '111222333' timeOfResponse: '2024-07-10T22:05:32.203Z' controlNumber: '000000001' httpStatusCode: 200 OK meta: traceId: b727b8e7-1f00-4011-bc6e-e41444d406d8 payer: payerId: '60054' payerName: Cigna status: SUCCESS tradingPartnerServiceId: '60054' x12: ISA*00* *00* *ZZ*STEDITEST *ZZ*574183004559 *260213*1951*^*00501*980180479*0*T*>~GS*HN*STEDITEST*574183004559*20260213*195151*1*X*005010X214~ST*277*0001*005010X214~BHT*0085*08*01KHC8YJE8EY6A5HFR00Z5H305*20260213*195151*TH~HL*1**20*1~NM1*AY*2*STEDI INC*****46*117151744~TRN*1*01KHC8YJE8EY6A5HFR00Z5H305~DTP*050*D8*20260213~DTP*009*D8*20260213~HL*2*1*21*1~NM1*41*2*Test Data Health Services, Inc.*****46*123456~TRN*2*01KHC8Y4HNP0GVQ5NSVTPZBC0F~STC*A0>17>AY*20260213*WQ*109.2~QTY*90*1~AMT*YU*109.2~HL*3*2*19*1~NM1*85*2*Therapy Associates*****XX*1234567890~TRN*1*0~REF*TJ*123456789~QTY*QA*1~AMT*YU*109.2~HL*4*3*PT*0~NM1*QC*1*Anon*John****MI*U7777788888~TRN*2*111222333~STC*A1>20*20260213*WQ*109.2~DTP*472*RD8*20240101-20240101~SE*25*0001~GE*1*1~IEA*1*980180479~ schema: $ref: '#/components/schemas/ClaimsRawX12SubmissionResponseContent' description: ClaimsRawX12Submission 200 response '400': content: application/json: schema: $ref: '#/components/schemas/ValidationExceptionResponseContent' description: ValidationException 400 response '403': content: application/json: schema: $ref: '#/components/schemas/AccessDeniedExceptionResponseContent' description: AccessDeniedException 403 response '404': content: application/json: schema: $ref: '#/components/schemas/ResourceNotFoundExceptionResponseContent' description: ResourceNotFoundException 404 response '409': content: application/json: schema: $ref: '#/components/schemas/ConflictExceptionResponseContent' description: ConflictException 409 response '422': content: application/json: schema: $ref: '#/components/schemas/RequestChangedExceptionResponseContent' description: RequestChangedException 422 response '429': content: application/json: schema: $ref: '#/components/schemas/ThrottlingExceptionResponseContent' description: ThrottlingException 429 response '500': content: application/json: schema: $ref: '#/components/schemas/InternalFailureExceptionResponseContent' description: InternalFailureException 500 response '503': content: application/json: schema: $ref: '#/components/schemas/ServiceUnavailableExceptionResponseContent' description: ServiceUnavailableException 503 response '504': content: application/json: schema: $ref: '#/components/schemas/GatewayTimeoutExceptionResponseContent' description: GatewayTimeoutException 504 response tags: - Claim submission /change/medicalnetwork/professionalclaims/v3/submission: post: description: Submit an 837P professional claim in JSON format operationId: ClaimsSubmission parameters: - description: A unique string to identify this request to the server. The key can be up to 255 characters. You can safely retry requests with the same idempotency key within 24 hours of making the first request. This prevents you from sending duplicate claims due to network errors or other intermittent failures. [Learn more](https://www.stedi.com/docs/api-reference/index#idempotency-keys). in: header name: Idempotency-Key schema: description: A unique string to identify this request to the server. The key can be up to 255 characters. You can safely retry requests with the same idempotency key within 24 hours of making the first request. This prevents you from sending duplicate claims due to network errors or other intermittent failures. [Learn more](https://www.stedi.com/docs/api-reference/index#idempotency-keys). maxLength: 255 minLength: 1 type: string requestBody: content: application/json: examples: ClaimsSubmission_example1: description: '' summary: Submit claim value: billing: address: address1: 123 Some St address2: Floor 1 city: A City postalCode: '123450000' state: NY contactInformation: name: Test Data Health Services, Inc. phoneNumber: '5553334444' employerId: '123456789' npi: '1999999984' organizationName: Therapy Associates providerType: BillingProvider taxonomyCode: 2084P0800X claimInformation: benefitsAssignmentCertificationIndicator: Y claimChargeAmount: '109.20' claimFilingCode: CI claimFrequencyCode: '1' healthCareCodeInformation: - diagnosisCode: F1111 diagnosisTypeCode: ABK patientControlNumber: placeOfServiceCode: '02' planParticipationCode: A releaseInformationCode: Y serviceFacilityLocation: address: address1: 1234 Other St city: A City postalCode: '123450000' state: NY npi: '1999999984' organizationName: Smith Associates serviceLines: - professionalService: compositeDiagnosisCodePointers: diagnosisCodePointers: - '1' lineItemChargeAmount: '109.20' measurementUnit: UN procedureCode: '90837' procedureIdentifier: HC procedureModifiers: - '95' serviceUnitCount: '1' providerControlNumber: '111222333' renderingProvider: firstName: Jane lastName: Smith npi: '1999999984' providerType: RenderingProvider taxonomyCode: 111YP2000X serviceDate: '20240101' signatureIndicator: Y receiver: organizationName: Cigna submitter: contactInformation: name: Test Data Health Services, Inc. phoneNumber: '5552223333' organizationName: Test Data Health Services, Inc. submitterIdentification: subscriber: address: address1: 2222 Random St city: A City postalCode: '123450000' state: NY dateOfBirth: '20000101' firstName: John gender: M groupNumber: '3335555' lastName: Anon memberId: U7777788888 paymentResponsibilityLevelCode: P subscriberGroupName: Cigna tradingPartnerName: Cigna tradingPartnerServiceId: '6400' usageIndicator: T schema: $ref: '#/components/schemas/ClaimsSubmissionRequestContent' required: true responses: '200': content: application/json: examples: ClaimsSubmission_example1: description: '' summary: Submit claim value: claimReference: correlationId: 01HTCX97F6XS6F2K22D4KD59TK formatVersion: '5010' patientControlNumber: '22266555' payerId: '6400' rhclaimNumber: 01HTCX97F6XS6F2K22D4KD59TK serviceLines: - lineItemControlNumber: '111222333' timeOfResponse: '2024-04-01T13:23:54.255Z' controlNumber: '555123' httpStatusCode: 200 OK meta: traceId: a7f7c912-77f7-489d-96fc-c4ab3b5c33fc payer: payerId: '6400' payerName: Cigna status: SUCCESS tradingPartnerServiceId: '6400' x12: ISA*00* *00* *ZZ*STEDITEST *ZZ*574183004559 *260213*1951*^*00501*980180479*0*T*>~GS*HN*STEDITEST*574183004559*20260213*195151*1*X*005010X214~ST*277*0001*005010X214~BHT*0085*08*01KHC8YJE8EY6A5HFR00Z5H305*20260213*195151*TH~HL*1**20*1~NM1*AY*2*STEDI INC*****46*117151744~TRN*1*01KHC8YJE8EY6A5HFR00Z5H305~DTP*050*D8*20260213~DTP*009*D8*20260213~HL*2*1*21*1~NM1*41*2*Test Data Health Services, Inc.*****46*123456~TRN*2*01KHC8Y4HNP0GVQ5NSVTPZBC0F~STC*A0>17>AY*20260213*WQ*109.2~QTY*90*1~AMT*YU*109.2~HL*3*2*19*1~NM1*85*2*Therapy Associates*****XX*1234567890~TRN*1*0~REF*TJ*123456789~QTY*QA*1~AMT*YU*109.2~HL*4*3*PT*0~NM1*QC*1*Anon*John****MI*U7777788888~TRN*2*111222333~STC*A1>20*20260213*WQ*109.2~DTP*472*RD8*20240101-20240101~SE*25*0001~GE*1*1~IEA*1*980180479~ schema: $ref: '#/components/schemas/ClaimsSubmissionResponseContent' description: ClaimsSubmission 200 response '400': content: application/json: schema: $ref: '#/components/schemas/ValidationExceptionResponseContent' description: ValidationException 400 response '403': content: application/json: schema: $ref: '#/components/schemas/AccessDeniedExceptionResponseContent' description: AccessDeniedException 403 response '404': content: application/json: schema: $ref: '#/components/schemas/ResourceNotFoundExceptionResponseContent' description: ResourceNotFoundException 404 response '409': content: application/json: schema: $ref: '#/components/schemas/ConflictExceptionResponseContent' description: ConflictException 409 response '422': content: application/json: schema: $ref: '#/components/schemas/RequestChangedExceptionResponseContent' description: RequestChangedException 422 response '429': content: application/json: schema: $ref: '#/components/schemas/ThrottlingExceptionResponseContent' description: ThrottlingException 429 response '500': content: application/json: schema: $ref: '#/components/schemas/InternalFailureExceptionResponseContent' description: InternalFailureException 500 response '503': content: application/json: schema: $ref: '#/components/schemas/ServiceUnavailableExceptionResponseContent' description: ServiceUnavailableException 503 response '504': content: application/json: schema: $ref: '#/components/schemas/GatewayTimeoutExceptionResponseContent' description: GatewayTimeoutException 504 response tags: - Claim submission /dental-claims/raw-x12-submission: post: description: Submit an 837D dental claim in raw X12 EDI format operationId: DentalClaimsRawX12Submission parameters: - description: A unique string to identify this request to the server. The key can be up to 255 characters. You can safely retry requests with the same idempotency key within 24 hours of making the first request. This prevents you from sending duplicate claims due to network errors or other intermittent failures. [Learn more](https://www.stedi.com/docs/api-reference/index#idempotency-keys). in: header name: Idempotency-Key schema: description: A unique string to identify this request to the server. The key can be up to 255 characters. You can safely retry requests with the same idempotency key within 24 hours of making the first request. This prevents you from sending duplicate claims due to network errors or other intermittent failures. [Learn more](https://www.stedi.com/docs/api-reference/index#idempotency-keys). maxLength: 255 minLength: 1 type: string requestBody: content: application/json: examples: DentalClaimsRawX12Submission_example1: description: '' summary: Submit claim value: x12: ISA*00* *00* *ZZ*574183004559 *ZZ*STEDITEST *260213*2050*^*00501*000000042*0*T*>~GS*HC*574183004559*STEDITEST*20260213*205048*42*X*005010X224A2~ST*837*0001*005010X224A2~BHT*0019*00*01KHCCA4V6K00NFPX588G859SJ*20260213*2050*CH~NM1*41*2*ABA Inc*****46*1234567~PER*IC*BILLING DEPARTMENT*TE*3134893157~NM1*40*2*United HealthCare Dental*****46*52133~HL*1**20*1~PRV*BI*PXC*106S00000X~NM1*85*2*ABA Inc*****XX*1999999992~N3*ABA Inc 123 Some St~N4*Denver*CO*802383000~REF*EI*123456789~PER*IC*ABA Inc*TE*3134893157~HL*2*1*22*0~SBR*P*18*1234567890******FI~NM1*IL*1*Doe*John****MI*123412345~N3*1234 Some St~N4*Buckeye*AZ*85326~DMG*D8*20180615*F~NM1*PR*2*United HealthCare Dental*****PI*52133~N3*PO Box 7000~N4*Camden*SC*29000~CLM*12345*832***12>B>1*Y*A*Y*Y~DN2*3*E****JP~REF*G1*20231010012345678~HI*ABK>K081~NM1*82*1*Doe*Jane****XX*1999999992~PRV*PE*PXC*106S00000X~LX*1~SV3*AD>D7140*832**1>2*I*2*****1~TOO*JP*3*M>O~DTP*472*D8*20230428~REF*6R*a0UDo000000dd2dMAA~NM1*82*1*Doe*Jane****XX*1999999992~PRV*PE*PXC*122300000X~SE*35*0001~GE*1*42~IEA*1*000000042~ schema: $ref: '#/components/schemas/DentalClaimsRawX12SubmissionRequestContent' required: true responses: '200': content: application/json: examples: DentalClaimsRawX12Submission_example1: description: '' summary: Submit claim value: claimReference: correlationId: 01J1M588QT2TAV2N093GNJ998T formatVersion: '5010' patientControlNumber: '22266555' payerId: '60054' rhclaimNumber: 01J1M588QT2TAV2N093GNJ998T serviceLines: - lineItemControlNumber: '111222333' timeOfResponse: '2024-07-10T22:05:32.203Z' controlNumber: '000000001' httpStatusCode: 200 OK meta: traceId: b727b8e7-1f00-4011-bc6e-e41444d406d8 payer: payerId: '60054' payerName: Cigna status: SUCCESS tradingPartnerServiceId: '60054' x12: ISA*00* *00* *ZZ*STEDITEST *ZZ*574183004559 *260213*1956*^*00501*343800641*0*T*>~GS*HN*STEDITEST*574183004559*20260213*195613*1*X*005010X214~ST*277*0001*005010X214~BHT*0085*08*01KHC96JC6ZRRJ3PB88T7JR7S8*20260213*195613*TH~HL*1**20*1~NM1*AY*2*STEDI INC*****46*117151744~TRN*1*01KHC96JC6ZRRJ3PB88T7JR7S8~DTP*050*D8*20260213~DTP*009*D8*20260213~HL*2*1*21*1~NM1*41*2*ABA Inc*****46*123456789~TRN*2*01KHC96GBNYA14YRBRJGFR13P7~STC*A0>17>AY*20260213*WQ*832.0~QTY*90*1~AMT*YU*832.0~HL*3*2*19*1~NM1*85*2*ABA Inc*****XX*1999999992~TRN*1*0~REF*TJ*123456789~QTY*QA*1~AMT*YU*832.0~HL*4*3*PT*0~NM1*QC*1*Doe*John****MI*123412345~TRN*2*12345~STC*A1>20*20260213*WQ*832.0~DTP*472*RD8*20230428-20230428~SE*25*0001~GE*1*1~IEA*1*343800641~ schema: $ref: '#/components/schemas/DentalClaimsRawX12SubmissionResponseContent' description: DentalClaimsRawX12Submission 200 response '400': content: application/json: schema: $ref: '#/components/schemas/ValidationExceptionResponseContent' description: ValidationException 400 response '403': content: application/json: schema: $ref: '#/components/schemas/AccessDeniedExceptionResponseContent' description: AccessDeniedException 403 response '404': content: application/json: schema: $ref: '#/components/schemas/ResourceNotFoundExceptionResponseContent' description: ResourceNotFoundException 404 response '409': content: application/json: schema: $ref: '#/components/schemas/ConflictExceptionResponseContent' description: ConflictException 409 response '422': content: application/json: schema: $ref: '#/components/schemas/RequestChangedExceptionResponseContent' description: RequestChangedException 422 response '429': content: application/json: schema: $ref: '#/components/schemas/ThrottlingExceptionResponseContent' description: ThrottlingException 429 response '500': content: application/json: schema: $ref: '#/components/schemas/InternalFailureExceptionResponseContent' description: InternalFailureException 500 response '503': content: application/json: schema: $ref: '#/components/schemas/ServiceUnavailableExceptionResponseContent' description: ServiceUnavailableException 503 response '504': content: application/json: schema: $ref: '#/components/schemas/GatewayTimeoutExceptionResponseContent' description: GatewayTimeoutException 504 response tags: - Claim submission /dental-claims/submission: post: description: Submit an 837D dental claim in JSON format operationId: DentalClaimsSubmission parameters: - description: A unique string to identify this request to the server. The key can be up to 255 characters. You can safely retry requests with the same idempotency key within 24 hours of making the first request. This prevents you from sending duplicate claims due to network errors or other intermittent failures. [Learn more](https://www.stedi.com/docs/api-reference/index#idempotency-keys). in: header name: Idempotency-Key schema: description: A unique string to identify this request to the server. The key can be up to 255 characters. You can safely retry requests with the same idempotency key within 24 hours of making the first request. This prevents you from sending duplicate claims due to network errors or other intermittent failures. [Learn more](https://www.stedi.com/docs/api-reference/index#idempotency-keys). maxLength: 255 minLength: 1 type: string requestBody: content: application/json: examples: DentalClaimsSubmission_example1: description: '' summary: Submit claim value: billing: address: address1: ABA Inc 123 Some St city: Denver postalCode: '802383000' state: CO contactInformation: name: ABA Inc phoneNumber: '3134893157' employerId: '123456789' npi: '1999999992' organizationName: ABA Inc providerType: BillingProvider taxonomyCode: 106S00000X claimInformation: benefitsAssignmentCertificationIndicator: Y claimChargeAmount: '832.00' claimFilingCode: FI claimFrequencyCode: '1' claimSupplementalInformation: priorAuthorizationNumber: '20231010012345678' healthCareCodeInformation: - diagnosisCode: K08101 diagnosisTypeCode: ABK patientControlNumber: placeOfServiceCode: '12' planParticipationCode: A releaseInformationCode: Y serviceFacilityLocation: address: address1: ABA Inc 123 Some St city: Denver postalCode: '802383100' state: CO npi: '1999999992' organizationName: ABA Inc phoneNumber: '3134893157' serviceLines: - dentalService: compositeDiagnosisCodePointers: diagnosisCodePointers: - '1' lineItemChargeAmount: '832.00' oralCavityDesignation: - '1' - '2' placeOfServiceCode: '12' procedureCode: D7140 procedureCount: 2 prosthesisCrownOrInlayCode: I providerControlNumber: a0UDo000000dd2dMAA renderingProvider: firstName: Jane lastName: Doe npi: '1999999992' taxonomyCode: 122300000X serviceDate: '20230428' teethInformation: - toothCode: '3' toothSurfaceCodes: - M - O signatureIndicator: Y toothStatus: - toothNumber: '3' toothStatusCode: E payerAddress: address1: PO Box 7000 city: Camden postalCode: '29000' state: SC receiver: organizationName: United HealthCare Dental rendering: firstName: Jane lastName: Doe npi: '1999999992' providerType: RenderingProvider taxonomyCode: 106S00000X submitter: contactInformation: name: BILLING DEPARTMENT phoneNumber: '3134893157' organizationName: ABA Inc submitterIdentification: ~GS*HN*STEDITEST*574183004559*20260213*195613*1*X*005010X214~ST*277*0001*005010X214~BHT*0085*08*01KHC96JC6ZRRJ3PB88T7JR7S8*20260213*195613*TH~HL*1**20*1~NM1*AY*2*STEDI INC*****46*117151744~TRN*1*01KHC96JC6ZRRJ3PB88T7JR7S8~DTP*050*D8*20260213~DTP*009*D8*20260213~HL*2*1*21*1~NM1*41*2*ABA Inc*****46*123456789~TRN*2*01KHC96GBNYA14YRBRJGFR13P7~STC*A0>17>AY*20260213*WQ*832.0~QTY*90*1~AMT*YU*832.0~HL*3*2*19*1~NM1*85*2*ABA Inc*****XX*1999999992~TRN*1*0~REF*TJ*123456789~QTY*QA*1~AMT*YU*832.0~HL*4*3*PT*0~NM1*QC*1*Doe*John****MI*123412345~TRN*2*12345~STC*A1>20*20260213*WQ*832.0~DTP*472*RD8*20230428-20230428~SE*25*0001~GE*1*1~IEA*1*343800641~ schema: $ref: '#/components/schemas/DentalClaimsSubmissionResponseContent' description: DentalClaimsSubmission 200 response '400': content: application/json: schema: $ref: '#/components/schemas/ValidationExceptionResponseContent' description: ValidationException 400 response '403': content: application/json: schema: $ref: '#/components/schemas/AccessDeniedExceptionResponseContent' description: AccessDeniedException 403 response '404': content: application/json: schema: $ref: '#/components/schemas/ResourceNotFoundExceptionResponseContent' description: ResourceNotFoundException 404 response '409': content: application/json: schema: $ref: '#/components/schemas/ConflictExceptionResponseContent' description: ConflictException 409 response '422': content: application/json: schema: $ref: '#/components/schemas/RequestChangedExceptionResponseContent' description: RequestChangedException 422 response '429': content: application/json: schema: $ref: '#/components/schemas/ThrottlingExceptionResponseContent' description: ThrottlingException 429 response '500': content: application/json: schema: $ref: '#/components/schemas/InternalFailureExceptionResponseContent' description: InternalFailureException 500 response '503': content: application/json: schema: $ref: '#/components/schemas/ServiceUnavailableExceptionResponseContent' description: ServiceUnavailableException 503 response '504': content: application/json: schema: $ref: '#/components/schemas/GatewayTimeoutExceptionResponseContent' description: GatewayTimeoutException 504 response tags: - Claim submission /export/pdf: get: description: Retrieve a Stedi generatedCMS-1500 Claim Form PDF for a submitted 837P (professional) claim by business identifier operationId: ExportPDF parameters: - description: The business identifier for the claim PDF you want to retrieve. This value is returned as the `claimReference.correlationId` in the synchronous response Stedi returns when you submit a professional claim. examples: ExportPDF_example1: description: '' summary: Retrieve PDF value: a10b1111-7233-484c-8dee-b240c590c767 in: query name: businessId required: true schema: description: The business identifier for the claim PDF you want to retrieve. This value is returned as the `claimReference.correlationId` in the synchronous response Stedi returns when you submit a professional claim. type: string - description: If false, the generated PDF will only contain the form data on a white background, suitable for printing on pre-printed forms. The default is true. in: query name: background schema: description: If false, the generated PDF will only contain the form data on a white background, suitable for printing on pre-printed forms. The default is true. type: boolean responses: '200': content: application/json: examples: ExportPDF_example1: description: '' summary: Retrieve PDF value: errors: - error: No artifacts found for transaction transactionId: a10b3344-7288-484a-8dbb-b240c123c767 pdfs: - data: JVBERi0xLjcKJYGBgYEKCjcgMCBvYmoKPDwKL0ZpbHRlciAvRmxhdGVEZWNvZGUKL0xlbmd0aCAxMAo ... transactionId: a10b1111-7233-484c-8dee-b240c590c767 schema: $ref: '#/components/schemas/ExportPDFResponseContent' description: ExportPDF 200 response '400': content: application/json: schema: $ref: '#/components/schemas/ExportPDF400ErrorResponseContent' description: ExportPDF400Error 400 response '403': content: application/json: schema: $ref: '#/components/schemas/ExportPDF403ErrorResponseContent' description: ExportPDF403Error 403 response '404': content: application/json: schema: $ref: '#/components/schemas/ExportPDF404ErrorResponseContent' description: ExportPDF404Error 404 response '429': content: application/json: schema: $ref: '#/components/schemas/ThrottlingExceptionResponseContent' description: ThrottlingException 429 response '500': content: application/json: schema: $ref: '#/components/schemas/InternalFailureExceptionResponseContent' description: InternalFailureException 500 response '503': content: application/json: schema: $ref: '#/components/schemas/ServiceUnavailableExceptionResponseContent' description: ServiceUnavailableException 503 response '504': content: application/json: schema: $ref: '#/components/schemas/GatewayTimeoutExceptionResponseContent' description: GatewayTimeoutException 504 response tags: - Claim submission /export/{transactionId}/1500/pdf: get: description: Retrieve the generated CMS-1500 Claim Form PDF for a submitted 837P professional claim operationId: GetPDF1500 parameters: - description: A unique identifier for the processed claim within Stedi. This ID is included in the transaction processed event for the claim, which you can receive automatically through Stedi [webhooks](https://www.stedi.com/docs/healthcare/configure-webhooks). You can also retrieve this ID through the [Poll Transactions endpoint](https://www.stedi.com/docs/healthcare/api-reference/get-poll-transactions) or from the transaction's details page within Stedi. examples: GetPDF1500_example1: description: '' summary: Retrieve PDF value: a10b1111-7233-484c-8dee-b240c590c767 in: path name: transactionId required: true schema: description: A unique identifier for the processed claim within Stedi. This ID is included in the transaction processed event for the claim, which you can receive automatically through Stedi [webhooks](https://www.stedi.com/docs/healthcare/configure-webhooks). You can also retrieve this ID through the [Poll Transactions endpoint](https://www.stedi.com/docs/healthcare/api-reference/get-poll-transactions) or from the transaction's details page within Stedi. maxLength: 36 minLength: 36 pattern: ^[0-9a-fA-F]{8}-[0-9a-fA-F]{4}-[0-9a-fA-F]{4}-[0-9a-fA-F]{4}-[0-9a-fA-F]{12}$ type: string - description: If false, the generated PDF will only contain the form data on a white background, suitable for printing on pre-printed forms. The default is true. in: query name: background schema: description: If false, the generated PDF will only contain the form data on a white background, suitable for printing on pre-printed forms. The default is true. type: boolean responses: '200': content: application/octet-stream: examples: GetPDF1500_example1: description: '' summary: Retrieve PDF value: JVBERi0xLjcKJYGBgYEKCjcgMCBvYmoKPDwKL0ZpbHRlciAvRmxhdGVEZWNvZGUKL0xlbmd0aCAxMAo ... schema: $ref: '#/components/schemas/GetPDF1500OutputPayload' description: GetPDF1500 200 response '400': content: application/json: schema: $ref: '#/components/schemas/ValidationExceptionResponseContent' description: ValidationException 400 response '403': content: application/json: schema: $ref: '#/components/schemas/AccessDeniedExceptionResponseContent' description: AccessDeniedException 403 response '404': content: application/json: schema: $ref: '#/components/schemas/ResourceNotFoundExceptionResponseContent' description: ResourceNotFoundException 404 response '429': content: application/json: schema: $ref: '#/components/schemas/ThrottlingExceptionResponseContent' description: ThrottlingException 429 response '500': content: application/json: schema: $ref: '#/components/schemas/InternalFailureExceptionResponseContent' description: InternalFailureException 500 response '503': content: application/json: schema: $ref: '#/components/schemas/ServiceUnavailableExceptionResponseContent' description: ServiceUnavailableException 503 response '504': content: application/json: schema: $ref: '#/components/schemas/GatewayTimeoutExceptionResponseContent' description: GatewayTimeoutException 504 response tags: - Claim submission components: schemas: PregnancyIndicator: description: Code indicating whether the patient is pregnant. Can be set to `Y` - Yes. enum: - Y type: string ConflictExceptionResponseContent: description: Exception returned when a resource conflict is detected, such as a duplicate submission already in progress. properties: code: description: Unique error code identifying the specific type of error. type: string message: description: Human readable error message explaining why the request was rejected. type: string required: - message type: object QuestionResponseCode: description: Code indicating a yes or no condition response to the question. Can be set to `N` - No, `W` - Not Applicable, or `Y` - Yes. enum: - N - W - Y type: string ContractInformationContractTypeCode: description: Code indicating the type of contract. Can be set to `01` - Diagnosis Related Group (DRG), `02` - Per Diem, `03` - Variable Per Diem, `04` - Flat, `05` - Capitated, `06` - Percent, or `09` - Other. enum: - '01' - '02' - '03' - '04' - '05' - '06' - 09 type: string ValueInformation: properties: valueCode: description: The value code. maxLength: 30 type: string valueCodeAmount: description: The monetary amount associated with the value code, expressed as a decimal. pattern: ^\d+(\.\d{1,2})?$ type: string required: - valueCode - valueCodeAmount type: object ReportInformation: properties: attachmentControlNumber: description: "A control number assigned to the attachment. The payer uses this identifier to match the attachment to the claim.\n - You must include either this property or `attachmentId` in the request, but not both. Including both properties will result in an error.\n - We recommend using a ULID or UUID of up to 50 characters.\n - Stedi autogenerates a control number if you don't provide one." type: string attachmentId: description: "The unique identifier for an attachment file you previously uploaded to Stedi. This value is returned in the `attachmentId` property of the [Create Claim Attachment (275) JSON](https://www.stedi.com/docs/healthcare/api-reference/post-healthcare-submit-claim-attachment) response. Stedi uses it to generate and submit the 275 claim attachment transaction to the payer.\n - This property is **required** when you're submitting attachment files through Stedi.\n - You must include either this property or `attachmentControlNumber` in the request, but not both. Including both properties will result in an error." maxLength: 36 minLength: 36 pattern: ^[0-9a-fA-F]{8}-[0-9a-fA-F]{4}-[0-9a-fA-F]{4}-[0-9a-fA-F]{4}-[0-9a-fA-F]{12}$ type: string attachmentReportTypeCode: $ref: '#/components/schemas/AttachmentReportTypeCode' attachmentTransmissionCode: $ref: '#/components/schemas/ReportInformationAttachmentTransmissionCode' required: - attachmentReportTypeCode - attachmentTransmissionCode type: object ClaimNotes: description: Free-form information to substantiate the medical treatment that isn't provided elsewhere in the claim submission. Also used to provide narrative information from the forms Home Health Certification and Plan of Treatment or Medical Update and Patient Information, as needed to substantiate home health services. You can provide up to 10 strings in this array. properties: additionalInformation: deprecated: true items: type: string type: array allergies: description: Allergies items: type: string maxItems: 10 minItems: 1 type: array diagnosisDescription: description: Diagnosis Description items: type: string maxItems: 10 minItems: 1 type: array dme: description: Durable Medical Equipment (DME) and Supplies items: type: string maxItems: 10 minItems: 1 type: array functionalLimitsOrReasonHomebound: description: Functional Limitations, Reason Homebound, or Both items: type: string maxItems: 10 minItems: 1 type: array goalRehabOrDischargePlans: description: Goals, Rehabilitation Potential, or Discharge Plans items: type: string maxItems: 10 minItems: 1 type: array medications: description: Medications items: type: string maxItems: 10 minItems: 1 type: array nutritionalRequirments: description: Nutritional Requirements items: type: string maxItems: 10 minItems: 1 type: array ordersForDiscipLinesAndTreatments: description: Orders for Disciplines and Treatments items: type: string maxItems: 10 minItems: 1 type: array reasonsPatientLeavesHome: description: Reasons Patient Leaves Home items: type: string maxItems: 10 minItems: 1 type: array safetyMeasures: description: Safety Measures items: type: string maxItems: 10 minItems: 1 type: array supplementalPlanOfTreatment: description: Supplementary Plan of Treatment items: type: string maxItems: 10 minItems: 1 type: array timesAndReasonsPatientNotAtHome: description: Times and Reasons Patient Not at Home items: type: string maxItems: 10 minItems: 1 type: array unusualHomeOrSocialEnv: description: Unusual Home, Social Environment, or Both items: type: string maxItems: 10 minItems: 1 type: array updatedInformation: description: Updated Information items: type: string maxItems: 10 minItems: 1 type: array type: object OperatingPhysicianIdentificationQualifierCode: description: 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` - Location Number. Note that UPIN is deprecated and should not be used. enum: - 0B - 1G - G2 - LU type: string Supervising: description: 'The entity responsible for overseeing the rendering provider and the care reported in this claim. Applies when the rendering provider is supervised by a physician. Use when the provider applies to the entire claim, not just a specific service line. This should be an individual, not an organization, and you should supply at least the provider''s `lastName` and an identifier, which is typically the `npi`.' properties: address: $ref: '#/components/schemas/ClaimsAddress' deprecated: true commercialNumber: description: The commercial number of the supervising provider. type: string contactInformation: $ref: '#/components/schemas/ClaimsContactInformation' deprecated: true employerId: deprecated: true type: string firstName: description: The first name of the supervising provider. maxLength: 35 minLength: 1 type: string lastName: description: The last name of the supervising provider. maxLength: 60 minLength: 1 type: string locationNumber: description: The location number of the supervising provider. type: string middleName: description: The middle name or initial of the supervising provider. maxLength: 25 minLength: 1 type: string npi: description: The individual [National Provider Identifier (NPI)](https://www.stedi.com/docs/healthcare/national-provider-identifier) assigned to the supervising provider. pattern: ^\d{10}$ type: string organizationName: description: The supervising provider's business name, when the provider is not an individual. maxLength: 60 minLength: 1 type: string providerType: deprecated: true description: This field is now automatically populated and it only remains for backwards compatibility. type: string providerUpinNumber: deprecated: true description: Deprecated; do not use. type: string ssn: deprecated: true description: Social Security Number without spaces or punctuation (9 digits) pattern: ^\d{9}$ type: string stateLicenseNumber: description: The state license number of the supervising provider. This is assigned directly by a payer in order to identify the provider in their system. This is not commonly used. type: string suffix: description: The suffix of the supervising provider's name, such as Jr. or III. maxLength: 10 minLength: 1 type: string taxonomyCode: deprecated: true maxLength: 10 minLength: 10 pattern: ^[A-Za-z0-9]{10}$ type: string type: object PlaceOfServiceCode: description: Code identifying the type of facility where the services were or may be performed. enum: - '01' - '02' - '03' - '04' - '05' - '06' - '07' - 08 - 09 - '10' - '11' - '12' - '13' - '14' - '15' - '16' - '17' - '18' - '19' - '20' - '21' - '22' - '23' - '24' - '25' - '26' - '27' - '31' - '32' - '33' - '34' - '41' - '42' - '49' - '50' - '51' - '52' - '53' - '54' - '55' - '56' - '57' - '58' - '60' - '61' - '62' - '65' - '66' - '71' - '72' - '81' - '99' type: string DentalServiceLineAssistantSurgeon: properties: commercialNumber: description: The provider's commercial number. type: string firstName: description: The provider's first name. maxLength: 35 minLength: 1 type: string lastName: description: The provider's last name. maxLength: 60 minLength: 1 type: string locationNumber: description: The provider's location number. type: string middleName: description: The provider's middle name or initial. maxLength: 25 minLength: 1 type: string npi: description: The individual National Provider Identifier (NPI) assigned to the provider. pattern: ^\d{10}$ type: string organizationName: description: The provider's business name. maxLength: 60 minLength: 1 type: string providerUpinNumber: description: Deprecated; do not use. type: string stateLicenseNumber: description: The provider's state license number. This is assigned directly by a payer in order to identify the provider in their system. This is not commonly used. type: string suffix: description: The provider's name suffix, such as Jr. or III. maxLength: 10 minLength: 1 type: string taxonomyCode: description: Code from the National Uniform Claims Committee [Health Care Provider Taxonomy Code Set](https://taxonomy.nucc.org/). This identifies the provider's type and/or area of specialty. maxLength: 10 minLength: 10 pattern: ^[A-Za-z0-9]{10}$ type: string type: object InstitutionalReferring: description: 'Information about the provider who referred the patient for care. - Include this object only when the referring provider is different than the provider listed in the `attending` object. - Use this object for providers that apply to the entire claim. - This should be an individual, not an organization, and you should supply at least the provider''s `lastName` and an identifier, which is typically the `npi`.' properties: address: $ref: '#/components/schemas/InstitutionalAddress' deprecated: true commercialNumber: deprecated: true type: string contactInformation: $ref: '#/components/schemas/InstitutionalContactInformation' deprecated: true employerId: deprecated: true type: string firstName: description: The provider's first name. maxLength: 35 minLength: 1 type: string lastName: description: The provider's last name. maxLength: 60 minLength: 1 type: string locationNumber: deprecated: true type: string middleName: description: The provider's middle name or initial. maxLength: 25 minLength: 1 type: string npi: description: The individual [National Provider Identifier (NPI)](https://www.stedi.com/docs/healthcare/national-provider-identifier) assigned to the provider. pattern: ^\d{10}$ type: string organizationName: description: The provider's business name. maxLength: 60 minLength: 1 type: string providerType: $ref: '#/components/schemas/ReferringProviderType' deprecated: true description: This field is now automatically populated and it only remains for backwards compatibility. providerUpinNumber: deprecated: true type: string secondaryIdentificationQualifierCode: $ref: '#/components/schemas/ReferringSecondaryIdentificationQualifierCode' secondaryIdentifier: description: 'The identifier specified in `secondaryIdentifierQualifierCode`. You can only include one secondary identifier for the provider.' type: string stateLicenseNumber: deprecated: true type: string suffix: description: The provider's name suffix, such as Jr. or III. maxLength: 10 minLength: 1 type: string taxonomyCode: deprecated: true maxLength: 10 minLength: 10 pattern: ^[A-Za-z0-9]{10}$ type: string required: - lastName type: object InstitutionalRendering: description: 'Information about the provider who delivered the medical services or non-surgical procedures listed in the claim. This must be an individual, not an organization, and you must supply at least the provider''s `lastName` and an identifier, which is typically the `npi`. The provider''s `firstName` is also required, if applicable. Include this object when all of the following are true: - The rendering provider is different than the provider listed in the `attending` object. - The provider applies to the entire claim or to at least one service line. For example, if a claim had two service lines with two different rendering providers, you would include the provider for the first service line here and leave the `claimInformation.serviceLines[].renderingProvider` object for that service line blank. Then, you would specify the second provider in the appropriate service line''s `claimInformation.serviceLines[].renderingProvider` object. - State or federal regulatory requirements call for a combined claim. A combined claim includes both facility and professional components, such as a Medicaid clinic bill or a critical access hospital claim.' properties: address: $ref: '#/components/schemas/InstitutionalAddress' deprecated: true commercialNumber: deprecated: true description: The provider's commercial number. type: string contactInformation: $ref: '#/components/schemas/InstitutionalContactInformation' deprecated: true employerId: deprecated: true type: string firstName: description: The provider's first name. maxLength: 35 minLength: 1 type: string lastName: description: The provider's last name. maxLength: 60 minLength: 1 type: string locationNumber: deprecated: true description: The provider's location number. type: string middleName: description: The provider's middle name or initial. maxLength: 25 minLength: 1 type: string npi: description: The individual [National Provider Identifier (NPI)](https://www.stedi.com/docs/healthcare/national-provider-identifier) assigned to the provider. pattern: ^\d{10}$ type: string organizationName: description: The provider's business name. maxLength: 60 minLength: 1 type: string providerType: deprecated: true description: This field is now automatically populated and it only remains for backwards compatibility. type: string providerUpinNumber: deprecated: true type: string secondaryIdentificationQualifierCode: $ref: '#/components/schemas/RenderingSecondaryIdentificationQualifierCode' secondaryIdentifier: description: 'The identifier specified in the `secondaryIdentificationQualifierCode`. You can only include one secondary identifier for the provider.' type: string stateLicenseNumber: deprecated: true description: The provider's state license number. This is assigned directly by a payer in order to identify the provider in their system. This is not commonly used. type: string suffix: description: The provider's name suffix, such as Jr. or III. maxLength: 10 minLength: 1 type: string taxonomyCode: deprecated: true maxLength: 10 minLength: 10 pattern: ^[A-Za-z0-9]{10}$ type: string required: - lastName type: object ToothStatusCode: description: Can be set to `E` - To Be Extracted, `M` - Missing. enum: - E - M type: string AmbulanceCertificationConditionCodesItem: description: 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/healthcare/claims-code-lists#ambulance-certification-condition-codes) for a complete list. enum: - '01' - '04' - '05' - '06' - '07' - 08 - 09 - '12' type: string ExternalCauseOfInjuryPresentOnAdmissionIndicator: description: 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 (onset occurred prior to admission to the hospital), `U` - Unknown, or `W` - Not Applicable. enum: - N - U - Y - W type: string FormIdentification: description: Use this object to attach standardized supplemental information to the claim when required by the payer. One example is payer documentation requirements for home health services. properties: formIdentifier: description: A code from the industry code list you identified in `formTypeCode`. type: string formTypeCode: $ref: '#/components/schemas/FormTypeCode' supportingDocumentation: description: Use to provide information in response to a coded questionnaire document. items: $ref: '#/components/schemas/SupportingDocumentation' maxItems: 99 minItems: 1 type: array required: - formIdentifier - formTypeCode type: object DentalServiceLinePricingRepricingInformation: description: Repricing information about the line item. This information is completed by repricers, not providers. For capitated encounters, pricing or repricing information usually is not applicable and is provided to qualify other information within the claim. properties: exceptionCode: $ref: '#/components/schemas/ClaimsExceptionCode' measurementUnitCode: $ref: '#/components/schemas/DentalMeasurementUnitCode' description: The unit of measure for the service that was repriced. Can be set to `UN` - Units. policyComplianceCode: $ref: '#/components/schemas/PolicyComplianceCode' description: Code indicating the policy compliance status of the claim. Visit [Claims code lists](https://www.stedi.com/docs/healthcare/claims-code-lists#policy-compliance-codes-2) for a complete list. pricingMethodologyCode: $ref: '#/components/schemas/PricingMethodologyCode' rejectReasonCode: $ref: '#/components/schemas/RejectReasonCode' description: Code indicating the rejection message returned from the third party organization. Visit [Claims code lists](https://www.stedi.com/docs/healthcare/claims-code-lists#reject-reason-codes-2) for a complete list. repricedAllowedAmount: description: The dollar amount, expressed as a decimal. For example, `100.50`. pattern: ^\d+(\.\d{1,2})?$ type: string repricedApprovedHCPCSCode: description: The procedure code for the service that was repriced. type: string repricedApprovedServiceUnitCount: description: The number of units for the service that was repriced, expressed as a decimal. The maximum length for this field is 8 digits excluding the decimal. When a decimal is used, the maximum number of digits allowed to the right of the decimal is three. format: double type: number repricedSavingAmount: description: The dollar amount, expressed as a decimal. pattern: ^\d+(\.\d{1,2})?$ type: string repricingOrganizationIdentifier: description: The identifier of the organization that repriced the claim. type: string repricingPerDiemOrFlatRateAmount: description: The pricing rate associated with per diem or flat rate repricing, expressed as a decimal. type: string serviceIdQualifier: $ref: '#/components/schemas/DentalServiceIdQualifier' description: The qualifier for the type of code included in `repricedApprovedHCPCSCode`. Can be set to `AD` - American Dental Association Codes. required: - pricingMethodologyCode - repricedAllowedAmount type: object InstitutionalDelayReasonCode: description: Code indicating the reason for the delay in claim submission. Visit [Claims code lists](https://www.stedi.com/docs/healthcare/claims-code-lists#delay-reason-codes) for a complete list. enum: - '1' - '2' - '3' - '4' - '5' - '6' - '7' - '8' - '9' - '10' - '11' - '15' type: string ConditionIndicatorDurableMedicalEquipmentCertificationConditionIndicator: description: Code indicating whether there is a certification. Can be set to `N` - No or `Y` - Yes. enum: - Y - N type: string ServiceLineReferringProviderIdentificationQualifierCode: description: The type of identifier used in `secondaryIdentifier`. Can be set to `0B` - State License Number, `1G` - Provider UPIN Number, or `G2` - Provider Commercial Number. Note that UPIN is deprecated and should not be used. enum: - 0B - 1G - G2 type: string AdmittingDiagnosis: properties: admittingDiagnosisCode: description: "The admitting diagnosis code for the patient.\n - You must submit a valid, billable code at the highest level of specificity. Include the 4th - 7th characters as applicable.\n - **Don't** submit the decimal point for ICD codes. The decimal point is implied.\n - **Don't** submit ICD-10 header codes. Header codes exist to group related codes and aren't valid for billing. These header codes can change with each new version of ICD-10, so we recommend reviewing your diagnosis codes every year to ensure that they aren't classified as header codes in the most recent version. To determine whether a code is a header code, you can also search the [Value Set Authority Center](https://vsac.nlm.nih.gov/context/cs). If the 'Header' property is set, the code is a header code and you shouldn't use it in claim submissions." maxLength: 30 type: string qualifierCode: $ref: '#/components/schemas/AdmittingDiagnosisQualifierCode' required: - admittingDiagnosisCode - qualifierCode type: object 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 BillingProviderType: description: Defines the billing provider type. enum: - BillingProvider type: string DentalServiceLine: properties: assistantSurgeon: $ref: '#/components/schemas/DentalServiceLineAssistantSurgeon' description: 'Information about the assistant surgeon who rendered the care. Use this object when the rendering providers provided these services in the role of the assistant surgeon. This should be an individual, not an organization, and you should supply at least the surgeon''s `lastName` and an identifier, which is typically the `npi`.' contractInformation: $ref: '#/components/schemas/DentalContractInformation' dentalService: $ref: '#/components/schemas/DentalService' description: Information about the service rendered to the patient, including the procedure code, the line item charge amount, and the place of service. fileInformation: description: Used to send additional data specifically requested by the payer. Not commonly used. items: type: string maxItems: 10 minItems: 1 type: array lineAdjudicationInformation: description: Includes service line adjudication information for coordination of benefits between the initial payers of a health care claim and all subsequent payers. items: $ref: '#/components/schemas/DentalLineAdjudicationInformation' type: array linePricingRepricingInformation: $ref: '#/components/schemas/DentalServiceLinePricingRepricingInformation' postageTaxAmount: description: The amount of the postage, formatted as a decimal. When you include this property, the total `lineItemChargeAmount` for this service line must include this postage value. pattern: ^\d+(\.\d{1,2})?$ type: string providerControlNumber: description: A unique identifier for this service line within the claim. It appears in the 835 (ERA) response as `lineItemControlNumber`, allowing you to correlate ERAs to the specific service lines from the original claim. If you don't set this property, Stedi uses a random ULID. Stedi returns service line identifiers in the `claimReference.serviceLines[].lineItemControlNumber` object of the synchronous API response. maxLength: 30 type: string renderingProvider: $ref: '#/components/schemas/DentalServiceLineRenderingProvider' description: 'Information about the provider who rendered the services. This can be a individual or a company (a laboratory or other facility). This is where you should enter the substitute provider''s (locum tenens physician) information, if applicable. You should only include this object when the rendering provider information for this service line is different than the information listed in the `rendering` object for the entire claim.' salesTaxAmount: description: Sales tax, formatted as a decimal. When you include this property, the total `lineItemChargeAmount` for this service line must include this sales tax value. type: string serviceDate: description: The date the service was rendered (for services performed on a single day),. **Do not** supply a date here if you are including the `serviceLineDateInformation.treatmentStartDate` property in the service line. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string serviceFacilityLocation: $ref: '#/components/schemas/DentalServiceLineServiceFacilityLocation' description: "Information about where the services were rendered. This can be healthcare facilities, such as surgical centers or reference labs, OR the patient's address when services were rendered in their home.\n - Only include this object when the service facility location is **different** from the billing provider's address. If you include this object when the address is the same, Stedi omits all of the service facility location information from the claim submission, including the name and any identifiers.\n - For telehealth services, the service facility location is the provider's address, even though the patient may have been in their home or elsewhere when receiving services.\n - Sometimes the billing provider is an actual physician group that is located at the same address as a hospital, but is in fact a separate entity. In this case, you can differentiate the service facility location by including the specific suite or building number of the physician group. This ensures that the service facility location is different from the billing provider's address and is reported accurately." serviceLineDateInformation: $ref: '#/components/schemas/DentalServiceLineDateInformation' serviceLineReferenceInformation: $ref: '#/components/schemas/DentalServiceLineReferenceInformation' supervisingProvider: $ref: '#/components/schemas/DentalServiceLineSupervisingProvider' description: 'Information about the provider who oversaw the rendering provider and the care reported in this service line. Include this object when the supervising provider is different than the one listed in the `supervising` object for the entire claim. This should be an individual, not an organization, and you should supply at least the provider''s `lastName` and an identifier, which is typically the `npi`.' teethInformation: description: Identify a tooth by its number and the surfaces involved in the service. items: $ref: '#/components/schemas/ToothInformation' type: array required: - dentalService type: object ServiceLineOrderingProvider: properties: address: $ref: '#/components/schemas/ClaimsAddress' claimOfficeNumber: deprecated: true type: string commercialNumber: type: string contactInformation: $ref: '#/components/schemas/ContactInformationOrderingProvider' employerId: deprecated: true type: string employerIdentificationNumber: deprecated: true type: string firstName: description: The provider's first name. maxLength: 35 minLength: 1 type: string lastName: description: The provider's last name. maxLength: 60 minLength: 1 type: string locationNumber: deprecated: true type: string middleName: description: The provider's middle name or initial. maxLength: 25 minLength: 1 type: string naic: deprecated: true type: string npi: description: The individual [National Provider Identifier (NPI)](https://www.stedi.com/docs/healthcare/national-provider-identifier) assigned to the provider. pattern: ^\d{10}$ type: string organizationName: description: The provider's business name. maxLength: 60 minLength: 1 type: string otherIdentifier: type: string payerIdentificationNumber: type: string providerType: deprecated: true description: This field is now automatically populated and it only remains for backwards compatibility. type: string providerUpinNumber: deprecated: true type: string secondaryIdentifier: description: Secondary identifiers for the ordering provider. items: $ref: '#/components/schemas/ServiceLineOrderingProviderSecondaryIdentifierItem' maxItems: 20 minItems: 1 type: array ssn: deprecated: true description: Social Security Number without spaces or punctuation (9 digits) pattern: ^\d{9}$ type: string stateLicenseNumber: type: string suffix: description: The provider's name suffix, such as Jr. or III. maxLength: 10 minLength: 1 type: string taxonomyCode: deprecated: true maxLength: 10 minLength: 10 pattern: ^[A-Za-z0-9]{10}$ type: string type: object Attending: description: 'Information about the individual who has overall responsibility for the patient''s medical care and treatment reported in the claim. This information is required when the claim contains any services other than non-scheduled transportation claims. This provider should be an individual, not an organization, and you should supply at least the provider''s `lastName` and an identifier, which is typically the `npi`.' properties: address: $ref: '#/components/schemas/InstitutionalAddress' deprecated: true contactInformation: $ref: '#/components/schemas/InstitutionalContactInformation' deprecated: true employerId: deprecated: true type: string firstName: description: The provider's first name. maxLength: 35 minLength: 1 type: string lastName: description: The provider's last name. This is **required**. maxLength: 60 minLength: 1 type: string middleName: description: The provider's middle name or initial. maxLength: 25 minLength: 1 type: string npi: description: The individual [National Provider Identifier (NPI)](https://www.stedi.com/docs/healthcare/national-provider-identifier) assigned to the provider. pattern: ^\d{10}$ type: string organizationName: description: The provider's business name. maxLength: 60 minLength: 1 type: string providerType: deprecated: true description: This field is now automatically populated and it only remains for backwards compatibility. type: string secondaryIdentificationQualifierCode: $ref: '#/components/schemas/OperatingPhysicianIdentificationQualifierCode' secondaryIdentifier: description: 'The identifier referenced by `secondaryIdentificationQualifierCode`. For example, if `secondaryIdentificationQualifierCode` is set to `0B`, this property should be the provider''s state license number. You can only include one secondary identifier for the provider.' type: string suffix: description: The provider's name suffix, such as Jr. or III. maxLength: 10 minLength: 1 type: string taxonomyCode: description: The provider's [taxnonomy code](https://www.cms.gov/medicare/enrollment-renewal/providers-suppliers/health-care-taxonomy), a unique 10-character code that designates their classification and specialization. Only applies to the attending provider. maxLength: 10 minLength: 10 pattern: ^[A-Za-z0-9]{10}$ type: string type: object GenderWithUnknown: enum: - M - F - U type: string Subscriber: description: '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 business entity. - When a dependent has a unique, payer-assigned member ID, treat them as the `subscriber` for the claim submission - include their information here and omit the `dependent` object from the request. Stedi treats the subscriber as an individual when the request doesn''t contain a value for the `subscriber.organizationName` property. - You must set the `dateOfBirth` and `gender` properties when the subscriber is the patient. Stedi determines that the subscriber is the patient when the `dependent` object is not included in the request. - If either `dateOfBirth` or `gender` is set, you must include both properties. You can either include both properties or neither within a single request. - You must include `address` in this object when the patient is the subscriber. If the patient is a dependent, include address information in the `dependent` object instead.' properties: address: $ref: '#/components/schemas/RequestSubscriberDependentAddress' description: "The subscriber's address. Every claim must include address information in either the `subscriber` (when the patient is the subscriber) or `dependent` (when the patient is a dependent) object. You must include at least the `address1` and `city` properties in this object. The `state` and `postalCode` properties are also required for all United States and Canadian addresses.\n - The address must be the patient's correct address at the time of service. Don't use placeholder values to complete unknown address information. Use of outdated or placeholder values could cause the payer to reject, deny, or delay the claim due to suspected fraud.\n - If you don't know the patient's address, you should first submit a [Real-Time Eligibility Check](https://www.stedi.com/docs/healthcare/api-reference/post-healthcare-eligibility) for the patient and then copy the patient's address from either the `subscriber` or `dependent` object in the response.\n - If the patient doesn't have a current address, you can populate the `address1` property with `UNKNOWN` and populate the city, state, and zip code with appropriate values based on your discretion. However, some payers may have explicit rules for how to handle this situation, so you should check the payer's specific requirements before using this approach." contactInformation: $ref: '#/components/schemas/ContactInformationSubscriberDependent' dateOfBirth: description: The subscriber's date of birth. This property is **required** if the subscriber is an individual. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string firstName: description: The subscriber's first name. This property is **recommended** when the subscriber is an individual. Some payers reject requests without the `firstName` property. type: string gender: $ref: '#/components/schemas/SubscriberGender' description: "Identifies the subscriber's gender. This property is **required** when the subscriber is the patient. Can be set to `F` - Female, `M` - Male, or `U` - Unknown. \n\nSome payers may reject the claim if the patient's gender doesn't match the gender they have recorded in their member records. If the gender isn't known or the patient declines to answer, use `U` or perform an eligibility check to determine the gender according to the payer's records." groupNumber: description: "The subscriber's health plan group number.\n - Provide this property OR the `policyNumber`, not both.\n - Provide this property OR the `subscriberGroupName`, not both. If this property is set, Stedi ignores the `subscriberGroupName` property." type: string insuranceTypeCode: $ref: '#/components/schemas/SubscriberInsuranceTypeCode' description: 'Identifies the type of insurance policy within a specific insurance program. This property is **required** when sending claims to Medicare and Medicare is not the primary payer (`paymentResponsibilityLevelCode` is not set to `P`). Otherwise, don''t include this property in the claim. Visit [Claims code lists](https://www.stedi.com/docs/healthcare/claims-code-lists#insurance-type-codes) for a complete list of insurance type codes.' lastName: description: "The subscriber's last name. This property is **required** if the subscriber is an individual.\n\n **Don't** include the subscriber's name suffix, such as Jr. or III. Use the designated `suffix` property instead." type: string memberId: description: The member ID for the subscriber's insurance policy. This property is **required** if the subscriber is an individual. maxLength: 80 minLength: 2 type: string middleName: description: The subscriber's middle name or initial. type: string organizationName: description: The business name of the entity submitting the claim. When the subscriber is an organization, you should identify the patient in the `dependent` object. maxLength: 60 minLength: 1 type: string paymentResponsibilityLevelCode: $ref: '#/components/schemas/SubscriberPaymentResponsibilityLevelCode' policyNumber: description: The subscriber's health plan policy number. You should provide either this property OR the `groupNumber`, not both. type: string ssn: description: The subscriber's Social Security Number. pattern: ^\d{9}$ type: string subscriberGroupName: description: "The name of the subscriber's health plan. For example, Cigna or Blue Cross Blue Shield. \n\nProvide either this property OR the `groupNumber`, not both. If `groupNumber` is set, Stedi ignores this value and uses the value in `groupNumber`." type: string suffix: description: The suffix of the subscriber's name, such as Jr. or Sr. Only include the subscriber's personal name suffix - **don't** include professional or academic titles, such as M.D. or MBA. type: string type: object InstitutionalOtherPayerServiceFacilityLocation: description: Information regarding the other payer's service facility location. This is where the service was performed. properties: otherPayerServiceFacilityLocationIdentifier: description: The facility's identifier. The `qualifier` can be set to `OB` - State License Number, `G2` - Provider Commercial Number, or `LU` - Location Number. items: $ref: '#/components/schemas/InstitutionalReferenceIdentification' maxItems: 3 minItems: 1 type: array required: - otherPayerServiceFacilityLocationIdentifier type: object ExportPDFResponseContent: properties: errors: description: Errors that prevented Stedi from returning one or more PDFs for the specified `businessId`. This array may be empty if there were no errors. items: $ref: '#/components/schemas/PDFError' type: array pdfs: description: Data for PDF files Stedi generated for the specified `businessId`. This array may be empty if there are no PDFs available for the specified `businessId`. It may also contain multiple PDFs if there is more than one claim with the same `businessId` value. items: $ref: '#/components/schemas/PDFData' type: array type: object PatientReasonForVisitQualifierCode: description: Code identifying the type of reason for visit code used. Can be set to `APR` - International Classification of Diseases Clinical Modification Patient's Reason for Visit or `PR` - International Classification of Diseases Clinical Modification Patient's Reason for Visit. Note that ICD-9 is deprecated and cannot be used in new claims. enum: - APR - PR type: string InstitutionalServiceFacilityLocation: description: 'The service facility location. Required when the location of healthcare services is different from the billing provider''s address. - When an organization''s healthcare provider''s [NPI](https://www.stedi.com/docs/healthcare/national-provider-identifier) is provided to identify the service location, the organization healthcare provider must be external to the entity identified as the billing provider (for example, a reference lab). - The service location can''t be a component or subpart of the billing provider entity. Only include this object when the service location is **different** from the billing provider''s address. If you include this object when the address is the same, Stedi omits all of the service facility location information from the claim submission, including the name and any identifiers. - Sometimes the billing provider is an actual physician group that is located at the same address as a hospital, but is in fact a separate entity. In this case, you can differentiate the service facility location by including the specific suite or building number of the physician group. This ensures that the service facility location is different from the billing provider''s address and is reported accurately.' properties: address: $ref: '#/components/schemas/InstitutionalAddress' description: "The location where services were rendered. \n\n If this was in an an area where there are no street addresses, enter a description of where the service was rendered. For example, 'crossroad of State Road 34 and 45' or 'Exit near Mile marker 265 on Interstate 80'. \n\n For United States addresses, you **must** include the full nine-digit zip code with no separators, such as `100031502`. If you don't know the full zip code, you can find it using the [USPS ZIP Code Lookup](https://tools.usps.com/zip-code-lookup.htm) tool." identificationCode: description: The organization [National Provider Identifier (NPI)](https://www.stedi.com/docs/healthcare/national-provider-identifier) assigned to the service facility location. Required when the service location to be identified has an NPI and is not a component or subpart of the billing provider. type: string organizationName: description: The business name of the laboratory or facility. maxLength: 60 minLength: 1 type: string secondaryIdentificationQualifierCode: $ref: '#/components/schemas/ServiceFacilityLocationSecondaryIdentificationQualifierCode' secondaryIdentifier: description: 'The identifier specified in `secondaryIdentifierQualifierCode`. You can only include one secondary identifier for the service facility.' maxLength: 50 type: string required: - address - organizationName type: object RelationshipToSubscriberCode: description: 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` - Cadaver Donor, `53` - Life Partner, or `G8` - Other Relationship. enum: - '01' - '19' - '20' - '21' - '39' - '40' - '53' - G8 type: string OtherPayerSupervisingProviderIdentifierItem: properties: identifier: description: The identifier. The format and length of this value depends on the `qualifier` you set. type: string otherIdentifier: deprecated: true description: The identifier for the other payer who provided this reference number. This is only required when the reference number is provided by the non-destination payer. The value must match the `claimInformation.otherSubscriberInformation[].otherPayerName.otherPayerIdentifier` property. type: string qualifier: description: Set to `0B` - State License Number, `1G` - Provider UPIN Number, `LU` - Location Number or `G2` - Provider Commercial Number. Note that UPIN is deprecated and shouldn't be used for new claims. type: string required: - identifier - qualifier type: object InstitutionalAdjustmentGroupCode: description: Code identifying the general category of payment adjustment. Can be set to `CO` - Contractual Obligations, `CR` - Correction and Reversals, `OA` - Other adjustments, `PI` - Payor Initiated Reductions, or `PR` - Patient Responsibility. enum: - CO - CR - OA - PI - PR type: string ProfessionalService: description: Information about the service rendered. properties: compositeDiagnosisCodePointers: $ref: '#/components/schemas/CompositeDiagnosisCodePointers' copayStatusCode: $ref: '#/components/schemas/CopayStatusCode' description: description: A free form description to clarify the procedure code and any procedure modifiers, as needed. maxLength: 80 minLength: 1 type: string emergencyIndicator: $ref: '#/components/schemas/EmergencyIndicator' epsdtIndicator: $ref: '#/components/schemas/EpsdtIndicator' description: '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 care services for children under age 21 who are enrolled in Medicaid. If this value is set to `Y`, you must also include the `claimInformation.epsdtReferral` object in your claim submission.' familyPlanningIndicator: $ref: '#/components/schemas/FamilyPlanningIndicator' lineItemChargeAmount: description: The total charge amount for the service, including the provider's base charge and any applicable tax or postage. It is acceptable to set this to `0` (zero). pattern: ^\d+(\.\d{1,2})?$ type: string measurementUnit: $ref: '#/components/schemas/MeasurementUnit' placeOfServiceCode: description: A code identifying the location where services were rendered. Visit [Place of Service Codes](https://www.cms.gov/medicare/coding-billing/place-of-service-codes/code-sets) for a complete list. type: string procedureCode: description: The procedure code. type: string procedureIdentifier: $ref: '#/components/schemas/ProcedureIdentifier' procedureModifiers: description: A modifier code that clarifies or improves the reporting accuracy of the associated procedure code. If not required, do not send. items: type: string maxItems: 4 minItems: 1 type: array serviceUnitCount: description: The number of units of the service provided, formatted as a decimal. The units depend on the procedure code being billed and the nature of the service. For example, they may correspond to office visits (1 unit per visit), individual diagnostic tests (1 unit per test), or time (when a service is billed in 15-minute increments, 4 units could equal 1 hour). type: string required: - compositeDiagnosisCodePointers - lineItemChargeAmount - measurementUnit - procedureCode - procedureIdentifier - serviceUnitCount type: object PrincipalDiagnosis: properties: presentOnAdmissionIndicator: $ref: '#/components/schemas/PrincipalDiagnosisPresentOnAdmissionIndicator' principalDiagnosisCode: description: "The principal diagnosis code for the patient.\n - You must submit a valid, billable code at the highest level of specificity. Include the 4th - 7th characters as applicable.\n - **Don't** submit the decimal point for ICD codes. The decimal point is implied.\n - **Don't** submit ICD-10 header codes. Header codes exist to group related codes and aren't valid for billing. These header codes can change with each new version of ICD-10, so we recommend reviewing your diagnosis codes every year to ensure that they aren't classified as header codes in the most recent version. To determine whether a code is a header code, you can also search the [Value Set Authority Center](https://vsac.nlm.nih.gov/context/cs). If the 'Header' property is set, the code is a header code and you shouldn't use it in claim submissions." maxLength: 30 type: string qualifierCode: $ref: '#/components/schemas/PrincipalDiagnosisQualifierCode' required: - principalDiagnosisCode - qualifierCode type: object EpsdtReferral: description: Required on Early & Periodic Screening, Diagnosis, and Treatment (EPSDT) claims when the screening service is being billed in this claim. properties: certificationConditionCodeAppliesIndicator: $ref: '#/components/schemas/CertificationConditionCodeAppliesIndicator' conditionCodes: description: Code indicating the patient's status. Set to `AV` when the patient refused the referral. Set to `NU` when you set `certificationConditionCodeAppliesIndicator` to `N`. Set to `S2` when the patient is currently under treatment for the referred diagnostic or corrective health problem. Set to `ST` when _either_ the patient is referred to another provider for diagnostic or corrective treatment for at least one health problem identified during an initial or periodic screening service (not including dental referrals) _or_ the patient is scheduled for another appointment with the screening provider for diagnostic or corrective treatment for at least one health problem identified during an initial or periodic screening service (not including dental referrals). items: $ref: '#/components/schemas/EpsdtReferralConditionCodesItem' maxItems: 3 minItems: 1 type: array required: - certificationConditionCodeAppliesIndicator - conditionCodes type: object InstitutionalClaimsExceptionCode: description: 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 Hospital, `2` - Emergency Care, `3` - Services or Specialist not in Network, `4` - Out-of-Service Area, `5` - State Mandates, or `6` - Other. enum: - '1' - '2' - '3' - '4' - '5' - '6' type: string InstitutionalError: properties: code: description: The error code. type: string description: description: The description of the error code. type: string field: description: The field related to the error. type: string followupAction: description: Recommended followup actions to correct the error. type: string location: description: Where the error is located in the original request. type: string value: description: The value for the data causing the error. type: string type: object ToothInformation: properties: toothCode: description: An [American Dental Association CDT Code](https://www.ada.org/publications/cdt) for the procedures performed on a specific tooth. You can only use this object to report individual teeth. You can't use it to report areas of the oral cavity, such as quadrants or sextants. Areas of the oral cavity are reported in the `claimInformation.serviceLines[].dentalService.oralCavityDesignation` property. You can only include multiples of this object when `claimInformation.serviceLines[].dentalService.procedureCount` is equal to 1. When applicable, you can include this object up to 32 times within a single service line. type: string toothSurfaceCodes: description: Code identifying the area of the tooth that was treated. Can be set to `B` - Buccal, `D`- Distal, `F`- Facial, `I`- Incisal, `L` - Lingual, `M` - Mesial, or `O` Occlusal. items: $ref: '#/components/schemas/ToothSurfaceCode' maxItems: 5 minItems: 1 type: array required: - toothCode type: object InstitutionalMeasurementUnitCode: description: 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. enum: - F2 - GR - ME - ML - UN type: string ServiceLineResponseIdentifier: properties: lineItemControlNumber: description: A unique identifier for the service line, matching the value provided for the `claimInformation.serviceLines[].providerControlNumber` property in the claim submission. If you didn't provide a value for `providerControlNumber`, this property contains a randomly generated a ULID for the service line. type: string type: object HttpStatusCode: description: A `200` response indicates that Stedi successfully generated the X12 EDI claim format required by the payer. It does not indicate whether the payer has accepted the claim - the payer will respond later with a 277CA containing this information. [Learn more about 277CAs](https://www.stedi.com/docs/healthcare/receive-claim-responses#response-types). A `400` response indicates one or more problems with the claim data in the request. Examples include missing required fields, invalid values, or incorrect data types. The response includes a message describing the problem. enum: - 200 OK - 400 BAD_REQUEST type: string MedicareOutpatientAdjudication: description: Claim-level data related to the adjudication of Medicare claims not related to an inpatient setting. Required when outpatient adjudication information is reported in the remittance advice _or_ when you need to report remark codes. properties: claimPaymentRemarkCode: description: The remark code. Visit the X12 [Remittance Advice Remark Codes](https://x12.org/codes/remittance-advice-remark-codes) for a complete list. You can include up to five codes in this array. items: type: string maxItems: 5 minItems: 1 type: array endStageRenalDiseasePaymentAmount: description: The End-Stage Renal Disease (ESRD) payment amount, expressed as a decimal. pattern: ^\d+(\.\d{1,2})?$ type: string hcpcsPayableAmount: description: The claim Health Care Financing Administration Common Procedural Coding System (HCPCS) payable amount, expressed as a decimal. pattern: ^\d+(\.\d{1,2})?$ type: string nonPayableProfessionalComponentBilledAmount: description: The professional component amount billed but not payable, expressed as a decimal. pattern: ^\d+(\.\d{1,2})?$ type: string reimbursementRate: description: The reimbursement percentage, expressed as a decimal. type: string type: object ClaimsIndividualRelationshipCode: description: Code identifying the relationship to the person insured. Visit [Claims code lists](https://www.stedi.com/docs/healthcare/claims-code-lists#individual-relationship-codes) for a complete list. enum: - '01' - '18' - '19' - '20' - '21' - '39' - '40' - '53' - G8 type: string InstitutionalOtherPayerReferringProvider: description: Information regarding the other payer's referring provider. This is the provider who sent the patient to another provider for services. properties: otherPayerReferringProviderIdentifier: description: The provider's identifier. The `qualifier` can be set to `OB` - State License Number, `1G` - Provider UPIN Number, or `G2` - Provider Commercial Number. Note that UPIN numbers are deprecated and should not be used in new claims. items: $ref: '#/components/schemas/InstitutionalReferenceIdentification' maxItems: 3 minItems: 1 type: array required: - otherPayerReferringProviderIdentifier type: object OtherPayerBillingProviderEntityTypeQualifier: description: Code identifying the type of entity. Can be set to `1` - Person or `2` - Non-Person Entity. enum: - '1' - '2' type: string ToothSurfaceCode: enum: - B - D - F - I - L - M - O type: string OtherPayerOperatingPhysician: description: Information regarding the other payer's operating physician. The operating physician is the provider who performed the procedure. properties: otherPayerOperatingPhysicianIdentifier: description: The `qualifier` can be set to `OB` - State License Number, `1G` - Provider UPIN Number, `G2` - Provider Commercial Number, or `LU` - Location Number. Note that UPIN numbers are deprecated and should not be used in new claims. items: $ref: '#/components/schemas/InstitutionalReferenceIdentification' maxItems: 4 minItems: 1 type: array required: - otherPayerOperatingPhysicianIdentifier type: object ServiceLineProviderPurchasedService: properties: address: $ref: '#/components/schemas/ClaimsAddress' deprecated: true claimOfficeNumber: deprecated: true type: string commercialNumber: description: The provider's commercial number. type: string contactInformation: $ref: '#/components/schemas/ClaimsContactInformation' deprecated: true employerId: deprecated: true type: string employerIdentificationNumber: deprecated: true type: string firstName: deprecated: true type: string lastName: deprecated: true type: string locationNumber: deprecated: true type: string middleName: deprecated: true type: string naic: deprecated: true type: string npi: description: The [National Provider Identifier (NPI)](https://www.stedi.com/docs/healthcare/national-provider-identifier) assigned to the provider. pattern: ^\d{10}$ type: string organizationName: deprecated: true type: string otherIdentifier: deprecated: true type: string payerIdentificationNumber: description: The payer identification number. This must match the value you provided in `claimInformation.otherSubscriberInformation.otherPayerName.otherPayerIdentifier`. type: string providerType: deprecated: true description: This field is now automatically populated and it only remains for backwards compatibility. type: string providerUpinNumber: deprecated: true type: string secondaryIdentifier: description: Secondary identifiers for the purchased service provider. items: $ref: '#/components/schemas/ServiceLinePurchasedServiceProviderSecondaryIdentifierItem' maxItems: 20 minItems: 1 type: array ssn: deprecated: true description: Social Security Number without spaces or punctuation (9 digits) pattern: ^\d{9}$ type: string stateLicenseNumber: description: The provider's state license number. This is assigned directly by a payer in order to identify the provider in their system. This is not commonly used. type: string suffix: deprecated: true type: string taxonomyCode: deprecated: true maxLength: 10 minLength: 10 pattern: ^[A-Za-z0-9]{10}$ type: string type: object DentalSpecialProgramCode: description: 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 & Periodic Screening, Diagnosis and Treatment (EPSDT) or Child Assessment Program (CHAP), `02` - Physically Handicapped Children's Program, `03` - Special Federal Funding, or `05` - Disability. Codes `02`, `03`, and `05` are used for Medicaid claims only. enum: - '01' - '02' - '03' - '05' type: string InstitutionalIndividualRelationshipCode: enum: - '01' - '18' - '19' - '20' - '21' - '39' - '40' - '53' - G8 type: string ServiceLineDateInformation: description: Identify specific dates related to the service rendered. properties: beginTherapyDate: description: Required when a Durable Medical Equipment Regional Carrier Certificate of Medical Necessity (DMERC CMN) or DMERC Information Form (DIF), or Oxygen Therapy Certification is included on this service line. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string certificationRevisionOrRecertificationDate: pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string hemoglobinTestDate: description: Required on initial EPO claims service lines for dialysis patients when test results are being billed or reported. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string initialTreatmentDate: description: Required when this date is known to impact adjudication for claims involving spinal manipulation, physcial therapy, occupational therapy, or speech language pathology. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string lastCertificationDate: description: This is the date the ordering physician signed the CMN or Oxygen Therapy Certification, or the date the supplier signed the DMERC Information Form (DIF). pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string lastXRayDate: description: Required for claims involving spinal manipulation. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string prescriptionDate: description: Required when a drug is billed for this line and a prescription was written (or otherwise communicated by the prescriber if not written). pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string serumCreatineTestDate: description: Required on initial EPO claims service lines for dialysis patients when test results are being billed or reported. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string shippedDate: description: Required when billing or reporting products that were shipped. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string treatmentOrTherapyDate: description: This is the date of the latest visit or consultation. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string type: object OtherPayerRenderingProvider: description: Information about the rendering provider. properties: entityTypeQualifier: $ref: '#/components/schemas/OtherPayerRenderingProviderEntityTypeQualifier' otherPayerRenderingProviderSecondaryIdentifier: description: Identifiers for the rendering provider. items: $ref: '#/components/schemas/OtherPayerRenderingProviderIdentifierItem' maxItems: 3 minItems: 1 type: array required: - entityTypeQualifier type: object OtherDiagnosisInformation: properties: otherDiagnosisCode: description: "A diagnosis code for the patient.\n - You must submit a valid, billable code at the highest level of specificity. Include the 4th - 7th characters as applicable.\n - **Don't** submit the decimal point for ICD codes. The decimal point is implied.\n - **Don't** submit ICD-10 header codes. Header codes exist to group related codes and aren't valid for billing. These header codes can change with each new version of ICD-10, so we recommend reviewing your diagnosis codes every year to ensure that they aren't classified as header codes in the most recent version. To determine whether a code is a header code, you can also search the [Value Set Authority Center](https://vsac.nlm.nih.gov/context/cs). If the 'Header' property is set, the code is a header code and you shouldn't use it in claim submissions." maxLength: 30 type: string presentOnAdmissionIndicator: $ref: '#/components/schemas/OtherDiagnosisInformationPresentOnAdmissionIndicator' description: Indicates whether the other diagnosis was present on admission. Can be set to `N` - No (onset did NOT occur prior to admission to the hospital), `Y` - Yes (onset occurred prior to admission to the hospital), `U` - Unknown, or `W` - Not Applicable. qualifierCode: $ref: '#/components/schemas/OtherDiagnosisInformationQualifierCode' required: - otherDiagnosisCode - qualifierCode type: object DentalSubscriber: description: '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-assigned member ID, treat them as the `subscriber` for the claim submission - include their information here and omit the `dependent` object from the request. Note that the subscriber can be an individual or a business entity. Stedi treats the subscriber as an individual when the request doesn''t contain a value for the `subscriber.organizationName` property. - You must set the `dateOfBirth` and `gender` properties when the subscriber is the patient. Stedi determines that the subscriber is the patient when the `dependent` object is not included in the request. - If either `dateOfBirth` or `gender` is set, you must include both properties. You can either include both properties or neither within a single request. - You must include `address` in this object when the patient is the subscriber. If the patient is a dependent, include address information in the `dependent` object instead.' properties: address: $ref: '#/components/schemas/RequestSubscriberDependentAddress' description: "The subscriber's address. Every claim must include address information in either the `subscriber` (when the patient is the subscriber) or `dependent` (when the patient is a dependent) object. You must include at least the `address1` and `city` properties in this object. The `state` and `postalCode` properties are also required for all United States and Canadian addresses.\n - The address must be the patient's correct address at the time of service. Don't use placeholder values to complete unknown address information. Use of outdated or placeholder values could cause the payer to reject, deny, or delay the claim due to suspected fraud.\n - If you don't know the patient's address, you should first submit a [Real-Time Eligibility Check](https://www.stedi.com/docs/healthcare/api-reference/post-healthcare-eligibility) for the patient and then copy the patient's address from either the `subscriber` or `dependent` object in the response.\n - If the patient doesn't have a current address, you can populate the `address1` property with `UNKNOWN` and populate the city, state, and zip code with appropriate values based on your discretion. However, some payers may have explicit rules for how to handle this situation, so you should check the payer's specific requirements before using this approach." dateOfBirth: description: The subscriber's date of birth. This property is **required** if the subscriber is an individual. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string firstName: description: The subscriber's first name. This property is **recommended** when the subscriber is an individual. Some payers reject requests without the `firstName` property. type: string gender: $ref: '#/components/schemas/SubscriberGender' description: "Identifies the subscriber's gender. This property is **required** when the subscriber is the patient. Can be set to `F` - Female, `M` - Male, or `U` - Unknown. \n\nSome payers may reject the claim if the patient's gender doesn't match the gender they have recorded in their member records. If the gender isn't known or the patient declines to answer, use `U` or perform an eligibility check to determine the gender according to the payer's records." groupNumber: description: "The subscriber's health plan group number.\n - Provide this property OR the `policyNumber`, not both.\n - Provide this property OR the `subscriberGroupName`, not both. If this property is set, Stedi ignores the `subscriberGroupName` property." type: string insuranceTypeCode: $ref: '#/components/schemas/SubscriberInsuranceTypeCode' description: 'Identifies the type of insurance policy within a specific insurance program. This property is **required** when sending claims to Medicare and Medicare is not the primary payer (`paymentResponsibilityLevelCode` is not set to `P`). Otherwise, don''t include this property in the claim. Visit [Claims code lists](https://www.stedi.com/docs/healthcare/claims-code-lists#insurance-type-codes) for a complete list of insurance type codes.' lastName: description: "The subscriber's last name. This property is **required** if the subscriber is an individual.\n\n **Don't** include the subscriber's name suffix, such as Jr. or III. Use the designated `suffix` property instead." type: string memberId: description: The member ID for the subscriber's insurance policy. This property is **required** if the subscriber is an individual. maxLength: 80 minLength: 2 type: string middleName: description: The subscriber's middle name or initial. type: string organizationName: description: The business name of the entity submitting the claim. When the subscriber is an organization, you should identify the patient in the `dependent` object. maxLength: 60 minLength: 1 type: string paymentResponsibilityLevelCode: $ref: '#/components/schemas/SubscriberPaymentResponsibilityLevelCode' policyNumber: description: The subscriber's health plan policy number. You should provide either this property OR the `groupNumber`, not both. type: string ssn: description: The subscriber's Social Security Number. pattern: ^\d{9}$ type: string subscriberGroupName: description: "The name of the subscriber's health plan. For example, Cigna or Blue Cross Blue Shield. \n\nProvide either this property OR the `groupNumber`, not both. If `groupNumber` is set, Stedi ignores this value and uses the value in `groupNumber`." type: string suffix: description: The suffix of the subscriber's name, such as Jr. or Sr. Only include the subscriber's personal name suffix - **don't** include professional or academic titles, such as M.D. or MBA. type: string type: object PrincipalProcedureInformationQualifierCode: description: Code identifying the type of procedure code used. Can be set to `BBR` - International Classification of Diseases Clinical Modification (ICD-10-PCS) Principal Procedure Codes, `BR` - International Classification of Diseases Clinical Modification (ICD-9-CM) Principal Procedure Codes, or `CAH` - Advanced Billing Concepts (ABC) Codes. Note that ICD-9 and ABC codes are deprecated and cannot be used in new claims. enum: - BBR - BR - CAH type: string OtherPayerBillingProvider: description: Information about the billing provider. properties: entityTypeQualifier: $ref: '#/components/schemas/OtherPayerBillingProviderEntityTypeQualifier' otherPayerBillingProviderIdentifier: description: Identifiers for the billing provider. items: $ref: '#/components/schemas/OtherPayerBillingProviderIdentifierItem' maxItems: 2 minItems: 1 type: array required: - entityTypeQualifier - otherPayerBillingProviderIdentifier type: object OtherPayerReferringProvider: description: 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 specialist. properties: otherPayerReferringProviderIdentifier: description: Identifiers for the referring provider. items: $ref: '#/components/schemas/OtherPayerReferringProviderIdentifierItem' maxItems: 3 minItems: 1 type: array required: - otherPayerReferringProviderIdentifier type: object GetPDF1500OutputPayload: contentEncoding: byte description: 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. type: string ServiceLineRenderingProviderSecondaryIdentifierItem: properties: identifier: description: The identifier. The format and length of this value depends on the `qualifier` you set. type: string otherIdentifier: description: The identifier for the other payer who provided this reference number. This is only required when the reference number is provided by the non-destination payer. The value must match the `claimInformation.otherSubscriberInformation[].otherPayerName.otherPayerIdentifier` property. type: string qualifier: description: Set to `0B` - State License Number, `1G` - Provider UPIN Number, `G2` - Provider Commercial Number, or `LU` - Location Number. Note that UPIN is deprecated and shouldn't be used for new claims. type: string required: - identifier - qualifier type: object DurableMedicalEquipmentService: description: Information about durable medical equipment. For example, the rental and purchase price information. properties: days: description: The length of medical treatment required. type: string frequencyCode: $ref: '#/components/schemas/FrequencyCode' purchasePrice: description: The purchase price for the equipment, expressed as a decimal. For example, `100.50`. type: string rentalPrice: description: The rental price for the equipment, expressed as a decimal. For example, `100.50`. type: string required: - days - frequencyCode - purchasePrice - rentalPrice type: object ClaimsSubmissionResponseContent: properties: claimReference: $ref: '#/components/schemas/ClaimReference' controlNumber: description: An identifier for the transaction. type: string editResponses: description: Currently not used. items: $ref: '#/components/schemas/EditResponse' type: array editStatus: deprecated: true description: 'This shape is deprecated: Currently not used.' type: string errors: description: Errors resulting from claim edits. You must review and fix these errors before resubmitting. items: $ref: '#/components/schemas/ClaimsError' type: array failure: $ref: '#/components/schemas/Failure' httpStatusCode: $ref: '#/components/schemas/HttpStatusCode' meta: $ref: '#/components/schemas/ResponseMeta' payer: $ref: '#/components/schemas/ClaimsPayer' status: description: The status of the claim submission. type: string tradingPartnerServiceId: description: An ID for the payer you identified in the original claim. This value may differ from the `tradingPartnerServiceId` you submitted in the original request because it reflects the payer's internal concept of their ID, not necessarily the ID Stedi uses to route requests to this payer. type: string warnings: description: A list of warnings. Currently not used. items: $ref: '#/components/schemas/ClaimsWarning' type: array x12: description: 'A [277CA claim acknowledgment](https://www.stedi.com/docs/healthcare/claim-responses-overview#277ca-claim-acknowledgment) acceptance or rejection from Stedi in X12 EDI format. It indicates whether the claim has passed Stedi''s claim edits. When the claim fails one or more edits, the 277CA contains `STC` segments with information about each error. These are the same error codes that appear in the `errors` array. Note that this 277CA only indicates whether Stedi has accepted or rejected the claim submission. You may receive additional 277CA acceptances or rejections as the claim is routed to the payer.' type: string type: object InstitutionalSubscriber: description: '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-assigned member ID, treat them as the subscriber for the claim submission - include their information here and omit the `dependent` object from the request. - You must set the `dateOfBirth` and `gender` properties when the subscriber is the patient. Stedi determines that the subscriber is the patient when the `dependent` object is not included in the request. - If either `dateOfBirth` or `gender` is set, you must include both properties. You can either include both properties or neither within a single request. - You must include `address` in this object when the patient is the subscriber. If the patient is a dependent, include address information in the `dependent` object instead.' properties: address: $ref: '#/components/schemas/InstitutionalAddress' description: "The subscriber's address. Every claim must include address information in either the `subscriber` (when the patient is the subscriber) or `dependent` (when the patient is a dependent) object. You must include at least the `address1` and `city` properties in this object. The `state` and `postalCode` properties are also required for all United States and Canadian addresses.\n - The address must be the patient's correct address at the time of service. Don't use placeholder values to complete unknown address information. Use of outdated or placeholder values could cause the payer to reject, deny, or delay the claim due to suspected fraud.\n - If you don't know the patient's address, you should first submit a [Real-Time Eligibility Check](https://www.stedi.com/docs/healthcare/api-reference/post-healthcare-eligibility) for the patient and then copy the patient's address from either the `subscriber` or `dependents` object in the response.\n - If the patient doesn't have a current address, you can populate the `address1` property with `UNKNOWN` and populate the city, state, and zip code with appropriate values based on your discretion. However, some payers may have explicit rules for how to handle this situation, so you should check the payer's specific requirements before using this approach." dateOfBirth: description: The subscriber's date of birth, formatted as `YYYYMMDD`. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string firstName: description: The subscriber's first name. maxLength: 35 minLength: 1 type: string gender: $ref: '#/components/schemas/GenderWithUnknown' description: 'Code identifying the gender. Can be set to `F` - Female, `M` - Male, or `U` - Unknown. Some payers may reject the claim if the patient''s gender doesn''t match the gender they have recorded in their member records. If the gender isn''t known or the patient declines to answer, use `U` or perform an eligibility check to determine the gender according to the payer''s records.' groupNumber: description: The subscriber's health plan group number. maxLength: 50 type: string lastName: description: The subscriber's last name. **Don't** include the subscriber's name suffix, such as Jr. or III. Use the designated `suffix` property instead. maxLength: 60 minLength: 1 type: string memberId: description: The member ID for the subscriber's insurance policy. maxLength: 80 minLength: 2 type: string middleName: description: The subscriber's middle name or initial. maxLength: 25 minLength: 1 type: string paymentResponsibilityLevelCode: $ref: '#/components/schemas/InstitutionalSubscriberPaymentResponsibilityLevelCode' description: "Code identifying the payer's level of responsibility for paying this claim. Visit [Claims code lists](https://www.stedi.com/docs/healthcare/claims-code-lists#payment-responsibility-sequence-number-codes) for a complete list of possible codes.\n - Stedi sets this property to `P` - Primary by default. You only need to include it when you need to submit codes other than `P`. This can happen when the patient has multiple insurance policies. For example, if a patient is covered by both Medicare and an employer-sponsored commercial plan, you could bill the commercial plan first as `P` and then bill the Medicare payer second as `S`.\n - Either this property or `otherSubscriberInformation.paymentResponsibilityLevelCode` must be set to `P`. Stedi rejects claims - including secondary and tertiary claims - that don't include information for the primary payer." policyNumber: deprecated: true description: Deprecated. maxLength: 50 type: string ssn: description: The subscriber's Social Security Number. This must be a string of exactly nine numbers with no separators. For example, `123456789`. pattern: ^\d{9}$ type: string standardHealthId: deprecated: true description: Deprecated. Use the `memberId` property instead. type: string suffix: description: The subscriber's name suffix, such as Jr. or III. Only include the subscriber's personal name suffix - **don't** include professional or academic titles, such as M.D. or MBA. maxLength: 10 minLength: 1 type: string required: - firstName - lastName - paymentResponsibilityLevelCode type: object LineAdjustmentInformation: deprecated: true properties: bundledOrUnbundledLineNumber: pattern: ^\d{1,6}$ type: string claimAdjustment: $ref: '#/components/schemas/InstitutionalClaimAdjustment' claimPaidDate: pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string otherPayerPrimaryIdentifier: maxLength: 80 minLength: 2 type: string paidServiceUnitCount: pattern: ^\d{1,8}(\.\d{1,3})?$ type: string procedureCode: maxLength: 48 type: string procedureCodeDescription: maxLength: 80 type: string procedureModifiers: items: type: string maxItems: 4 minItems: 1 type: array remainingPatientLiability: pattern: ^\d+(\.\d{1,2})?$ type: string serviceIdQualifier: $ref: '#/components/schemas/LineAdjudicationInformationProductOrServiceIDQualifier' serviceLinePaidAmount: pattern: ^\d+(\.\d{1,2})?$ type: string required: - claimPaidDate - otherPayerPrimaryIdentifier - paidServiceUnitCount - procedureCode - remainingPatientLiability - serviceIdQualifier - serviceLinePaidAmount type: object ConditionInformation: description: HI properties: conditionCodes: description: An array of condition codes. items: type: string maxItems: 12 minItems: 1 type: array required: - conditionCodes type: object DentalService: properties: compositeDiagnosisCodePointers: $ref: '#/components/schemas/CompositeDiagnosisCodePointers' description: description: A free form description to clarify the procedure code and any procedure modifiers, as needed. maxLength: 80 minLength: 1 type: string lineItemChargeAmount: description: The total charge amount for the service, including the provider's base charge and any applicable tax or postage. It is acceptable to set this to `0` (zero). pattern: ^\d+(\.\d{1,2})?$ type: string oralCavityDesignation: description: 'Required when the nomenclature associated with the procedure reported in `claimInformation.serviceLines[].dentalService.procedureCode` refers to a quadrant or arch and the area of the oral cavity is not uniquely defined. - You can include up to five codes per service line. - You should report individual tooth numbers in one or more `teethInformation` objects.' items: type: string maxItems: 5 minItems: 1 type: array placeOfServiceCode: description: Code identifying the type of facility where the services were or may be performed. Visit [Place of Service Codes](https://www.cms.gov/medicare/coding-billing/place-of-service-codes/code-sets) for a complete list. type: string procedureCode: description: The procedure code. type: string procedureCount: description: The number of procedures performed. format: double type: number procedureModifiers: description: Modifier codes that clarify or improve the reporting accuracy of the associated procedure code. You can include up to four modifiers in this array. Only include modifier codes when required; otherwise, do not send. items: type: string maxItems: 4 minItems: 1 type: array prosthesisCrownOrInlayCode: $ref: '#/components/schemas/ProsthesisCrownOrInlayCode' required: - lineItemChargeAmount - procedureCode type: object DentalServiceLineRenderingProvider: properties: commercialNumber: description: The provider's commercial number. type: string firstName: description: The provider's first name. maxLength: 35 minLength: 1 type: string lastName: description: The provider's last name. maxLength: 60 minLength: 1 type: string locationNumber: description: The provider's location number. type: string middleName: description: The provider's middle name or initial. maxLength: 25 minLength: 1 type: string npi: description: The National Provider Identifier (NPI) assigned to the provider. pattern: ^\d{10}$ type: string organizationName: description: The provider's business name. maxLength: 60 minLength: 1 type: string providerUpinNumber: description: Deprecated; do not use. type: string stateLicenseNumber: description: The provider's state license number. This is assigned directly by a payer in order to identify the provider in their system. This is not commonly used. type: string suffix: description: The provider's name suffix, such as Jr. or III. maxLength: 10 minLength: 1 type: string taxonomyCode: description: Code from the National Uniform Claims Committee [Health Care Provider Taxonomy Code Set](https://taxonomy.nucc.org/). This identifies the provider's type and/or area of specialty. maxLength: 10 minLength: 10 pattern: ^[A-Za-z0-9]{10}$ type: string required: - taxonomyCode type: object ValidationException: description: '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 documented constraints.' properties: fieldList: description: 'A list of specific failures encountered while validating the input. A 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 title: ValidationException type: object InstitutionalClaimSupplementalInformationServiceLine: description: Additional information or documentation required for the claim. This is where you can include information about [attachments](https://www.stedi.com/docs/healthcare/submit-claim-attachments), if applicable. properties: adjustedRepricedClaimRefNumber: deprecated: true maxLength: 50 type: string autoAccidentState: deprecated: true maxLength: 50 type: string claimControlNumber: deprecated: true maxLength: 50 type: string claimNumber: deprecated: true type: string demoProjectIdentifier: deprecated: true maxLength: 50 type: string investigationalDeviceExemptionNumber: deprecated: true maxLength: 50 type: string medicalRecordNumber: deprecated: true maxLength: 50 type: string peerReviewAuthorizationNumber: deprecated: true maxLength: 50 type: string priorAuthorizationNumber: deprecated: true maxLength: 50 type: string referralNumber: deprecated: true maxLength: 50 type: string reportInformation: $ref: '#/components/schemas/InstitutionalReportInformation' description: 'Required when you plan to submit an [attachment](https://www.stedi.com/docs/healthcare/submit-claim-attachments) for the claim electronically through Stedi APIs or SFTP, when there is a paper attachment following this claim, or when the provider deems it necessary to identify additional information that is being held at the provider''s office and is available upon request. Use this object when there is a single attachment for the claim. If there are multiple attachments, use the `reportInformations` array instead.' reportInformations: description: 'An array of report information for the claim. Use this when you need to submit multiple report information records. You can submit up to 10 objects in this array. Required when you plan to submit [attachments](https://www.stedi.com/docs/healthcare/submit-claim-attachments) for the claim electronically through Stedi APIs or SFTP, when there is a paper attachment following this claim, or when the provider deems it necessary to identify that they have additional information at their office that is available upon request.' items: $ref: '#/components/schemas/InstitutionalReportInformation' maxItems: 10 minItems: 0 type: array repricedClaimNumber: deprecated: true maxLength: 50 type: string serviceAuthorizationExceptionCode: $ref: '#/components/schemas/InstitutionalServiceAuthorizationExceptionCode' deprecated: true type: object ResponseMeta: description: Metadata from Stedi about the request. properties: applicationMode: description: Indicates where this request can be found for support. type: string billerId: description: The biller ID assigned to this request. type: string senderId: description: The sender ID assigned to this request. type: string submitterId: description: The submitter ID assigned to this request. type: string traceId: description: The file execution ID, a unique identifier assigned to the processed file within the Stedi platform. type: string type: object InstitutionalServiceLineRenderingProvider: description: "Information about the provider who delivered the medical services or non-surgical procedures in this service line. This must be an individual, not an organization, and you must include the provider's `lastName` and an identifier, which is typically the `npi`. The provider's `firstName` is also required, if applicable.\n\nInclude this object when the following are both true:\n - The rendering provider for this service line is different than the provider listed in the `attending` and `rendering` objects for the entire claim.\n - State or federal regulatory requirements call for a combined claim. A combined claim includes both facility and professional components, such as a Medicaid clinic bill or a critical access hospital claim." properties: address: $ref: '#/components/schemas/InstitutionalAddress' deprecated: true commercialNumber: deprecated: true maxLength: 50 type: string contactInformation: $ref: '#/components/schemas/InstitutionalContactInformation' deprecated: true employerId: deprecated: true maxLength: 50 type: string firstName: description: The provider's first name. maxLength: 35 minLength: 1 type: string lastName: description: The provider's last name. maxLength: 60 minLength: 1 type: string locationNumber: deprecated: true maxLength: 50 type: string middleName: description: The provider's middle name or initial. maxLength: 25 minLength: 1 type: string npi: description: The individual [National Provider Identifier (NPI)](https://www.stedi.com/docs/healthcare/national-provider-identifier) assigned to the provider. pattern: ^\d{10}$ type: string organizationName: description: The provider's business name. maxLength: 60 minLength: 1 type: string providerType: $ref: '#/components/schemas/RenderingProviderType' deprecated: true description: This field is now automatically populated and it only remains for backwards compatibility. providerUpinNumber: deprecated: true maxLength: 50 type: string referenceIdentification: description: Additional identifiers for the provider. You can set `qualifier` to `2U` - Payer Identification Number. items: $ref: '#/components/schemas/InstitutionalReferenceIdentification' maxItems: 20 minItems: 1 type: array secondaryIdentificationQualifierCode: $ref: '#/components/schemas/OperatingPhysicianIdentificationQualifierCode' secondaryIdentifier: description: 'The identifier specified in `secondaryIdentifierQualifierCode`. You can only include one secondary identifier for the provider.' maxLength: 50 type: string stateLicenseNumber: deprecated: true type: string suffix: description: The provider's suffix, such as Jr. or Sr. maxLength: 10 minLength: 1 type: string taxonomyCode: deprecated: true pattern: ^[A-Za-z0-9]{10}$ type: string type: object DrugIdentification: description: To report prescribed drugs and biologics. properties: linkSequenceNumber: description: Required when the provided medication involves the compounding of two or more drugs being reported and there is no prescription number. The link sequence number is a provider assigned number that is unique to this claim. It allows the receiver to piece together the components of the compound. type: string measurementUnitCode: $ref: '#/components/schemas/MeasurementUnitCode' nationalDrugCode: type: string nationalDrugUnitCount: description: The numeric value of the drug quantity. type: string pharmacyPrescriptionNumber: description: In cases where a compound drug is being billed, the components of the compound will all have the same prescription number. Payers receiving the claim can relate all the components by matching the prescription number. type: string serviceIdQualifier: $ref: '#/components/schemas/DrugIdentificationServiceIdQualifier' required: - measurementUnitCode - nationalDrugCode - nationalDrugUnitCount - serviceIdQualifier type: object Failure: description: Currently not used. properties: code: type: string description: type: string type: object InstitutionalClaimFilingIndicatorCode: enum: - '11' - '12' - '13' - '14' - '15' - '16' - '17' - AM - BL - CH - DS - FI - HM - LM - MA - MB - MC - OF - TV - VA - WC - ZZ type: string ClaimsAddress: properties: address1: description: The first line of the street address. This typically contains the building number and street name. type: string address2: description: The second line of the street address. This typically contains the apartment or suite number. type: string city: description: The city name. type: string countryCode: description: Use the alpha-2 country codes from Part 1 of ISO 3166. type: string countrySubDivisionCode: description: Use the country subdivision codes from Part 2 of ISO 3166. type: string postalCode: description: The postal zone or zip code. Exclude punctuation and spaces. type: string state: description: The state or province code. Only required when the city is in the Unites States and Canada. type: string required: - address1 - city 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 ClaimFilingIndicatorCode: description: 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 insurance. Visit [Claims code lists](https://www.stedi.com/docs/healthcare/claims-code-lists#claim-filing-indicator-codes) for a complete list. enum: - '11' - '12' - '13' - '14' - '15' - '16' - '17' - AM - BL - CH - CI - DS - FI - HM - LM - MA - MB - MC - OF - TV - VA - WC - ZZ type: string ClaimsProvider: description: 'The entity responsible for overseeing the rendering provider and the care reported in this claim. Applies when the rendering provider is supervised by a physician. Use when the provider applies to the entire claim, not just a specific service line. This should be an individual, not an organization, and you should supply at least the provider''s `lastName` and an identifier, which is typically the `npi`.' properties: address: $ref: '#/components/schemas/ClaimsAddress' deprecated: true commercialNumber: description: The commercial number of the supervising provider. type: string contactInformation: $ref: '#/components/schemas/ClaimsContactInformation' deprecated: true employerId: deprecated: true type: string firstName: description: The first name of the supervising provider. maxLength: 35 minLength: 1 type: string lastName: description: The last name of the supervising provider. maxLength: 60 minLength: 1 type: string locationNumber: description: The location number of the supervising provider. type: string middleName: description: The middle name or initial of the supervising provider. maxLength: 25 minLength: 1 type: string npi: description: The individual [National Provider Identifier (NPI)](https://www.stedi.com/docs/healthcare/national-provider-identifier) assigned to the supervising provider. pattern: ^\d{10}$ type: string organizationName: description: The supervising provider's business name, when the provider is not an individual. maxLength: 60 minLength: 1 type: string providerType: description: This field is now automatically populated and it only remains for backwards compatibility. type: string providerUpinNumber: deprecated: true description: Deprecated; do not use. type: string ssn: deprecated: true description: Social Security Number without spaces or punctuation (9 digits) pattern: ^\d{9}$ type: string stateLicenseNumber: description: The state license number of the supervising provider. type: string suffix: description: The suffix of the supervising provider's name, such as Jr. or III. maxLength: 10 minLength: 1 type: string taxonomyCode: deprecated: true maxLength: 10 minLength: 10 pattern: ^[A-Za-z0-9]{10}$ type: string required: - providerType type: object InstitutionalLineAdjudicationInformation: properties: adjudicationOrPaymentDate: description: The date the claim was paid. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string bundledLineNumber: description: The LX assigned number of the service line into which this service line is bundled. It's only used to bundle service lines. pattern: ^\d{1,6}$ type: string lineAdjustment: description: Adjustment reason codes and amounts as needed for the service line. You can include up to five of these objects within `claimInformation.serviceLines[].lineAdjudicationInformation[].claimAdjustmentInformation`. items: $ref: '#/components/schemas/InstitutionalClaimAdjustment' type: array otherPayerPrimaryIdentifier: description: The payer ID for the payer responsible for reimbursement. maxLength: 80 minLength: 2 type: string paidServiceUnitCount: description: The number of paid units from the remittance advice. When paid units are not present on the remittance advice, use the original billed units. The maximum length for this property is 8 digits excluding the decimal. When a decimal is used, the maximum number of digits allowed to the right of the decimal is three. pattern: ^\d{1,8}(\.\d{1,3})?$ type: string procedureCode: description: The procedure code. maxLength: 48 type: string procedureCodeDescription: description: A description of the procedure identified in `procedureCode`. maxLength: 80 type: string procedureModifier: description: A modifier that conveys special circumstances related to the performance of the service. items: type: string maxItems: 4 minItems: 1 type: array productOrServiceIDQualifier: $ref: '#/components/schemas/LineAdjudicationInformationProductOrServiceIDQualifier' remainingPatientLiability: description: The remaining amount (as determined by the provider) to be paid after the other payer identified in the `otherPayerPrimaryIdentifier` property has adjudicated the claim. Expressed as a decimal. Only used in claims submitted by providers - not in payer-to-payer coordination of benefits (COB). Don't include this if you already provided `claimInformation.otherSubscriberInformation.remainingPatientLiability` for the claim. pattern: ^\d+(\.\d{1,2})?$ type: string serviceLinePaidAmount: description: The amount paid for this service line, expressed as a decimal. Zero (0) is an acceptable value. pattern: ^\d+(\.\d{1,2})?$ type: string serviceLineRevenueCode: description: The revenue code for the service line. maxLength: 48 type: string required: - adjudicationOrPaymentDate - otherPayerPrimaryIdentifier - paidServiceUnitCount - serviceLinePaidAmount - serviceLineRevenueCode type: object OccurrenceInformation: properties: occurrenceSpanCode: description: The occurrence span code. maxLength: 30 type: string occurrenceSpanCodeDate: description: The date or date range for the occurrence span. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])(-\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01]))?$ type: string required: - occurrenceSpanCode - occurrenceSpanCodeDate type: object EmergencyIndicator: description: 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 intervention as a result of severe, life threatening, or potentially disabling conditions. enum: - Y type: string InstitutionalProcedureIdentifier: description: "Code identifying the type of `procedureCode`. If you set this property, you must also set `procedureCode`.\n\nCan be set to `ER` - Jurisdiction Specific Procedure and Supply Codes, `HC` - Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes, `HP` - Health Insurance Prospective Payment System (HIPPS) Skilled Nursing Facility Rate Code, `IV` - Home Infusion EDI Coalition (HIEC) Product/Service Code, or `WK` - Advanced Billing Concepts (ABC) Codes. Note that ABC codes are deprecated and shouldn't be used in new claims. \n\nVisit [Claims code lists](https://www.stedi.com/docs/healthcare/claims-code-lists#product-or-service-id-qualifier-codes) for more information and usage instructions." enum: - ER - HC - HP - IV - WK type: string PolicyComplianceCode: enum: - '1' - '2' - '3' - '4' - '5' type: string ClaimsServiceLineSupervisingProvider: properties: address: $ref: '#/components/schemas/ClaimsAddress' deprecated: true claimOfficeNumber: deprecated: true type: string commercialNumber: description: The provider's commercial number. type: string contactInformation: $ref: '#/components/schemas/ClaimsContactInformation' deprecated: true employerId: deprecated: true description: The provider's Employer Identification Number (EIN). The EIN is typically a string of exactly nine numbers with no separators, unless otherwise specified by the provider. If you include this value, you cannot include the provider's `ssn`. type: string employerIdentificationNumber: deprecated: true description: The provider's Employer Identification Number (EIN). This field is the same as `employerId`. The EIN is typically a string of exactly nine numbers with no separators, unless otherwise specified by the provider. If you include this value, you cannot include the provider's `ssn`. type: string firstName: description: The provider's first name. maxLength: 35 minLength: 1 type: string lastName: description: The provider's last name. maxLength: 60 minLength: 1 type: string locationNumber: description: The provider's location number. type: string middleName: description: The provider's middle name or initial. maxLength: 25 minLength: 1 type: string naic: deprecated: true description: The National Association of Insurance Commissioners (NAIC) code. type: string npi: description: The individual [National Provider Identifier (NPI)](https://www.stedi.com/docs/healthcare/national-provider-identifier) assigned to the provider. pattern: ^\d{10}$ type: string organizationName: description: The provider's business name. You should include either the `lastName` or `organizationName` property in this object. maxLength: 60 minLength: 1 type: string otherIdentifier: type: string payerIdentificationNumber: deprecated: true description: The payer identification number. type: string providerType: deprecated: true description: This field is now automatically populated and it only remains for backwards compatibility. type: string providerUpinNumber: deprecated: true description: Deprecated; do not use. type: string secondaryIdentifier: description: Secondary identifiers for the supervising provider. items: $ref: '#/components/schemas/ServiceLineSupervisingProviderSecondaryIdentifierItem' maxItems: 20 minItems: 1 type: array ssn: deprecated: true description: The provider's SSN. pattern: ^\d{9}$ type: string stateLicenseNumber: description: The provider's state license number. This is assigned directly by a payer in order to identify the provider in their system. This is not commonly used. type: string suffix: description: The provider's name suffix, such as Jr. or III. maxLength: 10 minLength: 1 type: string taxonomyCode: deprecated: true description: Code from the National Uniform Claims Committee [Health Care Provider Taxonomy Code Set](https://taxonomy.nucc.org/). This identifies the provider's type and/or area of specialty. maxLength: 10 minLength: 10 pattern: ^[A-Za-z0-9]{10}$ type: string type: object DentalServiceLineServiceFacilityLocation: properties: address: $ref: '#/components/schemas/ClaimsAddress' commercialNumber: description: The provider's commercial number. type: string locationNumber: description: The provider's location number. type: string npi: description: The organization National Provider Identifier (NPI) assigned to the service facility. Only include this property when the service facility is not a component or subpart of the billing provider. Don't include when the service facility is the patient's home. pattern: ^\d{10}$ type: string organizationName: description: The provider's business name. maxLength: 60 minLength: 1 type: string providerUpinNumber: description: Deprecated; do not use. type: string required: - organizationName type: object DentalClaimsSubmissionRequestContent: properties: assistantSurgeon: $ref: '#/components/schemas/AssistantSurgeon' billing: $ref: '#/components/schemas/Billing' claimIdentifier: $ref: '#/components/schemas/ClaimIdentifier' claimInformation: $ref: '#/components/schemas/DentalClaimInformation' description: "Information about the healthcare claim. \n\n Note that the objects and properties marked as required are required for all claims, while others are conditionally required, depending on type of claim and claim circumstances. For example, you must always provide the `placeOfServiceCode` property, but you only need to provide the `otherSubscriberInformation` object in coordination of benefits scenarios. When you include a conditionally required object, you must provide all of its required properties." dependent: $ref: '#/components/schemas/DentalDependent' payToAddress: $ref: '#/components/schemas/ClaimsAddress' description: 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 paper checks at a different location, such as a PO Box, lockbox, or other mailing address. payToPlan: $ref: '#/components/schemas/PayToPlan' payerAddress: $ref: '#/components/schemas/ClaimsAddress' description: The payer's address. Some payers use this for internal routing. Only provide this address if the payer explicitly requires it. receiver: $ref: '#/components/schemas/Receiver' referring: $ref: '#/components/schemas/Referring' rendering: $ref: '#/components/schemas/Rendering' submitter: $ref: '#/components/schemas/Submitter' description: 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 submit at least `organizationName` or `lastName` properties and the `contactInformation` object. If you don't supply the `submitterIdentification` property, Stedi uses the value from `billing.npi` in the request. subscriber: $ref: '#/components/schemas/DentalSubscriber' supervising: $ref: '#/components/schemas/Supervising' tradingPartnerName: description: This is the payer's business name, like Cigna or Aetna. type: string tradingPartnerSecondaryIdentifiers: $ref: '#/components/schemas/TradingPartnerSecondaryIdentifiers' description: Secondary identifiers for the payer. You can include up to three properties in this object. tradingPartnerServiceId: description: "The payer ID. Visit the [Payer Network](https://www.stedi.com/healthcare/network) for a complete list.\n - You can send requests using the primary payer ID, the Stedi payer ID, or any alias listed in the payer record.\n - You must include leading `0` characters - payer IDs are alphanumeric strings and must be treated as complete strings, not integers. For example, use `00540` for SISCO, not `540`." type: string usageIndicator: description: Whether you want to send a test or production claim. This property also allows you to filter claims in the Stedi portal by production or test data. By default, this property is set to `P` for production data. Use `T` to designate a claim as test data. type: string required: - billing - claimInformation - receiver - submitter - subscriber - tradingPartnerServiceId type: object ValidationExceptionResponseContent: description: 'A standard error for input validation failures. Thrown when a member of the input structure falls outside of the modeled or documented constraints.' properties: code: description: A code describing the type of validation failure. type: string message: description: A message describing the causes of the validation failure. There may be more than one. type: string required: - message type: object ProsthesisCrownOrInlayCode: description: 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 `priorPlacementDate` or `estimatedPriorPlacementDate` properties within the `claimInformation.serviceLines[].serviceLineDateInformation` object. enum: - I - R type: string OtherInsuredQualifier: description: Code identifying the type of entity. Can be set to `1` - Person or `2` - Non-Person Entity. enum: - '1' - '2' type: string DentalLineAdjudicationInformation: description: Includes service line adjudication information for coordination of benefits between the initial payers of a health care claim and all subsequent payers. properties: adjudicationOrPaymentDate: description: The date the other payer adjudicated or paid the claim. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string bundledOrUnbundledLineNumber: description: The LX assigned number of the service line into which this service line is bundled. It's only used to bundle service lines. type: string claimAdjustmentInformation: description: Required when the payer made line level adjustments which caused the amount paid to differ from the amount originally charged. You can include up to five objects in this array. items: $ref: '#/components/schemas/ClaimAdjustment' maxItems: 5 minItems: 1 type: array otherPayerPrimaryIdentifier: description: The payer ID for the payer responsible for reimbursement. type: string paidServiceUnitCount: description: The number of paid units from the remittance advice. expressed as a decimal. When paid units are not present on the remittance advice, use the original billed units. The maximum length for this property is 8 digits excluding the decimal. When a decimal is used, the maximum number of digits allowed to the right of the decimal is three. type: string procedureCode: description: The procedure code. type: string procedureCodeDescription: description: The meaning of the procedure code. type: string procedureModifier: description: Modifiers that convey special circumstances related to the performance of the service. You can include up to four modifiers in this array. items: type: string maxItems: 4 minItems: 1 type: array remainingPatientLiability: description: The amount of the service line that the patient is still responsible for, expressed as a decimal. pattern: ^\d+(\.\d{1,2})?$ type: string serviceIdQualifier: $ref: '#/components/schemas/DentalLineAdjudicationInformationServiceIdQualifier' description: Code identifying the the type of product or service ID. Can be set to `AD` - American Dental Association Codes or `ER` - Jurisdiction Specific Procedure and Supply Codes. serviceLinePaidAmount: description: The amount paid for this service line, expressed as a decimal. Zero (0) is an acceptable value. pattern: ^\d+(\.\d{1,2})?$ type: string required: - adjudicationOrPaymentDate - otherPayerPrimaryIdentifier - paidServiceUnitCount - procedureCode - serviceIdQualifier - serviceLinePaidAmount type: object ReleaseOfInformationCode: description: 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 to `I` - Informed Consent to Release Medical Information or `Y` - Yes. Code `I` is required when the provider has not collected a signature AND state or federal laws do not require a signature be collected. Code `Y` is required when the provider has collected a signature OR when state or federal laws require a signature be collected. enum: - I - Y type: string AssistantSurgeon: description: 'Information about the assistant surgeon who rendered the care. Use this object when the rendering providers provided these services in the role of the assistant surgeon. This should be an individual, not an organization, and you should supply at least the surgeon''s `lastName`, `taxonomyCode`, and an identifier, which is typically the `npi`.' properties: address: $ref: '#/components/schemas/ClaimsAddress' commercialNumber: description: The provider's commercial number. type: string contactInformation: $ref: '#/components/schemas/ClaimsContactInformation' firstName: description: The assistant surgeon's first name. maxLength: 35 minLength: 1 type: string lastName: description: The assistant surgeon's last name. You must include either the `lastName` or `organizationName` property in this object. maxLength: 60 minLength: 1 type: string locationNumber: description: The provider's location number. type: string middleName: description: The assistant surgeon's middle name or initial. maxLength: 25 minLength: 1 type: string npi: description: The individual National Provider Identifier (NPI) assigned to the surgeon. pattern: ^\d{10}$ type: string providerUpinNumber: deprecated: true description: Deprecated; do not use. type: string stateLicenseNumber: description: The provider's state license number. This is assigned directly by a payer in order to identify the provider in their system. This is not commonly used. type: string suffix: description: The assistant surgeon's name suffix, such as Jr. or III. maxLength: 10 minLength: 1 type: string taxonomyCode: description: "Code from the National Uniform Claims Committee [Health Care Provider Taxonomy Code Set](https://taxonomy.nucc.org/). This identifies the provider's type and/or area of specialty. For example, code `\t1223S0112X` is for Oral and Maxillofacial Surgery." maxLength: 10 minLength: 10 pattern: ^[A-Za-z0-9]{10}$ type: string required: - lastName - taxonomyCode type: object OtherPayerReferringProviderIdentifierItem: properties: identifier: description: The identifier. The format and length of this value depends on the `qualifier` you set. type: string otherIdentifier: deprecated: true description: The identifier for the other payer who provided this reference number. This is only required when the reference number is provided by the non-destination payer. The value must match the `claimInformation.otherSubscriberInformation[].otherPayerName.otherPayerIdentifier` property. type: string qualifier: description: Set to `0B` - State License Number, `1G` - Provider UPIN Number, or `G2` - Provider Commercial Number. Note that UPIN is deprecated and shouldn't be used for new claims. type: string required: - identifier - qualifier type: object InstitutionalPayer: description: Information about the payer for the submitted claim. properties: payerID: description: The payer's ID. This is the same as the `tradingPartnerServiceId`. type: string payerName: description: The payer's business name, such as Aetna or Cigna. maxLength: 60 minLength: 1 type: string type: object ClaimContractInformation: description: Required when the submitter is contractually obligated to supply this information on post-adjudicated claims. properties: contractAmount: description: The total dollar amount of the contract, expressed as a decimal. For example, `100.50`. pattern: ^\d+(\.\d{1,2})?$ type: string contractCode: description: The contract code. This is a unique identifier for the contract. type: string contractPercentage: description: The allowance or charge percent, expressed as a decimal. For example, `0.80`. type: string contractTypeCode: $ref: '#/components/schemas/ClaimContractInformationContractTypeCode' contractVersionIdentifier: description: An additional identifer for the contract. Identifies the revision level of a particular format, program, technique or algorithm. type: string termsDiscountPercentage: description: Terms discount percentage, expressed as a percent, available to the purchaser if an invoice is paid on or before the Terms Discount Due Date. type: string required: - contractTypeCode type: object SubscriberPaymentResponsibilityLevelCode: description: "Code identifying the payer's level of responsibility for paying this claim. Visit [Claims code lists](https://www.stedi.com/docs/healthcare/claims-code-lists#payment-responsibility-sequence-number-codes) for a complete list of possible codes.\n - Stedi sets this property to `P` - Primary by default. You only need to include it when you need to submit codes other than `P`. This can happen when the patient has multiple insurance policies. For example, if a patient is covered by both Medicare and an employer-sponsored commercial plan, you could bill the commercial plan first as `P` and then bill the Medicare payer second as `S`.\n - Either this property or `otherSubscriberInformation.paymentResponsibilityLevelCode` must be set to `P` to indicate the primary insurance payer. Stedi rejects claims - including secondary and tertiary claims - that don't include information for the primary payer." enum: - A - B - C - D - E - F - G - H - P - S - T - U type: string DurableMedicalEquipmentCertificateOfMedicalNecessityAttachmentTransmissionCode: description: Code indicating the timing, transmission method, or format by which attachments will be sent. Required when the actual attachment is maintained by an attachment warehouse or similar vendor. Visit [Claims code lists](https://www.stedi.com/docs/healthcare/claims-code-lists#attachment-transmission-codes) for a complete list. Use code `NS` when the paperwork is available on request at the provider's site, but is not being sent with the claim at this time. enum: - AB - AD - AF - AG - NS type: string PatientReasonForVisit: properties: patientReasonForVisitCode: description: "The patient's reason for visit code.\n - You must submit a valid, billable code at the highest level of specificity. Include the 4th - 7th characters as applicable.\n - **Don't** submit the decimal point for ICD codes. The decimal point is implied.\n - **Don't** submit ICD-10 header codes. Header codes exist to group related codes and aren't valid for billing. These header codes can change with each new version of ICD-10, so we recommend reviewing your diagnosis codes every year to ensure that they aren't classified as header codes in the most recent version. To determine whether a code is a header code, you can also search the [Value Set Authority Center](https://vsac.nlm.nih.gov/context/cs). If the 'Header' property is set, the code is a header code and you shouldn't use it in claim submissions." maxLength: 30 type: string qualifierCode: $ref: '#/components/schemas/PatientReasonForVisitQualifierCode' required: - patientReasonForVisitCode - qualifierCode type: object DentalContractInformationContractTypeCode: description: Code indicating the type of contract. Can be set to `02` - Per Diem, `03` - Variable Per Diem, `04` - Flat, `05` - Capitated, `06` - Percent, or `09` - Other. enum: - '02' - '03' - '04' - '05' - '06' - 09 type: string DentalServiceLineDateInformation: description: Identify specific dates related to the service rendered. properties: applianceDate: description: The date the appliance was placed. Required when the orthodontic appliance placement date is different than the date you supplied in `claimInformation.claimDateInformation.appliancePlacementDate`. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string estimatedPriorPlacementDate: description: The estimated date when the previous appliance was placed. Either this property or `priorPlacementDate` is required when the `claimInformation.serviceLines[].dentalService.prosthesisCrownOrInlayCode` for this service line is set to `R` for Replacement. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string priorPlacementDate: description: The exact date when the previous appliance was placed. Either this property or `estimatedPriorPlacementDate` is required when the `claimInformation.serviceLines[].dentalService.prosthesisCrownOrInlayCode` for this service line is set to `R` for Replacement. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string replacementDate: description: The date the orthodontic appliance was replaced. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string treatmentCompletionDate: description: The date the treatment was completed. If you include this property, **do not** include the `serviceDate` property in this service line. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string treatmentStartDate: description: 'The date the treatment began. This may apply to the following scenarios: initial impression or preparation for a crown or denture, reporting initial endontic treatment, or reporting the implant fixture placement. If you include this property, **do not** include the `serviceDate` property in this service line.' pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string type: object ClaimNote: description: Comments or special instructions related to the claim. Contains information required to substantiate the medical treatment that isn't provided elsewhere in the claim. properties: additionalInformation: description: Additional information. type: string certificationNarrative: description: Certification narrative. type: string diagnosisDescription: description: Additional information about the diagnosis. type: string goalRehabOrDischargePlans: description: Information about goals, rehabilitation potential, or discharge plans. type: string thirdPartOrgNotes: description: Notes from a third-party organization. type: string type: object OrthodonticTotalMonthsOfTreatment: properties: monthsCount: description: The estimated number of treatment months, expressed as a decimal. format: double type: number monthsRemaining: description: The number of months remaining in the treatment, expressed as a decimal. format: double type: number treatmentIndicator: description: The only allowed value is `Y`, which indicates that services reported in this claim are for orthodontic purposes. Only include this property if you haven't set the `monthsCount` or `monthsRemaining` properties. type: string type: object AdmittingDiagnosisQualifierCode: description: Code identifying the type of admitting diagnosis code used. Can be set to `ABJ` - International Classification of Diseases Clinical Modification (ICD-10-CM) Admitting Diagnosis or `BJ` - International Classification of Diseases Clinical Modification (ICD-9-CM) Admitting Diagnosis. Note that ICD-9 is deprecated and cannot be used in new claims. enum: - ABJ - BJ type: string ContactInformationSubscriberDependent: description: Only use this object for payer administrative contacts on property and casualty claims. Otherwise, you shoudn't include contact information here. If you include this object, you must supply at least one communication method (phone, fax, or email). properties: email: description: The email address. type: string faxNumber: description: The fax number. type: string name: description: The full name of the person or office. type: string phoneExtension: description: The phone extension, if applicable. type: string phoneNumber: description: The phone number, formatted as AAABBBCCCC, where AAA represents the area code. For example, you would format the phone number `123-456-7890` as `1234567890`. You should always include the area code, if applicable. Don't include long distance access numbers (such as `1`) or extensions in this field. type: string required: - name type: object PlanParticipationCode: description: Code indicating whether the provider accepts assignment. This refers to whether the provider accepts assignment and/or has a participation agreement with the destination payer. It does not indicate whether the patient has assigned benefits to the provider. Can be set to `A` - Assigned, `B` - Assignment Accepted on Clinical Lab Services Only, or `C` - Not Assigned. Choose `A` when the provider accepts assignment and/or has a participation agreement with the destination payer, OR the provider does not accept assignment and/or have a participation agreement, but is advising the payer to adjudicate this specific claim under the participating provider benefits allowed under certain plans. enum: - A - B - C type: string PayToPlanName: description: Use for subrogation payment requests. If you include this information, you must also set the `claimInformation.otherSubscriberInformation.payerPaidAmount` to the amount the payer (for example, Medicaid) actually paid. properties: address: $ref: '#/components/schemas/InstitutionalAddress' description: Specify the location of the named party. claimOfficeNumber: description: The Claim Office Number. maxLength: 50 type: string identificationCode: description: The identification code specified by the `identificationCodeQualifier`. maxLength: 80 minLength: 2 type: string identificationCodeQualifier: $ref: '#/components/schemas/PayToPlanNameIdentificationCodeQualifier' naic: description: The National Association of Insurance Commisioners (NAIC) code. This is the five-digit identifier assigned to each insurance company. pattern: ^\d{5}$ type: string organizationName: description: The business name of the organization to which the payment should be made. maxLength: 60 minLength: 1 type: string payerIdentificationNumber: description: The payer identification number. Only include this information when the `identificationCodeQualifier` is set to `XV` - Centers for Medicare and Medicaid Services PlanID. maxLength: 50 type: string taxId: description: The payer tax identification number (TIN). This is a unique number assigned to the payer by the IRS. pattern: ^\d{9}$ type: string required: - identificationCode - identificationCodeQualifier - organizationName - taxId type: object SpecialProgramCode: description: 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` - Physically Handicapped Children's Program, `03` - Special Federal Funding, `05` - Disability, or `09` - Second Opinion or Surgery. enum: - '02' - '03' - '05' - 09 type: string ClaimContractInformationContractTypeCode: description: 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` - Percent, or `09` - Other. enum: - '01' - '02' - '03' - '04' - '05' - '06' - 09 type: string InstitutionalProviderType: enum: - BillingProvider - AttendingProvider - ReferringProvider - RenderingProvider type: string ClaimAdjustment: properties: adjustmentDetails: items: $ref: '#/components/schemas/ClaimAdjustmentDetails' maxItems: 6 minItems: 1 type: array adjustmentGroupCode: $ref: '#/components/schemas/AdjustmentGroupCode' required: - adjustmentDetails - adjustmentGroupCode type: object Ordering: deprecated: true description: Deprecated; please use `claimInformation.serviceLines[].orderingProvider` instead. properties: address: $ref: '#/components/schemas/ClaimsAddress' claimOfficeNumber: type: string commercialNumber: type: string contactInformation: $ref: '#/components/schemas/ClaimsContactInformation' employerId: type: string employerIdentificationNumber: type: string firstName: type: string lastName: type: string locationNumber: type: string middleName: type: string naic: type: string npi: pattern: ^\d{10}$ type: string organizationName: type: string payerIdentificationNumber: type: string providerType: deprecated: true description: This field is now automatically populated and it only remains for backwards compatibility. type: string providerUpinNumber: type: string ssn: description: Social Security Number without spaces or punctuation (9 digits) pattern: ^\d{9}$ type: string stateLicenseNumber: type: string suffix: type: string taxonomyCode: maxLength: 10 minLength: 10 pattern: ^[A-Za-z0-9]{10}$ type: string type: object OtherPayerRenderingProviderIdentifierItem: properties: identifier: description: The identifier. The format and length of this value depends on the `qualifier` you set. type: string otherIdentifier: deprecated: true description: The identifier for the other payer who provided this reference number. This is only required when the reference number is provided by the non-destination payer. The value must match the `claimInformation.otherSubscriberInformation[].otherPayerName.otherPayerIdentifier` property. type: string qualifier: description: Set to `0B` - State License Number, `1G` - Provider UPIN Number, `LU` - Location Number, or `G2` - Provider Commercial Number. Note that UPIN is deprecated and shouldn't be used for new claims. type: string required: - identifier - qualifier type: object ClaimIdentifier: description: "A code specifying the type of transaction. Defaults to `CH` if not provided.\n - `31`: Only for use by state Medicaid agencies performing post payment recovery.\n - `CH`: Use when the transaction contains only fee for service claims or claims with at least one chargeable line item. Also use when it's not clear whether a transaction contains claims or capitated encounters, or if the transaction contains a mix of claims and capitated encounters.\n - `RP`: Use for capitated encounters. Also use when the transaction is being sent to an entity for purposes other than adjudication of a claim. For example, when you're sending the claim to a state health agency that is using the claim for health data reporting purposes." enum: - '31' - CH - RP type: string ClaimSupplementalInformation: description: Additional information or documentation required for the claim. This is where you can include information about [attachments](https://www.stedi.com/docs/healthcare/submit-claim-attachments), if applicable. properties: adjustedRepricedClaimNumber: description: Required when the repricer believes this information is necessary. Providers should not complete this property. type: string carePlanOversightNumber: description: Required when the physician is billing Medicare for Care Plan Oversight (CPO). This is the number of the home health agency or hospice providing Medicare covered services to the patient. type: string claimControlNumber: description: 'This is the Payer Claim Control Number (PCCN) for an existing claim that this claim is meant to replace or cancel. This property is generally **required** when the `claimInformation.claimFrequencyCode` is set to `7` or `8`. One exception to this guidance is Original Medicare, which specifies that you omit the PCCN from resubmissions. Visit [Resubmit or cancel claims](https://www.stedi.com/docs/healthcare/resubmit-cancel-claims) for complete details and information about where to find the PCCN for an existing claim.' type: string claimNumber: deprecated: true description: 'The claim number assigned by clearinghouse, van, etc. Stedi overwrites this value when it sends the claim to the payer, so you shouldn''t include this property in your request. We strongly recommend using the `claimInformation.patientControlNumber` property as your claim tracking ID.' type: string cliaNumber: description: Required for all CLIA certified facilities performing CLIA covered laboratory services. When this claim contains both in-house and outsourced laboratory services, use the CLIA Number for laboratory services performed by the billing or rendering provider. You can report outsourced laboratory services in the `serviceLines` object. type: string demoProjectIdentifier: description: Required when it is necessary to identify claims that are atypical in ways such as content, purpose, and/or payment. For example, claims made as the result of a demonstration or a clinical trial. type: string investigationalDeviceExemptionNumber: description: Required when claim involves a Food and Drug Administration (FDA) assigned investigational device exemption (IDE) number. When more than one IDE applies, you must split into separate claims. type: string mammographyCertificationNumber: description: Required when mammography services are rendered by a certified mammography provider. type: string medicalRecordNumber: description: Required when the provider needs to identify the actual medical record of the patient for this episode of care. type: string medicareCrossoverReferenceId: description: Required when the submitter is Medicare and the claim is a Medigap or COB crossover claim. type: string priorAuthorizationNumber: description: 'Required when an authorization number is assigned by the payer or UMO _and_ the services on this claim were preauthorized. The UMO (Utilization Management Organization) is generally the entity empowered to make a decision regarding the outcome of a health services review or the owner of information. If there are multiple prior authorization numbers associated with this claim, send one here and then override it as necessary for each service line in `claimInformation.serviceLines[].serviceLineReferenceInformation.priorAuthorization`.' type: string referralNumber: description: Required when a referral number is assigned by the payer or Utilization Management Organization (UMO) _and_ a referral is involved. type: string reportInformation: $ref: '#/components/schemas/ReportInformation' description: 'Required when you plan to submit an [attachment](https://www.stedi.com/docs/healthcare/submit-claim-attachments) for the claim electronically through Stedi APIs or SFTP, when there is a paper attachment following this claim, or when the provider deems it necessary to identify additional information that is being held at the provider''s office and is available upon request. Use this object when there is a single attachment for the claim. If there are multiple attachments, use the `reportInformations` array instead.' reportInformations: description: 'An array of report information for the claim. Use this when you need to submit multiple report information records. You can submit up to 10 objects in this array. Required when you plan to submit [attachments](https://www.stedi.com/docs/healthcare/submit-claim-attachments) for the claim electronically through Stedi APIs or SFTP, when there is a paper attachment following this claim, or when the provider deems it necessary to identify that they have additional information at their office that is available upon request.' items: $ref: '#/components/schemas/ReportInformation' maxItems: 10 minItems: 0 type: array repricedClaimNumber: description: Required when the repricer believes this information is necessary. Providers should not complete this property. type: string serviceAuthorizationExceptionCode: $ref: '#/components/schemas/ServiceAuthorizationExceptionCode' type: object AdjustmentGroupCode: description: Code identifying the general category of payment adjustment. Can be set to `CO` - Contractual Obligations, `CR` - Correction and Reversals, `OA` - Other Adjustments, `PI` - Payor Initiated Reductions, or `PR - Patient Responsibility. enum: - CO - CR - OA - PI - PR type: string PriorAuthorization: properties: otherPayerPrimaryIdentifier: description: This must match the value in `claimInformation.otherSubscriberInformation.otherPayerName.otherPayerIdentifier`. type: string priorAuthorizationOrReferralNumber: description: 'A prior authorization (preauthorization) number that applies to this service line. **Important**: Only use this property for service-level prior authorization numbers that differ from the claim-level authorization (`claimInformation.claimSupplementalInformation.priorAuthorizationNumber`).' type: string required: - priorAuthorizationOrReferralNumber type: object PricingMethodologyCode: description: Code indicating the pricing or repricing methodology. Visit [Claims code lists](https://www.stedi.com/docs/healthcare/claims-code-lists#pricing-methodology-codes-2) for a complete list. enum: - '00' - '01' - '02' - '03' - '04' - '05' - '06' - '07' - 08 - 09 - '10' - '11' - '12' - '13' - '14' type: string Rendering: description: 'Information about the person or company (laboratory or other facility) who rendered the care. Use this object for all types of rendering providers including laboratories. When a substitute provider (locum tenens) was used, enter that provider''s information here. - Use when the provider applies to the entire claim or to at least one service line. For example, if a claim had two service lines with two different rendering providers, you would include the provider for the first service line here and leave the `claimInformation.serviceLines[].renderingProvider` object for that service line blank. Then, you would specify the second provider in the appropriate service line''s `claimInformation.serviceLines[].renderingProvider` object. - You can omit this object when the rendering provider is the same as the billing provider. In that case, you would include the provider''s information in the `billing` object and leave this object blank.' properties: address: $ref: '#/components/schemas/ClaimsAddress' deprecated: true commercialNumber: description: The provider's commercial number. type: string contactInformation: $ref: '#/components/schemas/ClaimsContactInformation' deprecated: true firstName: description: The provider's first name, if the provider is an individual. maxLength: 35 minLength: 1 type: string lastName: description: The provider's last name, if the provider is an individual. You must include either the `lastName` or `organizationName` property in this object. maxLength: 60 minLength: 1 type: string locationNumber: description: The provider's location number. type: string middleName: description: The provider's middle name or initial, if the provider is an individual. maxLength: 25 minLength: 1 type: string npi: description: The [National Provider Identifier (NPI)](https://www.stedi.com/docs/healthcare/national-provider-identifier) assigned to the provider. pattern: ^\d{10}$ type: string organizationName: description: The provider's business name, if the provider is an organization. You must include either the `lastName` or `organizationName` property in this object. maxLength: 60 minLength: 1 type: string providerType: deprecated: true description: This field is now automatically populated and it only remains for backwards compatibility. type: string providerUpinNumber: deprecated: true description: Deprecated; do not use. type: string stateLicenseNumber: description: The provider's state license number. This is assigned directly by a payer in order to identify the provider in their system. This is not commonly used. type: string suffix: description: The provider's name suffix, such as Jr. or III. maxLength: 10 minLength: 1 type: string taxonomyCode: description: Code from the National Uniform Claims Committee [Health Care Provider Taxonomy Code Set](https://taxonomy.nucc.org/). This identifies the provider's type and/or area of specialty. maxLength: 10 minLength: 10 pattern: ^[A-Za-z0-9]{10}$ type: string type: object CopayStatusCode: description: Code indicating whether co-payment requirements were met. Can be set to `O` - Copay exempt. enum: - '0' type: string DentalPlanParticipationCode: enum: - A - C type: string InstitutionalService: properties: description: description: The description of the procedure identified in `procedureCode`. type: string lineItemChargeAmount: description: The amount charged for the service line, expressed as a decimal. This should include the provider's base charge and any applicable tax amounts reported within the service line. pattern: ^\d+(\.\d{1,2})?$ type: string measurementUnit: $ref: '#/components/schemas/InstitutionalMeasurementUnit' nonCoveredChargeAmount: description: The non-covered service amount, expressed as a decimal. This property isn't intended for sending claims to secondary insurance after receiving a remittance from the original payer. It's used when a provider wants to report that they performed an uncovered service for a patient, but they aren't asking for payment. For example, a cosmetic procedure that isn't covered by the patient's health plan. pattern: ^\d+(\.\d{1,2})?$ type: string procedureCode: description: The procedure code. If you set this property, you must also set the `procedureIdentifier`. type: string procedureIdentifier: $ref: '#/components/schemas/InstitutionalProcedureIdentifier' procedureModifiers: description: A modifier that conveys special circumstances related to the performance of the service. items: type: string maxItems: 4 minItems: 1 type: array serviceLineRevenueCode: description: The identifying number for the product or service. Visit the [National Uniform Billing Committee (NUBC) Codes](https://www.nubc.org/license) documentation for a complete list. maxLength: 48 type: string serviceUnitCount: description: 'The number of units of service provided. The maximum length for this property is 8 digits, excluding the decimal. When a decimal is used, the maximum number of digits allowed to the right of the decimal is 3. The units depend on the procedure code being billed and the nature of the service. For example, they may correspond to days (1 unit = 1 inpatient day), individual treatments or encounters (3 units = 3 dialysis sessions), or medication doses (2 units = 2 doses or vials).' maxLength: 15 type: string required: - lineItemChargeAmount - measurementUnit - serviceLineRevenueCode - serviceUnitCount type: object PDFData: properties: data: contentEncoding: byte description: A base64 encoded string of the CMS-1500 Claim Form PDF. To render the PDF, you must decode the base64 string and save it to a file with a `.pdf` extension. type: string transactionId: description: "A unique identifier for the processed claim associated with the specified `businessId`. \n\nThis ID is included in the transaction processed event for each claim, which you can receive automatically through Stedi [webhooks](https://www.stedi.com/docs/healthcare/configure-webhooks). You can also retrieve this ID through the [Poll Transactions endpoint](https://www.stedi.com/docs/healthcare/api-reference/get-poll-transactions) or from the transaction's details page within Stedi." maxLength: 36 minLength: 36 pattern: ^[0-9a-fA-F]{8}-[0-9a-fA-F]{4}-[0-9a-fA-F]{4}-[0-9a-fA-F]{4}-[0-9a-fA-F]{12}$ type: string type: object DependentGender: description: '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 answer or does not identify as male or female. Note that some payers may reject the claim if the patient''s gender doesn''t match the gender they have recorded in their member records.' enum: - M - F - U type: string OtherSubscriberInformationInsuranceTypeCode: description: Code identifying the type of insurance policy within a specific insurance program. Visit [Claims code lists](https://www.stedi.com/docs/healthcare/claims-code-lists#insurance-type-codes) for a complete list. enum: - '12' - '13' - '14' - '15' - '16' - '41' - '42' - '43' - '47' type: string InstitutionalClaimReference: description: Information about the claim. properties: claimType: description: The type of claim, always `INST`. type: string correlationId: description: An identifier Stedi assigns to the claim. type: string customerClaimNumber: description: A tracking number that Stedi assigns to the claim. type: string formatVersion: description: The X12 EDI version Stedi used to generate the claim for the payer. This is always `5010`. type: string patientControlNumber: description: The `patientControlNumber` from the original request, if supplied. This is a unique identifier that you assign to the claim so you can track the claim and correlate it with responses from the payer. type: string payerId: description: The payer's ID. This is the same as the `tradingPartnerServiceId`. type: string rhClaimNumber: description: A tracking number Stedi assigns to the claim. This is the same as the `correlationId`. type: string serviceLines: description: Contains a unique identifier for each service line, listed in the order the service lines were included in the claim. You can use these identifiers to correlate payer responses to specific service lines. items: $ref: '#/components/schemas/ServiceLineResponseIdentifier' type: array submitterId: description: Stedi's ID for the entity that submitted the claim. type: string timeOfResponse: description: A timestamp for Stedi's response to the claim submission. type: string type: object InstitutionalSubscriberPaymentResponsibilityLevelCode: description: 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 Six, `D` - Payer Responsibility Seven, `E` - Payer Responsibility Eight, `F` - Payer Responsibility Nine, `G` - Payer Responsibility Ten, `H` - Payer Responsibility Eleven, `P` - Primary, `S` - Secondary, `T` Tertiary, or `U` - Unknown (only use in payer-to-payer COB claims). enum: - A - B - C - D - E - F - G - H - P - S - T - U type: string MissingParameter: description: Returned when a required parameter is missing from the request. properties: code: description: The error code `MISSING_PARAMETER`. type: string details: description: Additional details about the missing parameter error. type: string message: description: A message indicating which parameter is missing. type: string title: MissingParameter type: object OtherPayerSupervisingProvider: description: Information about the supervising provider. properties: otherPayerSupervisingProviderIdentifier: description: Identifiers for the supervising provider. items: $ref: '#/components/schemas/OtherPayerSupervisingProviderIdentifierItem' maxItems: 3 minItems: 1 type: array required: - otherPayerSupervisingProviderIdentifier type: object CompositeDiagnosisCodePointers: description: '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.healthCareCodeInformation` object array. The pointer values can be from 1 to 12 (integer numbers). - You **must** set at least one pointer for the primary diagnosis. Then, you can add up to three additional pointers (up to four in total). - The number of pointers cannot exceed the number of diagnosis codes in the `claimInformation.healthCareCodeInformation` object array. For example, if you only supplied one diagnosis code, then the only valid pointer value is 1. - Don''t put ICD-10-CM codes here - they belong in `claimInformation.healthCareCodeInformation`.' properties: diagnosisCodePointers: description: A diagnosis code pointer for this service line. items: type: string maxItems: 2147483647 minItems: 1 type: array required: - diagnosisCodePointers type: object ClaimInformationRelatedCausesCodeItem: description: 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. enum: - AA - EM - OA type: string OperatingPhysician: properties: firstName: description: The physician's first name. maxLength: 35 minLength: 1 type: string identificationQualifierCode: $ref: '#/components/schemas/OperatingPhysicianIdentificationQualifierCode' lastName: description: The physician's last name. maxLength: 60 minLength: 1 type: string middleName: description: The physician's middle name or initial. maxLength: 25 minLength: 1 type: string npi: description: The individual [National Provider Identifier (NPI)](https://www.stedi.com/docs/healthcare/national-provider-identifier) assigned to the physician. pattern: ^\d{10}$ type: string organizationName: description: The physician's business name. maxLength: 60 minLength: 1 type: string secondaryIdentifier: description: 'The identifier specified in `identificationQualifierCode`. You can only include one secondary identifier for the provider.' type: string suffix: description: The physician's name suffix, such as Jr. or III. maxLength: 10 minLength: 1 type: string required: - lastName type: object DentalClaimInformation: properties: autoAccidentCountryCode: description: The country code where the accident occurred. Use when `relatedCausesCode` = `AA` and the accident occurred in a country other than US or Canada. type: string autoAccidentStateCode: description: A code identifying the state or province in which the automobile accident occurred. Use this code when `relatedCausesCode` is set to `AA`. type: string benefitsAssignmentCertificationIndicator: $ref: '#/components/schemas/ClaimInformationBenefitsAssignmentCertificationIndicator' claimChargeAmount: description: The total dollar amount charged for the services on this claim, expressed as a decimal. For example, `100.50`. This is the total amount before any adjustments or payments. The amount must balance to the sum of the service line charges. pattern: ^\d+(\.\d{1,2})?$ type: string claimContractInformation: $ref: '#/components/schemas/DentalClaimContractInformation' claimDateInformation: $ref: '#/components/schemas/DentalClaimDateInformation' description: Dates related to services within the claim, including the date an appliance was placed and the date of the accident (if applicable). All dates apply to all services in the claim unless specifically overridden within an individual service line. claimFilingCode: $ref: '#/components/schemas/ClaimFilingCode' claimFrequencyCode: $ref: '#/components/schemas/ClaimFrequencyCode' description: "[Bill Type Frequency Code](https://www.nubc.org/system/files/media/file/2019/06/billTypeFrequencyCodes837.pdf) specifying the frequency of the claim. Can be set to `1` - Admit thru Discharge Claim, `7` - Replacement of Prior Claim, or `8` - Void/Cancel of Prior Claim.\n - Set this to `1` when you're submitting a new claim and when you're resubmitting a claim that was rejected before it entered the payer's processing system. You must also set this property to `1` for every resubmission to Original Medicare because Original Medicare doesn't accept code `7`.\n - Set this to `7` when you need to resubmit a corrected claim that the payer has already processed. These are claims that the payer has already adjudicated or claims that the payer has rejected with a 277CA containing the Payer Claim Control Number (PCCN), indicating it has entered the payer's system.\n - When resubmitting with code `7` or voiding with code `8`, you must also include the Payer Claim Control Number (sometimes called the ICN) in the `claimInformation.claimSupplementalInformation.claimControlNumber` property. An exception is Original Medicare, which requires that you omit the Payer Claim Control Number from resubmissions.\n - For resubmissions and cancellations, we strongly recommend including a unique Patient Control Number in the `claimInformation.patientControlNumber` for tracking purposes.\n\nVisit [Resubmit or cancel claims](https://www.stedi.com/docs/healthcare/resubmit-cancel-claims) for complete details." claimNotes: description: Include comments or special instructions related to the claim. Required when the provider needs to include additional information to substantiate the medical treatment that can't be provided elsewhere in the claim submission. You can include up to five objects in this array. items: type: string maxItems: 5 minItems: 1 type: array claimPricingRepricingInformation: $ref: '#/components/schemas/ClaimPricingRepricingInformation' claimSupplementalInformation: $ref: '#/components/schemas/DentalClaimSupplementalInformation' delayReasonCode: $ref: '#/components/schemas/DelayReasonCode' fileInformation: deprecated: true description: Please use the `fileInformationList` array instead. type: string fileInformationList: description: An array of additional information items the payer requested. Not commonly used. items: type: string maxItems: 10 minItems: 1 type: array healthCareCodeInformation: description: "Details about the patient's healthcare diagnosis. Only required when the diagnosis may have an impact on the adjudication of the claim in cases where specific dental procedures may minimize the risks associated with the connection between the patient's oral and systemic health conditions.\n - Use `ABK` as the type for the principal diagnosis code and `ABF` for any other diagnosis codes you include.\n - Use one `ABK` code as the first object, and then you can submit up to 3 `ABF` codes as needed. If you need to submit more codes than this, you must create additional, separate claims." items: $ref: '#/components/schemas/DentalHealthCareInformation' maxItems: 4 minItems: 1 type: array orthodonticTotalMonthsOfTreatment: $ref: '#/components/schemas/OrthodonticTotalMonthsOfTreatment' description: 'Information about orthodontic treatment. Required when the claim contains services related to treatment for orthodontic purposes. You **must** include one of these properties in this object: `monthsCount`, `monthsRemaining`, or `treatmentIndicator`.' otherSubscriberInformation: description: 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 the patient has coverage. It's used for coordination of benefits scenarios. items: $ref: '#/components/schemas/DentalOtherSubscriberInformation' maxItems: 10 minItems: 1 type: array patientAmountPaid: description: 'The total amount in dollars the patient or their representatives have paid on this claim. For example, `20.50`. This includes any co-payments, co-insurance, or other amounts already collected from the patient. If the patient has not paid anything, you should omit this property entirely - **don''t** set it to `0`.' pattern: ^\d+(\.\d{1,2})?$ type: string patientControlNumber: description: "An identifier you assign to the claim. We **strongly recommend** submitting a unique value for this property so you can use it to correlate this claim with responses, such as the [277CA claim acknowledgment](https://www.stedi.com/docs/healthcare/receive-claim-responses#correlate-277ca) and the [835 ERA](https://www.stedi.com/docs/healthcare/receive-claim-responses#correlate-835-era).\n - Use random strings. The identifier should be more complex than a simple sequential number and should be hard to guess. Formats with patient initials or the date of service in them can create duplicates. We recommend using [nanoid](https://www.npmjs.com/package/nanoid) or a similar library configured with the characters from the [basic character set](https://www.stedi.com/docs/healthcare/submit-dental-claims#character-restrictions) to generate unique IDs.\n - Keep it to 17 characters max. Some payers cut off values longer than 17 characters in 277CAs and ERAs, which makes it hard to match them with the original claim.\n - Use only characters available in the [basic character set](https://www.stedi.com/docs/healthcare/submit-dental-claims#character-restrictions), and avoid special characters that are only available in the extended character set. Using other characters may result in data loss or mismatches when correlating claims with responses." maxLength: 20 minLength: 1 type: string placeOfServiceCode: $ref: '#/components/schemas/PlaceOfServiceCode' description: Code identifying the type of facility where the services were or may be performed. Visit [Place of Service Codes](https://www.cms.gov/medicare/coding-billing/place-of-service-codes/code-sets) for a complete list. planParticipationCode: $ref: '#/components/schemas/DentalPlanParticipationCode' description: "The code indicating whether the provider accepts assignment in their relationship with the payer. Can be set to `A` - Assigned or `C` - Not Assigned. Code `A` is required when either the provider accepts assignment or has a participation agreement with the payer OR when the provider doesn't accept assignment or have a participation agreement but is advising the payer to adjudicate this specific claim under participating provider benefits allowed in certain plans.\n\n Note that this is **not** where you should indicate whether the patient has assigned benefits to the provider - you must indicate that in the `benefitsAssignmentCertificationIndicator` property." predeterminationOfBenefits: description: "Required when the entire claim is being submitted as a predetermination of benefits. Predetermination of benefits claims are submitted in advance of services to get an estimate of what the patient's health plan will pay.\n - Can be set to `true` to indicate predetermination of dental benefits.\n - Not all dental payers support predetermination of benefits claims.\n - Some payers prohibit setting `claimInformation.claimDateInformation.serviceDate` for predetermination of benefits claims. Refer to your payer's specific guidelines for more information." type: boolean propertyCasualtyClaimNumber: description: The agency claim number for this transaction. Used when services included in this claim are part of a property and casualty claim. type: string relatedCausesCode: description: 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. You can include up to two codes in this array. items: $ref: '#/components/schemas/ClaimInformationRelatedCausesCodeItem' maxItems: 2 minItems: 1 type: array releaseInformationCode: $ref: '#/components/schemas/ReleaseInformationCode' serviceFacilityLocation: $ref: '#/components/schemas/ClaimServiceFacilityLocation' description: "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 service was rendered. This can be healthcare facilities, such as surgical centers or reference labs, OR the patient's address when services were rendered in their home.\n - Only include this object when the service facility location is **different** from the billing provider's address. If you include this object when the address is the same, Stedi omits all of the service facility location information from the claim submission, including the name and any identifiers.\n - For telehealth services, the service facility location is the provider's address, even though the patient may have been in their home or elsewhere when receiving services.\n - Sometimes the billing provider is an actual physician group that is located at the same address as a hospital, but is in fact a separate entity. In this case, you can differentiate the service facility location by including the specific suite or building number of the physician group. This ensures that the service facility location is different from the billing provider's address and is reported accurately." serviceLines: description: "Information about one or more services rendered to the patient.\n - Each service line must be a unique service event as defined by the payer's billing policies. This means that you can use the same procedure code on multiple service lines as long as they are distinct events.\n - Some procedure codes are date-specific. In these cases, you may need to create a separate service line with that code for each applicable date of service, even if the episode of care extended over multiple days.\n - Service lines can share the same dates of service if the patient received multiple services on the same day." items: $ref: '#/components/schemas/DentalServiceLine' type: array signatureIndicator: $ref: '#/components/schemas/SignatureIndicator' specialProgramCode: $ref: '#/components/schemas/DentalSpecialProgramCode' toothStatus: description: The status of the teeth involved in the service. Required when the submitter is reporting a missing tooth or a tooth to be extracted in the future. You can include up to 35 objects in this array. items: $ref: '#/components/schemas/ToothStatus' type: array required: - benefitsAssignmentCertificationIndicator - claimChargeAmount - claimFrequencyCode - patientControlNumber - placeOfServiceCode - releaseInformationCode - serviceLines - signatureIndicator type: object OtherPayerEntityTypeQualifier: enum: - '1' - '2' type: string ClaimServiceFacilityLocationSecondaryIdentifierItem: properties: identifier: description: The identifier. The format and length of this value depends on the `qualifier` you set. type: string otherIdentifier: deprecated: true description: The identifier for the other payer who provided this reference number. This is only required when the reference number is provided by the non-destination payer. The value must match the `claimInformation.otherSubscriberInformation[].otherPayerName.otherPayerIdentifier` property. type: string qualifier: description: Set to `0B` - State License Number, `LU` - Location Number, or `G2` - Provider Commercial Number. type: string required: - identifier - qualifier type: object ExternalCauseOfInjuryQualifierCode: description: Code identifying the type of external cause of injury code used. Can be set to `ABN` - International Classification of Diseases Clinical Modification External Cause of Injury Code or `BN` - International Classification of Diseases Clinical Modification External Cause of Injury Code. Note that ICD-9 is deprecated and cannot be used in new claims. enum: - ABN - BN type: string DentalServiceLineReferenceInformation: description: Additional identifiers for the service line. properties: adjustedRepricedLineItemReferenceNumber: description: Required when a repricing (pricing) organization needs to have an identifying number on the service line. Only completed by repricing organizations. type: string predeterminationOfBenefits: description: The Predetermination of Benefits Identification Numbers relevant to this service line. Required for services that have been previously predetermined and are now being submitted for payment. You can include up to five objects in this array. items: $ref: '#/components/schemas/PredeterminationOfBenefits' maxItems: 5 minItems: 1 type: array priorAuthorization: description: "Prior authorization (preauthorization) numbers that apply to this service line.\n - Put each unique number in a separate array element.\n - You can use the same number on multiple service lines.\n\n**Important**: Only include prior authorization numbers that differ from the claim-level authorization in `claimInformation.claimSupplementalInformation.priorAuthorizationNumber`." items: $ref: '#/components/schemas/PriorAuthorization' maxItems: 5 minItems: 1 type: array referralNumber: description: Required when this service line involved a referral number that is different than the number reported at the claim level. You can include up to five objects in this array. items: type: string maxItems: 5 minItems: 1 type: array repricedLineItemReferenceNumber: description: Required when a repricing (pricing) organization needs to have an identifying number on the service line. Only completed by repricing organizations. type: string type: object DentalClaimsSubmissionResponseContent: properties: claimReference: $ref: '#/components/schemas/ClaimReference' controlNumber: description: An identifier for the transaction. type: string editResponses: description: Currently not used. items: $ref: '#/components/schemas/EditResponse' type: array editStatus: deprecated: true description: 'This shape is deprecated: Currently not used.' type: string errors: description: Errors resulting from claim edits. You must review and fix these errors before resubmitting. items: $ref: '#/components/schemas/ClaimsError' type: array failure: $ref: '#/components/schemas/Failure' httpStatusCode: $ref: '#/components/schemas/HttpStatusCode' meta: $ref: '#/components/schemas/ResponseMeta' payer: $ref: '#/components/schemas/ClaimsPayer' status: description: The status of the claim submission. type: string tradingPartnerServiceId: description: An ID for the payer you identified in the original claim. This value may differ from the `tradingPartnerServiceId` you submitted in the original request because it reflects the payer's internal concept of their ID, not necessarily the ID Stedi uses to route requests to this payer. type: string warnings: description: A list of warnings. Currently not used. items: $ref: '#/components/schemas/ClaimsWarning' type: array x12: description: 'A [277CA claim acknowledgment](https://www.stedi.com/docs/healthcare/claim-responses-overview#277ca-claim-acknowledgment) acceptance or rejection from Stedi in X12 EDI format. It indicates whether the claim has passed Stedi''s claim edits. When the claim fails one or more edits, the 277CA contains `STC` segments with information about each error. These are the same error codes that appear in the `errors` array. Note that this 277CA only indicates whether Stedi has accepted or rejected the claim submission. You may receive additional 277CA acceptances or rejections as the claim is routed to the payer.' type: string type: object OtherPayerAssistantSurgeon: description: Information about the assistant surgeon. properties: entityTypeQualifier: $ref: '#/components/schemas/OtherPayerEntityTypeQualifier' description: Code identifying the type of entity. Can be set to `1` - Person or `2` - Non-Person Entity. In practice, you should always set this to `1` - Person. otherPayerAssistantSurgeonIdentifier: description: An identifier for the assistant surgeon. items: $ref: '#/components/schemas/OtherPayerAssistantSurgeonIdentifierItem' maxItems: 3 minItems: 1 type: array required: - entityTypeQualifier - otherPayerAssistantSurgeonIdentifier type: object MeasurementUnit: description: 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 counted from the moment that the practitioner, having completed the preoperative evaluation, starts an intravenous line, places monitors, administers pre-anesthesia sedation, or otherwise physically begins to prepare the patient for anesthesia. Time continues throughout the case and while the practitioner accompanies the patient to the post-anesthesia recovery unit (PACU). Time stops when the practitioner releases the patient to the care of PACU personnel. enum: - MJ - UN type: string ServiceLineServiceFacilityLocation: description: '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 service was rendered. This can be healthcare facilities, such as surgical centers or reference labs, OR the patient''s address when services were rendered in their home. - Only include this object when the service facility location is **different** from the billing provider''s address. If you include this object when the address is the same, Stedi omits all of the service facility location information from the claim submission, including the name and any identifiers. - For telehealth services, the service facility location is the provider''s address, even though the patient may have been in their home or elsewhere when receiving services. - Don''t use this object when reporting ambulance services - use `ambulancePickupLocation` and `ambulanceDropoffLocation` instead. - Sometimes the billing provider is an actual physician group that is located at the same address as a hospital, but is in fact a separate entity. In this case, you can differentiate the service facility location by including the specific suite or building number of the physician group. This ensures that the service facility location is different from the billing provider''s address and is reported accurately.' properties: address: $ref: '#/components/schemas/ClaimsAddress' description: "The address of where services were rendered. \n\n If the service facility location is in an area where there are no street addresses, enter a description of where the service was rendered. For example, 'crossroad of State Road 34 and 45'. \n\n For United States addresses, you **must** include the full nine-digit zip code with no separators, such as `100031502`. If you don't know the full zip code, you can find it using the [USPS ZIP Code Lookup](https://tools.usps.com/zip-code-lookup.htm) tool." npi: description: The organization [National Provider Identifier (NPI)](https://www.stedi.com/docs/healthcare/national-provider-identifier) assigned to the service facility. Only include this property when the service facility is not a component or subpart of the `billing` provider. Don't include when the service facility is the patient's home. pattern: ^\d{10}$ type: string organizationName: description: The laboratory or facility name. When services were rendered in the patient's home, we recommend setting this to `Residence` or something similar. maxLength: 60 minLength: 1 type: string phoneExtension: deprecated: true description: The telephone extension, if applicable. Only submit the numeric extension. For example, don't include data that indicates an extension, such as 'ext.' or 'x-'. type: string phoneName: deprecated: true description: The full name of the person or office. type: string phoneNumber: deprecated: true description: The phone number, formatted as AAABBBCCCC, where AAA represents the area code, BBB is the telephone number prefix, and CCCC is the telephone number. The phone number should only include the digits 0 to 9. Don't include separators, such as dashes, and don't include long distance access numbers, such as 1. For example, you would format the phone number 123-456-7890 as 1234567890. type: string secondaryIdentifier: description: Secondary identifier for the service facility location. Used when another identifier is needed for the claims processor to identify the facility or when the entity is not a healthcare provider and does not have an [NPI](https://www.stedi.com/docs/healthcare/national-provider-identifier). items: $ref: '#/components/schemas/ServiceFacilityLocationSecondaryIdentifierItem' maxItems: 3 minItems: 1 type: array required: - address - organizationName type: object MedicareInpatientAdjudication: properties: capitalExceptionAmount: description: The capital exception amount, expressed as a decimal. type: string capitalHSPDRGAmount: description: The Prospective Payment System (PPS) capital, hospital specific portion, Diagnosis Related Group (DRG) amount. Expressed as a decimal. type: string claimDRGAmount: description: The Diagnosis Related Group (DRG) amount, expressed as a decimal. type: string claimDisproportionateShareAmount: description: The disproportionate share amount, expressed as a decimal. type: string claimIndirectTeachingAmount: description: The indirect teaching amount, expressed as a decimal. type: string claimMspPassThroughAmount: description: The Medicare Secondary Payer (MSP) pass-through amount, expressed as a decimal. type: string claimPaymentRemarkCode: description: The claim payment remark code. Refer to the X12 [Remittance Advice Remark Codes](https://x12.org/codes/remittance-advice-remark-codes) for a complete list. You can include up to four codes in this array. items: type: string maxItems: 5 minItems: 1 type: array claimPpsCapitalAmount: description: The Prospective Payment System (PPS) capital amount, expressed as a decimal. type: string claimPpsCapitalOutlierAmmount: description: The Prospective Payment System (PPS) capital outlier amount, expressed as a decimal. type: string costReportDayCount: description: The number of cost report days, expressed as a decimal. type: string coveredDaysOrVisitsCount: description: The number of covered days, expressed as a decimal. type: string lifetimePsychiatricDaysCount: description: The number of lifetime psychiatric days, expressed as a decimal. type: string nonPayableProfessionalComponentBilledAmount: description: The professional component amount billed but not payable, expressed as a decimal. type: string oldCapitalAmount: description: The old capital amount, expressed as a decimal. type: string ppsCapitalDshDrgAmount: description: The prospective Payment System (PPS) capital, disproportionate share, hospital Diagnosis Related Group (DRG) amount. Expressed as a decimal. type: string ppsCapitalHspDrgAmount: description: The Prospective Payment System (PPS) capital, disproportionate share, hospital Diagnosis Related Group (DRG) amount. Expressed as a decimal. type: string ppsCapitalImeAmount: description: The Prospective Payment System (PPS) capital Indirect Medical Education (IME) claim amount, expressed as a decimal. type: string ppsOperatingFederalSpecificDrgAmount: description: The federal specific Diagnosis Related Group (DRG) amount, expressed as a decimal. type: string ppsOperatingHospitalSpecificDrgAmount: description: The hospital specific Diagnosis Related Group (DRG) amount, expressed as a decimal. type: string required: - coveredDaysOrVisitsCount type: object ClaimFrequencyCode: description: '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 is void or canceled' enum: - '1' - '7' - '8' type: string InstitutionalOtherInsuredQualifier: description: Code identifying the type of entity. Can be set to `1` - Person or `2` - Non-Person Entity. enum: - '1' - '2' type: string EpsdtReferralConditionCodesItem: enum: - AV - NU - S2 - ST type: string FormTypeCode: description: 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 Carrier (DMERC) Certificate of Medical Necessity (CMN) Forms. Set this to `AS` when you plan to include a home health form in the `formIdentifier` property. enum: - AS - UT type: string ClaimsContactInformation: description: You must include at least one communication method (phone, fax, or email) in this object. properties: email: description: The email address. type: string faxNumber: description: The fax number. type: string name: description: The full name of the person or office. type: string phoneExtension: description: The phone extension, if applicable. type: string phoneNumber: description: The phone number, formatted as AAABBBCCCC, where AAA represents the area code, BBB is the telephone number prefix, and CCCC is the telephone number. The phone number should only include the digits 0 to 9. Don't include separators, such as dashes, and don't include long distance access numbers, such as 1. For example, you would format the phone number 123-456-7890 as 1234567890. type: string type: object InstitutionalResponseMeta: description: Metadata from Stedi about the request. properties: applicationMode: description: Indicates where this request can be found for support. type: string billerId: description: The biller ID assigned to this request. type: string senderId: description: The sender ID assigned to this request. type: string submitterId: description: The submitter ID assigned to this request. type: string traceId: description: The file execution ID, a unique identifier assigned to the processed file within the Stedi platform. type: string type: object OtherSubscriberInformationBenefitsAssignmentCertificationIndicator: description: 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 patient), `Y` - Yes (Payment should go directly to the provider), or `W` - Not Applicable. enum: - N - W - Y type: string SubscriberGender: description: "Identifies the subscriber's gender. Can be set to `F` - Female, `M` - Male, or `U` - Unknown. \n\nThis property is **required** if the subscriber is an individual. \n\nYou should set this property to `U` when the patient declines to answer or does not identify as male or female. Note that some payers may reject the claim if the patient's gender doesn't match the gender they have recorded in their member records." enum: - M - F - U type: string ConditionIndicatorDurableMedicalEquipment: description: Required when a Durable Medical Equipment Regional Carrier Certificate of Medical Necessity (DMERC CMN) or a DMERC Information Form (DIF), or Oxygen Therapy Certification is included on this service line and the information is necessary for adjudication. properties: certificationConditionIndicator: $ref: '#/components/schemas/ConditionIndicatorDurableMedicalEquipmentCertificationConditionIndicator' conditionIndicator: $ref: '#/components/schemas/ConditionIndicator' conditionIndicatorCode: $ref: '#/components/schemas/ConditionIndicatorCode' required: - certificationConditionIndicator - conditionIndicator type: object ClaimServiceFacilityLocation: description: '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 service was rendered. This can be healthcare facilities, such as surgical centers or reference labs, OR the patient''s address when services were rendered in their home. - Only include this object when the service facility location is **different** from the billing provider''s address. If you include this object when the address is the same, Stedi omits all of the service facility location information from the claim submission, including the name and any identifiers. - For telehealth services, the service facility location is the provider''s address, even though the patient may have been in their home or elsewhere when receiving services. - Don''t use this object when reporting ambulance services - use `ambulancePickupLocation` and `ambulanceDropoffLocation` instead. - Sometimes the billing provider is an actual physician group that is located at the same address as a hospital, but is in fact a separate entity. In this case, you can differentiate the service facility location by including the specific suite or building number of the physician group. This ensures that the service facility location is different from the billing provider''s address and is reported accurately.' properties: address: $ref: '#/components/schemas/ClaimsAddress' description: "The address of where services were rendered. \n\n If the service facility location is in an area where there are no street addresses, enter a description of where the service was rendered. For example, 'crossroad of State Road 34 and 45'. \n\n For United States addresses, you **must** include the full nine-digit zip code with no separators, such as `100031502`. If you don't know the full zip code, you can find it using the [USPS ZIP Code Lookup](https://tools.usps.com/zip-code-lookup.htm) tool." npi: description: The organization [National Provider Identifier (NPI)](https://www.stedi.com/docs/healthcare/national-provider-identifier) assigned to the service facility. Only include this property when the service facility is not a component or subpart of the `billing` provider. Don't include when the service facility is the patient's home. pattern: ^\d{10}$ type: string organizationName: description: The laboratory or facility name. When services were rendered in the patient's home, we recommend setting this to `Residence` or something similar. maxLength: 60 minLength: 1 type: string phoneExtension: description: The telephone extension, if applicable. Only submit the numeric extension. For example, don't include data that indicates an extension, such as 'ext.' or 'x-'. type: string phoneName: description: The full name of the person or office. type: string phoneNumber: description: The phone number, formatted as AAABBBCCCC, where AAA represents the area code, BBB is the telephone number prefix, and CCCC is the telephone number. The phone number should only include the digits 0 to 9. Don't include separators, such as dashes, and don't include long distance access numbers, such as 1. For example, you would format the phone number 123-456-7890 as 1234567890. type: string secondaryIdentifier: description: Secondary identifiers for the service facility location. Used when another identifier is needed for the claims processor to identify the facility or when the entity is not a healthcare provider and does not have an [NPI](https://www.stedi.com/docs/healthcare/national-provider-identifier). items: $ref: '#/components/schemas/ClaimServiceFacilityLocationSecondaryIdentifierItem' maxItems: 3 minItems: 1 type: array required: - address - organizationName type: object ClaimInformationBenefitsAssignmentCertificationIndicator: description: 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 to assign benefits. Can be set to `N` - No (Payment should go to the patient), `Y` - Yes (Payment should go directly to the provider), or `W` - Not Applicable (use when patient refuses to assign benefits). enum: - N - W - Y type: string InstitutionalClaimsRawX12SubmissionResponseContent: properties: claimReference: $ref: '#/components/schemas/InstitutionalClaimReference' controlNumber: description: An identifier for the transaction. type: string editResponses: description: Currently not used. items: $ref: '#/components/schemas/EditResponse' type: array editStatus: deprecated: true description: 'This shape is deprecated: Currently not used.' type: string errors: description: Errors resulting from claim edits. You must review and fix these errors before resubmitting. items: $ref: '#/components/schemas/InstitutionalError' type: array failure: $ref: '#/components/schemas/Failure' httpStatusCode: $ref: '#/components/schemas/HttpStatusCode' meta: $ref: '#/components/schemas/InstitutionalResponseMeta' payer: $ref: '#/components/schemas/InstitutionalPayer' status: description: The status of the claim submission. type: string tradingPartnerServiceId: description: An ID for the payer you identified in the original claim. This value may differ from the `tradingPartnerServiceId` you submitted in the original request because it reflects the payer's internal concept of their ID, not necessarily the ID Stedi uses to route requests to this payer. type: string warnings: description: A list of warnings. Currently not used. items: $ref: '#/components/schemas/ClaimsWarning' type: array x12: description: 'A [277CA claim acknowledgment](https://www.stedi.com/docs/healthcare/claim-responses-overview#277ca-claim-acknowledgment) acceptance or rejection from Stedi in X12 EDI format. It indicates whether the claim has passed Stedi''s claim edits. When the claim fails one or more edits, the 277CA contains `STC` segments with information about each error. These are the same error codes that appear in the `errors` array. Note that this 277CA only indicates whether Stedi has accepted or rejected the claim submission. You may receive additional 277CA acceptances or rejections as the claim is routed to the payer.' type: string type: object ClaimsPayer: description: Information about the payer for the submitted claim. properties: payerID: deprecated: true description: 'This shape is deprecated: Please use payerId.' type: string payerId: description: The payer's ID. This is the same as the `tradingPartnerServiceId`. type: string payerName: description: The payer's business name, such as Aetna or Cigna. maxLength: 60 minLength: 1 type: string type: object MeasurementReferenceIdentificationCode: description: Code identifying the type of measurement. Can be set to `OG` - Original or `TR` - Test Results. enum: - OG - TR type: string InstitutionalClaimDateInformation: description: Dates and times related to the claim. For example, when the patient was discharged from the hospital. properties: admissionDateAndHour: description: When the patient was admitted to the hospital or facility. This property is **required** on inpatient claims. Can be expressed as a date and time (YYYYMMDDHHMM) or a single date (YYYYMMDD). pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])([01]\d|2[0-3])[0-5]\d$|^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string dischargeHour: description: The time the patient was discharged from the hospital or facility. This property is **required** on final inpatient claims. Can be expressed as a time in format HHMM. pattern: ^([01]\d|2[0-3])[0-5]\d$ type: string repricerReceivedDate: description: The date the repricer received the claim. Required when a repricer is passing the claim onto the payer. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string statementBeginDate: description: The beginning date of the statement. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string statementEndDate: description: The ending date of the statement. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string required: - statementBeginDate - statementEndDate type: object MaximumResponseSizeExceeded: properties: code: type: string details: type: string message: type: string type: object AmbulanceCertification: description: Required when the claim involves ambulance transport services. properties: certificationConditionIndicator: $ref: '#/components/schemas/AmbulanceCertificationCertificationConditionIndicator' conditionCodes: items: $ref: '#/components/schemas/AmbulanceCertificationConditionCodesItem' maxItems: 5 minItems: 1 type: array required: - certificationConditionIndicator - conditionCodes type: object DurableMedicalEquipmentCertification: description: Required when a Durable Medical Equipment Regional Carrier Certificate of Medical Necessity (DMERC CMN) or a DMERC Information Form (DIF) or Oxygen Therapy Certification is included on this service line. properties: certificationTypeCode: $ref: '#/components/schemas/CertificationTypeCode' durableMedicalEquipmentDurationInMonths: description: The length of time the DME equipment is needed. type: string required: - certificationTypeCode - durableMedicalEquipmentDurationInMonths type: object ServiceLineOrderingProviderSecondaryIdentifierItem: properties: identifier: description: The identifier. The format and length of this value depends on the `qualifier` you set. type: string otherIdentifier: description: The identifier for the other payer who provided this reference number. This is only required when the reference number is provided by the non-destination payer. The value must match the `claimInformation.otherSubscriberInformation[].otherPayerName.otherPayerIdentifier` property. type: string qualifier: description: Set to `0B` - State License Number, `1G` - Provider UPIN Number, or `G2` - Provider Commercial Number. Note that UPIN is deprecated and shouldn't be used for new claims. type: string required: - identifier - qualifier type: object ClaimPricingInformationProductOrServiceIDQualifier: description: 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 Administration Common Procedural Coding System (HCPCS) Codes, `HP` - Health Insurance Prospective Payment System (HIPPS) Skilled Nursing Facility Rate Code, `IV` - Home Infusion EDI Coalition (HIEC) Product/Service Code, or `WK` - Advanced Billing Concepts (ABC) Codes. Note that ABC codes are deprecated and should not be used in new claims. If you provide this property, you must also provide `repricedApprovedHCPCSCode` Visit [Claims code lists](https://www.stedi.com/docs/healthcare/claims-code-lists#product-or-service-id-qualifier-codes) for a complete list and additional usage notes. enum: - ER - HC - HP - IV - WK type: string ClaimReference: description: Information about the claim. properties: claimType: deprecated: true description: 'This shape is deprecated: Currently not used.' type: string correlationId: description: An identifier Stedi assigns to the claim. type: string customerClaimNumber: description: A tracking number that Stedi assigns to the claim. type: string formatVersion: description: The X12 EDI version Stedi used to generate the claim for the payer. This is always `5010`. type: string patientControlNumber: description: The `patientControlNumber` from the original request, if supplied. This is a unique identifier that you assign to the claim so you can track the claim and correlate it with responses from the payer. type: string payerID: deprecated: true description: 'This shape is deprecated: Please use payerId.' type: string payerId: description: The payer's ID. This is the same as the `tradingPartnerServiceId`. type: string rhclaimNumber: description: A tracking number Stedi assigns to the claim. This is the same as the `correlationId`. type: string serviceLines: description: Contains a unique identifier for each service line, listed in the order the service lines were included in the claim. You can use these identifiers to correlate payer responses to specific service lines. items: $ref: '#/components/schemas/ServiceLineResponseIdentifier' type: array submitterId: description: Stedi's ID for the entity that submitted the claim. type: string timeOfResponse: description: A timestamp for Stedi's response to the claim submission. type: string type: object ClaimsServiceLineRenderingProvider: properties: address: $ref: '#/components/schemas/ClaimsAddress' deprecated: true claimOfficeNumber: deprecated: true type: string commercialNumber: description: The provider's commercial number. type: string contactInformation: $ref: '#/components/schemas/ClaimsContactInformation' deprecated: true employerId: deprecated: true description: The provider's Employer Identification Number (EIN). The EIN is typically a string of exactly nine numbers with no separators, unless otherwise specified by the provider. If you include this value, you cannot include the provider's `ssn`. type: string employerIdentificationNumber: deprecated: true description: The provider's Employer Identification Number (EIN). This field is the same as `employerId`. The EIN is typically a string of exactly nine numbers with no separators, unless otherwise specified by the provider. If you include this value, you cannot include the provider's `ssn`. type: string firstName: description: The provider's first name. maxLength: 35 minLength: 1 type: string lastName: description: The provider's last name. You should include either the `lastName` or `organizationName` property in this object. maxLength: 60 minLength: 1 type: string locationNumber: description: The provider's location number. type: string middleName: description: The provider's middle name or initial. maxLength: 25 minLength: 1 type: string naic: deprecated: true description: The National Association of Insurance Commissioners (NAIC) code. type: string npi: description: The [National Provider Identifier (NPI)](https://www.stedi.com/docs/healthcare/national-provider-identifier) assigned to the provider. pattern: ^\d{10}$ type: string organizationName: description: The provider's business name. You should include either the `lastName` or `organizationName` property in this object. maxLength: 60 minLength: 1 type: string otherIdentifier: type: string payerIdentificationNumber: description: The payer identification number. type: string providerType: deprecated: true description: This field is now automatically populated and it only remains for backwards compatibility. type: string providerUpinNumber: deprecated: true description: Deprecated; do not use. type: string secondaryIdentifier: description: An identifier for the provider. items: $ref: '#/components/schemas/ServiceLineRenderingProviderSecondaryIdentifierItem' maxItems: 20 minItems: 1 type: array ssn: deprecated: true description: The provider's Social Security Number. If you provide this value, you cannot include the provider's `employerId`. pattern: ^\d{9}$ type: string stateLicenseNumber: description: The provider's state license number. This is assigned directly by a payer in order to identify the provider in their system. This is not commonly used. type: string suffix: description: The provider's name suffix, such as Jr. or III. maxLength: 10 minLength: 1 type: string taxonomyCode: description: Code from the National Uniform Claims Committee [Health Care Provider Taxonomy Code Set](https://taxonomy.nucc.org/). This identifies the provider's type and/or area of specialty. maxLength: 10 minLength: 10 pattern: ^[A-Za-z0-9]{10}$ type: string type: object InstitutionalOtherPayerBillingProvider: description: Information regarding the other payer's billing provider. properties: otherPayerBillingProviderIdentifier: description: The provider's identifier. The `qualifier` can be set to `G2` - Provider Commercial Number or `LU` - Location Number. Note that UPIN numbers are deprecated and should not be used in new claims. items: $ref: '#/components/schemas/InstitutionalReferenceIdentification' maxItems: 3 minItems: 1 type: array required: - otherPayerBillingProviderIdentifier type: object ServiceFacilityLocationSecondaryIdentifierItem: properties: identifier: description: The identifier. The format and length of this value depends on the `qualifier` you set. type: string otherIdentifier: description: The identifier for the other payer who provided this reference number. This is only required when the reference number is provided by the non-destination payer. The value must match the `claimInformation.otherSubscriberInformation[].otherPayerName.otherPayerIdentifier` property. type: string qualifier: description: Set to `G2` - Provider Commercial Number, or `LU` - Location Number. type: string required: - identifier - qualifier type: object LineAdjudicationInformationProductOrServiceIDQualifier: description: Code identifying the type of `procedureCode`. Can be set to `ER` - Jurisdiction Specific Procedure and Supply Codes, `HC` - Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes, `HP` - Health Insurance Prospective Payment System (HIPPS) Skilled Nursing Facility Rate Code, `IV` - Home Infusion EDI Coalition (HIEC) Product/Service Code, or `WK` - Advanced Billing Concepts (ABC) Codes. Note that ABC codes are deprecated and shouldn't be used in new claims. Visit [Claims code lists](https://www.stedi.com/docs/healthcare/claims-code-lists#product-or-service-id-qualifier-codes) for a complete list and usage guidelines. enum: - ER - HC - HP - IV - WK type: string InstitutionalProvidersObject: properties: address: $ref: '#/components/schemas/InstitutionalAddress' description: The provider's business address. Only applies to the billing provider. contactInformation: $ref: '#/components/schemas/InstitutionalContactInformation' description: The provider's contact information. Only applies to the billing provider. You must include at least one communication method (phone, fax, or email) in this object. employerId: description: The provider's employer ID, also known as an EIN or TIN. Must be a string of exactly nine numbers with no separators. This is **required** for the billing provider, and doesn’t apply to other provider types. type: string firstName: description: The provider's first name. maxLength: 35 minLength: 1 type: string lastName: description: The provider's last name. maxLength: 60 minLength: 1 type: string middleName: description: The provider's middle name or initial. maxLength: 25 minLength: 1 type: string npi: description: The [National Provider Identifier (NPI)](https://www.stedi.com/docs/healthcare/national-provider-identifier) of the provider. Note that this is **required** for billing providers that have an NPI assigned. pattern: ^\d{10}$ type: string organizationName: description: The provider's business name, when the provider is not an individual. maxLength: 60 minLength: 1 type: string providerType: $ref: '#/components/schemas/InstitutionalProviderType' description: The type of provider. Set to the type that matches the provider's role in the claim. For example, if the provider is the referring provider, set this to `ReferringProvider`. secondaryIdentificationQualifierCode: $ref: '#/components/schemas/OperatingPhysicianIdentificationQualifierCode' secondaryIdentifier: description: 'The identifier referenced by `secondaryIdentificationQualifierCode`. For example, if `secondaryIdentificationQualifierCode` is set to `0B`, this property should be the provider''s state license number. You can only include one secondary identifier for the provider.' type: string suffix: description: The provider's name suffix, such as Jr. or III. maxLength: 10 minLength: 1 type: string taxonomyCode: description: The provider's [taxnonomy code](https://www.cms.gov/medicare/enrollment-renewal/providers-suppliers/health-care-taxonomy), a unique 10-character code that designates their classification and specialization. Only applies to the attending provider. maxLength: 10 minLength: 10 pattern: ^[A-Za-z0-9]{10}$ type: string required: - providerType type: object NoTransactionsFound: properties: code: type: string details: type: string message: type: string type: object ConditionIndicator: description: 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` - Replacement Item. enum: - '38' - ZV type: string OtherPayerOtherOperatingPhysician: description: Information regarding the other payer's other operating physician. The other operating physician is the provider who performed a secondary surgical procedure or assisted the `otherPayerOperatingPhysician`. properties: otherPayerOtherOperatingPhysicianIdentifier: description: The physician's identifier. The `qualifier` can be set to `OB` - State License Number, `1G` - Provider UPIN Number, `G2` - Provider Commercial Number, or `LU` - Location Number. Note that UPIN numbers are deprecated and should not be used in new claims. items: $ref: '#/components/schemas/InstitutionalReferenceIdentification' maxItems: 4 minItems: 1 type: array required: - otherPayerOtherOperatingPhysicianIdentifier type: object InstitutionalBilling: description: 'Information about the billing provider. The following information is required: - An `address` that is a physical location such as the office where care is delivered or an administrative facility. - The provider''s Employer Identification Number (EIN) in `employerId`. - The provider''s business name in `organizationName`. - The provider''s [National Provider Identifier (NPI)](https://www.stedi.com/docs/healthcare/national-provider-identifier) in `npi`, if one is assigned. When the billing provider is not assigned an NPI, supply `secondaryIdentifier` with `secondaryIdentificationQualifierCode` set to `G2` (commercial number).' properties: address: $ref: '#/components/schemas/InstitutionalAddress' description: 'The provider''s address. This is **required** and must be a physical location such as the office where care is delivered or an administrative facility. If the billing provider expects to receive paper checks at a PO Box, lockbox, or other non-physical address, provide that in `billingPayToAddressName`. For United States addresses, you **must** include the full nine-digit zip code with no separators, such as `100031502`. If you don''t know the full zip code, you can find it using the [USPS ZIP Code Lookup](https://tools.usps.com/zip-code-lookup.htm) tool.' commercialNumber: deprecated: true maxLength: 50 type: string contactInformation: $ref: '#/components/schemas/InstitutionalContactInformation' description: The provider's contact information.You must include at least one communication method (phone, fax, or email) in this object. employerId: description: The provider's employer ID, also known as an EIN or TIN. Must be a string of exactly nine numbers with no separators. maxLength: 50 type: string firstName: description: The provider's first name. maxLength: 35 minLength: 1 type: string lastName: description: The provider's last name. maxLength: 60 minLength: 1 type: string locationNumber: deprecated: true maxLength: 50 type: string middleName: description: The provider's middle name or initial. maxLength: 25 minLength: 1 type: string npi: description: The organization [National Provider Identifier (NPI)](https://www.stedi.com/docs/healthcare/national-provider-identifier). Optional. When the billing provider is not assigned an NPI, supply `secondaryIdentifier` with `secondaryIdentificationQualifierCode` set to `G2` instead. pattern: ^\d{10}$ type: string organizationName: description: The provider's business name. maxLength: 60 minLength: 1 type: string providerType: $ref: '#/components/schemas/BillingProviderType' deprecated: true description: This field is now automatically populated and it only remains for backwards compatibility. providerUpinNumber: deprecated: true maxLength: 50 type: string secondaryIdentificationQualifierCode: $ref: '#/components/schemas/OperatingPhysicianIdentificationQualifierCode' secondaryIdentifier: description: 'The identifier specified in `secondaryIdentifierQualifierCode`. You can only include one secondary identifier for the provider.' maxLength: 50 type: string stateLicenseNumber: deprecated: true type: string suffix: description: The provider's suffix, such as Jr. or Sr. maxLength: 10 minLength: 1 type: string taxonomyCode: description: The provider's [taxnonomy code](https://www.cms.gov/medicare/enrollment-renewal/providers-suppliers/health-care-taxonomy), a unique 10-character code that designates their classification and specialization. maxLength: 10 minLength: 10 pattern: ^[A-Za-z0-9]{10}$ type: string required: - address - employerId type: object InstitutionalClaimAdjustment: properties: adjustmentGroupCode: $ref: '#/components/schemas/InstitutionalAdjustmentGroupCode' claimAdjustmentDetails: description: The adjustment reason, amount, and quantity. You can include up to six of these objects to describe a single `adjustmentGroupCode`. items: $ref: '#/components/schemas/InstitutionalClaimAdjustmentDetails' maxItems: 6 minItems: 1 type: array required: - adjustmentGroupCode type: object CertificationTypeCode: description: Code indicating the type of certification. Can be set to `I` - Initial, `R` - Renewal, or `S` - Revised. enum: - I - R - S type: string EpsdtIndicator: description: Code indicating whether there was EPSDT involvement in the service. Can be set to `Y` - Yes. EPSDT is a program that provides comprehensive and preventive health care services for children under age 21 who are enrolled in Medicaid. enum: - Y type: string PayToAddressNameEntityTypeQualifier: description: Code identifying the type of entity. Can be set to `2` - Non-Person Entity. enum: - '2' type: string DentalReportInformation: properties: attachmentControlNumber: description: "A control number assigned to the attachment. The payer uses this identifier to match the attachment to the claim.\n - You must include either this property or `attachmentId` in the request, but not both. Including both properties will result in an error.\n - We recommend using a ULID or UUID of up to 50 characters.\n - Stedi autogenerates a control number if you don't provide one." type: string attachmentId: description: "The unique identifier for the attachment file you previously uploaded to Stedi. This value is returned in the `attachmentId` property of the [Create Claim Attachment (275) JSON](https://www.stedi.com/docs/healthcare/api-reference/post-healthcare-submit-claim-attachment) response. Stedi uses it to generate and submit the 275 claim attachment transaction to the payer.\n - This property is **required** when you're submitting attachment files through Stedi.\n - You must include either this property or `attachmentControlNumber` in the request, but not both. Including both properties will result in an error." maxLength: 36 minLength: 36 pattern: ^[0-9a-fA-F]{8}-[0-9a-fA-F]{4}-[0-9a-fA-F]{4}-[0-9a-fA-F]{4}-[0-9a-fA-F]{12}$ type: string attachmentReportTypeCode: $ref: '#/components/schemas/DentalAttachmentReportTypeCode' attachmentTransmissionCode: $ref: '#/components/schemas/ReportInformationAttachmentTransmissionCode' required: - attachmentReportTypeCode - attachmentTransmissionCode type: object DentalOtherSubscriberInformation: properties: benefitsAssignmentCertificationIndicator: $ref: '#/components/schemas/OtherSubscriberInformationBenefitsAssignmentCertificationIndicator' claimFilingIndicatorCode: $ref: '#/components/schemas/ClaimFilingIndicatorCode' claimLevelAdjustments: description: Use this object to report prior payers' claim level adjustments that cause the amount paid to differ from the amount originally charged. Codes and associated amounts must come from either paper remittance advice or 835s (Electronic Remittance Advice) received on the claim. When the information originates from a paper remittance advice that does not use the standard Claim Adjustment Reason Codes, you must convert them to standard Claim Adjustment Reason Codes. items: $ref: '#/components/schemas/ClaimAdjustment' maxItems: 5 minItems: 1 type: array individualRelationshipCode: $ref: '#/components/schemas/ClaimsIndividualRelationshipCode' insuranceGroupOrPolicyNumber: description: The group or policy number. type: string insuranceTypeCode: $ref: '#/components/schemas/OtherSubscriberInformationInsuranceTypeCode' medicareOutpatientAdjudication: $ref: '#/components/schemas/DentalMedicareOutpatientAdjudication' nonCoveredChargeAmount: description: Required when the destination payer's cost avoidance policy allows providers to bypass claim submission to the otherwise prior payer identified in `otherSubscriberInformation.otherPayerName`. The amount must equal the total claim charge amount you reported in `claimInformation.claimChargeAmount`. pattern: ^\d+(\.\d{1,2})?$ type: string otherInsuredGroupName: description: The name of the health plan. type: string otherPayerAssistantSurgeon: $ref: '#/components/schemas/OtherPayerAssistantSurgeon' otherPayerBillingProvider: description: Information about the billing provider. items: $ref: '#/components/schemas/OtherPayerBillingProvider' type: array otherPayerName: $ref: '#/components/schemas/DentalOtherPayerName' otherPayerReferringProvider: description: 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 specialist. items: $ref: '#/components/schemas/OtherPayerReferringProvider' type: array otherPayerRenderingProvider: description: Information about the rendering provider. items: $ref: '#/components/schemas/OtherPayerRenderingProvider' type: array otherPayerServiceFacilityLocation: description: Information about the service facility location. items: $ref: '#/components/schemas/OtherPayerServiceFacilityLocation' type: array otherPayerSupervisingProvider: description: Information about the supervising provider. items: $ref: '#/components/schemas/OtherPayerSupervisingProvider' type: array otherSubscriberName: $ref: '#/components/schemas/DentalOtherSubscriberName' payerPaidAmount: description: The total amount in dollars the payer has paid on this claim. It is acceptable to set this to `0` (Zero). This is required when you include the `payToPlan` object, and you should set it to the amount the Medicaid agency actually paid. pattern: ^\d+(\.\d{1,2})?$ type: string paymentResponsibilityLevelCode: $ref: '#/components/schemas/OtherSubscriberInformationPaymentResponsibilityLevelCode' releaseOfInformationCode: $ref: '#/components/schemas/ReleaseOfInformationCode' remainingPatientLiability: description: This is the remaining amount (as determined by the provider) to be paid after the other payer identified in the `otherPayerName` object has adjudicated the claim. pattern: ^\d+(\.\d{1,2})?$ type: string required: - benefitsAssignmentCertificationIndicator - individualRelationshipCode - otherPayerName - otherSubscriberName - paymentResponsibilityLevelCode - releaseOfInformationCode type: object Dependent: description: "Dependent who received the medical care associated with the claim.\n - If the dependent has their own member ID for the health plan, you should include the dependent's information in the `subscriber` object instead. To check whether a dependent has a member ID, submit an [Eligibility Check](https://www.stedi.com/docs/healthcare/api-reference/post-healthcare-eligibility) to the payer. The payer returns the dependent's member ID in the `dependents.memberId` property in the response, if present.\n - You must include `address` in this object when the patient is a dependent." properties: address: $ref: '#/components/schemas/RequestSubscriberDependentAddress' description: "The dependent's address. Every claim must include address information in either the `subscriber` (when the patient is the subscriber) or `dependent` (when the patient is a dependent) object. You must include at least the `address1` and `city` properties in this object. The `state` and `postalCode` properties are also required for all United States and Canadian addresses.\n - The address must be the patient's correct address at the time of service. Don't use placeholder values to complete unknown address information. Use of outdated or placeholder values could cause the payer to reject, deny, or delay the claim due to suspected fraud.\n - If you don't know the patient's address, you should first submit a [Real-Time Eligibility Check](https://www.stedi.com/docs/healthcare/api-reference/post-healthcare-eligibility) for the patient and then copy the patient's address from either the `subscriber` or `dependent` object in the response.\n - If the patient doesn't have a current address, you can populate the `address1` property with `UNKNOWN` and populate the city, state, and zip code with appropriate values based on your discretion. However, some payers may have explicit rules for how to handle this situation, so you should check the payer's specific requirements before using this approach." contactInformation: $ref: '#/components/schemas/ContactInformationSubscriberDependent' dateOfBirth: description: The patient's date of birth pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string firstName: description: The patient's first name. type: string gender: $ref: '#/components/schemas/DependentGender' description: 'Code indiciating the patient''s gender. Can be set to `F` - Female, `M` - Male, or `U` - Unknown. Some payers may reject the claim if the patient''s gender doesn''t match the gender they have recorded in their member records. If the gender isn''t known or the patient declines to answer, use `U` or perform an eligibility check to determine the gender according to the payer''s records.' lastName: description: The patient's last name. **Don't** include the patient's name suffix, such as Jr. or III. Use the designated `suffix` property instead. type: string memberId: description: The patient's identification number. Only used in Property and Casualty claims. type: string middleName: description: The patient's middle name or initial. type: string relationshipToSubscriberCode: $ref: '#/components/schemas/RelationshipToSubscriberCode' ssn: description: The patient's Social Security Number. Only used for Property and Casualty claims. pattern: ^\d{9}$ type: string suffix: description: The patient's name suffix, such as Jr. or III. Only include the patient's personal name suffix - **don't** include professional or academic titles, such as M.D. or MBA. type: string required: - dateOfBirth - firstName - gender - lastName - relationshipToSubscriberCode type: object EditResponse: description: Currently not used. properties: allowOverride: type: string badData: type: string claimCorePath: type: string editActivity: type: string editName: type: string element: type: string errorDescription: type: string fieldIndex: type: string loop: type: string phaseID: type: string qualifierCode: type: string referenceID: type: string segment: type: string type: object InstitutionalServiceAuthorizationExceptionCode: description: Code indicating the type of service authorization exception. Visit [Claims code lists](https://www.stedi.com/docs/healthcare/claims-code-lists#service-authorization-exception-codes) for a complete list. enum: - '1' - '2' - '3' - '4' - '5' - '6' - '7' type: string PrincipalDiagnosisQualifierCode: description: Code identifying the type of diagnosis code used. Can be set to `ABK` - International Classification of Diseases Clinical Modification Principal Diagnosis or `BK` - International Classification of Diseases Clinical Modification (ICD-9-CM) Principal Diagnosis. Note that ICD-9 is deprecated and cannot be used in new claims. enum: - ABK - BK type: string InstitutionalClaimsSubmissionResponseContent: properties: claimReference: $ref: '#/components/schemas/InstitutionalClaimReference' controlNumber: description: An identifier for the transaction. type: string editResponses: description: Currently not used. items: $ref: '#/components/schemas/EditResponse' type: array editStatus: deprecated: true description: 'This shape is deprecated: Currently not used.' type: string errors: description: Errors resulting from claim edits. You must review and fix these errors before resubmitting. items: $ref: '#/components/schemas/InstitutionalError' type: array failure: $ref: '#/components/schemas/Failure' httpStatusCode: $ref: '#/components/schemas/HttpStatusCode' meta: $ref: '#/components/schemas/InstitutionalResponseMeta' payer: $ref: '#/components/schemas/InstitutionalPayer' status: description: The status of the claim submission. type: string tradingPartnerServiceId: description: An ID for the payer you identified in the original claim. This value may differ from the `tradingPartnerServiceId` you submitted in the original request because it reflects the payer's internal concept of their ID, not necessarily the ID Stedi uses to route requests to this payer. type: string warnings: description: A list of warnings. Currently not used. items: $ref: '#/components/schemas/ClaimsWarning' type: array x12: description: 'A [277CA claim acknowledgment](https://www.stedi.com/docs/healthcare/claim-responses-overview#277ca-claim-acknowledgment) acceptance or rejection from Stedi in X12 EDI format. It indicates whether the claim has passed Stedi''s claim edits. When the claim fails one or more edits, the 277CA contains `STC` segments with information about each error. These are the same error codes that appear in the `errors` array. Note that this 277CA only indicates whether Stedi has accepted or rejected the claim submission. You may receive additional 277CA acceptances or rejections as the claim is routed to the payer.' type: string type: object PayToPlanNameIdentificationCodeQualifier: description: 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 PlanID. Use `XV` when reporting the Health Plan ID (HPID) or Other Entity Identifier (OEID). enum: - PI - XV type: string ResourceNotFoundException: 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 ExportPDF403ErrorResponseContent: oneOf: - $ref: '#/components/schemas/MaximumResponseSizeExceeded' - $ref: '#/components/schemas/AccessDeniedException' DentalMedicareOutpatientAdjudication: description: Claim-level data related to the adjudication of Medicare claims not related to an inpatient setting. Required when outpatient adjudication information is reported in the remittance advice _or_ when you need to report remark codes. properties: claimPaymentRemarkCode: description: The remark code. Visit the X12 [Remittance Advice Remark Codes](https://x12.org/codes/remittance-advice-remark-codes) for a complete list. You can include up to five codes in this array. items: type: string maxItems: 5 minItems: 1 type: array hcpcsPayableAmount: description: The claim Health Care Financing Administration Common Procedural Coding System (HCPCS) payable amount, expressed as a decimal. pattern: ^\d+(\.\d{1,2})?$ type: string nonPayableProfessionalComponentBilledAmount: description: The professional component amount billed but not payable, expressed as a decimal. pattern: ^\d+(\.\d{1,2})?$ type: string reimbursementRate: description: The reimbursement percentage, expressed as a decimal. type: string type: object DentalMeasurementUnitCode: enum: - UN type: string InstitutionalClaimsRawX12SubmissionRequestContent: properties: x12: type: string required: - x12 type: object ClaimCodeInformation: description: Supply information specific to hospital claims, such as the priority of the admission. properties: admissionSourceCode: description: 'Code indicating the source of the admission, such as the emergency room (ER), a doctor’s referral, or another facility. This code is **required** for all institutional claims except when the `claimInformation.placeOfServiceCode` is set to `14` (Non-Patient Laboratory). Stedi rejects claims that don''t meet this requirement [Full code list](https://med.noridianmedicare.com/web/jea/topics/claim-submission/point-of-origin-codes).' type: string admissionTypeCode: description: The code indicating the priority of the admission. maxLength: 1 minLength: 1 type: string patientStatusCode: description: 'Code indicating patient status as of the end of the claim''s billed period. It tells the payer whether the patient was discharged, transferred, or still admitted. This code must be compatible with the `claimInformation.claimFrequencyCode`. For example, claim frequency code `1` (Admit thru Discharge Claim) means the patient''s stay is finished. In this case, the patient status code shouldn''t be `30` (Still a Patient), which indicates the patient is still in the facility. [Full code list](https://med.noridianmedicare.com/web/jea/topics/claim-submission/patient-discharge-status-codes)' maxLength: 2 minLength: 1 type: string required: - admissionTypeCode - patientStatusCode type: object InstitutionalSubmitterContactInformation: properties: email: description: The email address. type: string faxNumber: description: The fax number. type: string name: description: The full name of the person or office. maxLength: 60 minLength: 1 type: string phoneNumber: description: The phone number, formatted as AAABBBCCCC, where AAA represents the area code, BBB is the telephone number prefix, and CCCC is the telephone number. The phone number should only include the digits 0 to 9. Don't include separators, such as dashes, and don't include long distance access numbers, such as 1. For example, you would format the phone number 123-456-7890 as 1234567890. maxLength: 256 type: string validContact: deprecated: true type: boolean type: object DentalHealthCareInformation: properties: diagnosisCode: description: "The diagnosis code.\n - You must submit a valid, billable code at the highest level of specificity. Include the 4th - 7th characters as applicable.\n - **Don't** submit the decimal point for ICD codes. The decimal point is implied.\n - **Don't** submit ICD-10 header codes. Header codes exist to group related codes and aren't valid for billing. These header codes can change with each new version of ICD-10, so we recommend reviewing your diagnosis codes every year to ensure that they aren't classified as header codes in the most recent version. To determine whether a code is a header code, you can also search the [Value Set Authority Center](https://vsac.nlm.nih.gov/context/cs). If the 'Header' property is set, the code is a header code and you shouldn't use it in claim submissions." type: string diagnosisTypeCode: $ref: '#/components/schemas/DentalDiagnosisTypeCode' required: - diagnosisCode - diagnosisTypeCode type: object ServiceLine: properties: additionalNotes: description: Additional information the provider feels is necessary to substantiate the medical treatment that cannot be provided in other claim properties. Don't use this property to describe non-specific procedure codes. type: string ambulanceCertification: items: $ref: '#/components/schemas/AmbulanceCertification' maxItems: 3 minItems: 1 type: array ambulanceDropOffLocation: $ref: '#/components/schemas/ClaimsAddress' description: The address where the ambulance dropped off the patient. ambulancePatientCount: description: The number of patients transported by the ambulance. Required when more than one patient is transported in the same vehicle for Ambulance or non-emergency transportation services. type: integer ambulancePickUpLocation: $ref: '#/components/schemas/ClaimsAddress' description: The address where the ambulance picked up the patient. If the ambulance pickup location is in an area where there are no street addresses, enter a description of where the service was rendered. For example `Exit near mile marker 123 on I-95.` ambulanceTransportInformation: $ref: '#/components/schemas/AmbulanceTransportInformation' assignedNumber: deprecated: true description: Deprecated; Stedi computes this value for you. type: string conditionIndicatorDurableMedicalEquipment: $ref: '#/components/schemas/ConditionIndicatorDurableMedicalEquipment' contractInformation: $ref: '#/components/schemas/ContractInformation' drugIdentification: $ref: '#/components/schemas/DrugIdentification' durableMedicalEquipmentCertificateOfMedicalNecessity: $ref: '#/components/schemas/DurableMedicalEquipmentCertificateOfMedicalNecessity' durableMedicalEquipmentCertification: $ref: '#/components/schemas/DurableMedicalEquipmentCertification' durableMedicalEquipmentService: $ref: '#/components/schemas/DurableMedicalEquipmentService' fileInformation: description: Used to send additional data specifically requested by the payer. Not commonly used. items: type: string maxItems: 10 minItems: 1 type: array formIdentification: description: Use this object to attach standardized supplemental information to the claim when required by the payer. One example is payer documentation requirements for home health services. items: $ref: '#/components/schemas/FormIdentification' type: array goalRehabOrDischargePlans: description: The provider's goals, rehabilitation potential, or discharge plans for the patient. type: string hospiceEmployeeIndicator: description: Whether the rendering provider is a hospice employee. Required on all Medicare claims involving physician services to hospice patients. Set to `true` if the rendering provider is a hospice employee, and `false` if they are not. type: boolean lineAdjudicationInformation: description: Includes service line adjudication information for coordination of benefits between the initial payers of a health care claim and all subsequent payers. items: $ref: '#/components/schemas/LineAdjudicationInformation' maxItems: 15 minItems: 1 type: array linePricingRepricingInformation: $ref: '#/components/schemas/ClaimPricingRepricingInformation' obstetricAnesthesiaAdditionalUnits: description: The number of units reported by an anesthesia provider to reflect additional complexity of services. type: integer orderingProvider: $ref: '#/components/schemas/ServiceLineOrderingProvider' description: 'Information about the provider who requested the services or items reported in this service line. This should be an individual, not an organization, and you should supply at least the provider''s `lastName` and an identifier, which is typically the `npi`.' postageTaxAmount: description: The amount of the postage, formatted as a decimal. When you include this property, the total `lineItemChargeAmount` for this service line must include this postage value. pattern: ^\d+(\.\d{1,2})?$ type: string professionalService: $ref: '#/components/schemas/ProfessionalService' providerControlNumber: description: A unique identifier for this service line within the claim. It appears in the 835 (ERA) response as `lineItemControlNumber`, allowing you to correlate ERAs to the specific service lines from the original claim. If you don't set this property, Stedi uses a random ULID. Stedi returns service line identifiers in the `claimReference.serviceLines[].lineItemControlNumber` object of the synchronous API response. maxLength: 30 type: string purchasedServiceInformation: $ref: '#/components/schemas/PurchasedServiceInformation' purchasedServiceProvider: $ref: '#/components/schemas/ServiceLineProviderPurchasedService' description: Information about the provider who performed the purchased service. A purchased service provider performs a service on a contractual or reassignment basis for the billing provider. Examples of purchased services include processing a laboratory specimen and performing diagnostic testing services (excluding clinical laboratory testing) subject to Medicare's anti-markup rule. Note that a substitute provider (a locum tenens physician) is not considered a purchased service provider. referringProvider: $ref: '#/components/schemas/ClaimsServiceLineReferringProvider' description: 'Information about the provider who directed the patient to the rendering provider for care. For example, a primary care provider may refer patients to a specialist. Include this object when the referring provider is different than the one listed in the `referring` object for the entire claim. This should be an individual, not an organization, and you should supply at least the provider''s `lastName` and an identifier, which is typically the `npi`.' renderingProvider: $ref: '#/components/schemas/ClaimsServiceLineRenderingProvider' description: 'Information about the provider who rendered the services. This can be a individual or a company (a laboratory or other facility). This is where you should enter the substitute provider''s (locum tenens physician) information, if applicable. You should only include this object when the rendering provider information for this service line is different than the information listed in the `rendering` object for the entire claim.' salesTaxAmount: description: Sales tax, formatted as a decimal. When you include this property, the total `lineItemChargeAmount` for this service line must include this sales tax value. type: string serviceDate: description: The date the service was rendered (for services performed on a single day). When you send this property with `serviceDateEnd`, it will be used as the start date for the date range in which the service was rendered. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string serviceDateEnd: description: The end date of the service period. If you send this property, you must also send `serviceDate`. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string serviceFacilityLocation: $ref: '#/components/schemas/ServiceLineServiceFacilityLocation' description: "Information about where the services were rendered. This can be healthcare facilities, such as surgical centers or reference labs, OR the patient's address when services were rendered in their home.\n - Only include this object when the service facility location is **different** from the billing provider's address. If you include this object when the address is the same, Stedi omits all of the service facility location information from the claim submission, including the name and any identifiers.\n - For telehealth services, the service facility location is the provider's address, even though the patient may have been in their home or elsewhere when receiving services.\n - Don't use this object when reporting ambulance services - use `ambulancePickupLocation` and `ambulanceDropoffLocation` instead.\n - Sometimes the billing provider is an actual physician group that is located at the same address as a hospital, but is in fact a separate entity. In this case, you can differentiate the service facility location by including the specific suite or building number of the physician group. This ensures that the service facility location is different from the billing provider's address and is reported accurately." serviceLineDateInformation: $ref: '#/components/schemas/ServiceLineDateInformation' serviceLineReferenceInformation: $ref: '#/components/schemas/ServiceLineReferenceInformation' serviceLineSupplementalInformation: description: 'Supporting documentation for the service line. Required when you plan to submit [attachments](https://www.stedi.com/docs/healthcare/submit-claim-attachments) for the service line electronically through Stedi APIs or SFTP, when there is a paper attachment following this claim, or when the provider deems it necessary to identify additional information that is being held at the provider''s office and is available upon request. You can submit up to 10 objects in this array.' items: $ref: '#/components/schemas/ReportInformation' maxItems: 10 minItems: 1 type: array supervisingProvider: $ref: '#/components/schemas/ClaimsServiceLineSupervisingProvider' description: 'Information about the provider who oversaw the rendering provider and the care reported in this service line. Include this object when the supervising provider is different than the one listed in the `supervising` object for the entire claim. This should be an individual, not an organization, and you should supply at least the provider''s `lastName` and an identifier, which is typically the `npi`.' testResults: description: Required on Dialysis related service lines for ESRD, or required on on DMERC service lines to report the Patient's Height from the Certificate of Medical Necessity (CMN). Use HT qualifier. items: $ref: '#/components/schemas/Measurements' maxItems: 5 minItems: 1 type: array thirdPartyOrganizationNotes: description: Required when the TPO/repricer needs to forward additional information to the payer. Providers shouldn't complete this property. type: string required: - professionalService - serviceDate type: object OtherPayerAssistantSurgeonIdentifierItem: properties: identifier: description: The identifier. The format and length of this value depends on the `qualifier` you set. type: string otherIdentifier: deprecated: true description: The identifier for the other payer who provided this reference number. This is only required when the reference number is provided by the non-destination payer. The value must match the `claimInformation.otherSubscriberInformation[].otherPayerName.otherPayerIdentifier` property. type: string qualifier: description: Set to `0B` - State License Number, `1G` - Provider UPIN Number, `G2` - Commercial Number, or `LU` - Location Number. Note that UPIN is deprecated and shouldn't be used in new claims. type: string required: - identifier - qualifier type: object ReportInformationAttachmentTransmissionCode: description: '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` - Electronically Only, `EM` - E-Mail, `FT` - File Transfer, or `FX` - By Fax. Set this to `EL` when you plan to submit attachments electronically through Stedi APIs.' enum: - AA - BM - EL - EM - FT - FX type: string OtherDiagnosisInformationQualifierCode: description: Code identifying the type of diagnosis code used. Can be set to `ABF` - International Classification of Diseases Clinical Modification (ICD-10-CM) or `BF` - International Classification of Diseases Clinical Modification (ICD-9-CM). Note that ICD-9 is deprecated and cannot be used in new claims. enum: - ABF - BF type: string SpinalManipulationServiceInformation: description: Information about a chiropractic service rendered to the patient. Required on chiropractic claims involving spinal manipulation when the information is known to impact the payer's adjudication process. properties: patientConditionCode: $ref: '#/components/schemas/PatientConditionCode' description: A code indicating the nature of a patient's condition. Can be set to `A` - Acute Condition, `C` - Chronic Condition, `D`- Non-acute, `E` - Non-Life Threatening, `F` - Routine, `G` - Symptomatic, or `M` - Acute Manifestation of a Chronic Condition. patientConditionDescription1: description: The description of the patient's condition. type: string patientConditionDescription2: description: Additional description of the patient's condition type: string required: - patientConditionCode type: object ClaimsServiceLineReferringProvider: properties: address: $ref: '#/components/schemas/ClaimsAddress' deprecated: true claimOfficeNumber: deprecated: true type: string commercialNumber: description: The provider's commercial number. type: string contactInformation: $ref: '#/components/schemas/ClaimsContactInformation' deprecated: true employerId: deprecated: true description: The provider's Employer Identification Number (EIN). The EIN is typically a string of exactly nine numbers with no separators, unless otherwise specified by the provider. If you include this value, you cannot include the provider's `ssn`. type: string employerIdentificationNumber: deprecated: true description: The provider's Employer Identification Number (EIN). This field is the same as `employerId`. The EIN is typically a string of exactly nine numbers with no separators, unless otherwise specified by the provider. If you include this value, you cannot include the provider's `ssn`. type: string firstName: description: The provider's first name. maxLength: 35 minLength: 1 type: string lastName: description: The provider's last name. maxLength: 60 minLength: 1 type: string locationNumber: deprecated: true description: The provider's location number. type: string middleName: description: The provider's middle name or initial. maxLength: 25 minLength: 1 type: string naic: deprecated: true description: The National Association of Insurance Commissioners (NAIC) code. type: string npi: description: The individual [National Provider Identifier (NPI)](https://www.stedi.com/docs/healthcare/national-provider-identifier) assigned to the provider. pattern: ^\d{10}$ type: string organizationName: description: The provider's organization name. maxLength: 60 minLength: 1 type: string otherIdentifier: type: string payerIdentificationNumber: description: The payer identification number. type: string providerType: deprecated: true description: This field is now automatically populated and it only remains for backwards compatibility. type: string providerUpinNumber: deprecated: true description: Deprecated; do not use. type: string secondaryIdentifier: description: Secondary identifiers for the referring provider. items: $ref: '#/components/schemas/ServiceLineReferringProviderSecondaryIdentifierItem' maxItems: 20 minItems: 1 type: array ssn: deprecated: true description: The provider's Social Security Number. If you provide this value, you cannot include the provider's `employerId`. pattern: ^\d{9}$ type: string stateLicenseNumber: description: The provider's state license number. This is assigned directly by a payer in order to identify the provider in their system. This is not commonly used. type: string suffix: description: The provider's name suffix, such as Jr. or III. maxLength: 10 minLength: 1 type: string taxonomyCode: deprecated: true description: Code from the National Uniform Claims Committee [Health Care Provider Taxonomy Code Set](https://taxonomy.nucc.org/). This identifies the provider's type and/or area of specialty. maxLength: 10 minLength: 10 pattern: ^[A-Za-z0-9]{10}$ type: string type: object ServiceLineReferringProviderSecondaryIdentifierItem: properties: identifier: description: The identifier. The format and length of this value depends on the `qualifier` you set. type: string otherIdentifier: description: The identifier for the other payer who provided this reference number. This is only required when the reference number is provided by the non-destination payer. The value must match the `claimInformation.otherSubscriberInformation[].otherPayerName.otherPayerIdentifier` property. type: string qualifier: description: Set to `0B` - State License Number, `1G` - Provider UPIN Number, or `G2` - Provider Commercial Number. Note that UPIN is deprecated and shouldn't be used for new claims. type: string required: - identifier - qualifier type: object OtherPayerName: description: Details about the other payer. properties: otherPayerAddress: $ref: '#/components/schemas/ClaimsAddress' description: The payer's address. otherPayerAdjudicationOrPaymentDate: description: The date the other payer adjudicated the claim. Required when this payer has previously adjudicated the claim and you aren’t including a value for `LineAdjudicationInformation.adjudicationOrPaymentDate`. type: string otherPayerClaimAdjustmentIndicator: description: The only valid value is `true`. Required when Required when the claim is being sent in the payer-to-payer COB model AND the destination payer is secondary to this payer AND this payer has re-adjudicated the claim. type: boolean otherPayerClaimControlNumber: description: The claim control number assigned by this payer. type: string otherPayerIdentifier: description: The identifier specified in `otherPayerIdentifierCode`. When sending Line Adjudication Information for this payer, the identifier sent in `lineAdjudicationInformation.otherPayerPrimaryIdentifier` must match this value. type: string otherPayerIdentifierTypeCode: $ref: '#/components/schemas/OtherPayerIdentifierTypeCode' otherPayerOrganizationName: description: The payer's organization name. maxLength: 60 minLength: 1 type: string otherPayerPriorAuthorizationNumber: description: The authorization number assigned by this payer. type: string otherPayerPriorAuthorizationOrReferralNumber: description: The referral number assigned by this payer. type: string otherPayerSecondaryIdentifier: description: An additional identification number to identify the other payer. items: $ref: '#/components/schemas/OtherPayerSecondaryIdentifierItem' maxItems: 2 minItems: 1 type: array required: - otherPayerIdentifier - otherPayerIdentifierTypeCode - otherPayerOrganizationName type: object ClaimsWarning: description: '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 errors means Stedi still submitted the claim. If you receive warnings, we recommend closely monitoring 277CA responses from the payer for rejections. If the claim is rejected, we recommend fixing the issues identified in the warnings before resubmitting.' properties: code: description: A machine-readable code indicating the type of problem. type: string description: description: A human-readable description of the problem. type: string type: object Measurements: properties: measurementQualifier: $ref: '#/components/schemas/MeasurementQualifier' measurementReferenceIdentificationCode: $ref: '#/components/schemas/MeasurementReferenceIdentificationCode' testResults: description: The value of the measurement. type: string required: - measurementQualifier - measurementReferenceIdentificationCode - testResults type: object ClaimInformationConditionCodesItem: enum: - AV - NU - S2 - ST type: string LineAdjudicationInformation: description: Includes service line adjudication information for coordination of benefits between the initial payers of a health care claim and all subsequent payers. properties: adjudicationOrPaymentDate: description: The date the other payer adjudicated or paid the claim. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string bundledOrUnbundledLineNumber: description: The LX assigned number of the service line into which this service line is bundled. It's only used to bundle service lines. type: string claimAdjustmentInformation: description: Required when the payer made line level adjustments which caused the amount paid to differ from the amount originally charged. You can include up to five objects in this array. items: $ref: '#/components/schemas/ClaimAdjustment' maxItems: 5 minItems: 1 type: array otherPayerPrimaryIdentifier: description: The payer ID for the payer responsible for reimbursement. type: string paidServiceUnitCount: description: The number of paid units from the remittance advice. expressed as a decimal. When paid units are not present on the remittance advice, use the original billed units. The maximum length for this property is 8 digits excluding the decimal. When a decimal is used, the maximum number of digits allowed to the right of the decimal is three. type: string procedureCode: description: The procedure code. type: string procedureCodeDescription: description: The meaning of the procedure code. type: string procedureModifier: description: Modifiers that convey special circumstances related to the performance of the service. You can include up to four modifiers in this array. items: type: string maxItems: 4 minItems: 1 type: array remainingPatientLiability: description: The amount of the service line that the patient is still responsible for, expressed as a decimal. pattern: ^\d+(\.\d{1,2})?$ type: string serviceIdQualifier: $ref: '#/components/schemas/LineAdjudicationInformationServiceIdQualifier' serviceLinePaidAmount: description: The amount paid for this service line, expressed as a decimal. Zero (0) is an acceptable value. pattern: ^\d+(\.\d{1,2})?$ type: string required: - adjudicationOrPaymentDate - otherPayerPrimaryIdentifier - paidServiceUnitCount - procedureCode - serviceIdQualifier - serviceLinePaidAmount type: object PayToPlan: description: Use for subrogation payment requests. If you include this information, you must also set the `claimInformation.otherSubscriberInformation.payerPaidAmount` to the amount the payer (for example, Medicaid) actually paid. properties: address: $ref: '#/components/schemas/ClaimsAddress' description: The address of the pay-to-plan organization. organizationName: description: The last name of the individual, or the business name of the pay-to-plan organization. maxLength: 60 minLength: 1 type: string primaryIdentifier: description: The identifier you specified in `primaryIdentifierTypeCode`. type: string primaryIdentifierTypeCode: $ref: '#/components/schemas/PrimaryIdentifierTypeCode' secondaryIdentifier: description: The secondary identifier you specified in `secondaryIdentifierTypeCode`. type: string secondaryIdentifierTypeCode: $ref: '#/components/schemas/SecondaryIdentifierTypeCode' taxIdentificationNumber: description: The Employer Identification Number (EIN). This must be a string of exactly nine numbers with no separators. maxLength: 9 minLength: 9 type: string required: - address - organizationName - primaryIdentifier - primaryIdentifierTypeCode - taxIdentificationNumber type: object ExternalCauseOfInjury: properties: externalCauseOfInjury: description: "The external cause of injury code(s) for the patient.\n - You must submit a valid, billable code at the highest level of specificity. Include the 4th - 7th characters as applicable.\n - **Don't** submit the decimal point for ICD codes. The decimal point is implied.\n - **Don't** submit ICD-10 header codes. Header codes exist to group related codes and aren't valid for billing. These header codes can change with each new version of ICD-10, so we recommend reviewing your diagnosis codes every year to ensure that they aren't classified as header codes in the most recent version. To determine whether a code is a header code, you can also search the [Value Set Authority Center](https://vsac.nlm.nih.gov/context/cs). If the 'Header' property is set, the code is a header code and you shouldn't use it in claim submissions." maxLength: 30 type: string presentOnAdmissionIndicator: $ref: '#/components/schemas/ExternalCauseOfInjuryPresentOnAdmissionIndicator' qualifierCode: $ref: '#/components/schemas/ExternalCauseOfInjuryQualifierCode' required: - externalCauseOfInjury - qualifierCode type: object SecondaryIdentifierTypeCode: description: Code identifying the type of secondary identifier. Can be set to `2U` - Payer Identification Number, `FY` - Claim Office Number, or `NF` - National Association of Insurance Commissioners. You should only set this to `2U` when you set the `primaryIdentifierTypeCode` to `XV`. enum: - 2U - FY - NF type: string OtherSubscriberName: description: The person or entity who is the primary policyholder for the other payer's health plan. properties: otherInsuredAdditionalIdentifier: description: The primary policyholder's Social Security Number. The Social Security Number must be a string of exactly nine numbers with no separators. For example `123456789`. type: string otherInsuredAddress: $ref: '#/components/schemas/ClaimsAddress' description: The other subscriber's address. otherInsuredFirstName: description: The primary policyholder's first name, if they are an individual. type: string otherInsuredIdentifier: description: The identifier you specified in `otherInsuredIdentifierTypeCode`. type: string otherInsuredIdentifierTypeCode: $ref: '#/components/schemas/OtherInsuredIdentifierTypeCode' otherInsuredLastName: description: The primary policyholder's last name or organizational name. Don't include the primary policyholder's name suffix, such as Jr. or III. Use the designated `otherInsuredNameSuffix` property instead. type: string otherInsuredMiddleName: description: The primary policyholder's middle name or initial, if they are an individual. type: string otherInsuredNameSuffix: description: The primary policyholder's name suffix, such as Jr. or III. Only include the subscriber's personal name suffix - **don't** include professional or academic titles, such as M.D. or MBA. type: string otherInsuredQualifier: $ref: '#/components/schemas/OtherInsuredQualifier' required: - otherInsuredIdentifier - otherInsuredIdentifierTypeCode - otherInsuredLastName - otherInsuredQualifier type: object DurableMedicalEquipmentCertificateOfMedicalNecessity: description: Required on claims that include a Durable Medical Equipment Regional Carrier (DMERC) Certificate of Medical Necessity (CMN). properties: attachmentTransmissionCode: $ref: '#/components/schemas/DurableMedicalEquipmentCertificateOfMedicalNecessityAttachmentTransmissionCode' required: - attachmentTransmissionCode type: object OtherProcedureInformationQualifierCode: enum: - BBQ - BQ type: string ClaimInformation: description: "Information about the healthcare claim. \n\nNote that the objects and properties marked as **required** are required for all claims, while others are conditionally required, depending on type of claim and claim circumstances. For example, you must always provide the patient's diagnosis codes in the `healthCareCodeInformation` object, but you only need to provide the `otherSubscriberInformation` object in coordination of benefits scenarios. When you include a conditionally required object, you must provide all of its required properties." properties: ambulanceCertification: description: Required when the claim involves ambulance transport services. items: $ref: '#/components/schemas/AmbulanceCertification' maxItems: 3 minItems: 1 type: array ambulanceDropOffLocation: $ref: '#/components/schemas/ClaimsAddress' description: The address where the ambulance dropped off the patient. ambulancePickUpLocation: $ref: '#/components/schemas/ClaimsAddress' description: The address where the ambulance picked up the patient. If the ambulance pickup location is in an area where there are no street addresses, enter a description of where the service was rendered. For example `Exit near mile marker 123 on I-95.` ambulanceTransportInformation: $ref: '#/components/schemas/AmbulanceTransportInformation' anesthesiaRelatedSurgicalProcedure: description: The surgical code. Required on claims where anesthesiology services are being billed or reported when the provider knows the surgical code and knows the adjudication of the claim will depend on provision of the surgical code. items: type: string maxItems: 2 minItems: 1 type: array autoAccidentCountryCode: description: The country code where the accident occurred. Use when `relatedCausesCode` = `AA` and the accident occurred in a country other than US or Canada. type: string autoAccidentStateCode: description: A code identifying the state or province in which the automobile accident occurred. Use this code when `relatedCausesCode` is set to `AA`. type: string benefitsAssignmentCertificationIndicator: $ref: '#/components/schemas/ClaimInformationBenefitsAssignmentCertificationIndicator' claimChargeAmount: description: The total dollar amount charged for the services on this claim, expressed as a decimal. For example, `100.50`. This is the total amount before any adjustments or payments. The amount must balance to the sum of the service line charges. pattern: ^\d+(\.\d{1,2})?$ type: string claimContractInformation: $ref: '#/components/schemas/ClaimContractInformation' claimDateInformation: $ref: '#/components/schemas/ClaimDateInformation' claimFilingCode: $ref: '#/components/schemas/ClaimFilingCode' claimFrequencyCode: $ref: '#/components/schemas/ClaimFrequencyCode' description: "[Bill Type Frequency Code](https://www.nubc.org/system/files/media/file/2019/06/billTypeFrequencyCodes837.pdf) specifying the frequency of the claim. Can be set to `1` - Admit thru Discharge Claim, `7` - Replacement of Prior Claim, or `8` - Void/Cancel of Prior Claim.\n - Set this to `1` when you're submitting a new claim and when you're resubmitting a claim that was rejected before it entered the payer's processing system. You must also set this property to `1` for every resubmission to Original Medicare because Original Medicare doesn't accept code `7`.\n - Set this to `7` when you need to resubmit a corrected claim that the payer has already processed. These are claims that the payer has already adjudicated or claims that the payer has rejected with a 277CA containing the Payer Claim Control Number (PCCN), indicating it has entered the payer's system.\n - When resubmitting with code `7` or voiding with code `8`, you must also include the Payer Claim Control Number (sometimes called the ICN) in the `claimInformation.claimSupplementalInformation.claimControlNumber` property. An exception is Original Medicare, which requires that you omit the Payer Claim Control Number from resubmissions.\n - For resubmissions and cancellations, we strongly recommend including a unique Patient Control Number in the `claimInformation.patientControlNumber` for tracking purposes.\n\nVisit [Resubmit or cancel claims](https://www.stedi.com/docs/healthcare/resubmit-cancel-claims) for complete details." claimNote: $ref: '#/components/schemas/ClaimNote' claimPricingRepricingInformation: $ref: '#/components/schemas/ClaimPricingRepricingInformation' claimSupplementalInformation: $ref: '#/components/schemas/ClaimSupplementalInformation' conditionInformation: description: Required when condition information applies to the claim. You can include up to 24 codes in the array. Visit the National Uniform Claim Committee for a complete list of possible [condition codes](https://www.nucc.org/index.php/code-sets-mainmenu-41/condition-codes-mainmenu-38). items: $ref: '#/components/schemas/ConditionInformation' maxItems: 2 minItems: 1 type: array deathDate: description: The patient's date of death. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string delayReasonCode: $ref: '#/components/schemas/DelayReasonCode' epsdtReferral: $ref: '#/components/schemas/EpsdtReferral' description: "Required on Early & Periodic Screening, Diagnosis, and Treatment (EPSDT) claims when the screening service is being billed in this claim.\n\n This is **required** if any of the claim service lines are for EPSDT services. That means you must include this object if any `claimInformation.serviceLines[].professionalService.epsdtIndicator` properties are set to `Y`." fileInformation: deprecated: true description: Please use the `fileInformationList` array instead. type: string fileInformationList: description: An array of additional information items the payer requested. Not commonly used. items: type: string maxItems: 10 minItems: 1 type: array healthCareCodeInformation: description: "Details about the patient's healthcare diagnosis.\n - Use `ABK` as the type for the principal diagnosis code and `ABF` for any other diagnosis codes you include.\n - One `ABK` code is required as the first object, and then you can submit up to 11 `ABF` codes as needed. If you need to submit more codes than this, you must create additional, separate claims." items: $ref: '#/components/schemas/ClaimsHealthCareInformation' maxItems: 12 minItems: 1 type: array homeboundIndicator: description: Required for Medicare claims when an independent laboratory renders an EKG tracing or obtains a specimen from a homebound or institutionalized patient. type: boolean otherSubscriberInformation: description: 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 the patient has coverage. It's used for coordination of benefits scenarios. items: $ref: '#/components/schemas/OtherSubscriberInformation' maxItems: 10 minItems: 1 type: array patientAmountPaid: description: 'The total amount in dollars the patient or their representatives have paid on this claim. For example, `20.50`. This includes any co-payments, co-insurance, or other amounts already collected from the patient. If the patient has not paid anything, you should omit this property entirely - **don''t** set it to `0`.' pattern: ^\d+(\.\d{1,2})?$ type: string patientConditionInformationVision: description: Required on vision claims involving replacement lenses or frames when this information is known to impact reimbursement. items: $ref: '#/components/schemas/PatientConditionInformationVision' maxItems: 3 minItems: 1 type: array patientControlNumber: description: "An identifier you assign to the claim.\n\nWe **strongly recommend** submitting a unique value for this property so you can use it to correlate this claim with responses, such as the [277CA claim acknowledgment](https://www.stedi.com/docs/healthcare/receive-claim-responses#correlate-277ca) and the [835 ERA](https://www.stedi.com/docs/healthcare/receive-claim-responses#correlate-835-era).\n - Use random strings. The identifier should be more complex than a simple sequential number and should be hard to guess. Formats with patient initials or the date of service in them can create duplicates. We recommend using [nanoid](https://www.npmjs.com/package/nanoid) or a similar library configured with the characters from the [basic character set](https://www.stedi.com/docs/healthcare/submit-professional-claims#character-restrictions) to generate unique IDs.\n - Keep it to 17 characters max. Some payers cut off values longer than 17 characters in 277CAs and ERAs, which makes it hard to match them with the original claim.\n - Use only characters available in the [basic character set](https://www.stedi.com/docs/healthcare/submit-professional-claims#character-restrictions), and avoid special characters that are only available in the extended character set. Using other characters may result in data loss or mismatches when correlating claims with responses.\n - If you plan to submit the autogenerated CMS-1500 PDF for this claim, you must limit this value to 14 characters or this value will be truncated in the PDF. This value appears in Box 26 (Patient's Account No.) on the CMS-1500 form." maxLength: 20 minLength: 1 type: string patientSignatureSourceCode: description: Code indicating how the patient or subscriber authorization signatures were obtained and how they are being retained by the provider. Can be set to `true` - Signature generated by provider because the patient was not physically present for services. This means the signature was generated by an entity other than the patient according to State or Federal law. This property is **required** for claims submitted to Medicare. type: boolean patientWeight: description: The patient's weight in pounds, such as `150`. You should only set this property if the payer specifically requests it, such as for some Medicare DME claims. Otherwise, including this property can trigger claim edits. type: string placeOfServiceCode: $ref: '#/components/schemas/PlaceOfServiceCode' description: Code identifying the type of facility where the services were or may be performed. Visit [Place of Service Codes](https://www.cms.gov/medicare/coding-billing/place-of-service-codes/code-sets) for a complete list. planParticipationCode: $ref: '#/components/schemas/PlanParticipationCode' pregnancyIndicator: $ref: '#/components/schemas/PregnancyIndicator' propertyCasualtyClaimNumber: description: The agency claim number for this transaction. Used when services included in this claim are part of a property and casualty claim. type: string relatedCausesCode: description: 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. You can include up to two codes in this array. items: $ref: '#/components/schemas/ClaimInformationRelatedCausesCodeItem' maxItems: 2 minItems: 1 type: array releaseInformationCode: $ref: '#/components/schemas/ReleaseInformationCode' serviceFacilityLocation: $ref: '#/components/schemas/ClaimServiceFacilityLocation' serviceLines: description: "Information about one or more services rendered to the patient.\n - Each service line must be a unique service event as defined by the payer's billing policies. This means that you can use the same procedure code on multiple service lines as long as they are distinct events.\n - Some procedure codes are date-specific. In these cases, you may need to create a separate service line with that code for each applicable date of service, even if the episode of care extended over multiple days.\n - Service lines can share the same dates of service if the patient received multiple services on the same day." items: $ref: '#/components/schemas/ServiceLine' maxItems: 50 minItems: 1 type: array signatureIndicator: $ref: '#/components/schemas/SignatureIndicator' specialProgramCode: $ref: '#/components/schemas/SpecialProgramCode' spinalManipulationServiceInformation: $ref: '#/components/schemas/SpinalManipulationServiceInformation' required: - benefitsAssignmentCertificationIndicator - claimChargeAmount - claimFilingCode - claimFrequencyCode - healthCareCodeInformation - patientControlNumber - placeOfServiceCode - planParticipationCode - releaseInformationCode - serviceLines - signatureIndicator type: object TradingPartnerSecondaryIdentifiers: description: Secondary identifiers for the payer. You can include up to three properties in this object. properties: claimOfficeNumber: description: Claim Office Number. maxLength: 50 type: string employerIdentificationNumber: description: Employer Identification Number. This must be a string of exactly nine numbers with no separators. maxLength: 50 type: string naic: description: National Association of Insurance Commissioners (NAIC) Code. maxLength: 50 type: string payerIdentificationNumber: deprecated: true description: 'Payer Identification Number. This shape is deprecated since 1/9/25.' maxLength: 50 type: string type: object PrincipalDiagnosisPresentOnAdmissionIndicator: description: 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 (onset occurred prior to admission to the hospital), `U` - Unknown, or `W` - Not Applicable. enum: - N - Y - U - W type: string DrugIdentificationServiceIdQualifier: description: Code indicating the source of the drug code or product number. Visit [Claims code lists](https://www.stedi.com/docs/healthcare/claims-code-lists#drug-identification-product-or-service-id-qualifier-codes) for a complete list. enum: - EN - EO - HI - N4 - 'ON' - UK - UP type: string ServiceLineReferenceInformation: description: Additional identifiers for the service line. properties: adjustedRepricedLineItemReferenceNumber: description: Required when a repricing (pricing) organization needs to have an identifying number on an adjusted service line. type: string clinicalLaboratoryImprovementAmendmentNumber: type: string immunizationBatchNumber: type: string mammographyCertificationNumber: type: string priorAuthorization: description: "Prior authorization (preauthorization) numbers that apply to this service line.\n - Put each unique number in a separate array element.\n - You can use the same number on multiple service lines.\n\n**Important**: Only include prior authorization numbers that differ from the claim-level authorization in `claimInformation.claimSupplementalInformation.priorAuthorizationNumber`." items: $ref: '#/components/schemas/PriorAuthorization' maxItems: 5 minItems: 1 type: array referralNumber: items: type: string maxItems: 5 minItems: 1 type: array referringCliaNumber: type: string repricedLineItemReferenceNumber: description: Required when a repricing (pricing) organization needs to have an identifying number on the service line. type: string type: object DentalContractTypeCode: description: 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. enum: - '02' - '03' - '04' - '05' - '06' - 09 type: string ClaimPricingInformation: properties: exceptionCode: $ref: '#/components/schemas/InstitutionalClaimsExceptionCode' policyComplianceCode: $ref: '#/components/schemas/PolicyComplianceCode' description: Code indicating the policy compliance. Visit [Claims code lists](https://www.stedi.com/docs/healthcare/claims-code-lists#policy-compliance-codes) for a complete list. pricingMethodologyCode: $ref: '#/components/schemas/PricingMethodologyCode' description: The pricing methodology code. Visit [Claims code lists](https://www.stedi.com/docs/healthcare/claims-code-lists#pricing-methodology-codes) for a complete list. productOrServiceIDQualifier: $ref: '#/components/schemas/ClaimPricingInformationProductOrServiceIDQualifier' rejectReasonCode: $ref: '#/components/schemas/RejectReasonCode' description: Code indicating the rejection message returned from the third party organization. Visit [Claims code lists](https://www.stedi.com/docs/healthcare/claims-code-lists#reject-reason-codes) for a complete list. repricedAllowedAmount: description: The allowed amount, expressed as a decimal. type: string repricedApprovedAmount: description: The approved DRG amount, expressed as a decimal. type: string repricedApprovedDRGCode: description: The approved DRG code. type: string repricedApprovedHCPCSCode: description: The approved procedure code. If you provide this property, you must also include `productOrServiceIDQualifier`. type: string repricedApprovedRevenueCode: description: The approved revenue code. type: string repricedApprovedServiceUnitCode: $ref: '#/components/schemas/RepricedApprovedServiceUnitCode' repricedApprovedServiceUnitCount: description: The approved service units or inpatient days. The maximum length for this field is 8 digits excluding the decimal. When a decimal is used, the maximum number of digits allowed to the right of the decimal is three. type: string repricedOrgIdentifier: description: The organization identification number. type: string repricedPerDiem: description: The pricing rate associated with per diem or flat rate pricing, expressed as a decimal. type: string repricedSavingAmount: description: The savings amount, expressed as a decimal. type: string required: - pricingMethodologyCode - repricedAllowedAmount type: object InstitutionalSubmitter: description: The entity submitting the healthcare claim. This is an organization, such as a hospital or other treatment center. properties: contactInformation: $ref: '#/components/schemas/InstitutionalSubmitterContactInformation' description: Contact information for the institution submitting the claim. This should be the person or department that deals with data submission and claim processing issues. You must include at least one communication method (phone, fax, or email) in this object. organizationName: description: The business name of the institution submitting the claim. maxLength: 60 minLength: 1 type: string taxId: description: The submitter's Electronic Transmitter Identification Number (ETIN), **as assigned by the payer**. For some payers, this may be the same as the submitter's NPI, EIN/TIN, but it can also be another unique identifier. Payers can refer to this identifier as the Provider Number, Submitter ID, Submitter Identifier, Submitter Primary Number, Sender Code, Certified Contracted Provider ID, and other names. maxLength: 80 minLength: 2 type: string required: - contactInformation - organizationName - taxId type: object PatientConditionCode: description: A code indicating the nature of a patient's condition. enum: - A - C - D - E - F - G - M type: string OtherInsuredIdentifierTypeCode: description: 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 Identification Number. The code `MI` should be the subscriber's identification number as assigned by the payer, such as their subscriber ID. You should also use `MI` in claims submitted to the Indian Health Service/Contract Health Services (IHS/CHS) Fiscal Intermediary for the purpose of reporting the Tribe Residency Code (Tribe County State). For IHS/CHS claims, you should also put the SSN in the `otherInsuredAdditionalIdentifier` property.) enum: - II - MI type: string ReportInformationAttachmentReportTypeCode: description: 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 lists](https://www.stedi.com/docs/healthcare/claims-code-lists#attachment-report-type-codes) for a complete list. enum: - '03' - '04' - '05' - '06' - '07' - 08 - 09 - '10' - '11' - '13' - '15' - '21' - A3 - A4 - AM - AS - B2 - B3 - B4 - BR - BS - BT - CB - CK - CT - D2 - DA - DB - DG - DJ - DS - EB - HC - HR - I5 - IR - LA - M1 - MT - NN - OB - OC - OD - OE - OX - OZ - P4 - P5 - PE - PN - PO - PQ - PY - PZ - RB - RR - RT - RX - SG - V5 - XP type: string CodeCategory: description: Identifies the category to which the `conditionCode` applies. Can be set to `E1` - Spectacle Lenses, `E2` - Contact Lenses, or `E3` - Spectacle Frames. enum: - E1 - E2 - E3 type: string InstitutionalClaimAdjustmentDetails: properties: adjustmentAmount: description: The dollar amount of the adjustment, expressed as a decimal. type: string adjustmentQuantity: description: The units of service being adjusted, expressed as a decimal. type: string adjustmentReasonCode: description: Code identifying the detailed reason the adjustment was made. Visit the X12 [Claim Adjustment Reason Codes](https://x12.org/codes/claim-adjustment-reason-codes) for a complete list. type: string required: - adjustmentAmount - adjustmentReasonCode type: object Referring: description: '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 specialist. Use when the referring provider applies to the entire claim, not just a specific service line. This should be an individual, not an organization, and you should supply at least the provider''s `lastName` and an identifier, which is typically the `npi`.' properties: address: $ref: '#/components/schemas/ClaimsAddress' deprecated: true commercialNumber: description: The provider's commercial number. type: string contactInformation: $ref: '#/components/schemas/ClaimsContactInformation' deprecated: true firstName: description: The provider's first name. maxLength: 35 minLength: 1 type: string lastName: description: The provider's last name. maxLength: 60 minLength: 1 type: string middleName: description: The provider's middle name or initial. maxLength: 25 minLength: 1 type: string npi: description: The individual [National Provider Identifier (NPI)](https://www.stedi.com/docs/healthcare/national-provider-identifier) assigned to the provider. pattern: ^\d{10}$ type: string organizationName: description: The provider's business name. maxLength: 60 minLength: 1 type: string providerType: deprecated: true description: This field is now automatically populated and it only remains for backwards compatibility. type: string providerUpinNumber: deprecated: true description: Deprecated; do not use. type: string stateLicenseNumber: description: The provider's state license number. This is assigned directly by a payer in order to identify the provider in their system. This is not commonly used. type: string suffix: description: The provider's name suffix, such as Jr. or III. maxLength: 10 minLength: 1 type: string taxonomyCode: deprecated: true maxLength: 10 minLength: 10 pattern: ^[A-Za-z0-9]{10}$ type: string type: object AttachmentReportTypeCode: description: 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 lists](https://www.stedi.com/docs/healthcare/claims-code-lists#attachment-report-type-codes) for a complete list. enum: - '03' - '04' - '05' - '06' - '07' - 08 - 09 - '10' - '11' - '13' - '15' - '21' - A3 - A4 - AM - AS - B2 - B3 - B4 - BR - BS - BT - CB - CK - CT - D2 - DA - DB - DG - DJ - DS - EB - HC - HR - I5 - IR - LA - M1 - MT - NN - OB - OC - OD - OE - OX - OZ - P4 - P5 - PE - PN - PO - PQ - PY - PZ - RB - RR - RT - RX - SG - V5 - XP type: string ExportPDF400ErrorResponseContent: oneOf: - $ref: '#/components/schemas/MissingParameter' - $ref: '#/components/schemas/ValidationException' InstitutionalClaimInformation: description: Information about the healthcare claim. Note that the objects and properties marked as required are required for all claims, while others are conditionally required, depending on type of claim and claim circumstances. For example, you must always provide the `claimChargeAmount`, but you only need to provide the `otherSubscriberInformation` object in coordination of benefits scenarios. When you include a conditionally required object, you must provide all of its required properties. properties: admittingDiagnosis: $ref: '#/components/schemas/AdmittingDiagnosis' description: The diagnosis for which the patient sought medical care. This may be different from the principal diagnosis. benefitsAssignmentCertificationIndicator: $ref: '#/components/schemas/InstitutionalClaimInformationBenefitsAssignmentCertificationIndicator' description: A code indicating whether the patient or an authorized person has authorized the plan to remit payment directly to the provider. Use `W` when the patient refuses to assign benefits. Can be set to `N` - No (Payment should go to the patient), `Y` - Yes (Payment should go directly to the provider), or `W` - Not Applicable. billingNote: description: To communicate special instructions regarding claim billing. Required when the provider judges the information is needed to substantiate the medical treatment and cannot be provided elsewhere in the request. maxLength: 80 type: string claimChargeAmount: description: The total dollar amount charged for the services on this claim, expressed as a decimal. For example, `100.50`. This is the total amount before any adjustments or payments. The amount must balance to the sum of the service line charges. pattern: ^\d+(\.\d{1,2})?$ type: string claimCodeInformation: $ref: '#/components/schemas/ClaimCodeInformation' claimContractInformation: $ref: '#/components/schemas/ClaimContractInformation' claimDateInformation: $ref: '#/components/schemas/InstitutionalClaimDateInformation' claimFilingCode: $ref: '#/components/schemas/ClaimFilingCode' claimFrequencyCode: description: "Code specifying the frequency of the claim. Not all payers allow all codes. Can be set to `1` - Admit thru Discharge Claim, `2` - Interim – First Claim, `3` - Interim – Continuing Claim, `4` - Interim – Last Claim, `7` - Replacement, `8` - Void, and `9` - Final Claim for a Home Health PPS Episode.\n - The claim frequency code and patient status code (`claimInformation.claimCodeInformation.patientStatusCode`) must be compatible. For example, claim frequency code `1` (Admit thru Discharge Claim) means the patient’s stay is finished. In this case, the patient status code shouldn't be `30` (Still a Patient), which indicates the patient is still in the facility.\n - Set this to `7` when you need to resubmit a corrected claim that the payer has already processed. These are claims that the payer has already adjudicated or claims that the payer has rejected with a 277CA containing the Payer Claim Control Number (PCCN), indicating it has entered the payer's system. Note that Original Medicare doesn't accept code `7` for resubmissions, so you'll need to resubmit with the same code as the original claim.\n - When resubmitting with code `7` or voiding with code `8`, you must also include the Payer Claim Control Number (sometimes called the ICN) in the `claimInformation.claimSupplementalInformation.claimControlNumber` property. An exception is Original Medicare, which requires that you omit the Payer Claim Control Number from resubmissions.\n - For resubmissions and cancellations, we strongly recommend including a unique Patient Control Number in the `claimInformation.patientControlNumber` for tracking purposes.\n\nVisit [Resubmit or cancel claims](https://www.stedi.com/docs/healthcare/resubmit-cancel-claims) for complete details." maxLength: 1 type: string claimNotes: $ref: '#/components/schemas/ClaimNotes' claimPricingInformation: $ref: '#/components/schemas/ClaimPricingInformation' description: Specifies pricing or repricing information about a claim. Required when this information is deemed necessary by the repricer. For capitated encounters, pricing or repricing information is usually not applicable and is provided to qualify other information within the claim. claimSupplementalInformation: $ref: '#/components/schemas/InstitutionalClaimSupplementalInformation' conditionCodes: description: "Indicates the condition of the patient for EPSDT referral situations. Can be set to `AV` - Available-Not Used, `NU` - Not Used, `S2` - Under Treatment, `ST` - New Services Requested.\n - Use `AV` when the patient refused a referral.\n - Use `S2` when the patient is currently under treatment for the referred diagnostic or corrective health problem.\n - Use `ST` when the patient is referred to another provider for diagnostic or corrective treatment for at least one health problem identified during an initial or periodic screening service (not including dental referrals) OR the patient is scheduled for another appointment with the screening provider for diagnostic or corrective treatment for at least one health problem identified during an initial or periodic screening service (not including dental referrals)." items: $ref: '#/components/schemas/ClaimInformationConditionCodesItem' maxItems: 12 minItems: 1 type: array conditionCodesList: description: "Required when there is a Condition Code that applies to this claim. \n\n This is an array of arrays of objects. You can provide up to two object arrays, and each array can contain up to 12 objects." items: items: $ref: '#/components/schemas/InstitutionalConditionInformation' minItems: 1 type: array maxItems: 2 minItems: 1 type: array delayReasonCode: $ref: '#/components/schemas/InstitutionalDelayReasonCode' diagnosisRelatedGroupInformation: $ref: '#/components/schemas/DiagnosisRelatedGroupInformation' description: Diagnosis related group (DRG) code. Required when an inpatient hospital is under DRG contract with a payer and the contract requires the provider to identify the DRG to the payer. epsdtReferral: $ref: '#/components/schemas/EpsdtReferral' externalCauseOfInjuries: description: "Diagnosis codes to describe the patient's condition. Required when an external Cause of Injury is needed to describe an injury, poisoning, or adverse effect. \n\nNote that to fully describe an injury using ICD-10-CM, it will be necessary to report a series of 3 external cause of injury codes. Refer to the [ICD-10-CM Official Guidelines for Coding and Reporting](https://stacks.cdc.gov/view/cdc/158747).\n\nYou can provide up to 12 objects in this array." items: $ref: '#/components/schemas/ExternalCauseOfInjury' maxItems: 12 minItems: 1 type: array fileInformation: description: Used to send additional data specifically requested by the payer. Not commonly used. items: type: string maxItems: 10 minItems: 1 type: array occurrenceInformationList: description: Required when there is a Occurrence Code that applies to this claim. This is an array of arrays of objects. You can provide up to two object arrays, and each array can contain up to 12 objects. items: items: $ref: '#/components/schemas/OccurrenceInformation' minItems: 1 type: array maxItems: 2 minItems: 1 type: array occurrenceSpanInformations: description: Required when there is an Occurrence Span Code that applies to this claim. This is an array or arrays of objects. You can provide up to two object arrays and each array can contain up to 12 objects. items: items: $ref: '#/components/schemas/OccurrenceSpanInformation' minItems: 1 type: array maxItems: 2 minItems: 1 type: array otherDiagnosisInformationList: description: Additional diagnosis codes relevant to the claim. Required when other condition(s) coexist or develop(s) subsequently during the patient's treatment. This is an array of arrays of objects. You can provide up to two object arrays, and each object array can contain up to 12 objects. items: items: $ref: '#/components/schemas/OtherDiagnosisInformation' minItems: 1 type: array maxItems: 2 minItems: 1 type: array otherProcedureInformationList: description: Required on inpatient claims when additional procedures must be reported. This is an array of arrays of objects. You can provide up to two object arrays, and each array can contain up to 12 objects. items: items: $ref: '#/components/schemas/OtherProcedureInformation' minItems: 1 type: array maxItems: 2 minItems: 1 type: array otherSubscriberInformation: $ref: '#/components/schemas/InstitutionalOtherSubscriberInformation' patientAmountPaid: deprecated: true type: string patientControlNumber: description: "An identifier you assign to the claim. We **strongly recommend** submitting a unique value for this property so that you can use it to correlate this claim with responses, such as the [277CA claim acknowledgment](https://www.stedi.com/docs/healthcare/receive-claim-responses#correlate-277ca) and the [835 ERA](https://www.stedi.com/docs/healthcare/receive-claim-responses#correlate-835-era).\n - Use random strings. The identifier should be more complex than a simple sequential number and should be hard to guess. Formats with patient initials or the date of service in them can create duplicates. We recommend using [nanoid](https://www.npmjs.com/package/nanoid) or a similar library configured with the characters from the [basic character set](https://www.stedi.com/docs/healthcare/submit-institutional-claims#character-restrictions) to generate unique IDs.\n - Keep it to 17 characters max. Some payers cut off values longer than 17 characters in 277CAs and ERAs, which makes it hard to match them with the original claim.\n - Use only characters available in the [basic character set](https://www.stedi.com/docs/healthcare/submit-institutional-claims#character-restrictions), and avoid special characters that are only available in the extended character set. Using other characters may result in data loss or mismatches when correlating claims with responses." maxLength: 20 type: string patientEstimatedAmountDue: description: The total estimated amount the patient must pay for the services listed in this claim. Expressed as a decimal, such as `20.50`. This includes any co-payments, co-insurance, or other costs. pattern: ^\d+(\.\d{1,2})?$ type: string patientReasonForVisits: description: The diagnosis for which the patient visited an outpatient provider. Required when the claim involves outpatient visits. This may be different from the principal diagnosis. This is an array of objects and you can provide up to three objects. items: $ref: '#/components/schemas/PatientReasonForVisit' maxItems: 3 minItems: 1 type: array patientWeight: deprecated: true type: string placeOfServiceCode: description: Code identifying the type of facility where the services were or may be performed. This must be the two-digit facility type code from the National Uniform Billing Committee [Official UB-04 Data File](https://www.nubc.org/license) (FL 04 - Type of Bill Facility Codes). maxLength: 2 type: string planParticipationCode: $ref: '#/components/schemas/PlanParticipationCode' principalDiagnosis: $ref: '#/components/schemas/PrincipalDiagnosis' description: This is the diagnosis for the condition determined to be primarily responsible for admission of the patient into the health facility for care. principalProcedureInformation: $ref: '#/components/schemas/PrincipalProcedureInformation' description: The procedure code for the primary procedure performed on the patient. Required on inpatient claims when a procedure was performed. propertyCasualtyClaimNumber: description: The agency claim number for this transaction. Used when services included in this claim are part of a property and casualty claim. This property is typically not used by Stedi customers. type: string releaseInformationCode: $ref: '#/components/schemas/ReleaseInformationCode' serviceFacilityLocation: $ref: '#/components/schemas/InstitutionalServiceFacilityLocation' serviceLines: description: "Information about one or more services rendered to the patient.\n - Each service line must be a unique service event as defined by the payer's billing policies. This means that you can use the same procedure code on multiple service lines as long as they are distinct events.\n - Some procedure codes are date-specific. In these cases, you may need to create a separate service line with that code for each applicable date of service, even if the episode of care extended over multiple days.\n - Service lines can share the same dates of service if the patient received multiple services on the same day." items: $ref: '#/components/schemas/InstitutionalServiceLine' minItems: 1 type: array signatureIndicator: deprecated: true type: string treatmentCodeInformationList: description: Required when Home Health Agencies need to report Plan of Treatment information under various payer contracts. This is an array of arrays of strings. You can provide up to two string arrays, and each array can contain up to 12 strings. Each string represents one treatment code. items: items: type: string minItems: 1 type: array maxItems: 2 minItems: 1 type: array valueInformationList: description: Required when there is a Value Code that applies to this claim. This is an array of arrays of objects. You can provide up to two object arrays, and each array can contain up to 12 objects. items: items: $ref: '#/components/schemas/ValueInformation' minItems: 1 type: array maxItems: 2 minItems: 1 type: array required: - benefitsAssignmentCertificationIndicator - claimChargeAmount - claimCodeInformation - claimDateInformation - claimFilingCode - claimFrequencyCode - patientControlNumber - placeOfServiceCode - planParticipationCode - principalDiagnosis - releaseInformationCode - serviceLines type: object InstitutionalServiceLineSupplementalInformation: properties: attachmentControlNumber: description: "A control number assigned to the attachment. The payer uses this identifier to match the attachment to the claim.\n - You must include either this property or `attachmentId` in the request, but not both. Including both properties will result in an error.\n - We recommend using a ULID or UUID of up to 50 characters.\n - Stedi autogenerates a control number if you don't provide one." type: string attachmentId: description: "The unique identifier for the attachment file you previously uploaded to Stedi. This value is returned in the `attachmentId` property of the [Create Claim Attachment (275) JSON](https://www.stedi.com/docs/healthcare/api-reference/post-healthcare-submit-claim-attachment) response. Stedi uses it to generate and submit the 275 claim attachment transaction to the payer.\n - This property is **required** when you're submitting attachment files through Stedi.\n - You must include either this property or `attachmentControlNumber` in the request, but not both. Including both properties will result in an error." maxLength: 36 minLength: 36 pattern: ^[0-9a-fA-F]{8}-[0-9a-fA-F]{4}-[0-9a-fA-F]{4}-[0-9a-fA-F]{4}-[0-9a-fA-F]{12}$ type: string attachmentReportTypeCode: $ref: '#/components/schemas/ServiceLineSupplementalInformationAttachmentReportTypeCode' attachmentTransmissionCode: $ref: '#/components/schemas/ServiceLineSupplementalInformationAttachmentTransmissionCode' description: '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` - Electronically Only, `EM` - E-Mail, `FT` - File Transfer, or `FX` - By Fax. Set this to `EL` when you plan to submit attachments electronically through Stedi APIs.' required: - attachmentReportTypeCode - attachmentTransmissionCode type: object ServiceLineSupervisingProviderSecondaryIdentifierItem: properties: identifier: description: The identifier. The format and length of this value depends on the `qualifier` you set. type: string otherIdentifier: description: The identifier for the other payer who provided this reference number. This is only required when the reference number is provided by the non-destination payer. The value must match the `claimInformation.otherSubscriberInformation[].otherPayerName.otherPayerIdentifier` property. type: string qualifier: description: Set to `0B` - State License Number, `1G` - Provider UPIN Number, `G2` - Provider Commercial Number, or `LU` - Location Number. Note that UPIN is deprecated and shouldn't be used for new claims. type: string required: - identifier - qualifier type: object DiagnosisRelatedGroupInformation: properties: drugRelatedGroupCode: description: The diagnosis related group code. maxLength: 30 type: string required: - drugRelatedGroupCode type: object DentalAttachmentReportTypeCode: description: 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](https://www.stedi.com/docs/healthcare/claims-code-lists#attachment-report-type-codes) for a complete list. enum: - B4 - DA - DG - EB - OZ - P6 - RB - RR type: string ClaimsDiagnosisTypeCode: description: Code indicating the specific industry code list. Can be set to `ABK` - International Classification of Diseases Clinical Modification (ICD-10-CM) Principal Diagnosis or `ABF` - International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis. enum: - BK - ABK - BF - ABF type: string InstitutionalOtherPayerName: properties: otherInsuredAdditionalIdentifier: deprecated: true type: string otherPayerAddress: $ref: '#/components/schemas/InstitutionalAddress' description: The address of the other payer. You must include at least the `address1` and `city` properties in this object. otherPayerAdjudicationOrPaymentDate: type: string otherPayerClaimAdjustmentIndicator: description: Required when the claim is being sent in the payer-to-payer COB model, AND the destination payer is secondary to the payer identified in this object, AND the payer identified in this object re-adjudicated the claim. Can be set to `Y` - Yes. type: boolean otherPayerClaimControlNumber: description: The other payer's claim control number for this claim. type: string otherPayerIdentifier: description: The identifier specified in `otherPayerIdentifierTypeCode`. type: string otherPayerIdentifierTypeCode: $ref: '#/components/schemas/InstitutionalOtherPayerIdentifierTypeCode' otherPayerOrganizationName: description: The business name of the other payer. maxLength: 60 minLength: 1 type: string otherPayerPriorAuthorizationNumber: description: The other payer's prior authorization number. Required when this payer has assigned a prior authorization number to this claim. type: string otherPayerPriorAuthorizationOrReferralNumber: description: The other payer's referral number. Required when this payer has assigned a referral number to this claim. type: string otherPayerSecondaryIdentifier: description: Additional identification number for the other payer. The `qualifier` property can be set to `2U` - Payer Identification Number, `EI` - Employer's Identification Number, `FY` - Claim Office Number, or `NF` - National Association of Insurance Commissioners (NAIC) Code. items: $ref: '#/components/schemas/InstitutionalReferenceIdentification' maxItems: 2 minItems: 1 type: array required: - otherPayerIdentifier - otherPayerIdentifierTypeCode - otherPayerOrganizationName type: object OtherPayerServiceFacilityLocationSecondaryIdentifierItem: properties: identifier: description: The identifier. The format and length of this value depends on the `qualifier` you set. type: string otherIdentifier: deprecated: true description: The identifier for the other payer who provided this reference number. This is only required when the reference number is provided by the non-destination payer. The value must match the `claimInformation.otherSubscriberInformation[].otherPayerName.otherPayerIdentifier` property. type: string qualifier: description: Set to `0B` - State License Number, `LU` - Location Number, or `G2` - Provider Commercial Number. type: string required: - identifier - qualifier type: object ConditionIndicatorCode: description: A second code indicating the condition of the certificate. Can be set to `38` - Certification signed by the physician is on file at the supplier's office or `ZV` - Replacement Item. enum: - '38' - ZV type: string InstitutionalReferenceIdentification: properties: identifier: description: The identifier specified in `qualifier`. type: string qualifier: description: The code qualifying the type of `identifier`. type: string required: - identifier - qualifier type: object DentalContractInformation: description: Required when the submitter is contractually obligated to supply this information on post-adjudicated claims. properties: contractAmount: description: The total dollar amount of the contract, expressed as a decimal. For example, `100.50`. pattern: ^\d+(\.\d{1,2})?$ type: string contractCode: description: The contract code. This is an identifier for the contract. type: string contractPercentage: description: The allowance or charge percent, expressed as a decimal. For example, `0.80`. type: string contractTypeCode: $ref: '#/components/schemas/DentalContractInformationContractTypeCode' contractVersionIdentifier: description: An additional identifier for the contract. Identifies the revision level of a particular format, program, technique or algorithm. type: string termsDiscountPercentage: description: Terms discount percentage, expressed as a decimal, available to the purchaser if an invoice is paid on or before the Terms Discount Due Date. type: string required: - contractTypeCode type: object InstitutionalClaimInformationBenefitsAssignmentCertificationIndicator: enum: - N - W - Y type: string DentalServiceLineSupervisingProvider: properties: commercialNumber: description: The provider's commercial number. type: string firstName: description: The provider's first name. maxLength: 35 minLength: 1 type: string lastName: description: The provider's last name. maxLength: 60 minLength: 1 type: string locationNumber: description: The provider's location number. type: string middleName: description: The provider's middle name or initial. maxLength: 25 minLength: 1 type: string npi: description: The individual National Provider Identifier (NPI) assigned to the provider. pattern: ^\d{10}$ type: string organizationName: description: The provider's business name. maxLength: 60 minLength: 1 type: string providerUpinNumber: description: Deprecated; do not use. type: string stateLicenseNumber: description: The provider's state license number. This is assigned directly by a payer in order to identify the provider in their system. This is not commonly used. type: string suffix: description: The provider's name suffix, such as Jr. or III. maxLength: 10 minLength: 1 type: string taxonomyCode: deprecated: true description: Code from the National Uniform Claims Committee [Health Care Provider Taxonomy Code Set](https://taxonomy.nucc.org/). This identifies the provider's type and/or area of specialty. maxLength: 10 minLength: 10 pattern: ^[A-Za-z0-9]{10}$ type: string type: object Receiver: description: The entity responsible for the payment of the claim, such as an insurance company or government agency. properties: organizationName: description: The business name of the payer receiving the claim, such as Aetna or Cigna. maxLength: 60 minLength: 1 type: string receiverId: description: The ID of the receiver. The only accepted value is `BPUMR` for drop-to-paper claims; omit otherwise. pattern: ^BPUMR$ type: string required: - organizationName type: object ServiceLineSupplementalInformationAttachmentTransmissionCode: description: 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 Only, `EM` - E-Mail, `FT` - File Transfer, or `FX` - By Fax. enum: - AA - BM - EL - EM - FT - FX type: string ClaimsHealthCareInformation: properties: diagnosisCode: description: "The diagnosis code.\n - You must submit a valid, billable code at the highest level of specificity. Include the 4th - 7th characters as applicable.\n - **Don't** submit the decimal point for ICD codes. The decimal point is implied.\n - **Don't** submit ICD-10 header codes. Header codes exist to group related codes and aren't valid for billing. These header codes can change with each new version of ICD-10, so we recommend reviewing your diagnosis codes every year to ensure that they aren't classified as header codes in the most recent version. To determine whether a code is a header code, you can also search the [Value Set Authority Center](https://vsac.nlm.nih.gov/context/cs). If the 'Header' property is set, the code is a header code and you shouldn't use it in claim submissions." type: string diagnosisTypeCode: $ref: '#/components/schemas/ClaimsDiagnosisTypeCode' required: - diagnosisCode - diagnosisTypeCode type: object FamilyPlanningIndicator: description: Code indicating whether the service was related to family planning. Can be set to `Y` - Yes. enum: - Y type: string DentalOtherSubscriberName: description: The person or entity who is the primary policyholder for the other payer's health plan. properties: otherInsuredAdditionalIdentifiers: description: The primary policyholder's Social Security Number. The Social Security Number must be a string of exactly nine numbers with no separators. For example `123456789`. items: type: string maxItems: 2 minItems: 1 type: array otherInsuredAddress: $ref: '#/components/schemas/ClaimsAddress' description: The other subscriber's address. otherInsuredFirstName: description: The primary policyholder's first name, if they are an individual. type: string otherInsuredIdentifier: description: The identifier you specified in `otherInsuredIdentifierTypeCode`. type: string otherInsuredIdentifierTypeCode: $ref: '#/components/schemas/OtherInsuredIdentifierTypeCode' otherInsuredLastName: description: The primary policyholder's last name or organizational name. Don't include the primary policyholder's name suffix, such as Jr. or III. Use the designated `otherInsuredNameSuffix` property instead. type: string otherInsuredMiddleName: description: The primary policyholder's middle name or initial, if they are an individual. type: string otherInsuredNameSuffix: description: The primary policyholder's name suffix, such as Jr. or III. Only include the subscriber's personal name suffix - **don't** include professional or academic titles, such as M.D. or MBA. type: string otherInsuredQualifier: $ref: '#/components/schemas/OtherInsuredQualifier' required: - otherInsuredIdentifier - otherInsuredIdentifierTypeCode - otherInsuredLastName - otherInsuredQualifier type: object RequestSubscriberDependentAddress: description: '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 is a dependent) object. You must include at least the `address1` and `city` properties in this object. The `state` and `postalCode` properties are also required for all United States and Canadian addresses. - The address must be the patient''s correct address at the time of service. Don''t use placeholder values to complete unknown address information. Use of outdated or placeholder values could cause the payer to reject, deny, or delay the claim due to suspected fraud. - If you don''t know the patient''s address, you should first submit a [Real-Time Eligibility Check](https://www.stedi.com/docs/healthcare/api-reference/post-healthcare-eligibility) for the patient and then copy the patient''s address from either the `subscriber` or `dependent` object in the response. - If the patient doesn''t have a current address, you can populate the `address1` property with `UNKNOWN` and populate the city, state, and zip code with appropriate values based on your discretion. However, some payers may have explicit rules for how to handle this situation, so you should check the payer''s specific requirements before using this approach.' properties: address1: description: The first line of the street address. This typically contains the building number and street name. type: string address2: description: The second line of the street address. This typically contains the apartment or suite number. type: string city: description: The city name. type: string countryCode: description: Use the alpha-2 country codes from Part 1 of ISO 3166. type: string countrySubDivisionCode: description: Use the country subdivision codes from Part 2 of ISO 3166. type: string postalCode: description: The postal zone or zip code. Exclude punctuation and spaces. type: string state: description: The state or province code. Only required when the city is in the Unites States and Canada. type: string required: - address1 - city type: object SupportingDocumentation: description: Use to provide information in response to a coded questionnaire document. properties: questionNumber: type: string questionResponse: description: A text response to the question. type: string questionResponseAsDate: description: Date value. type: string questionResponseAsPercent: description: Percent formatted as a decimal. type: string questionResponseCode: $ref: '#/components/schemas/QuestionResponseCode' required: - questionNumber type: object ExportPDF404ErrorResponseContent: oneOf: - $ref: '#/components/schemas/NoTransactionsFound' - $ref: '#/components/schemas/ResourceNotFoundException' OtherPayerBillingProviderIdentifierItem: properties: identifier: description: The identifier. The format and length of this value depends on the `qualifier` you set. type: string otherIdentifier: deprecated: true description: The identifier for the other payer who provided this reference number. This is only required when the reference number is provided by the non-destination payer. The value must match the `claimInformation.otherSubscriberInformation[].otherPayerName.otherPayerIdentifier` property. type: string qualifier: description: Set to `LU` - Location Number, or `G2` - Provider Commercial Number. type: string required: - identifier - qualifier type: object OtherPayerIdentifierTypeCode: description: 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 reporting Health Plan ID (HPID) or Other Entity Identifier (OEID). enum: - PI - XV type: string RequestChangedExceptionResponseContent: description: Exception returned when a request uses an idempotency key that was previously used with different request parameters. properties: code: description: Unique error code identifying the specific type of error. type: string message: description: Human readable error message explaining why the request was rejected. type: string required: - message type: object PatientConditionInformationVisionCertificationConditionIndicator: description: Code indicating whether there is a certification. Can be set to `N` - No or `Y` - Yes. enum: - N - Y type: string InstitutionalDependent: properties: address: $ref: '#/components/schemas/InstitutionalAddress' description: "The patient's address. Every claim must include this information in either the `subscriber` (when the patient is the subscriber) or `dependent` (when the patient is a dependent) object. You must include at least the `address1` and `city` properties in this object. The `state` and `postalCode` properties are also required for all United States and Canadian addresses.\n - The address must be the patient's correct address at the time of service. Don't use placeholder values to complete unknown address information. Use of outdated or placeholder values could cause the payer to reject, deny, or delay the claim due to suspected fraud.\n - If you don't know the patient's address, you should first submit a [Real-Time Eligibility Check](https://www.stedi.com/docs/healthcare/api-reference/post-healthcare-eligibility) for the patient and then copy the patient's address from either the `subscriber` or `dependent` object in the response.\n - If the patient doesn't have a current address, you can populate the `address1` property with `UNKNOWN` and populate the city, state, and zip code with appropriate values based on your discretion. However, some payers may have explicit rules for how to handle this situation, so you should check the payer's specific requirements before using this approach." dateOfBirth: description: The patient's date of birth. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string firstName: description: The patient's first name. maxLength: 35 minLength: 1 type: string gender: $ref: '#/components/schemas/GenderWithUnknown' description: 'Code identifying the gender. Can be set to `F` - Female, `M` - Male, or `U` - Unknown. Some payers may reject the claim if the patient''s gender doesn''t match the gender they have recorded in their member records. If the gender isn''t known or the patient declines to answer, use `U` or perform an eligibility check to determine the gender according to the payer''s records.' lastName: description: The patient's last name. **Don't** include the patient's name suffix, such as Jr. or III. Use the designated `suffix` property instead. maxLength: 60 minLength: 1 type: string middleName: description: The patient's middle name or initial. maxLength: 25 minLength: 1 type: string relationshipToSubscriberCode: $ref: '#/components/schemas/InstitutionalRelationshipToSubscriberCode' description: Identifies the relationship of the patient to the subscriber. Can be set to `01` - Spouse, `19` - Child, `20` - Employee, `21` - Unknown, `39` - Organ Donor, `40` - Cadaver Donor, `53` - Life Partner, or `G8` - Other Relationship. ssn: description: The patient's Social Security Number. Only used for Property and Casualty claims. pattern: ^\d{9}$ type: string suffix: description: The patient's name suffix, such as Jr. or III. Only include the patient's personal name suffix - **don't** include professional or academic titles, such as M.D. or MBA. maxLength: 10 minLength: 1 type: string required: - dateOfBirth - firstName - gender - lastName - relationshipToSubscriberCode type: object OtherPayerAttendingProvider: description: Information regarding the other payer's attending provider. The attending provider is the provider who is primarily responsible for the care of the patient. properties: otherPayerAttendingProviderIdentifier: description: The provider's identifier. The `qualifier` can be set to `OB` - State License Number, `1G` - Provider UPIN Number, `G2` - Provider Commercial Number, or `LU` - Location Number. Note that UPIN numbers are deprecated and should not be used in new claims. items: $ref: '#/components/schemas/InstitutionalReferenceIdentification' maxItems: 4 minItems: 1 type: array required: - otherPayerAttendingProviderIdentifier type: object OtherSubscriberInformationPaymentResponsibilityLevelCode: description: 'Code identifying the payer''s level of responsibility for paying this claim. Visit [Claims code lists](https://www.stedi.com/docs/healthcare/claims-code-lists#payment-responsibility-sequence-number-codes) for a complete list. - Either this property or `subscriber.paymentResponsibilityLevelCode` must be set to `P` to indicate the primary insurance payer. Stedi rejects claims - including secondary and tertiary claims - that don''t include information for the primary payer. - You may need to use other codes if the patient has multiple insurance policies. For example, if a patient is covered by both Medicare and an employer-sponsored commercial plan, you could bill the commercial payer first as `P` and then bill the Medicare payer second as `S`.' enum: - A - B - C - D - E - F - G - H - P - S - T - U type: string InstitutionalConditionInformation: properties: conditionCode: description: The condition code. maxLength: 30 type: string required: - conditionCode 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 MeasurementUnitCode: description: Code identifying the unit of measurement. Can be set to `F2` - International Unit, `GR` - Gram, `ME` - Milligram, `ML` - Milliliter, or `UN` - Unit. enum: - F2 - GR - ME - ML - UN type: string InstitutionalReportInformation: properties: attachmentControlNumber: description: "A control number assigned to the attachment. The payer uses this identifier to match the attachment to the claim.\n - You must include either this property or `attachmentId` in the request, but not both. Including both properties will result in an error.\n - We recommend using a ULID or UUID of up to 50 characters.\n - Stedi autogenerates a control number if you don't provide one." type: string attachmentId: description: "The unique identifier for the attachment file you previously uploaded to Stedi. This value is returned in the `attachmentId` property of the [Create Claim Attachment (275) JSON](https://www.stedi.com/docs/healthcare/api-reference/post-healthcare-submit-claim-attachment) response. Stedi uses it to generate and submit the 275 claim attachment transaction to the payer.\n - This property is **required** when you're submitting attachment files through Stedi.\n - You must include either this property or `attachmentControlNumber` in the request, but not both. Including both properties will result in an error." maxLength: 36 minLength: 36 pattern: ^[0-9a-fA-F]{8}-[0-9a-fA-F]{4}-[0-9a-fA-F]{4}-[0-9a-fA-F]{4}-[0-9a-fA-F]{12}$ type: string attachmentReportTypeCode: $ref: '#/components/schemas/ReportInformationAttachmentReportTypeCode' attachmentTransmissionCode: $ref: '#/components/schemas/InstitutionalReportInformationAttachmentTransmissionCode' description: '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` - Electronically Only, `EM` - E-Mail, `FT` - File Transfer, or `FX` - By Fax. Set this to `EL` when you plan to submit attachments electronically through Stedi APIs.' required: - attachmentReportTypeCode - attachmentTransmissionCode type: object LineAdjudicationInformationServiceIdQualifier: description: Code identifying the type of `procedureCode`. Visit [Claims code lists](https://www.stedi.com/docs/healthcare/claims-code-lists#composite-medical-procedure-product-or-service-id-qualifier-codes) for a complete list. enum: - ER - HC - HP - IV - WK type: string DentalClaimsRawX12SubmissionResponseContent: properties: claimReference: $ref: '#/components/schemas/ClaimReference' controlNumber: description: An identifier for the transaction. type: string editResponses: description: Currently not used. items: $ref: '#/components/schemas/EditResponse' type: array editStatus: deprecated: true description: 'This shape is deprecated: Currently not used.' type: string errors: description: Errors resulting from claim edits. You must review and fix these errors before resubmitting. items: $ref: '#/components/schemas/ClaimsError' type: array failure: $ref: '#/components/schemas/Failure' httpStatusCode: $ref: '#/components/schemas/HttpStatusCode' meta: $ref: '#/components/schemas/ResponseMeta' payer: $ref: '#/components/schemas/ClaimsPayer' status: description: The status of the claim submission. type: string tradingPartnerServiceId: description: An ID for the payer you identified in the original claim. This value may differ from the `tradingPartnerServiceId` you submitted in the original request because it reflects the payer's internal concept of their ID, not necessarily the ID Stedi uses to route requests to this payer. type: string warnings: description: A list of warnings. Currently not used. items: $ref: '#/components/schemas/ClaimsWarning' type: array x12: description: 'A [277CA claim acknowledgment](https://www.stedi.com/docs/healthcare/claim-responses-overview#277ca-claim-acknowledgment) acceptance or rejection from Stedi in X12 EDI format. It indicates whether the claim has passed Stedi''s claim edits. When the claim fails one or more edits, the 277CA contains `STC` segments with information about each error. These are the same error codes that appear in the `errors` array. Note that this 277CA only indicates whether Stedi has accepted or rejected the claim submission. You may receive additional 277CA acceptances or rejections as the claim is routed to the payer.' type: string type: object InstitutionalAddress: properties: address1: description: The first line of the street address. This typically contains the building number and street name. maxLength: 55 type: string address2: description: The second line of the street address. This typically contains the apartment or suite number. maxLength: 55 type: string city: description: The city name. maxLength: 30 type: string countryCode: description: Use the alpha-2 country codes from Part 1 of ISO 3166. maxLength: 3 minLength: 2 type: string countrySubDivisionCode: description: Use the country subdivision codes from Part 2 of ISO 3166. maxLength: 3 minLength: 1 type: string postalCode: description: The postal zone or zip code. Exclude punctuation and spaces. maxLength: 15 minLength: 3 type: string state: description: The state or province code. Only required when the city is in the Unites States and Canada. maxLength: 2 minLength: 2 type: string required: - address1 - city type: object InstitutionalServiceLine: properties: adjustedRepricedLineItemReferenceNumber: description: Required when a repricing (pricing) organization needs to have an identifying number on an adjusted service line in their submission to their payer organization. Providers shouldn't complete this property. maxLength: 50 type: string assignedNumber: deprecated: true description: Stedi assigns this value automatically. It's a unique number identifying the service line within the claim. maxLength: 6 pattern: ^\d+$ type: string description: description: 'A free-form description to clarify information about the service line. You can use this to further describe the service/product/supply reported in the service line or for non-specific procedure codes. Non-specific procedure codes may include descriptors such as ''Not Otherwise Classified (NOC)'', ''Unlisted'', ''Unspecified'', ''Other'', ''Prescription Drug: Generic'', ''Prescription Drug, Brand Name'', or ''Miscellaneous''.' maxLength: 80 type: string drugIdentification: $ref: '#/components/schemas/InstitutionalDrugIdentification' description: Report drugs and biologics related to the service line. Required when government regulation mandates that prescribed drugs and biologics are reported with NDC numbers _or_ when when the provider or submitter chooses to report NDC numbers to enhance the claim reporting or adjudication processes. facilityTaxAmount: description: The amount of the facility tax or surcharge, formatted as a decimal. Required when a facility tax applies to the service being reported. The `claimInformation.serviceLines[].institutionalService.lineItemChargeAmount` must include the amount you report here. pattern: ^\d+(\.\d{1,2})?$ type: string institutionalService: $ref: '#/components/schemas/InstitutionalService' description: Details about the service line, including the procedure code and the line item charge amount. lineAdjudicationInformation: description: Includes service line adjudication information for coordination of benefits between the initial payers of a health care claim and all subsequent payers. items: $ref: '#/components/schemas/InstitutionalLineAdjudicationInformation' maxItems: 15 minItems: 1 type: array lineAdjustmentInformation: $ref: '#/components/schemas/LineAdjustmentInformation' deprecated: true lineItemControlNumber: description: A unique identifier for this service line within the claim. It appears in the 835 (ERA) response as `lineItemControlNumber`, allowing you to correlate ERAs to the specific service lines from the original claim. If you don't set this property, Stedi uses a random ULID. Stedi returns service line identifiers in the `claimReference.serviceLines[].lineItemControlNumber` object of the synchronous API response. maxLength: 50 type: string lineNoteText: description: Another way to provide additional information for comment or special instruction - same as `thirdPartyOrganizationNotes`. Required when the TPO/repricer needs to forward additional information to the payer. maxLength: 80 type: string linePricingInformation: $ref: '#/components/schemas/LinePricingInformation' deprecated: true lineRepricingInformation: $ref: '#/components/schemas/ClaimPricingInformation' description: Information about the pricing or repricing of the service line. This information should only be completed by repricers. lineSupplementInformation: $ref: '#/components/schemas/InstitutionalClaimSupplementalInformationServiceLine' operatingPhysician: $ref: '#/components/schemas/OperatingPhysician' description: 'Information about the individual with primary responsibility for performing the surgical procedure(s) listed in the service line. Required when a surgical procedure code is listed. This should be an individual, not an organization, and you should supply at least the provider''s `lastName` and an identifier, which is typically the `npi`.' otherOperatingPhysician: $ref: '#/components/schemas/OperatingPhysician' description: 'Information about the individual who performed a secondary surgical procedure or assisted the `operatingPhysician`. Required when another operating physician is involved in the surgical procedures listed in the service line. This should be an individual, not an organization, and you should supply at least the provider''s `lastName` and an identifier, which is typically the `npi`.' referringProvider: $ref: '#/components/schemas/InstitutionalServiceLineReferringProvider' renderingProvider: $ref: '#/components/schemas/InstitutionalServiceLineRenderingProvider' repricedLineItemReferenceNumber: description: Required when a repricing (pricing) organization needs to have an identifying number on the service line in their submission to their payer organization. maxLength: 50 type: string serviceDate: description: "Either a single date of service or the beginning of a range of service dates. If a range is provided, the end date should be provided in `serviceDateEnd`. \n\nThis property is required on outpatient service lines where a drug is not being billed and the Statement Covers Period is greater than one day. \n\nIt's also required when a drug is being billed and the payer's adjudication is known to be impacted by the drug duration or the date the prescription was written. In cases where a drug is being billed on a service line, this property may be used to indicate the date the prescription was written (or otherwise communicated by the prescriber if not written). \n\nThis property may also be used to indicate the beginning of the duration for which the drug supply will be used by the patient. The difference in dates, including both the begin and end dates, are the days supply of the drug. Example: 20000101-20000107 (1/1/00 to 1/7/00) is used for a 7 day supply where the first day of the drug used by the patient is 1/1/00. In the event a drug is administered on less than a daily basis (for example, every other day) the date range would include the entire period during which the drug was supplied, including the last day the drug was used. Example: 20000101-20000108 (1/1/00 to 1/8/00) is used for an 8 days supply where the prescription is written for Q48 (every 48 hours), four doses of the drug are dispensed and the first dose is used on 1/1/00." pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string serviceDateEnd: description: The end of a range of service dates. If you include this property, you must also include `serviceDate` to indicate the beginning of the range. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string serviceLineDateInformation: $ref: '#/components/schemas/InstitutionalServiceLineDateInformation' deprecated: true serviceLineReferenceInformation: $ref: '#/components/schemas/InstitutionalServiceLineReferenceInformation' serviceLineSupplementalInformation: $ref: '#/components/schemas/InstitutionalServiceLineSupplementalInformation' description: 'Supporting documentation for the service line. Required when you plan to submit an [attachment](https://www.stedi.com/docs/healthcare/submit-claim-attachments) for the service line electronically through Stedi APIs or SFTP, when there is a paper attachment following this claim, or when the provider deems it necessary to identify additional information that is being held at the provider''s office and is available upon request. Use this object when there is a single attachment. If there are multiple attachments, use the `serviceLineSupplementalInformations` array instead.' serviceLineSupplementalInformations: description: "An array of supplemental information for the service line. This is the array version of the `serviceLineSupplementalInformation` property.\n\n This array is required when you plan to submit multiple [attachments](https://www.stedi.com/docs/healthcare/submit-claim-attachments) for the service line electronically through Stedi APIs or SFTP, when there is a paper attachment following this claim, or when the provider deems it necessary to identify additional information that is being held at the provider's office and is available upon request.\n\nYou can submit up to 10 objects in this array." items: $ref: '#/components/schemas/InstitutionalServiceLineSupplementalInformation' maxItems: 10 minItems: 0 type: array serviceTaxAmount: description: The amount of the service tax or surcharge, formatted as a decimal. Required when a service tax or surcharge applies to the service being reported. The `claimInformation.serviceLines[].institutionalService.lineItemChargeAmount` must include the amount you report here. pattern: ^\d+(\.\d{1,2})?$ type: string thirdPartyOrganizationNotes: description: To provide additional information for comment or special instruction. Required when the TPO/repricer needs to forward additional information to the payer. maxLength: 80 type: string required: - institutionalService type: object RejectReasonCode: enum: - T1 - T2 - T3 - T4 - T5 - T6 type: string DentalOtherPayerName: description: Details about the other payer. properties: otherPayerAddress: $ref: '#/components/schemas/ClaimsAddress' description: The payer's address. otherPayerAdjudicationOrPaymentDate: description: The date the other payer adjudicated the claim. Required when this payer has previously adjudicated the claim and you aren’t including a value for `LineAdjudicationInformation.adjudicationOrPaymentDate`. type: string otherPayerClaimAdjustmentIndicator: description: The only valid value is `true`. Required when Required when the claim is being sent in the payer-to-payer COB model AND the destination payer is secondary to this payer AND this payer has re-adjudicated the claim. type: boolean otherPayerClaimControlNumber: description: The claim control number assigned by this payer. type: string otherPayerIdentifier: description: The identifier specified in `otherPayerIdentifierCode`. When sending Line Adjudication Information for this payer, the identifier sent in `lineAdjudicationInformation.otherPayerPrimaryIdentifier` must match this value. type: string otherPayerIdentifierTypeCode: $ref: '#/components/schemas/OtherPayerIdentifierTypeCode' otherPayerOrganizationName: description: The payer's organization name. maxLength: 60 minLength: 1 type: string otherPayerPredeterminationIdentification: description: The authorization number assigned by this payer. type: string otherPayerPriorAuthorizationNumber: description: The authorization number assigned by this payer. type: string otherPayerPriorAuthorizationOrReferralNumber: description: The referral number assigned by this payer. type: string otherPayerSecondaryIdentifier: description: An additional identification number to identify the other payer. items: $ref: '#/components/schemas/OtherPayerSecondaryIdentifierItem' maxItems: 2 minItems: 1 type: array required: - otherPayerIdentifier - otherPayerIdentifierTypeCode - otherPayerOrganizationName type: object AmbulanceCertificationCertificationConditionIndicator: description: Code indicating whether there is an ambulance certification. enum: - N - Y type: string ClaimsRawX12SubmissionRequestContent: properties: x12: type: string required: - x12 type: object InstitutionalContactInformation: properties: email: description: The email address. type: string faxNumber: description: The fax number. type: string name: description: The full name of the person or office. maxLength: 60 minLength: 1 type: string phoneNumber: description: The phone number, formatted as AAABBBCCCC, where AAA represents the area code, BBB is the telephone number prefix, and CCCC is the telephone number. The phone number should only include the digits 0 to 9. Don't include separators, such as dashes, and don't include long distance access numbers, such as 1. For example, you would format the phone number 123-456-7890 as 1234567890. maxLength: 256 type: string validContact: deprecated: true type: boolean required: - name type: object InstitutionalServiceLineDateInformation: deprecated: true properties: beginServiceDate: pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string endServiceDate: pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string serviceDate: pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string validDateInformation: type: boolean type: object FrequencyCode: description: Code indicating the frequency at which the rental equipment is billed. Can be set to `1` - weekly, `4` - monthly, or `6` - daily. enum: - '1' - '4' - '6' type: string InstitutionalRelationshipToSubscriberCode: description: 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` - Cadaver Donor, `53` - Life Partner, or `G8` - Other Relationship. enum: - '01' - '19' - '20' - '21' - '39' - '40' - '53' - G8 type: string ClaimPricingRepricingInformation: description: Repricing information to be completed by repricers, not providers. For capitated encounters, pricing or repricing information usually is not applicable and is provided to qualify other information within the claim. properties: exceptionCode: $ref: '#/components/schemas/ClaimsExceptionCode' policyComplianceCode: $ref: '#/components/schemas/PolicyComplianceCode' description: Code indicating the policy compliance. Visit [Claims code lists](https://www.stedi.com/docs/healthcare/claims-code-lists#policy-compliance-codes-2) for a complete list. pricingMethodologyCode: $ref: '#/components/schemas/PricingMethodologyCode' rejectReasonCode: $ref: '#/components/schemas/RejectReasonCode' description: Code indicating the rejection message returned from the third party organization. Visit [Claims code lists](https://www.stedi.com/docs/healthcare/claims-code-lists#reject-reason-codes-2) for a complete list. repricedAllowedAmount: description: The dollar amount, expressed as a decimal. For example, `100.50`. pattern: ^\d+(\.\d{1,2})?$ type: string repricedApprovedAmbulatoryPatientGroupAmount: description: The dollar amount, expressed as a decimal. pattern: ^\d+(\.\d{1,2})?$ type: string repricedApprovedAmbulatoryPatientGroupCode: description: The code indicating the type of repricing. type: string repricedSavingAmount: description: The dollar amount, expressed as a decimal. pattern: ^\d+(\.\d{1,2})?$ type: string repricingOrganizationIdentifier: description: The identifier of the organization that repriced the claim. type: string repricingPerDiemOrFlatRateAmount: description: The pricing rate associated with per diem or flat rate repricing, expressed as a decimal. type: string required: - pricingMethodologyCode - repricedAllowedAmount type: object InstitutionalReportInformationAttachmentTransmissionCode: description: 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` - Electronically Only, `EM` - E-Mail, `FT` - File Transfer, or `FX` - By Fax. enum: - AA - BM - EL - EM - FT - FX type: string PatientConditionInformationVision: description: Required on vision claims involving replacement lenses or frames when this information is known to impact reimbursement. . properties: certificationConditionIndicator: $ref: '#/components/schemas/PatientConditionInformationVisionCertificationConditionIndicator' codeCategory: $ref: '#/components/schemas/CodeCategory' conditionCodes: description: Code indicating the reason for the vision services. Visit [Claim code lists](https://www.stedi.com/docs/healthcare/claims-code-lists#vision-condition-codes) for a complete list. items: $ref: '#/components/schemas/PatientConditionInformationVisionConditionCodesItem' maxItems: 5 minItems: 1 type: array required: - certificationConditionIndicator - codeCategory - conditionCodes type: object InstitutionalOtherInsuredIdentifierTypeCode: description: 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 States or `MI` - Member Identification Number. Note that `II` is deprecated and should not be used in new claims. enum: - II - MI type: string DentalClaimSupplementalInformation: description: Additional information or documentation required for the claim. This is where you can include information about [attachments](https://www.stedi.com/docs/healthcare/submit-claim-attachments), if applicable. properties: adjustedRepricedClaimNumber: description: Required when the repricer believes this information is necessary. Providers should not complete this property. type: string claimControlNumber: description: 'This is the Payer Claim Control Number (PCCN) for an existing claim that this claim is meant to replace or cancel. This property is generally **required** when the `claimInformation.claimFrequencyCode` is set to `7` or `8`. One exception to this guidance is Original Medicare, which specifies that you omit the PCCN from resubmissions. Visit [Resubmit or cancel claims](https://www.stedi.com/docs/healthcare/resubmit-cancel-claims) for complete details and information about where to find the PCCN for an existing claim.' type: string claimNumber: deprecated: true description: 'The claim number assigned by clearinghouse, van, etc. Stedi overwrites this value when it sends the claim to the payer, so you shouldn''t include this property in your request. We strongly recommend using the `claimInformation.patientControlNumber` property as your claim tracking ID.' type: string predeterminationOfBenefitsIdentifier: description: The Predetermination of Benefits Identification Number assigned by the payer. Required for services that have been previously predetermined and are now being submitted for payment. The identifier you supply here applies to the entire claim. type: string priorAuthorizationNumber: description: 'Required when an authorization number is assigned by the payer or UMO _and_ the services on this claim were preauthorized. This authorization number applies to the payer you listed in the `receiver` object. If you need to include authorization numbers for other payers, you can include them in `claimInformation.otherSubscriberInformation.otherPayerName.otherPayerPriorAuthorizationNumber`. The UMO (Utilization Management Organization) is generally the entity empowered to make a decision regarding the outcome of a health services review or the owner of information. If there are multiple prior authorization numbers associated with this claim, send one here and then override it as necessary for each service line in `claimInformation.serviceLines[].serviceLineReferenceInformation.priorAuthorization`.' type: string referralNumber: description: Required when a referral number is assigned by the payer or Utilization Management Organization (UMO) _and_ a referral is involved. type: string reportInformation: $ref: '#/components/schemas/DentalReportInformation' description: 'Required when you plan to submit an [attachment](https://www.stedi.com/docs/healthcare/submit-claim-attachments) for the claim electronically through Stedi APIs or SFTP, when there is a paper attachment following this claim, or when the provider deems it necessary to identify additional information that is being held at the provider''s office and is available upon request. Use this object when there is a single attachment for the claim. If there are multiple attachments, use the `reportInformations` array instead.' reportInformations: description: 'An array of report information for the claim. Use this when you need to submit multiple report information records. You can submit up to 10 objects in this array. Required when you plan to submit [attachments](https://www.stedi.com/docs/healthcare/submit-claim-attachments) for the claim electronically through Stedi APIs or SFTP, when there is a paper attachment following this claim, or when the provider deems it necessary to identify that they have additional information at their office that is available upon request.' items: $ref: '#/components/schemas/DentalReportInformation' maxItems: 10 minItems: 0 type: array repricedClaimNumber: description: Required when the repricer believes this information is necessary. Providers should not complete this property. type: string serviceAuthorizationExceptionCode: $ref: '#/components/schemas/ServiceAuthorizationExceptionCode' type: object InstitutionalServiceLineReferenceInformation: description: Additional identifiers for the service line. We **strongly recommend** setting the `providerControlNumber` property for each service line within the claim. oneOf: - properties: providerControlNumber: description: A unique identifier for this service line within the claim. It appears in the 835 (ERA) response as `lineItemControlNumber`, allowing you to correlate ERAs to the specific service lines from the original claim. We **strongly recommend** setting this property for every service line within the claim. We also recommend using a [ULID](https://github.com/ulid/spec) instead of a UUID because payers are only required to store up to 30 characters for this value. maxLength: 30 type: string required: - providerControlNumber title: providerControlNumber type: object - properties: repricedLineItemRefNumber: description: Required when a repricing (pricing) organization needs to have an identifying number on the service line in their submission to their payer organization. Providers shouldn't complete this property. type: string required: - repricedLineItemRefNumber title: repricedLineItemRefNumber type: object - properties: adjustedRepricedLineItemRefNumber: description: Required when a repricing (pricing) organization needs to have an identifying number on an adjusted service line in their submission to their payer organization. Providers shouldn't complete this property. type: string required: - adjustedRepricedLineItemRefNumber title: adjustedRepricedLineItemRefNumber type: object ContactInformationOrderingProvider: properties: email: description: The email address. type: string faxNumber: description: The fax number, formatted as AAABBBCCCC. type: string name: description: The full name of the person or office. type: string phoneExtension: description: The phone extension, if applicable. type: string phoneNumber: description: The phone number, formatted as AAABBBCCCC, where AAA represents the area code, BBB is the telephone number prefix, and CCCC is the telephone number. The phone number should only include the digits 0 to 9. Don't include separators, such as dashes, and don't include long distance access numbers, such as 1. For example, you would format the phone number 123-456-7890 as 1234567890. type: string required: - name type: object PurchasedServiceInformation: description: 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 services purchased from another source OR when adjudication is known to be impacted by the acquisition cost of lenses. properties: purchasedServiceChargeAmount: description: The cost of the purchased service. type: string purchasedServiceProviderIdentifier: description: This must be the same identifier you provided within `claimInformation.serviceLines[].purchasedServiceProvider`. type: string required: - purchasedServiceChargeAmount - purchasedServiceProviderIdentifier type: object ServiceFacilityLocationSecondaryIdentificationQualifierCode: description: Code identifying the type of secondary identification. Can be set to `0B` - State License Number, `G2` - Provider Commercial Number, or `LU` - Location Number. enum: - 0B - G2 - LU type: string ServiceLineSupplementalInformationAttachmentReportTypeCode: description: 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 lists](https://www.stedi.com/docs/healthcare/claims-code-lists#attachment-report-type-codes) for a complete list. enum: - '03' - '04' - '05' - '06' - '07' - 08 - 09 - '10' - '11' - '13' - '15' - '21' - A3 - A4 - AM - AS - B2 - B3 - B4 - BR - BS - BT - CB - CK - CT - D2 - DA - DB - DG - DJ - DS - EB - HC - HR - I5 - IR - LA - M1 - MT - NN - OB - OC - OD - OE - OX - OZ - P4 - P5 - PE - PN - PO - PQ - PY - PZ - RB - RR - RT - RX - SG - V5 - XP type: string Submitter: description: 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 submit at least `organizationName` or `lastName` properties and the `contactInformation` object. If you don't supply the `submitterIdentification` property, Stedi uses the value from `billing.npi` in the request. properties: contactInformation: $ref: '#/components/schemas/ClaimsContactInformation' description: Contact information for the person or office handling administrative communications regarding the claim. You can include a maximum of two objects in this array. firstName: description: The first name of the individual submitting the claim. maxLength: 35 minLength: 1 type: string lastName: description: The last name of the individual submitting the claim. maxLength: 60 minLength: 1 type: string middleName: description: The middle name or initial of the individual submitting the claim. maxLength: 25 minLength: 1 type: string organizationName: description: The business name of the organization submitting the claim. maxLength: 60 minLength: 1 type: string submitterIdentification: description: "The submitter's Electronic Transmitter Identification Number (ETIN), as assigned by the payer. For some payers, this may be the same as the submitter's NPI or TIN, but it can also be another unique identifier. Payers can refer to this identifier as the Provider Number, Submitter ID, Submitter Identifier, Submitter Primary Number, Sender Code, Certified Contracted Provider ID, and other names.\n\n If you don't provide this property, Stedi uses the billing provider's NPI from `billing.npi` property." maxLength: 80 minLength: 2 type: string required: - contactInformation type: object ClaimsExceptionCode: description: Code specifying the exception reason for consideration of out-of-network health care services. This is the reason generated by the third-party health organization. Visit [Claims code lists](https://www.stedi.com/docs/healthcare/claims-code-lists#exception-codes-2) for a complete list. enum: - '1' - '2' - '3' - '4' - '5' - '6' type: string InstitutionalMeasurementUnit: description: The unit of measurement for the service. Can be set to `DA` - Days or `UN` - Unit. enum: - DA - UN type: string InstitutionalOtherPayerIdentifierTypeCode: description: 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 PlanID. Use `XV` when reporting Health Plan ID (HPID) or Other Entity Identifier (OEID). enum: - PI - XV type: string OccurrenceSpanInformation: properties: occurrenceSpanCode: description: The occurrence span code. maxLength: 30 type: string occurrenceSpanCodeEndDate: description: The end date for the occurrence span. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string occurrenceSpanCodeStartDate: description: The start date for the occurrence span. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string required: - occurrenceSpanCode - occurrenceSpanCodeEndDate - occurrenceSpanCodeStartDate type: object InstitutionalOtherSubscriberName: properties: address: $ref: '#/components/schemas/InstitutionalAddress' description: The subscriber's address. You must include at least the `address1` and `city` properties in this object. firstName: deprecated: true type: string otherInsuredAdditionalIdentifier: description: The subscriber's social security number (SSN). This must be a string of exactly nine numbers with no separators. items: type: string maxItems: 2 minItems: 1 type: array otherInsuredFirstName: description: The subscriber's first name. type: string otherInsuredIdentifier: description: The identifier specified in `otherInsuredIdentifierTypeCode`. type: string otherInsuredIdentifierTypeCode: $ref: '#/components/schemas/InstitutionalOtherInsuredIdentifierTypeCode' otherInsuredLastName: description: The last name (when the subscriber is an individual) or the name of the organization (when the subscriber is an organization). **Don't** include the subscriber's name suffix, such as Jr. or III. Use the designated `otherInsuredSuffix` property instead. type: string otherInsuredMiddleName: description: The subscriber's middle name or initial. type: string otherInsuredQualifier: $ref: '#/components/schemas/InstitutionalOtherInsuredQualifier' otherInsuredSuffix: description: The subscriber's name suffix, such as Jr or III. Only include the subscriber's personal name suffix - **don't** include professional or academic titles, such as M.D. or MBA. type: string required: - otherInsuredIdentifier - otherInsuredIdentifierTypeCode - otherInsuredLastName - otherInsuredQualifier type: object InstitutionalReceiver: description: The entity responsible for the payment of the claim, such as an insurance company or government agency. properties: organizationName: description: The business name of the payer receiving the claim, such as Aetna or Cigna. maxLength: 60 minLength: 1 type: string receiverId: description: The ID of the receiver. The only accepted value is `BPUMR` for drop-to-paper claims; omit otherwise. pattern: ^BPUMR$ type: string taxId: description: The receiver's Electronic Transmitter Identification Number (ETIN), as assigned by the payer. This may be the same as the payer's TIN, but it can also be another unique identifier. We **strongly recommend** including this property in your request. maxLength: 80 minLength: 2 type: string required: - organizationName type: object RenderingProviderType: description: Defines the rendering provider type. enum: - RenderingProvider type: string OtherPayerSecondaryIdentifierItem: properties: identifier: description: The identifier. The format and length of this value depends on the `qualifier` you set. type: string otherIdentifier: deprecated: true description: The identifier for the other payer who provided this reference number. This is only required when the reference number is provided by the non-destination payer. The value must match the `claimInformation.otherSubscriberInformation[].otherPayerName.otherPayerIdentifier` property. type: string qualifier: description: Set to `2U` - Payer Identification Number, `EI` - Employer Identification Number, `FY` - Claim Office Number, or `NF` - National Association of Insurance Commissioners (NAIC) Code. type: string required: - identifier - qualifier type: object InstitutionalServiceLineReferringProvider: description: 'Information about the provider who referred the patient for care. - Include this object only when the referring provider is different than the provider listed in the `attending` object. - This should be an individual, not an organization, and you should supply at least the provider''s `lastName` and an identifier, which is typically the `npi`.' properties: address: $ref: '#/components/schemas/InstitutionalAddress' deprecated: true commercialNumber: deprecated: true maxLength: 50 type: string contactInformation: $ref: '#/components/schemas/InstitutionalContactInformation' deprecated: true employerId: deprecated: true maxLength: 50 type: string firstName: description: The provider's first name. maxLength: 35 minLength: 1 type: string lastName: description: The provider's last name. maxLength: 60 minLength: 1 type: string locationNumber: deprecated: true maxLength: 50 type: string middleName: description: The provider's middle name or initial. maxLength: 25 minLength: 1 type: string npi: description: The individual [National Provider Identifier (NPI)](https://www.stedi.com/docs/healthcare/national-provider-identifier) assigned to the provider. pattern: ^\d{10}$ type: string organizationName: description: The provider's business name. maxLength: 60 minLength: 1 type: string providerType: $ref: '#/components/schemas/ReferringProviderType' deprecated: true description: This field is now automatically populated and it only remains for backwards compatibility. providerUpinNumber: deprecated: true maxLength: 50 type: string referenceIdentification: description: Additional identifiers for the provider. You can set `qualifier` to `2U` - Payer Identification Number. items: $ref: '#/components/schemas/InstitutionalReferenceIdentification' maxItems: 20 minItems: 1 type: array secondaryIdentificationQualifierCode: $ref: '#/components/schemas/ServiceLineReferringProviderIdentificationQualifierCode' description: The type of identifier used in `secondaryIdentifier`. Can be set to `0B` - State License Number, `1G` - Provider UPIN Number, or `G2` - Provider Commercial Number. Note that UPIN is deprecated and should not be used. secondaryIdentifier: description: 'The identifier specified in `secondaryIdentifierQualifierCode`. You can only include one secondary identifier for the provider.' maxLength: 50 type: string stateLicenseNumber: deprecated: true type: string suffix: description: The provider's suffix, such as Jr. or Sr. maxLength: 10 minLength: 1 type: string taxonomyCode: deprecated: true pattern: ^[A-Za-z0-9]{10}$ type: string type: object DentalClaimDateInformation: properties: accidentDate: description: The date of the accident related to this claim. Required when `relatedCausesCode` is set to `AA` - Auto Accident or `OA` - Other Accident. Also required when `relatedCausesCode` is set to `EM` - Employment and this claim is the result of an accident. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string appliancePlacementDate: description: The date the appliance was placed. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string repricerReceivedDate: description: The date the repricing entity received the initial claim. Required when a repricer is passing the claim onto the payer. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string serviceDate: description: A single service date or a range of service dates. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])(-\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01]))?$ type: string type: object ServiceUnavailableExceptionResponseContent: description: The server is temporarily unavailable. properties: code: description: Classification of the exception type. type: string message: description: Human readable exception message. type: string required: - message type: object InstitutionalClaimsSubmissionRequestContent: properties: attending: $ref: '#/components/schemas/Attending' billing: $ref: '#/components/schemas/InstitutionalBilling' billingPayToAddressName: $ref: '#/components/schemas/PayToAddressName' billingPayToPlanName: $ref: '#/components/schemas/PayToPlanName' claimIdentifier: $ref: '#/components/schemas/InstitutionalClaimIdentifier' claimInformation: $ref: '#/components/schemas/InstitutionalClaimInformation' controlNumber: description: Not currently used. maxLength: 9 minLength: 9 pattern: ^\d+$ type: string dependent: $ref: '#/components/schemas/InstitutionalDependent' description: "Dependent who received the medical care associated with the claim.\n - When the dependent has their own member ID for the health plan, you should include the dependent's information in the `subscriber` object instead. To check whether a dependent has a member ID, submit an [Eligibility Check](https://www.stedi.com/docs/healthcare/api-reference/post-healthcare-eligibility) to the payer. The payer returns the dependent's member ID in the `dependents.memberId` property in the response, if present.\n - You must include `address` in this object when the patient is a dependent." operatingPhysician: $ref: '#/components/schemas/OperatingPhysician' description: 'Information about the individual with primary responsibility for performing the surgical procedure(s) listed in the claim. Required when a surgical procedure code is listed on the claim. Use this object for operating physicians that apply to the entire claim. This should be an individual, not an organization, and you should supply at least the physician''s `lastName` and an identifier, which is typically the `npi`.' otherOperatingPhysician: $ref: '#/components/schemas/OperatingPhysician' description: 'Information about any other operating physician involved in the surgical procedures listed in the claim. Required when another operating physician is involved in the surgical procedures listed in the claim. Use this object for physicians that apply to the entire claim. This should be an individual, not an organization, and you should supply at least the physician''s `lastName` and an identifier, which is typically the `npi`.' payerAddress: $ref: '#/components/schemas/InstitutionalAddress' description: Address information for the entity responsible for payment of the claim, listed in the `receiver` object. providers: description: Another way to send information for each provider relevant to the claim. This object overwrites the information you send in the `billing`, `referring`, `rendering`, and `attending` objects. Note that your request **must** include information about the billing provider either here or within the `billing` object. items: $ref: '#/components/schemas/InstitutionalProvidersObject' maxItems: 4 minItems: 1 type: array receiver: $ref: '#/components/schemas/InstitutionalReceiver' referring: $ref: '#/components/schemas/InstitutionalReferring' rendering: $ref: '#/components/schemas/InstitutionalRendering' submitter: $ref: '#/components/schemas/InstitutionalSubmitter' subscriber: $ref: '#/components/schemas/InstitutionalSubscriber' tradingPartnerName: description: This is the payer's business name, like Cigna or Aetna. type: string tradingPartnerSecondaryIdentifiers: $ref: '#/components/schemas/TradingPartnerSecondaryIdentifiers' description: Secondary identifiers for the payer. You can include up to three properties in this object. tradingPartnerServiceId: description: "The payer ID. Visit the [Payer Network](https://www.stedi.com/healthcare/network) for a complete list.\n - You can send requests using the primary payer ID, the Stedi payer ID, or any alias listed in the payer record.\n - You must include leading `0` characters - payer IDs are alphanumeric strings and must be treated as complete strings, not integers. For example, use `00540` for SISCO, not `540`." type: string usageIndicator: description: Whether you want to send a test or production claim. This property also allows you to filter claims in the Stedi portal by production or test data. By default, this property is set to `P` for production data. Use `T` to designate a claim as test data. type: string required: - claimInformation - receiver - submitter - subscriber - tradingPartnerServiceId type: object InstitutionalOtherPayerRenderingProvider: description: Information regarding the other payer's rendering provider. The rendering provider is the provider who performed the service or non-surgical procedure. properties: otherPayerRenderingProviderIdentifier: description: The provider's identifier. The `qualifier` can be set to `OB` - State License Number, `1G` - Provider UPIN Number, `G2` - Provider Commercial Number, or `LU` - Location Number. Note that UPIN numbers are deprecated and should not be used in new claims. items: $ref: '#/components/schemas/InstitutionalReferenceIdentification' maxItems: 4 minItems: 1 type: array required: - otherPayerRenderingProviderIdentifier type: object InstitutionalClaimSupplementalInformation: description: Additional information or documentation required for the claim. This is where you can include information about [attachments](https://www.stedi.com/docs/healthcare/submit-claim-attachments), if applicable. properties: adjustedRepricedClaimRefNumber: description: The adjusted repriced claim reference number. Required when the repricer believes this information is necessary. Providers should not complete this property. maxLength: 50 type: string autoAccidentState: description: Required when the services reported on this claim are related to an auto accident and the accident occurred in a country or location that has a state, province, or sub-country code. maxLength: 50 type: string claimControlNumber: description: 'This is the Payer Claim Control Number (PCCN) for an existing claim that this claim is meant to replace or cancel. This property is generally **required** when the `claimInformation.claimFrequencyCode` is set to `7` or `8`. One exception to this guidance is Original Medicare, which specifies that you omit the PCCN from resubmissions. Visit [Resubmit or cancel claims](https://www.stedi.com/docs/healthcare/resubmit-cancel-claims) for complete details and information about where to find the PCCN for an existing claim.' maxLength: 50 type: string claimNumber: deprecated: true description: 'The identifier assigned by clearinghouse, van, etc. when they need to assign their own unique claim number. Stedi overwrites this value when it sends the claim to the payer, so you shouldn''t include this property in your request. We strongly recommend using the `claimInformation.patientControlNumber` property as your claim tracking ID.' type: string demoProjectIdentifier: description: Required when it is necessary to identify claims that are atypical in ways such as content, purpose, and/or payment. For example, claims made as the result of a demonstration or a clinical trial. maxLength: 50 type: string investigationalDeviceExemptionNumber: description: Required when claim involves a Food and Drug Administration (FDA) assigned investigational device exemption (IDE) number. When more than one IDE applies, you must split into separate claims. maxLength: 50 type: string medicalRecordNumber: description: Required when the provider needs to identify the actual medical record of the patient for this episode of care. maxLength: 50 type: string peerReviewAuthorizationNumber: description: Required when an external Peer Review Organization assigns an Approval Number to services deemed medically necessary by that organization. maxLength: 50 type: string priorAuthorizationNumber: description: 'Required when an authorization number is assigned by the payer or UMO _and_ the services on this claim were preauthorized. The UMO (Utilization Management Organization) is generally the entity empowered to decide the outcome of a health services review or the owner of the information. You can only send one prior authorization (preauthorization) number per claim. If different numbers apply to specific service lines, you must split those service lines into separate claims.' maxLength: 50 type: string referralNumber: description: Required when a referral number is assigned by the payer or Utilization Management Organization (UMO) and a referral is involved. This value applies to the entire claim unless overridden within a specific service line. maxLength: 50 type: string reportInformation: $ref: '#/components/schemas/InstitutionalReportInformation' description: 'Required when you plan to submit an [attachment](https://www.stedi.com/docs/healthcare/submit-claim-attachments) for the claim electronically through Stedi APIs or SFTP, when there is a paper attachment following this claim, or when the provider deems it necessary to identify additional information that is being held at the provider''s office and is available upon request. Use this object when there is a single attachment for the claim. If there are multiple attachments, use the `reportInformations` array instead.' reportInformations: description: 'An array of report information for the claim. Use this when you need to submit multiple report information records. You can submit up to 10 objects in this array. Required when you plan to submit [attachments](https://www.stedi.com/docs/healthcare/submit-claim-attachments) for the claim electronically through Stedi APIs or SFTP, when there is a paper attachment following this claim, or when the provider deems it necessary to identify that they have additional information at their office that is available upon request.' items: $ref: '#/components/schemas/InstitutionalReportInformation' maxItems: 10 minItems: 0 type: array repricedClaimNumber: description: Required when the repricer believes this information is necessary. Providers should not complete this property. maxLength: 50 type: string serviceAuthorizationExceptionCode: $ref: '#/components/schemas/InstitutionalServiceAuthorizationExceptionCode' type: object DentalDiagnosisTypeCode: description: Code indicating the specific industry code list. Can be set to `ABK` - International Classification of Diseases Clinical Modification (ICD-10-CM) Principal Diagnosis or `ABF` - International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis, `TQ` Systemized Nomenclature of Dentistry (SNODENT). enum: - ABK - ABF - TQ type: string PrincipalProcedureInformation: properties: principalProcedureCode: description: The principal procedure code for the patient. It must be a valid code from the appropriate coding system. **Don't** submit the decimal for ICD codes; the decimal is implied. maxLength: 30 type: string principalProcedureDate: description: The date when the procedure was performed. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string qualifierCode: $ref: '#/components/schemas/PrincipalProcedureInformationQualifierCode' required: - principalProcedureCode - qualifierCode type: object CertificationConditionCodeAppliesIndicator: description: Code indicating whether an EPSDT referral was given to the patient. Can be set to `N` - No or `Y` - Yes. enum: - N - Y type: string OtherSubscriberInformation: properties: benefitsAssignmentCertificationIndicator: $ref: '#/components/schemas/OtherSubscriberInformationBenefitsAssignmentCertificationIndicator' claimFilingIndicatorCode: $ref: '#/components/schemas/ClaimFilingIndicatorCode' claimLevelAdjustments: description: Use this object to report prior payers' claim level adjustments that cause the amount paid to differ from the amount originally charged. Codes and associated amounts must come from either paper remittance advice or 835s (Electronic Remittance Advice) received on the claim. When the information originates from a paper remittance advice that does not use the standard Claim Adjustment Reason Codes, you must convert them to standard Claim Adjustment Reason Codes. items: $ref: '#/components/schemas/ClaimAdjustment' maxItems: 5 minItems: 1 type: array individualRelationshipCode: $ref: '#/components/schemas/ClaimsIndividualRelationshipCode' insuranceGroupOrPolicyNumber: description: The group or policy number. type: string insuranceTypeCode: $ref: '#/components/schemas/OtherSubscriberInformationInsuranceTypeCode' medicareOutpatientAdjudication: $ref: '#/components/schemas/MedicareOutpatientAdjudication' nonCoveredChargeAmount: description: Required when the destination payer's cost avoidance policy allows providers to bypass claim submission to the otherwise prior payer identified in `otherSubscriberInformation.otherPayerName`. The amount must equal the total claim charge amount you reported in `claimInformation.claimChargeAmount`. pattern: ^\d+(\.\d{1,2})?$ type: string otherInsuredGroupName: description: The name of the health plan. type: string otherPayerBillingProvider: description: Information about the billing provider. items: $ref: '#/components/schemas/OtherPayerBillingProvider' type: array otherPayerName: $ref: '#/components/schemas/OtherPayerName' otherPayerReferringProvider: description: 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 specialist. items: $ref: '#/components/schemas/OtherPayerReferringProvider' type: array otherPayerRenderingProvider: description: Information about the rendering provider. items: $ref: '#/components/schemas/OtherPayerRenderingProvider' type: array otherPayerServiceFacilityLocation: description: Information about the service facility location. items: $ref: '#/components/schemas/OtherPayerServiceFacilityLocation' type: array otherPayerSupervisingProvider: description: Information about the supervising provider. items: $ref: '#/components/schemas/OtherPayerSupervisingProvider' type: array otherSubscriberName: $ref: '#/components/schemas/OtherSubscriberName' patientSignatureGeneratedForPatient: description: Code indicating how the patient or subscriber authorization signatures were obtained and how they are being retained by the provider. Can be set to `true` - Signature generated by provider because the patient was not physically present for services. This means the signature was generated by an entity other than the patient according to State or Federal law. This property is **required** for claims submitted to Medicare. type: boolean payerPaidAmount: description: The total amount in dollars the payer has paid on this claim. It is acceptable to set this to `0` (Zero). This is required when you include the `payToPlan` object, and you should set it to the amount the Medicaid agency actually paid. pattern: ^\d+(\.\d{1,2})?$ type: string paymentResponsibilityLevelCode: $ref: '#/components/schemas/OtherSubscriberInformationPaymentResponsibilityLevelCode' releaseOfInformationCode: $ref: '#/components/schemas/ReleaseOfInformationCode' remainingPatientLiability: description: This is the remaining amount (as determined by the provider) to be paid after the other payer identified in the `otherPayerName` object has adjudicated the claim. pattern: ^\d+(\.\d{1,2})?$ type: string required: - benefitsAssignmentCertificationIndicator - claimFilingIndicatorCode - individualRelationshipCode - otherPayerName - otherSubscriberName - paymentResponsibilityLevelCode - releaseOfInformationCode type: object ProcedureIdentifier: description: Code identifying the specific industry code list used for the `procedureCode`. Visit [Claims code lists](https://www.stedi.com/docs/healthcare/claims-code-lists#composite-medical-procedure-product-or-service-id-qualifier-codes) for a complete list. enum: - ER - HC - IV - WK type: string ClaimAdjustmentDetails: description: The adjustment reason codes and amounts. You can include up to six objects in this array to describe a single adjustment group code. properties: adjustmentAmount: description: The dollar amount of the adjustment, expressed as a decimal. For example, `100.50`. pattern: ^\d+(\.\d{1,2})?$ type: string adjustmentQuantity: description: The units of service being adjusted. type: string adjustmentReasonCode: description: Code identifying the detailed reason the adjustment was made. Visit the X12 [Claim Adjustment Reason Codes](https://x12.org/codes/claim-adjustment-reason-codes) for a complete list. type: string required: - adjustmentAmount - adjustmentReasonCode type: object ServiceLinePurchasedServiceProviderSecondaryIdentifierItem: properties: identifier: description: The identifier. The format and length of this value depends on the `qualifier` you set. type: string otherIdentifier: description: The identifier for the other payer who provided this reference number. This is only required when the reference number is provided by the non-destination payer. The value must match the `claimInformation.otherSubscriberInformation[].otherPayerName.otherPayerIdentifier` property. type: string qualifier: description: Set to `0B` - State License Number, `1G` - Provider UPIN Number, or `G2` - Provider Commercial Number. Note that UPIN is deprecated and shouldn't be used for new claims. type: string required: - identifier - qualifier type: object Billing: description: '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 administrative facility. - For tax identification, you must include either the provider''s Social Security Number (SSN) in the `ssn` property _or_ their Employer Identification Number (EIN) in the `employerId` property, but not both. - If the billing provider has an NPI, you must include it in the `npi` property. If the billing provider does not have an NPI, you must include either the `commercialNumber` or the `locationNumber` for identification. Some payers may require the `npi` **and** either the `commercialNumber` or the `locationNumber` as a secondary identifier. - Some solo providers may use their SSN as their EIN. In this case, submit the SSN in the `ssn` property and leave the `employerId` property blank.' properties: address: $ref: '#/components/schemas/ClaimsAddress' description: 'The billing provider''s address. This is **required** and must be a physical location such as the office where care is delivered or an administrative facility. If the billing provider expects to receive paper checks at a PO Box, lockbox, or other non-physical address, provide that in `payToAddress`. For United States addresses, you **must** include the full nine-digit zip code with no separators, such as `100031502`. If you don''t know the full zip code, you can find it using the [USPS ZIP Code Lookup](https://tools.usps.com/zip-code-lookup.htm) tool.' claimOfficeNumber: deprecated: true description: Claim Office Number. maxLength: 50 type: string commercialNumber: description: The billing provider's commercial number, as assigned by this payer. The commercial number is a unique identifier that the payer assigns to the provider. For providers without an NPI, you must provide either the `commercialNumber` or the `locationNumber` for identification. type: string contactInformation: $ref: '#/components/schemas/ClaimsContactInformation' description: Contact information for the billing provider. You can include a maximum of two objects in this array. employerId: description: The billing provider's Employer Identification Number (EIN). Typically a string of exactly nine numbers with no separators, unless otherwise instructed by the payer. If you include this value, you cannot include the `ssn`. type: string firstName: description: The billing provider's first name, if the provider is an individual. maxLength: 35 minLength: 1 type: string lastName: description: The provider's last name, if the provider is an individual. maxLength: 60 minLength: 1 type: string locationNumber: description: The billing provider's location number. For providers without an NPI, you must provide either the `commercialNumber` or the `locationNumber` for identification. type: string middleName: description: The provider's middle name or initial, if the provider is an individual. maxLength: 25 minLength: 1 type: string naic: deprecated: true description: National Association of Insurance Commissioners (NAIC) Code. maxLength: 50 type: string npi: description: The billing provider's [National Provider Identifier (NPI)](https://www.stedi.com/docs/healthcare/national-provider-identifier). Optional. When the billing provider is not assigned an NPI, supply `commercialNumber` or `locationNumber` instead. pattern: ^\d{10}$ type: string organizationName: description: The provider's business name. maxLength: 60 minLength: 1 type: string payerIdentificationNumber: deprecated: true description: Payer Identification Number. maxLength: 50 type: string providerType: deprecated: true description: This field is now automatically populated and it only remains for backwards compatibility. type: string providerUpinNumber: deprecated: true description: Deprecated; do not use. type: string ssn: description: The billing provider's Social Security Number. Must be a string of exactly nine numbers with no separators. If you include this value, you cannot include the `employerId`. pattern: ^\d{9}$ type: string stateLicenseNumber: description: The billing provider's state license number. This is assigned directly by a payer in order to identify the provider in their system. This is not commonly used. type: string suffix: description: The provider's name suffix, such as Jr. or III. maxLength: 10 minLength: 1 type: string taxonomyCode: description: Code from the National Uniform Claims Committee [Health Care Provider Taxonomy Code Set](https://taxonomy.nucc.org/). This identifies the billing provider's type and/or area of specialty. maxLength: 10 minLength: 10 pattern: ^[A-Za-z0-9]{10}$ type: string type: object InstitutionalOtherSubscriberInformation: description: 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 the patient has coverage. It's used for coordination of benefits scenarios. properties: benefitsAssignmentCertificationIndicator: $ref: '#/components/schemas/InstitutionalOtherSubscriberInformationBenefitsAssignmentCertificationIndicator' description: 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 patient), `Y` - Yes (Payment should go directly to the provider), or `W` - Not Applicable. Use `W` when the patient refuses to assign benefits. claimFilingIndicatorCode: $ref: '#/components/schemas/InstitutionalClaimFilingIndicatorCode' description: 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 insurance. Visit [Claims code lists](https://www.stedi.com/docs/healthcare/claims-code-lists#claim-filing-indicator-codes) for a complete list. claimLevelAdjustments: description: Supply adjustment reason codes and amounts as needed. Required when the claim has been adjudicated by the payer identified in this loop, and the claim has claim level adjustment information. Submitters must use this object to report prior payers' claim level adjustments that cause the amount paid to differ from the amount originally charged. Codes and associated amounts must come from either paper remittance advice or 835s (Electronic Remittance Advice) received on the claim. When the information originates from a paper remittance advice that does not use the standard Claim Adjustment Reason Codes, the paper values must be converted to standard Claim Adjustment Reason Codes. You can include up to five `claimLevelAdjustments` objects in this array. items: $ref: '#/components/schemas/InstitutionalClaimAdjustment' maxItems: 5 minItems: 1 type: array groupNumber: description: 'The group number for the subscriber''s health plan. Provide this property OR the `otherInsuredGroupName`, not both. If this property is set, Stedi ignores the `otherInsuredGroupName` property.' type: string individualRelationshipCode: $ref: '#/components/schemas/InstitutionalIndividualRelationshipCode' description: Code identifying the relationship to the person insured. Visit [Claims code lists](https://www.stedi.com/docs/healthcare/claims-code-lists#individual-relationship-codes) for a complete list. medicareInpatientAdjudication: $ref: '#/components/schemas/MedicareInpatientAdjudication' description: Claim-level data related to the adjudication of Medicare inpatient claims. Required when inpatient adjudication information is reported in the remittance advice _or_ when you need to report remark codes. medicareOutpatientAdjudication: $ref: '#/components/schemas/MedicareOutpatientAdjudication' nonCoveredChargeAmount: description: Required when the destination payer's cost avoidance policy allows providers to bypass claim submission to the otherwise prior payer identified in `otherPayerName`. The amount must equal the total claim charge amount you reported in `claimInformation.claimChargeAmount`. type: string otherInsuredGroupName: description: 'The name of the subscriber''s health plan. Provide either this property OR the `groupNumber`, not both. If `groupNumber` is set, Stedi ignores this value and uses the value in `groupNumber`.' type: string otherPayerAttendingProvider: $ref: '#/components/schemas/OtherPayerAttendingProvider' otherPayerBillingProvider: $ref: '#/components/schemas/InstitutionalOtherPayerBillingProvider' otherPayerName: $ref: '#/components/schemas/InstitutionalOtherPayerName' description: Details about the other payer. otherPayerOperatingPhysician: $ref: '#/components/schemas/OtherPayerOperatingPhysician' otherPayerOtherOperatingPhysician: $ref: '#/components/schemas/OtherPayerOtherOperatingPhysician' otherPayerReferringProvider: $ref: '#/components/schemas/InstitutionalOtherPayerReferringProvider' otherPayerRenderingProvider: $ref: '#/components/schemas/InstitutionalOtherPayerRenderingProvider' otherPayerServiceFacilityLocation: $ref: '#/components/schemas/InstitutionalOtherPayerServiceFacilityLocation' otherSubscriberName: $ref: '#/components/schemas/InstitutionalOtherSubscriberName' description: The person or entity who is the primary policyholder for the other payer's health plan. payerPaidAmount: description: The total amount in dollars the payer has paid on this claim. It is acceptable to set this to `0` (Zero). This is required when you include the `payToPlan` object, and you should set it to the amount the Medicaid agency actually paid. type: string paymentResponsibilityLevelCode: $ref: '#/components/schemas/InstitutionalOtherSubscriberInformationPaymentResponsibilityLevelCode' description: "Code identifying the payer's level of responsibility for paying this claim. Visit [Claims code lists](https://www.stedi.com/docs/healthcare/claims-code-lists#payment-responsibility-sequence-number-codes) for a complete list.\n - This will almost always be `P` - Primary. However, you may need to use other codes if the patient has multiple insurance policies. For example, if a patient is covered by both Medicare and an employer-sponsored commercial plan, you could bill Medicare first as `P` and then bill the commercial payer second as `S`.\n - Either this property or `subscriber.paymentResponsibilityLevelCode` must be set to `P` to indicate the primary insurance payer. Stedi rejects claims - including secondary and tertiary claims - that don't include information for the primary payer." policyNumber: description: The policy number for the subscriber's health plan. type: string releaseOfInformationCode: $ref: '#/components/schemas/ReleaseOfInformationCode' remainingPatientLiability: description: This is the remaining amount (as determined by the provider) to be paid after the other payer identified in the `otherPayerName` object has adjudicated the claim. Required when the other payer adjudicated the claim and provided claim level information only _or_ when the other payer adjudicated the claim, and the provider received a paper remittance advice, and the provider does not have the ability to report line item information. Don't include this property if you're specifying remaining patient liability at the service line level. type: string required: - benefitsAssignmentCertificationIndicator - claimFilingIndicatorCode - individualRelationshipCode - otherPayerName - otherSubscriberName - paymentResponsibilityLevelCode - releaseOfInformationCode type: object DentalLineAdjudicationInformationServiceIdQualifier: enum: - AD - ER type: string DentalServiceIdQualifier: enum: - AD type: string RenderingSecondaryIdentificationQualifierCode: description: 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` - Location Number. Note that UPIN is deprecated and should not be used. enum: - 0B - 1G - G2 - LU type: string PredeterminationOfBenefits: properties: otherPayerPrimaryIdentifier: description: The primary identifier of the payer who assigned the `predeterminationOfBenefits` number. This must match the identifier in the `claimInformation.otherSubscriberInformation.otherPayerName.otherPayerIdentifier` property. type: string predeterminationOfBenefits: description: The Predetermination of Benefits Identification Number. If you're including the identifier provided by the payer identified in `claimInformation.otherSubscriberInformation.otherPayerName`, you must also include the `otherPayerPrimaryIdentifier` property. type: string required: - predeterminationOfBenefits type: object AmbulanceTransportReasonCode: description: Code indicating the reason for ambulance transport. For example, `A` - Patient was transported to nearest facility for care of symptoms, complaints, or both. Visit [Claims code lists](https://www.stedi.com/docs/healthcare/claims-code-lists#ambulance-transport-reason-codes) for a complete list. enum: - A - B - C - D - E type: string DentalDependent: description: "Dependent who received the medical care associated with the claim.\n - If the dependent has their own member ID for the health plan, you should include the dependent's information in the `subscriber` object instead. To check whether a dependent has a member ID, submit an [Eligibility Check](https://www.stedi.com/docs/healthcare/api-reference/post-healthcare-eligibility) to the payer. The payer returns the dependent's member ID in the `dependents.memberId` property in the response, if present.\n - You must include `address` in this object when the patient is a dependent." properties: address: $ref: '#/components/schemas/RequestSubscriberDependentAddress' description: "The dependent's address. Every claim must include address information in either the `subscriber` (when the patient is the subscriber) or `dependent` (when the patient is a dependent) object. You must include at least the `address1` and `city` properties in this object. The `state` and `postalCode` properties are also required for all United States and Canadian addresses.\n - The address must be the patient's correct address at the time of service. Don't use placeholder values to complete unknown address information. Use of outdated or placeholder values could cause the payer to reject, deny, or delay the claim due to suspected fraud.\n - If you don't know the patient's address, you should first submit a [Real-Time Eligibility Check](https://www.stedi.com/docs/healthcare/api-reference/post-healthcare-eligibility) for the patient and then copy the patient's address from either the `subscriber` or `dependent` object in the response.\n - If the patient doesn't have a current address, you can populate the `address1` property with `UNKNOWN` and populate the city, state, and zip code with appropriate values based on your discretion. However, some payers may have explicit rules for how to handle this situation, so you should check the payer's specific requirements before using this approach." dateOfBirth: description: The patient's date of birth pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string firstName: description: The patient's first name. type: string gender: $ref: '#/components/schemas/DependentGender' description: 'Code indiciating the patient''s gender. Can be set to `F` - Female, `M` - Male, or `U` - Unknown. Some payers may reject the claim if the patient''s gender doesn''t match the gender they have recorded in their member records. If the gender isn''t known or the patient declines to answer, use `U` or perform an eligibility check to determine the gender according to the payer''s records.' lastName: description: The patient's last name. **Don't** include the patient's name suffix, such as Jr. or III. Use the designated `suffix` property instead. type: string memberId: description: The patient's identification number. Only used in Property and Casualty claims. type: string middleName: description: The patient's middle name or initial. type: string relationshipToSubscriberCode: $ref: '#/components/schemas/RelationshipToSubscriberCode' ssn: description: The patient's Social Security Number. Only used for Property and Casualty claims. pattern: ^\d{9}$ type: string suffix: description: The patient's name suffix, such as Jr. or III. Only include the patient's personal name suffix - **don't** include professional or academic titles, such as M.D. or MBA. type: string required: - dateOfBirth - firstName - gender - lastName - relationshipToSubscriberCode type: object RepricedApprovedServiceUnitCode: description: The approved service units or inpatient days. Can be set to `DA` - Days or `UN` - Unit. enum: - DA - UN type: string PatientConditionInformationVisionConditionCodesItem: description: Code indicating the reason for the vision services. Visit [Claims code lists](https://www.stedi.com/docs/healthcare/claims-code-lists#vision-condition-codes) for a complete list. enum: - L1 - L2 - L3 - L4 - L5 type: string InstitutionalOtherSubscriberInformationBenefitsAssignmentCertificationIndicator: enum: - N - Y - W type: string MeasurementQualifier: description: Code identifying the specific measurement. Can be set to `HT` - Height, `R1` - Hemoglobin, `R2` - Hematocrit, `R3` - Epoetin Starting Dosage, or `R4` - Creatinine. enum: - HT - R1 - R2 - R3 - R4 type: string InstitutionalOtherSubscriberInformationPaymentResponsibilityLevelCode: enum: - A - B - C - D - E - F - G - H - P - S - T - U type: string PrimaryIdentifierTypeCode: description: 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 reporting Health Plan ID (HPID) or Other Entity Identifier (OEID). enum: - PI - XV type: string DentalClaimContractInformation: description: Required when the submitter is contractually obligated to supply this information on post-adjudicated claims. properties: contractAmount: description: The total dollar amount of the contract, expressed as a decimal. For example, `100.50`. pattern: ^\d+(\.\d{1,2})?$ type: string contractCode: description: The contract code. This is a unique identifier for the contract. type: string contractPercentage: description: The allowance or charge percent, expressed as a decimal. For example, `0.80`. type: string contractTypeCode: $ref: '#/components/schemas/DentalContractTypeCode' contractVersionIdentifier: description: An additional identifer for the contract. Identifies the revision level of a particular format, program, technique or algorithm. type: string termsDiscountPercentage: description: Terms discount percentage, expressed as a percent, available to the purchaser if an invoice is paid on or before the Terms Discount Due Date. type: string required: - contractTypeCode type: object OtherPayerRenderingProviderEntityTypeQualifier: description: Code identifying the type of entity. Can be set to `1` - Person or `2` - Non-Person Entity. enum: - '1' - '2' type: string InstitutionalDrugIdentification: properties: linkSequenceNumber: description: The sequence number assigned to the drug or biologic. Required when the provided medication involves the compounding of two or more drugs being reported and there is no prescription number. The link sequence number is a provider-assigned number unique to this claim. Its purpose is to enable the receiver to piece together the components of the compound. Note that you can set either this property _or_ `pharmacyPrescriptionNumber`, but not both. maxLength: 50 type: string measurementUnitCode: $ref: '#/components/schemas/InstitutionalMeasurementUnitCode' nationalDrugCode: description: The National Drug Code (NDC) number for the drug or biologic. This is a unique number that identifies the drug or biologic, including the labeler code, product code, and package code. The NDC number must be formatted as 5-4-2, with hyphens separating the three parts. For example, 12345-6789-01. maxLength: 48 type: string nationalDrugUnitCount: description: The number of units of the drug or biologic, formtted as a decimal. pattern: ^\d{1,15}$ type: string pharmacyPrescriptionNumber: description: The prescription number assigned by the pharmacy. Required when dispensing of the drug has been done with an assigned prescription number. In cases where a compound drug is being billed, the components of the compound will all have the same prescription number. Payers receiving the claim can relate all the components by matching the prescription number. Note that you can set either this property _or_ `linkSequenceNumber`, but not both. maxLength: 50 type: string required: - measurementUnitCode - nationalDrugCode - nationalDrugUnitCount type: object SignatureIndicator: description: Indicates whether the provider's signature is on file. Can be set to `N` - No or `Y` - Yes. enum: - N - Y type: string ClaimDateInformation: description: You must provide at least one date related to the claim. For example, the date on which the patient was admitted to the hospital. properties: accidentDate: description: The date of the accident related to this claim. Required when `relatedCausesCode` is set to `AA` - Auto Accident or `OA` - Other Accident. Also required when `relatedCausesCode` is set to `EM` - Employment and this claim is the result of an accident. type: string acuteManifestationDate: description: The date the patient first experienced acute symptoms for a chronic condition. Required when the `patientConditionCode` = `A` (Acute Condition) or `M` (Acute Manifestation of a Chronic Condition), the claim involves spinal manipulation, and the payer is Medicare. type: string admissionDate: description: The date the patient was admitted to the hospital. Required on ambulance claims when the patient was known to be admitted to the hospital. Also required on inpatient claims. type: string assumedAndRelinquishedCareBeginDate: description: The date the provider filing this claim assumed care from another provider during post-operative care. Required when providers share post-operative care (global surgery claims). type: string assumedAndRelinquishedCareEndDate: description: The date the provider filing this claim relinquished post-operative care to another provider. Required when providers share post-operative care (global surgery claims). type: string authorizedReturnToWorkDate: description: The date the provider has authorized the patient to return to work. Required on claims where this information is necessary for adjudication, such as workers compensation claims. type: string disabilityBeginDate: description: The start date of the patient's disability period. You can include this date without providing a `disabilityEndDate` if the patient is currently disabled and the end date is unknown. Used for claims involving disability where the provider judges that the patient was or will be unable to perform the duties normally associated with their work. type: string disabilityEndDate: description: The end date of the patient's disability period. You can include this date without including a `disabilityStartDate` if the patient is no longer disabled and the start date is unknown. Used for claims involving disability where the provider judges that the patient was or will be unable to perform the duties normally associated with their work. type: string dischargeDate: description: The date the patient was discharged from the hospital. Required for inpatient claims when the patient was discharged from the facility and the discharge date is known type: string firstContactDate: description: Date the patient first consulted the provider for their condition by any means. This is not necessarily the same as the initial treatment date. Required for Property and Casualty claims when state mandated. type: string hearingAndVisionPrescriptionDate: description: The date of the patient's hearing and vision prescription. Required on claims where a prescription has been written for hearing devices or vision frames and lenses and it is being billed on this claim. type: string initialTreatmentDate: description: The date the patient first received treatment for the current illness or condition. Required when the Initial Treatment Date is known to impact adjudication for claims involving spinal manipulation, physical therapy, occupational therapy, speech language pathology, dialysis, optical refractions, or pregnancy. type: string lastMenstrualPeriodDate: description: The date of the patient's last menstrual period. Required when the provider believes the services on this claim are related to the patient's pregnancy. type: string lastSeenDate: description: The date that the patient was seen by the attending or supervising physician for the qualifying medical condition related to the services performed. Required when claims involve services for routine foot care and this date is known to impact the payer's adjudication process. type: string lastWorkedDate: description: The date the patient last worked, related to disability claims. Required on claims where this information is necessary for adjudication, such as workers compensation claims. type: string lastXRayDate: description: The date of the patient's last x-ray. Required when claim involves spinal manipulation and an x-ray was taken. type: string repricerReceivedDate: description: The date the repricing entity received the initial claim. Required when a repricer is passing the claim onto the payer. type: string symptomDate: description: The date the patient began experiencing acute symptoms for the current illness or condition. Required for the initial medical service or visit performed in response to a medical emergency when the date is available and is different than the date of service. type: string type: object ThrottlingExceptionResponseContent: description: The server response when usage plan or account-level throttling limits exceeded. properties: code: description: Error classification code type: string message: description: Human-readable error message type: string required: - message type: object ClaimFilingCode: description: '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 insurance. - Some payers reject claims with invalid codes. If you''re not sure which code to use, we recommend running a [real-time eligibility check](https://www.stedi.com/docs/healthcare/api-reference/post-healthcare-eligibility) and using the value returned in the most relevant `benefitsInformation.insuranceTypeCode` property. Note that the eligibility response uses a different code list than claims, so you may need to map that code value to the appropriate claim filing code. Visit [Claims code lists](https://www.stedi.com/docs/healthcare/claims-code-lists#claim-filing-indicator-codes) for a complete list.' enum: - '11' - '12' - '13' - '14' - '15' - '16' - '17' - AM - BL - CH - CI - DS - FI - HM - LM - MA - MB - MC - OF - TV - VA - WC - ZZ type: string ToothStatus: properties: toothNumber: description: The tooth number according to the American Dental Association tooth designation system. type: string toothStatusCode: $ref: '#/components/schemas/ToothStatusCode' required: - toothNumber - toothStatusCode type: object OtherProcedureInformation: properties: otherProcedureCode: description: The code from the code set specified in `qualifierCode`. Don't submit the decimal for ICD codes; the decimal is implied. maxLength: 30 type: string otherProcedureDate: description: The date when the procedure was performed. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string qualifierCode: $ref: '#/components/schemas/OtherProcedureInformationQualifierCode' description: 'Identifies an industry code list. This can be set to `BBQ`: International Classification of Diseases Clinical Modification (ICD-10-PCS) Other Procedure Codes or `BQ`: International Classification of Diseases Clinical Modification (ICD-9-CM) Other Procedure Codes. Note that ICD-9-CM codes are deprecated and shouldn''t be used in new claim submissions.' required: - otherProcedureCode - qualifierCode type: object ClaimsSubmissionRequestContent: properties: billing: $ref: '#/components/schemas/Billing' claimIdentifier: $ref: '#/components/schemas/ClaimIdentifier' claimInformation: $ref: '#/components/schemas/ClaimInformation' controlNumber: description: Not currently used. type: string dependent: $ref: '#/components/schemas/Dependent' ordering: $ref: '#/components/schemas/Ordering' deprecated: true payToAddress: $ref: '#/components/schemas/ClaimsAddress' description: 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 paper checks at a different location, such as a PO Box, lockbox, or other mailing address. payToPlan: $ref: '#/components/schemas/PayToPlan' payerAddress: $ref: '#/components/schemas/ClaimsAddress' description: The payer's address. Some payers use this for internal routing. Only provide this address if the payer explicitly requires it. providers: deprecated: true description: Information about all providers, with each provider specified by its type (for example, `Referring`). You can't include this array in the same request as dedicated provider objects, such as `referring` or `rendering`. items: $ref: '#/components/schemas/ClaimsProvider' maxItems: 2147483647 minItems: 1 type: array receiver: $ref: '#/components/schemas/Receiver' referring: $ref: '#/components/schemas/Referring' rendering: $ref: '#/components/schemas/Rendering' submitter: $ref: '#/components/schemas/Submitter' subscriber: $ref: '#/components/schemas/Subscriber' supervising: $ref: '#/components/schemas/Supervising' tradingPartnerName: description: This is the payer's business name, like Cigna or Aetna. type: string tradingPartnerSecondaryIdentifiers: $ref: '#/components/schemas/TradingPartnerSecondaryIdentifiers' description: Secondary identifiers for the payer. You can include up to three properties in this object. tradingPartnerServiceId: description: "The payer ID. Visit the [Payer Network](https://www.stedi.com/healthcare/network) for a complete list.\n - You can send requests using the primary payer ID, the Stedi payer ID, or any alias listed in the payer record.\n - You must include leading `0` characters - payer IDs are alphanumeric strings and must be treated as complete strings, not integers. For example, use `00540` for SISCO, not `540`." minLength: 1 type: string usageIndicator: description: Whether you want to send a test or production claim. This property also allows you to filter claims in the Stedi portal by production or test data. By default, this property is set to `P` for production data. Use `T` to designate a claim as test data. type: string required: - billing - claimInformation - receiver - submitter - subscriber - tradingPartnerServiceId type: object ContractInformation: description: Required when the submitter is contractually obligated to supply this information on post-adjudicated claims. properties: contractAmount: description: The total dollar amount of the contract, expressed as a decimal. For example, `100.50`. pattern: ^\d+(\.\d{1,2})?$ type: string contractCode: description: The contract code. This is an identifier for the contract. type: string contractPercentage: description: The allowance or charge percent, expressed as a decimal. For example, `0.80`. type: string contractTypeCode: $ref: '#/components/schemas/ContractInformationContractTypeCode' contractVersionIdentifier: description: An additional identifier for the contract. Identifies the revision level of a particular format, program, technique or algorithm. type: string termsDiscountPercentage: description: Terms discount percentage, expressed as a decimal, available to the purchaser if an invoice is paid on or before the Terms Discount Due Date. type: string required: - contractTypeCode type: object InstitutionalClaimIdentifier: description: "A code specifying the type of transaction. Defaults to `CH` if not provided.\n - `31`: Only for use by state Medicaid agencies performing post payment recovery.\n - `CH`: Use when the transaction contains only fee for service claims or claims with at least one chargeable line item. Also use when it's not clear whether a transaction contains claims or capitated encounters, or if the transaction contains a mix of claims and capitated encounters.\n - `RP`: Use for capitated encounters. Also use when the transaction is being sent to an entity for purposes other than adjudication of a claim. For example, when you're sending the claim to a state health agency that is using the claim for health data reporting purposes." enum: - '31' - CH - RP type: string OtherPayerServiceFacilityLocation: properties: otherPayerServiceFacilityLocationSecondaryIdentifier: description: A secondary identifier for the service facility location. items: $ref: '#/components/schemas/OtherPayerServiceFacilityLocationSecondaryIdentifierItem' maxItems: 3 minItems: 1 type: array required: - otherPayerServiceFacilityLocationSecondaryIdentifier type: object AccessDeniedExceptionResponseContent: description: The server response for authorization failure. properties: code: description: Error classification code type: string message: description: Human-readable error message type: string required: - message type: object LinePricingInformation: deprecated: true properties: apgAmount: pattern: ^\d+(\.\d{1,2})?$ type: string apgCode: type: string exceptionCode: $ref: '#/components/schemas/InstitutionalClaimsExceptionCode' flatRateAmount: pattern: ^\d+(\.\d{1,2})?$ type: string measurementUnitCode: $ref: '#/components/schemas/InstitutionalMeasurementUnit' policyComplianceCode: $ref: '#/components/schemas/PolicyComplianceCode' pricingMethodologyCode: $ref: '#/components/schemas/PricingMethodologyCode' rejectReasonCode: $ref: '#/components/schemas/RejectReasonCode' repricedAllowedAmount: pattern: ^\d+(\.\d{1,2})?$ type: string repricedApprovedHCPCSCode: maxLength: 48 type: string repricedApprovedServiceUnitCount: pattern: ^\d{1,8}(\.\d{1,3})?$ type: string repricedOrganizationIdentifier: type: string repricedSavingAmount: pattern: ^\d+(\.\d{1,2})?$ type: string serviceIdQualifier: $ref: '#/components/schemas/InstitutionalProcedureIdentifier' required: - pricingMethodologyCode - repricedAllowedAmount type: object DelayReasonCode: description: Code indicating the reason for the delay in claim submission. Visit [Claims code lists](https://www.stedi.com/docs/healthcare/claims-code-lists#delay-reason-codes) for a complete list. enum: - '1' - '2' - '3' - '4' - '5' - '6' - '7' - '8' - '9' - '10' - '11' - '15' type: string PDFError: properties: error: description: A message indicating the type of error that occurred. type: string transactionId: description: A unique identifier for the claim with one or more PDF errors. maxLength: 36 minLength: 36 pattern: ^[0-9a-fA-F]{8}-[0-9a-fA-F]{4}-[0-9a-fA-F]{4}-[0-9a-fA-F]{4}-[0-9a-fA-F]{12}$ type: string type: object GatewayTimeoutExceptionResponseContent: description: The server response for a gateway timeout error. properties: code: description: Classification of the exception type. type: string message: description: Human readable exception message. type: string required: - message type: object ReferringProviderType: description: Defines the referring provider type. enum: - ReferringProvider type: string OtherDiagnosisInformationPresentOnAdmissionIndicator: enum: - N - Y - U - W type: string ClaimsError: properties: code: description: The error code. type: string description: description: The description of the error code. type: string field: description: The field related to the error. type: string followupAction: description: Recommended followup actions to correct the error. type: string location: description: Where the error is located in the original request. type: string value: description: The value for the data causing the error. type: string type: object ClaimsRawX12SubmissionResponseContent: properties: claimReference: $ref: '#/components/schemas/ClaimReference' controlNumber: description: An identifier for the transaction. type: string editResponses: description: Currently not used. items: $ref: '#/components/schemas/EditResponse' type: array editStatus: deprecated: true description: 'This shape is deprecated: Currently not used.' type: string errors: description: Errors resulting from claim edits. You must review and fix these errors before resubmitting. items: $ref: '#/components/schemas/ClaimsError' type: array failure: $ref: '#/components/schemas/Failure' httpStatusCode: $ref: '#/components/schemas/HttpStatusCode' meta: $ref: '#/components/schemas/ResponseMeta' payer: $ref: '#/components/schemas/ClaimsPayer' status: description: The status of the claim submission. type: string tradingPartnerServiceId: description: An ID for the payer you identified in the original claim. This value may differ from the `tradingPartnerServiceId` you submitted in the original request because it reflects the payer's internal concept of their ID, not necessarily the ID Stedi uses to route requests to this payer. type: string warnings: description: A list of warnings. Currently not used. items: $ref: '#/components/schemas/ClaimsWarning' type: array x12: description: 'A [277CA claim acknowledgment](https://www.stedi.com/docs/healthcare/claim-responses-overview#277ca-claim-acknowledgment) acceptance or rejection from Stedi in X12 EDI format. It indicates whether the claim has passed Stedi''s claim edits. When the claim fails one or more edits, the 277CA contains `STC` segments with information about each error. These are the same error codes that appear in the `errors` array. Note that this 277CA only indicates whether Stedi has accepted or rejected the claim submission. You may receive additional 277CA acceptances or rejections as the claim is routed to the payer.' type: string type: object DentalClaimsRawX12SubmissionRequestContent: properties: x12: type: string required: - x12 type: object ReferringSecondaryIdentificationQualifierCode: description: The type of identifier used in `secondaryIdentifier`. Can be set to `0B` - State License Number, `1G` - Provider UPIN Number, or `G2` - Provider Commercial Number. Note that UPIN is deprecated and should not be used. enum: - 0B - 1G - G2 type: string ServiceAuthorizationExceptionCode: description: Code indicating the reason for the service authorization exception. Visit [Claims code lists](https://www.stedi.com/docs/healthcare/claims-code-lists#service-authorization-exception-codes) for a complete list. enum: - '1' - '2' - '3' - '4' - '5' - '6' - '7' type: string SubscriberInsuranceTypeCode: description: Identifies the type of insurance policy within a specific insurance program. Visit [Claims code lists](https://www.stedi.com/docs/healthcare/claims-code-lists#insurance-type-codes) for a complete list. enum: - '12' - '13' - '14' - '15' - '16' - '41' - '42' - '43' - '47' type: string AccessDeniedException: description: The server response for authorization failure. properties: code: description: Error classification code type: string message: description: Human-readable error message type: string required: - message type: object AmbulanceTransportInformation: description: Information about the ambulance service provided to the patient. properties: ambulanceTransportReasonCode: $ref: '#/components/schemas/AmbulanceTransportReasonCode' patientWeightInPounds: description: The weight of the patient, in pounds, at the time of transport. Provide this value as a decimal, such as `150.5` type: string roundTripPurposeDescription: description: The reason for the round trip ambulance service. type: string stretcherPurposeDescription: description: The reason for usage of a stretcher during ambulance service. type: string transportDistanceInMiles: description: The number of miles the ambulance traveled to transport the patient. Provide this value as a decimal, such as `20.5`. Note that `0` (zero) is a valid value when ambulance services do not include a charge for mileage. type: string required: - ambulanceTransportReasonCode - transportDistanceInMiles type: object ReleaseInformationCode: description: 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` - Yes, or `I` - Informed Consent to Release Medical Information for Conditions or Diagnoses Regulated by Federal Statues. Use `I` when the provider has not collected a signature AND state or federal laws do not require a signature be collected. enum: - I - Y type: string PayToAddressName: description: 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 paper checks at a different location, such as a PO Box, lockbox, or other mailing address. properties: address: $ref: '#/components/schemas/InstitutionalAddress' description: The address information. entityTypeQualifier: $ref: '#/components/schemas/PayToAddressNameEntityTypeQualifier' required: - address - entityTypeQualifier type: object securitySchemes: httpApiKeyAuth: description: A [Stedi API Key](https://www.stedi.com/app/settings/api-keys) for authentication. in: header name: Authorization type: apiKey x-stedi: lifecycle: general_availability product: claims public: true