components: schemas: 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 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 AccountNumberQualifier: description: Identifies the type of bank account being used for electronic payment transactions. This specifies whether the account is a checking (demand deposit) or savings account. enum: - DA - SA type: string AdditionalIdentificationDependent: description: Use this object when you need to provide an additional identification number for the dependent. This is rarely required for standard eligibility checks. properties: agencyClaimNumber: description: The Property and Casualty Claim Number associated with the patient. You should only submit this value when when you are submitting an eligibility request to a property and casualty payer. maxLength: 50 minLength: 1 type: string contractNumber: description: The contract number for an existing contract between the payer and the provider requesting the eligibility check. maxLength: 50 minLength: 1 type: string healthInsuranceClaimNumber: description: This property is never used in practice. maxLength: 50 minLength: 1 type: string identificationCardSerialNumber: description: The identification card serial number. You can include this when the ID card has a number in addition to the member ID number. The Identification Card Serial Number uniquely identifies the card when multiple cards have been or will be issued to a member, such as a replacement card. maxLength: 50 minLength: 1 type: string insurancePolicyNumber: description: The insurance policy number. maxLength: 50 minLength: 1 type: string medicalRecordIdentificationNumber: description: The medical record identification number. maxLength: 50 minLength: 1 type: string memberIdentificationNumber: description: 'Not intended for most use cases. Only set this when the property and casualty patient identifier is a member ID that would be used in an 837 claim submission. If the patient has their own member ID for the health plan, you should identify them in the `subscriber` object. If the patient doesn''t have their own member ID, don''t set this property.' maxLength: 50 minLength: 1 type: string patientAccountNumber: description: The patient account number. maxLength: 50 minLength: 1 type: string planNetworkIdentificationNumber: description: The plan network identification number. maxLength: 50 minLength: 1 type: string planNumber: description: The insurance plan number. maxLength: 50 minLength: 1 type: string policyNumber: description: The insurance group or policy number. maxLength: 50 minLength: 1 type: string type: object AdditionalIdentificationSubscriber: description: 'Use this object when you need to provide an identification number other than or in addition to the subscriber''s member ID. For example, you may provide the patient account number. Don''t include the health insurance claim number or the medicaid recipient ID number here unless they are different from the member ID.' properties: agencyClaimNumber: description: The Property and Casualty Claim Number associated with the patient. You should only submit this value when when you are submitting an eligibility request to a property and casualty payer. maxLength: 50 minLength: 1 type: string contractNumber: description: The contract number for an existing contract between the payer and the provider requesting the eligibility check. maxLength: 50 minLength: 1 type: string healthInsuranceClaimNumber: description: The health insurance claim number. maxLength: 50 minLength: 1 type: string identificationCardSerialNumber: description: The identification card serial number. You can include this when the ID card has a number in addition to the member ID number. The Identification Card Serial Number uniquely identifies the card when multiple cards have been or will be issued to a member, such as a replacement card. maxLength: 50 minLength: 1 type: string insurancePolicyNumber: description: The insurance policy number. maxLength: 50 minLength: 1 type: string medicalRecordIdentificationNumber: description: The medical record identification number. maxLength: 50 minLength: 1 type: string memberIdentificationNumber: description: This property is never used in practice. Supply the subscriber's member ID in `subscriber.memberId`. maxLength: 50 minLength: 1 type: string patientAccountNumber: description: The patient account number. maxLength: 50 minLength: 1 type: string planNetworkIdentificationNumber: description: The plan network identification number. maxLength: 50 minLength: 1 type: string planNumber: description: The insurance plan number. maxLength: 50 minLength: 1 type: string policyNumber: description: The insurance group or policy number. maxLength: 50 minLength: 1 type: string type: object AdditionalInformation: properties: description: description: A free-form message containing additional information about the benefits in the response. type: string type: object Address: properties: address1: description: The first line of the address. maxLength: 55 minLength: 1 type: string address2: description: The second line of the address. maxLength: 55 minLength: 1 type: string city: description: The city. maxLength: 30 minLength: 2 type: string countryCode: description: The two-letter country code from [Part 1 of ISO 3166](https://en.wikipedia.org/wiki/ISO_3166-1_alpha-2). maxLength: 2 minLength: 2 type: string countrySubDivisionCode: description: The country subdivision code from [Part 2 of ISO 3166](https://en.wikipedia.org/wiki/ISO_3166-2). maxLength: 3 minLength: 1 type: string postalCode: description: The United States or Canadian postal code, excluding punctuation and blanks. maxLength: 9 minLength: 5 type: string state: $ref: '#/components/schemas/ResponseStateOrProvinceCode' 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 Adjustments: description: Provider adjustment details including reason codes and amounts. properties: adjustmentReasonCode: description: A code identifying the reason for the adjustment. Visit [Provider Adjustment Reason Codes](https://www.stedi.com/docs/healthcare/claims-code-lists#provider-adjustment-reason-code) for a complete list and descriptions. type: string adjustmentReasonCodeValue: description: The description of the `adjustmentReasonCode`. type: string providerAdjustmentAmount: description: The amount of the adjustment, per the adjustment reason provided. A negative amount increases the claim payment and a positive amount decreases the claim payment. type: string providerAdjustmentIdentifier: description: An identifier used to assist the receiver in identifying, tracking, or reconciling the adjustment. type: string type: object 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 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 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 AmbulanceCertificationCertificationConditionIndicator: description: Code indicating whether there is an ambulance certification. enum: - N - Y 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 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 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 ApplicationModes: description: 'The type of data in the request. This is either `production` when you send a request with a standard API key or `test` when you send a request in test mode with a [test API key](https://www.stedi.com/docs/api-reference/index#api-key-types). The `information` value is not currently used. Payers may sometimes return other non-compliant values.' enum: - production - test - information 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 `\t\ 1223S0112X` is for Oral and Maxillofacial Surgery." maxLength: 10 minLength: 10 pattern: ^[A-Za-z0-9]{10}$ type: string required: - lastName - taxonomyCode 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 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 AuthOrCertIndicator: description: 'Code indicating whether the benefit is subject to prior authorization or certification. Payers may sometimes return other non-compliant values.' enum: - N - U - Y type: string BadRequestException: description: The server cannot process the request due to an apparent client error. properties: code: description: Error classification code type: string message: description: Human-readable error message type: string required: - message title: BadRequestException type: object BenefitRelatedEntityIdentification: description: 'Code identifying the type of value provided in `entityIdentificationValue`. For example, `FI` - Federal Taxpayer''s Identification Number. Payers may sometimes return other non-compliant values.' enum: - '24' - '34' - '46' - FA - FI - II - MI - NI - PI - PP - SV - XV - XX type: string BenefitsAdditionalInformation: description: Identifying information specific to this type of benefit. properties: alternativeListId: description: The alternative list ID. This identifier allows the payer to specify a list of drugs and its alternative drugs with the associated formulary status for the patient. type: string coverageListId: description: The coverage list ID. This identifier allows the payer to specify the identifier of a list of drugs that have coverage limitations for the associated patient. type: string drugFormularyNumber: description: The drug formulary number. type: string familyUnitNumber: description: The family unit number. This is returned when the payer is a pharmacy benefits manager (PBM) and the patient has a suffix to their member ID number that is used in the NCPDP Telecom Standard Insurance Segment, in field `303-C3` (Person Code). For all other uses, the family unit number (suffix) is considered part of the patient's member ID number. type: string groupDescription: description: Group name type: string groupNumber: description: The group number for the patient's health insurance plan. type: string hicNumber: description: The health insurance claim number (HICN). Note that CMS previously used the HICN to uniquely identify Medicare beneficiaries. However, they have since transitioned to a new, randomized Medicare Beneficiary Identifier (MBI) format. The HICN is no longer used for Medicare transactions but this property is now used by some payers to return MBI. If you receive a value in this property that matches the format specified in the [Medicare Beneficiary Identifier documentation](https://www.cms.gov/training-education/partner-outreach-resources/new-medicare-card/medical-beneficiary-identifiers-mbis), the number is likely an MBI and we recommend sending a follow-up eligibility check to CMS for additional benefits data. This most commonly occurs with patients who are covered by both Medicare and Medicaid. type: string insurancePolicyNumber: description: The insurance policy number. type: string medicaidRecepientIdNumber: description: The Medicaid Recipient Identification number. type: string medicalAssistanceCategory: description: The medical assistance category. type: string memberId: description: The patient's member ID. type: string planDescription: description: Plan name type: string planNetworkDescription: description: Plan network name type: string planNetworkIdNumber: description: The plan network identification number. type: string planNumber: description: The insurance plan number. type: string policyNumber: description: The patient's policy number. type: string priorAuthorizationNumber: description: The prior authorization number. type: string referralNumber: description: The referral number. type: string type: object BenefitsDateInformation: description: "Dates associated with the benefits.\n - This is where you can\ \ find benefit-specific eligibility dates, if provided. These dates override\ \ dates provided in `planDateInformation` for this benefit type.\n - This\ \ is where the payer may specify the last time the service was rendered (`latestVisitOrConsultation`),\ \ which you can use to determine whether the patient has already reached the\ \ allowed frequency, if applicable. For example, this object could contain\ \ the date when the patient received their last dental cleaning.\n - These\ \ dates only apply to the `benefitsInformation` object in which this `benefitsDateInformation`\ \ is provided." properties: added: description: Added date. Payers may return this information in the case of retroactive eligibility. 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 admission: description: The admission date or 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 admissions: description: The date(s) for admission. items: $ref: '#/components/schemas/DtpDate' type: array benefit: description: The benefit date. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])(-\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01]))?$ type: string benefitBegin: description: The date when the benefit begins. 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 benefitEnd: description: The date when the benefit ends. 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 certification: deprecated: true description: The certification date. 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 cobraBegin: deprecated: true description: The date when COBRA coverage begins. 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 cobraEnd: deprecated: true description: The date when COBRA coverage ends. 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 completion: description: The completion date. 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 coordinationOfBenefits: description: The coordination of benefits date. 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 dateOfDeath: description: The date of death. 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 dateOfLastUpdate: description: The date when the plan information was last updated. 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 discharge: description: The discharge date. 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 discharges: description: The date(s) when the patient was discharged. items: $ref: '#/components/schemas/DtpDate' type: array effectiveDateOfChange: deprecated: true description: The effective date of change. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])(-\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01]))?$ type: string eligibility: description: Plan eligibility 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 eligibilityBegin: description: The date when the patient is first eligible for benefits under the plan. 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 eligibilityEnd: description: The date when the patient is no longer eligible for benefits under the plan. 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 enrollment: deprecated: true description: The date when the patient is enrolled in the plan. 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 issue: deprecated: true description: The issue date. 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 latestVisitOrConsultation: description: The latest visit or consultation date. This date may be used to determine whether the patient has already reached the allowed frequency for a specific benefit. 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 periodEnd: description: The end of a period. 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 periodStart: description: The start of a period. 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 plan: description: Only included when multiple plans apply to the patient or multiple plan periods apply. 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 planBegin: description: Only included when multiple plans apply to the patient or multiple plan periods apply. 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 planEnd: deprecated: true description: The date coverage from the plan ends. 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 policyEffective: deprecated: true description: The date when the policy becomes effective. 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 policyExpiration: deprecated: true description: The date when the policy expires. 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 premiumPaidToDateEnd: deprecated: true description: The end of period when the plan premium payments are up-to-date. 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 premiumPaidtoDateBegin: deprecated: true description: The start of the period when the plan premium was paid in full. 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 primaryCareProvider: description: The primary care provider date. 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 service: description: The service date or 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 status: description: The status date. 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 BenefitsInformation: properties: additionalInformation: description: A free-form message containing additional information about the benefits in the response. items: $ref: '#/components/schemas/AdditionalInformation' type: array authOrCertIndicator: $ref: '#/components/schemas/AuthOrCertIndicator' description: "Code indicating whether the benefit is subject to prior authorization\ \ or certification. Can be `Y` - Yes, `N` - No, or `U` - Unknown.\n -\ \ When this property is set to `U`, it means the payer can't determine\ \ in real time whether prior authorization is required for the service.\ \ They may require additional details, like diagnosis or place of service\ \ to make a determination. Check the `additionalInformation[].description`\ \ property for any additional clarification. You can also contact the\ \ payer directly or use their provider portal to get more information.\n\ \ - Some payers may send additional notes about prior authorization rules\ \ in the `additionalInformation[].description` property. Payers may also\ \ send prior authorization notes in a separate `benefitsInformation` object\ \ with a code of `1` (Active coverage), `CB` (Coverage Benefit), or `D`\ \ (Benefit Description).\n\nVisit our [patient benefits docs](https://www.stedi.com/docs/healthcare/eligibility-network-status-authorization-referrals#is-prior-authorization-required)\ \ to learn more about prior authorization.\n\nPayers may sometimes return\ \ other non-compliant values." benefitAmount: description: "The monetary benefit amount, such as a patient's co-pay or\ \ deductible. This value is expressed as a decimal, such as 100.00. \n\ \ \n The payer will always send a value in this property when the `benefitsInformation[].code`\ \ = `B` - Co-Payment, `C` - Deductible, `G` - Out of Pocket (Stop Loss),\ \ `J` - Cost Containment, or `Y` - Spend Down. For those codes, this value\ \ represents the patient's portion of responsibility. \n \n The payer\ \ will **never** send this value when `benefitsInformation[].code` = `A`\ \ - Co-Insurance. This property can contain zero when the patient has\ \ no responsibility. \n \n Learn more about [patient costs](https://www.stedi.com/docs/healthcare/eligibility-patient-responsibility-benefits)." type: string benefitPercent: description: "The percentage of the benefit, such as co-insurance. This\ \ property can contain zero when the patient has no responsibility. \n\ \ \n The payer will always send a value in this property when `benefitsInformation[].code`\ \ = `A` - Co-Insurance. For this code, this value represents the patient's\ \ portion of the responsibility. The percentage is expressed as a decimal,\ \ such as `0.80` represents 80%. \n \n The payer will **never** send a\ \ value in this property when `benefitsInformation[].code` = `B` - Co-Payment,\ \ `C` - Deductible, `G` - Out of Pocket (Stop Loss), `J` - Cost Containment,\ \ or `Y` - Spend Down. \n \n Learn more about [patient costs](https://www.stedi.com/docs/healthcare/eligibility-patient-responsibility-benefits)." type: string benefitQuantity: description: The quantity of the benefit, qualified by the type specified in `quantityQualifier`. For example, `10` when the `quantityQualifier` is `Visits`. type: string benefitsAdditionalInformation: $ref: '#/components/schemas/BenefitsAdditionalInformation' benefitsDateInformation: $ref: '#/components/schemas/BenefitsDateInformation' benefitsRelatedEntities: description: 'Other entities associated with the eligibility or benefits. This could be a provider, an individual, an organization, or another payer. When present, this array typically contains information about the patient''s primary care provider (PCP), another organization that handles a specific benefit type (such as telehealth mental health services), or another health plan for the patient (coordination of benefits scenarios). - This is where information for a crossover carrier such as Medicaid or Medicare is provided, if it''s applicable to the patient and the payer supports it. - For Blue Cross Blue Shield (BCBS) payers, Stedi returns an entry containing information about the patient''s home plan - the plan that actually verified the coverage. In this object, the `entityIdentifier` property is set to `Party Performing Verification`. [Learn more](https://www.stedi.com/docs/healthcare/eligibility-active-coverage-benefits#bcbs-home-plan)' items: $ref: '#/components/schemas/BenefitsRelatedEntity' type: array benefitsRelatedEntity: $ref: '#/components/schemas/BenefitsRelatedEntity' deprecated: true description: Please use `benefitsInformation[].benefitsRelatedEntities` instead. benefitsServiceDelivery: items: $ref: '#/components/schemas/BenefitsServiceDelivery' type: array code: $ref: '#/components/schemas/BenefitsInformationCode' compositeMedicalProcedureIdentifier: $ref: '#/components/schemas/CompositeMedicalProcedureIdentifier' coverageLevel: $ref: '#/components/schemas/BenefitsInformationCoverageLevelName' coverageLevelCode: $ref: '#/components/schemas/BenefitsInformationCoverageLevelCode' eligibilityAdditionalInformation: $ref: '#/components/schemas/EligibilityAdditionalInformation' deprecated: true description: Please use `benefitsInformation[].eligibilityAdditionalInformationList` instead. eligibilityAdditionalInformationList: description: Used when there are multiple Nature of Injury Codes or a Facility Type Codes included in the response. items: $ref: '#/components/schemas/EligibilityAdditionalInformation' type: array headerLoopIdentifierCode: description: The loop header identifier number in the `LS` segment of the original X12 EDI transaction. type: string inPlanNetworkIndicator: $ref: '#/components/schemas/InPlanNetworkIndicatorName' inPlanNetworkIndicatorCode: $ref: '#/components/schemas/InPlanNetworkIndicatorCode' insuranceType: $ref: '#/components/schemas/InsuranceTypeName' insuranceTypeCode: $ref: '#/components/schemas/InsuranceTypeCode' description: 'Code identifying the type of insurance policy. Visit [Eligibility code lists](https://www.stedi.com/docs/healthcare/eligibility-code-lists#insurance-type-codes) for a complete list. Payers may sometimes return other non-compliant values.' name: $ref: '#/components/schemas/BenefitsInformationName' planCoverage: description: 'The specific product name or special program name for an insurance plan. For example `Gold 1-2-3`. Payers are normally required to send the plan name when `benefitsInformation[].code` is set to values `1` - `8` and the `benefitsInformation[].serviceTypeCodes` contains `30` (Health Benefit Plan Coverage). However, behavior may vary by payer, so don''t rely on this information being present in the response. Note that the plan name returned in this property may not exactly match the name the payer uses in official plan documents or marketing literature. Visit [What''s the plan name?](https://www.stedi.com/docs/healthcare/eligibility-active-coverage-benefits#what’s-the-plan-name%3F) in the benefits response documentation for more details.' type: string quantityQualifier: $ref: '#/components/schemas/QuantityQualifierName' description: 'The name of the `quantityQualifierCode`. Payers may sometimes return other non-compliant values.' quantityQualifierCode: $ref: '#/components/schemas/QuantityQualifierCode' description: 'Code indicating the type of quantity for the benefit. Visit [Eligibility code lists](https://www.stedi.com/docs/healthcare/eligibility-code-lists#quantity-qualifier-codes) for a complete list. Payers may sometimes return other non-compliant values.' serviceTypeCodes: description: 'Service Type Codes (STCs) related to the benefit type. For example, `7` - Anesthesia. Visit [Service Type Codes](https://www.stedi.com/docs/healthcare/send-eligibility-checks#service-type-codes) for a complete list. This list is specific to X12 version 005010, which is the mandated version for eligibility checks. It differs from the current [X12 Service Type Codes](https://x12.org/codes/service-type-codes) list, which applies to X12 versions later than 005010. Payers may sometimes return other non-compliant values.' items: $ref: '#/components/schemas/ResponseEligibilityServiceTypeCode' type: array serviceTypes: description: 'The names of the Service Type Codes listed in the `serviceTypeCodes` array. Visit [Service Type Codes](https://www.stedi.com/docs/healthcare/send-eligibility-checks#service-type-codes) for a complete list of codes and their names. The word physician in service type codes refers to any healthcare provider, including physician assistants, nurse practitioners, and other types of healthcare professionals. Payers may sometimes return other non-compliant values.' items: $ref: '#/components/schemas/ResponseEligibilityServiceType' type: array timeQualifier: $ref: '#/components/schemas/TimeQualifierName' description: 'The name of the `timeQualifierCode`. Payers may sometimes return other non-compliant values.' timeQualifierCode: $ref: '#/components/schemas/TimeQualifierCode' description: 'Code indicating the time period for the benefit information. Visit [Eligibility code lists](https://www.stedi.com/docs/healthcare/eligibility-code-lists#time-qualifier-codes) for a complete list. Payers may sometimes return other non-compliant values.' trailerLoopIdentifierCode: description: The loop trailer identifier number in the `LE` segment of the original X12 EDI transaction. type: string type: object BenefitsInformationCode: description: 'The code indicating the type of benefits information. Visit [Eligibility and benefit codes](https://www.stedi.com/docs/healthcare/eligibility-active-coverage-benefits#benefit-type-codes) for more information. Payers may sometimes return other non-compliant values.' enum: - '1' - '2' - '3' - '4' - '5' - '6' - '7' - '8' - A - B - C - CB - D - E - F - G - H - I - J - K - L - M - MC - N - O - P - Q - R - S - T - U - V - W - X - Y type: string BenefitsInformationCoverageLevelCode: description: "Code indicating the level of coverage for the patient. \n\nThis\ \ will either be `CHD` - Children Only, `DEP` - Dependents Only, `ECH` - Employee\ \ and Children, `EMP` - Employee Only, `ESP` - Employee and Spouse, `FAM`\ \ - Family, `IND` - Individual, `SPC` - Spouse and Children, `SPO` - Spouse\ \ Only, or `Unknown`.\n\nPayers may sometimes return other non-compliant values." enum: - CHD - DEP - ECH - EMP - ESP - FAM - IND - SPC - SPO type: string BenefitsInformationCoverageLevelName: description: 'The full name of the coverage level code. Payers may sometimes return other non-compliant values.' enum: - Children Only - Dependents Only - Employee and Children - Employee Only - Employee and Spouse - Family - Individual - Spouse and Children - Spouse Only type: string BenefitsInformationName: description: 'The full name of the benefits information code. Payers may sometimes return other non-compliant values.' enum: - Active Coverage - Active - Full Risk Capitation - Active - Services Capitated - Active - Services Capitated to Primary Care Physician - Active - Pending Investigation - Inactive - Inactive - Pending Eligibility Update - Inactive - Pending Investigation - Co-Insurance - Co-Payment - Deductible - Coverage Basis - Benefit Description - Exclusions - Limitations - Out of Pocket (Stop Loss) - Unlimited - Non-Covered - Cost Containment - Reserve - Primary Care Provider - Pre-existing Condition - Managed Care Coordinator - Services Restricted to Following Provider - Not Deemed a Medical Necessity - Benefit Disclaimer - Second Surgical Opinion Required - Other or Additional Payor - Prior Year(s) History - Card(s) Reported Lost/Stolen - Contact Following Entity for Eligibility or Benefit Information - Cannot Process - Other Source of Data - Health Care Facility - Spend Down type: string BenefitsRelatedEntity: description: 'Identify another entity associated with the eligibility or benefits. This could be a provider, an individual, an organization, or another payer. This array is commonly used to designate the patient''s primary care provider (PCP), another organization that handles a specific carveout benefit type, or another health plan for the patient (coordination of benefits scenarios). This is where information for a crossover carrier such as Medicaid or Medicare is provided, if it''s applicable to the patient and the payer supports it.' properties: address: $ref: '#/components/schemas/Address' description: The address of the entity, such as a provider or organization. contactInformation: $ref: '#/components/schemas/ContactInformation' description: The contact information for the entity, such as a phone number or email address. entityFirstname: description: The first name of the entity, if the entity is a person. type: string entityIdentification: $ref: '#/components/schemas/BenefitRelatedEntityIdentification' description: 'Code identifying the type of identifier in the `entityIdentificationValue` property. Visit [Eligibility code lists](https://www.stedi.com/docs/healthcare/eligibility-code-lists#identification-code-qualifiers) for a complete list. Payers may sometimes return other non-compliant values.' entityIdentificationValue: description: The identification number for the entity, qualified by the code in `entityIdentification`. type: string entityIdentifier: $ref: '#/components/schemas/RelatedEntityIdentifierName' description: 'Code identifying an organizational entity, a physical location, property, or individual. When set to `Party Performing Verification` for a BCBS payer, this is the patient''s home plan. Payers may sometimes return other non-compliant values.' entityMiddlename: description: The middle name or initial of the entity, if the entity is a person. type: string entityName: description: The last name (if the entity is a person) or the business name (if the entity is an organization). type: string entityRelationship: $ref: '#/components/schemas/BenefitsRelatedEntityRelationshipCode' description: 'Code specifying the relationship between the entity and the patient. Can be `01` - Parent, `02` - Child, `27` - Domestic Partner, `41` - Spouse, `48` - Employee, `65` - Other, or `72` - Unknown. Payers may sometimes return other non-compliant values.' entitySuffix: description: The name suffix, such as Sr. Jr. or III. type: string entityType: $ref: '#/components/schemas/EntityTypeQualifier' providerInformation: $ref: '#/components/schemas/ProviderInformation' type: object BenefitsRelatedEntityRelationshipCode: description: 'Code specifying the relationship between the entity and the patient. Payers may sometimes return other non-compliant values.' enum: - '01' - '02' - '27' - '41' - '48' - '65' - '72' type: string BenefitsServiceDelivery: description: The delivery or usage pattern for the benefits. properties: deliveryOrCalendarPatternCode: $ref: '#/components/schemas/DeliveryOrCalendarPatternQualifier' deliveryOrCalendarPatternQualifier: $ref: '#/components/schemas/DeliveryOrCalendarPatternQualifier' deliveryOrCalendarPatternQualifierCode: $ref: '#/components/schemas/DeliveryOrCalendarPatternQualifierCode' deliveryPatternTimeCode: $ref: '#/components/schemas/DeliveryPatternTimeQualifier' deliveryPatternTimeQualifier: $ref: '#/components/schemas/DeliveryPatternTimeQualifier' deliveryPatternTimeQualifierCode: $ref: '#/components/schemas/DeliveryPatternTimeQualifierCode' description: 'Code specifying the time for routine shipments or deliveries. Visit [Eligibility code lists](https://www.stedi.com/docs/healthcare/eligibility-code-lists#delivery-pattern-time-codes) for a complete list. Payers may sometimes return other non-compliant values.' numOfPeriods: description: The number of periods in the time period. For example, `12` when the `timePeriodQualifier` is `Hour`. type: string quantity: description: The quantity of the benefit. For example, `10` when the `quantityQualifier` is `Visits`. type: string quantityQualifier: $ref: '#/components/schemas/BenefitsServiceDeliveryQuantityQualifier' description: 'The name of the `quantityQualifierCode`. For example, `Days`. Payers may sometimes return other non-compliant values.' quantityQualifierCode: $ref: '#/components/schemas/BenefitsServiceDeliveryQuantityQualifierCode' description: 'Code specifying the type of quantity for the benefit. Can be `DY` - Days, `FL` - Units, `HS` - Hours, `MN` - Month, and `VS` - Visits. Payers may sometimes return other non-compliant values.' sampleSelectionModulus: description: Specifies the sampling frequency, based on the unit of measure. For example `every 2 months` or `once per calendar year`. type: string timePeriodQualifier: $ref: '#/components/schemas/TimePeriodQualifier' description: 'The name of the `timePeriodQualifierCode`. For example, `Calendar Year`. Payers may sometimes return other non-compliant values.' timePeriodQualifierCode: $ref: '#/components/schemas/TimePeriodQualifierCode' description: 'Code specifying the time period for the benefit information. Visit [Eligibility code lists](https://www.stedi.com/docs/healthcare/eligibility-code-lists#time-qualifier-codes) for a complete list. Payers may sometimes return other non-compliant values.' unitForMeasurementCode: $ref: '#/components/schemas/UnitForMeasurement' deprecated: true unitForMeasurementQualifier: $ref: '#/components/schemas/UnitForMeasurement' description: 'The name of the `unitForMeasurementQualifierCode`. For example, `Days`. Payers may sometimes return other non-compliant values.' unitForMeasurementQualifierCode: $ref: '#/components/schemas/UnitForMeasurementCode' description: 'Code specifying the unit of measurement. For example, `DA` - Days, `MO` - Months, `VS` - Visits, `WK` - Week, and `YR` - Years. Payers may sometimes return other non-compliant values.' type: object BenefitsServiceDeliveryQuantityQualifier: description: 'The name of the `quantityQualifierCode`. For example, `Days`. Payers may sometimes return other non-compliant values.' enum: - Days - Units - Hours - Month - Visits type: string BenefitsServiceDeliveryQuantityQualifierCode: description: 'Code specifying the type of quantity. Payers may sometimes return other non-compliant values.' enum: - DY - FL - HS - MN - VS type: string 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 BillingProviderType: description: Defines the billing provider type. enum: - BillingProvider type: string BusinessContactInformation: description: A person or office to whom administrative communications should be directed. properties: contactMethods: items: $ref: '#/components/schemas/ContactMethod' type: array contactName: description: The name of the contact person or entity. type: string type: object COB: properties: benefitOverlap: description: If set to `true`, the COB response contains benefits overlap. A benefits overlap indicates that the patient has active coverage from two or more payers for the same service type code, including the subtypes of medical coverage. type: boolean classification: description: "The classification for the benefits that have been discovered\ \ in the COB response. Stedi returns one of the following values:\n \ \ - `CobInstanceExistsPrimacyDetermined`: COB Instance Exists and Primacy\ \ was determined\n - `CobInstanceExistsPrimacyUndetermined`: COB Instance\ \ Exists and Primacy was NOT determined\n - `CoverageOverlapNoBenefitOverlap`:\ \ Coverage Overlap detected with no Benefit Overlap\n - `CoverageOverlapExistsNotSubjectToCob`:\ \ Coverage Overlap exists and is not subject to COB\n - `MemberFoundNoCob`:\ \ Member found, no COB found" type: string coverageOverlap: description: "If set to `true`, the COB response contains a coverage overlap,\ \ meaning that the patient has active coverage with two or more payers\ \ during the service date submitted in the COB request.\n - Coverage\ \ overlap can be for coverages from the same payer if the member ID is\ \ different between the two coverages.\n - A coverage overlap is necessary\ \ for a COB instance to exist.\n - A coverage overlap can exist without\ \ there being a COB instance if either of the two coverages is not subject\ \ to COB for any reason." type: boolean instanceExists: description: If set to `true`, the COB response contains at least one coordination of benefits instance. type: boolean primacyDetermined: description: If set to `true`, Stedi was able to determine the primary payer for the patient. If Stedi was unable to determine the primary payer, you must contact the payers directly to determine primacy. type: boolean type: object COBBenefitsDateInformation: description: Dates associated with the benefits. Dates listed only apply to the `benefitsInformation` object in which this benefitsDateInformation is provided. properties: benefitBegin: description: The date the benefits begin. type: string benefitEnd: description: The date the benefits end. type: string coordinationOfBenefits: description: Date or date range used for coordination of benefits instance. type: string periodEnd: description: The end of the coverage overlap. Included when Stedi finds an instance of coverage overlap. type: string periodStart: description: The start of the coverage overlap Included when Stedi finds an instance of coverage overlap. type: string planBegin: description: Coverage start date. If multiple coverage start dates exist due to different start dates on various coverage/service types, this date applies to the medical coverage. type: string type: object COBBenefitsInformation: properties: benefitsDateInformation: $ref: '#/components/schemas/COBBenefitsDateInformation' description: Dates associated with the benefits. All properties may either be expressed as a single date. Dates listed only apply to the `benefitsInformation` object in which this `benefitsDateInformation` is provided. benefitsRelatedEntities: description: 'Contains either information about another payer with which the patient has coverage or information about the subscriber associated with the additional health plan. For example, if you submit a COB check for a dependent to Cigna and Stedi finds additional coverage through Aetna, the `benefitsInformation[].benefitsRelatedEntities` instance would include subscriber details for the Aetna plan.' items: $ref: '#/components/schemas/COBBenefitsRelatedEntity' type: array code: $ref: '#/components/schemas/COBResponseBenefitsInformationCode' description: "The COB benefits information code. \n\nStedi returns entries\ \ with `benefitsInformation[].code` = `1` for every active coverage type\ \ for each health plan.\n\nStedi returns entries with `benefitsInformation[].code`\ \ = `R` when overlapping coverage exists within the date of service provided\ \ in the COB check." name: $ref: '#/components/schemas/COBBenefitsInformationName' description: The name of the benefit information code. serviceTypeCodes: description: Code identifying the type of services. items: $ref: '#/components/schemas/COBResponseServiceTypeCode' type: array serviceTypes: description: The full names of the service type codes. items: $ref: '#/components/schemas/COBResponseServiceTypeCodeName' type: array subscriber: $ref: '#/components/schemas/COBResponseBenefitsInformationSubscriber' description: Information about the primary policyholder for the insurance plan related to this `benefitsInformation` instance. type: object COBBenefitsInformationName: description: The full name of the benefits information code. enum: - Active Coverage - Inactive - Other or Additional Payor - Cannot Process type: string COBBenefitsRelatedEntity: properties: entityFirstname: description: The entity's first name, when the entity is a subscriber. type: string entityIdentification: $ref: '#/components/schemas/EntityIdentificationCode' description: Code identifying the type of `entityIdentificationValue`. This can be either `MI` - Member ID or `PI` - Payer ID. entityIdentificationValue: description: The identification number for the entity, qualified by the code in `entityIdentification`. The ID returned in this property is proprietary to our COB check product, so you can't use it as the Payer ID for eligibility checks or other API requests to Stedi. It likely doesn't match the Payer IDs listed in the [Payer Network](https://www.stedi.com/healthcare/network). type: string entityIdentifier: $ref: '#/components/schemas/EntityIdentifierName' description: 'Identifies the type of entity. This can either be a type of payer or the subscriber associated with the COB coverage. Note that Stedi uses `Payer` either when there is no COB instance or when Stedi is unable to determine primacy.' entityLastname: description: The entity's last name, when the entity is a subscriber. type: string entityMiddlename: description: The entity's middle name or initial, when the entity is a subscriber. type: string entityName: description: The payer's business name, when the entity is a payer. type: string type: object COBDependent: description: 'A dependent for which you want to check coordination of benefits. - An individual qualifies as a dependent when they are listed as a dependent on the subscriber''s insurance plan AND the payer cannot uniquely identify them through information outside the subscriber''s policy. For example, if the dependent has their own member ID number, you should identify them in the `subscriber` object instead. - The demographic information you provide **must** patch the payer''s data exactly. For example, if the payer has the dependent''s name as `Jonathan Doe`, a COB request for `Jon Doe` will fail because the name doesn''t match the payer''s records.' properties: dateOfBirth: description: The dependent's date of birth. pattern: ^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$ type: string firstName: description: The dependent's first name. maxLength: 35 minLength: 1 type: string lastName: description: The dependent's last name. maxLength: 60 minLength: 1 type: string ssn: description: The dependent's Social Security Number (SSN). pattern: ^\d{9}$ type: string required: - dateOfBirth - firstName - lastName type: object COBEncounter: description: 'Information about the encounter. - You can submit COB checks with the `30` service type code for Health Benefit Plan Coverage. This is the broadest service type code that covers all medical services and subtypes included in the patient’s health plan. - The service dates you provide **must** be within the past 2 years. COB checks don''t support requests with dates outside of this range. - Don''t send service dates that are in the future. Future service dates typically result in errors from the payer. - If you don''t specify a service date (either a single day or a range of dates), Stedi defaults to using the current date.' properties: beginningDateOfService: description: The beginning date of service. If you include this value, you must also include the `endDateOfService`. pattern: ^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$ type: string dateOfService: description: The date of service of the encounter. pattern: ^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$ type: string endDateOfService: description: The end date of service. If you include this value, you must also include the `beginningDateOfService`. pattern: ^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$ type: string serviceTypeCode: $ref: '#/components/schemas/COBServiceTypeCode' type: object COBMetaData: properties: applicationMode: description: The type of data in the request. Stedi uses `production` to identify transactions processed in our live clearinghouse environment. type: string outboundTraceId: description: The value provided in the `submitterTransactionIdentifier` property in the original COB request. type: string traceId: description: A unique ID Stedi assigns to the COB request. type: string type: object COBPayer: properties: name: description: The payer's name, such as `CIGNA`. type: string payerIdentification: description: The `tradingPartnerServiceId` (Payer ID) you used to identify the payer in the COB request. type: string type: object COBPlanDateInformation: description: 'Dates associated with the patient''s health plan coverage. This information is used to determine their eligibility for benefits. - The provided dates apply to every benefit within the patient''s health plan unless specifically noted within a `benefitsInformation[].benefitsDateInformation` object. - If the payer sends back date(s) that are different for the subscriber and dependents, Stedi includes only the dates for the dependent in this object and omits the subscriber''s date(s). Dependents can have different coverage dates than the subscriber due to qualifying life events, such as starting a new job or passing the age limit for coverage through their parent''s plan.' properties: planBegin: description: When the patient's health plan coverage begins. pattern: ^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$ type: string planEnd: description: When the patient's health plan coverage ends. pattern: ^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$ type: string type: object COBProvider: description: Information about the entity requesting the coverage. properties: firstName: description: The provider's first name. This property is required if the provider is an individual. maxLength: 35 minLength: 1 type: string lastName: description: The provider's last name. This property is required if the provider is an individual. maxLength: 60 minLength: 1 type: string npi: description: The provider's [National Provider Identifier (NPI)](https://www.stedi.com/docs/healthcare/national-provider-identifier). pattern: ^\d{10}$ type: string organizationName: description: The provider's business name. maxLength: 60 minLength: 1 type: string required: - npi type: object COBResponseBenefitsInformationCode: description: The code indicating the type of benefits information. Can be `1` - Active Coverage, `6` - Inactive, `R` - Other or Additional Payor, or `V` - Cannot Process. enum: - '1' - '6' - R - V type: string COBResponseBenefitsInformationSubscriber: properties: dateOfBirth: description: The subscriber's date of birth. pattern: ^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$ type: string type: object COBResponseDependent: description: Information about the dependent listed in the original COB request. properties: aaaErrors: description: When a COB request fails, the response contains one or more `AAA` errors that specify the reasons for the rejection and any recommended follow-up actions. items: $ref: '#/components/schemas/EligibilityCheckError' type: array address: $ref: '#/components/schemas/Address' description: The dependent's address. birthSequenceNumber: description: The number assigned to each family member born with the same birth date, such as twins or triplets. Indicates the birth order when there are multiple births associated with the provided birth date. type: string dateOfBirth: description: The dependent's date of birth. pattern: ^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$ type: string firstName: description: The dependent's first name. type: string gender: $ref: '#/components/schemas/GenderWithUnknown' description: Code indicating the dependent's gender. Can be `F` - Female, `M` - Male, or `U` - Unknown. groupNumber: description: The group number associated with the subscriber's insurance policy. type: string lastName: description: The dependent's last name. type: string memberId: description: The member ID for the subscriber's insurance policy. type: string middleName: description: The dependent's middle name or initial. type: string relationToSubscriber: $ref: '#/components/schemas/RelationToSubscriberCodeName' description: The name of the `relationToSubscriberCode`. For example, `Child` when the code is `19`. relationToSubscriberCode: $ref: '#/components/schemas/RelationToSubscriberCode' description: For the dependent, this can be `01` - Spouse, `19` - Child, `20` Employee, `21` - Unknown, `39` - Organ Donor, `40` - Cadaver Donor, `53` - Life Partner, or `G8` - Other Relationship. ssn: description: The dependent's Social Security Number (SSN). pattern: ^\d{9}$ type: string type: object COBResponseProvider: description: Information about the entity that submitted the original eligibility check request. This may be an individual practitioner, a medical group, a hospital, or another type of healthcare provider. properties: aaaErrors: description: When a COB request fails, the response contains one or more `AAA` errors that specify the reasons for the rejection and any recommended follow-up actions. items: $ref: '#/components/schemas/EligibilityCheckError' type: array npi: description: The provider's [National Provider Identifier (NPI)](https://www.stedi.com/docs/healthcare/national-provider-identifier). pattern: ^\d{10}$ type: string providerFirstName: description: The provider's first name. This applies to providers that are an individual. type: string providerName: description: The provider's last name. This applies to providers that are an individual. type: string providerOrgName: description: The provider's organization name. type: string type: object COBResponseServiceTypeCode: description: Code identifying the type of services included in a `benefitsInformation` object. enum: - '1' - '30' - '33' - '35' - '47' - '52' - '88' - '98' - AL - MH - UC type: string COBResponseServiceTypeCodeName: description: The names of the `benefitsInformation[].serviceTypeCodes` included in the response. enum: - Medical Care - Health Benefit Plan Coverage - Chiropractic - Dental Care - Hospital - Hospital - Emergency Medical - Pharmacy - Professional (Physician) Visit - Office - Vision (Optometry) - Mental Health - Urgent Care type: string COBResponseSubscriber: description: Information about the primary policyholder for the insurance plan listed in the COB request. properties: aaaErrors: description: When a payer rejects your request, the response contains one or more `AAA` errors that specify the reasons for the rejection and any recommended follow-up actions. items: $ref: '#/components/schemas/EligibilityCheckError' type: array address: $ref: '#/components/schemas/Address' description: The subscriber's address. birthSequenceNumber: description: The number assigned to each family member born with the same birth date, such as twins or triplets. Indicates the birth order when there are multiple births associated with the provided birth date. type: string dateOfBirth: description: The subscriber's date of birth. pattern: ^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$ type: string firstName: description: The subscriber's first name. type: string gender: $ref: '#/components/schemas/GenderWithUnknown' description: Code indicating the subscriber's gender. Can be `F`- Female, `M` - Male, or `U` - Unknown. groupNumber: description: The group number associated with the subscriber's insurance policy. type: string lastName: description: The subscriber's last name. type: string memberId: description: The member ID for the subscriber's insurance policy. type: string middleName: description: The subscriber's middle name or initial. type: string ssn: description: The subscriber's Social Security Number (SSN). pattern: ^\d{9}$ type: string type: object COBServiceTypeCode: description: The service type code for the encounter. If not provided, the default value is `30`. enum: - '30' type: string COBSubscriber: description: "The primary policyholder for the insurance plan _or_ a dependent\ \ with a unique member ID. If a dependent has a unique member ID, include\ \ their information here and leave `dependent` empty.\n\n\n\nThe demographic\ \ information you provide **must** match the payer's data exactly. For example,\ \ if the payer has the subscriber's name as `Jonathan Doe`, a COB request\ \ for `Jon Doe` will fail because the name doesn't match the payer's records.\ \ Also note that:\n - Any prefix on the member's card is considered part\ \ of the `memberID` used for the search.\n - Mismatches in the `memberId`\ \ are one of the most common causes of `Member Not Found` errors. We strongly\ \ recommend first performing an [Eligibility Check](https://www.stedi.com/docs/healthcare/api-reference/post-healthcare-eligibility)\ \ and using the `memberId` in the response to populate your COB check.\n \ \ - We recommend including the `ssn` property in addition to the `memberId`\ \ if possible. This allows Stedi to do an additional search for the patient\ \ when the `memberId` doesn't return a match.\n - Stedi can identify coverage\ \ overlap for the same payer if the member ID differs between the two coverages." properties: dateOfBirth: description: The subscriber'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 lastName: description: The patient's last name. maxLength: 60 minLength: 1 type: string memberId: description: "The member ID for the subscriber's insurance policy. \n\n\ You must provide at least one of the `memberId` or `ssn` properties in\ \ the request. However, we recommend including both if possible. This\ \ allows Stedi to do an additional search for patient information when\ \ the `memberId` doesn't return a match." maxLength: 80 minLength: 1 pattern: ^[A-Za-z0-9-]+$ type: string ssn: description: "The subscriber's Social Security Number (SSN). \n\nYou must\ \ provide at least one of the `memberId` or `ssn` properties in the request.\ \ However, we recommend including both if possible. This allows Stedi\ \ to do an additional search for patient information when the `memberId`\ \ doesn't return a match." pattern: ^\d{9}$ type: string required: - dateOfBirth - firstName - lastName 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 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 Claim: description: Information about the claim and its status. properties: claimStatus: $ref: '#/components/schemas/ComponentsSchemasClaimStatus' description: The status, required action, and paid information of a claim or service line. serviceDetails: description: Information about specific service lines and their status. Payers may not return service line details for all claims, even when you requested them. items: $ref: '#/components/schemas/ServiceDetail' type: array type: object ClaimAcknowledgmentDetails: properties: patientClaimStatusDetails: description: 'Patient information and the status of claims related to the patient. You can use the `claims[].claimStatus.referencedTransactionTraceNumber` in this object to correlate the 277CA with the original claim. Some payers batch acknowledgments for multiple claims into a single 277CA. In these cases, the 277CA will contain multiple `patientClaimStatusDetails` objects, each with its own `referencedTransactionTraceNumber` for the corresponding claim.' items: $ref: '#/components/schemas/PatientClaimStatusDetails' type: array providerOFServiceInformationTraceIdentifier: description: An identifier for claims related to this provider. type: string serviceProvider: $ref: '#/components/schemas/ClaimAcknowledgmentDetailsServiceProvider' serviceProviderClaimStatuses: description: Status information for claims related to the provider. items: $ref: '#/components/schemas/ServiceProviderClaimStatus' type: array type: object ClaimAcknowledgmentDetailsServiceProvider: description: Information about the service provider. properties: firstName: description: The provider's first name, when the provider is an individual. Can be up to 35 characters. type: string lastName: description: The provider's last name, when the provider is an individual. Can be up to 60 characters. type: string middleName: description: The provider's middle name or initial, when the provider is an individual. Can be up to 25 characters. type: string npi: description: The provider's National Provider Identifier. pattern: ^\d{10}$ type: string organizationName: description: The provider's business name. Can be up to 60 characters. type: string spn: description: The provider's service provider number. type: string suffix: description: The provider's name suffix, when the provider is an individual. Can be up to 10 characters. type: string tin: description: The provider's tax identification number. type: string type: object ClaimAcknowledgmentPayer: properties: centersForMedicareAndMedicaidServicePlanId: description: The payer's Centers for Medicare and Medicaid Services Plan ID. This is specifically for Health Plan ID (HPID) or Other Entity Identifier (OEID), both of which are no longer mandated for use. type: string claimStatusTransactions: description: Claim status details. items: $ref: '#/components/schemas/ClaimAcknowledgmentTransactions' type: array entityIdentifierCode: $ref: '#/components/schemas/PayerEntityIdentifierCode' description: Code identifying the type of organization. entityIdentifierCodeValue: $ref: '#/components/schemas/PayerEntityIdentifierCodeValue' description: The human-readable description of the entity identifier code. etin: description: The payer's Electronic Transmitter Identification Number. type: string federalTaxpayerIdentificationNumber: description: The payer's Federal Taxpayer Identification Number. pattern: ^\d{9}$ type: string organizationName: description: The payer or intermediary clearinghouse's business name. type: string payerContactInformation: $ref: '#/components/schemas/PayerContactInformation' deprecated: true payerIdentification: description: The payer's unique identifier. type: string type: object ClaimAcknowledgmentServiceIdQualifierCode: description: Code identifying the source of the procedure code in claim status reports. enum: - AD - ER - HC - HP - IV - NU - WK type: string ClaimAcknowledgmentServiceIdQualifierCodeValue: description: Human-readable descriptions for service ID qualifier codes. enum: - American Dental Association Codes - Jurisdiction Specific Procedure and Supply Codes - Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes - Health Insurance Prospective Payment System (HIPPS) Skilled Nursing Facility Rate Code - Home Infusion EDI Coalition (HIEC) Product/Service Code - National Uniform Billing Committee (NUBC) UB92 Codes - Advanced Billing Concepts (ABC) Codes type: string ClaimAcknowledgmentServiceLines: properties: beginServiceLineDate: description: The starting date of the service. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string endServiceLineDate: description: The ending date of the service. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string lineItemControlNumber: description: A unique identifier for the service line that matches the `providerControlNumber` submitted in the original claim. You can use this value to correlate the payer's response with specific service lines from the original claim. type: string service: $ref: '#/components/schemas/ClaimAcknowledgmentServiceLinesService' serviceClaimStatuses: description: The status of the specific service line. items: $ref: '#/components/schemas/ServiceClaimStatus' type: array serviceLineDate: description: The date of the service. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string type: object ClaimAcknowledgmentServiceLinesService: description: Information about the service provided. properties: amountPaid: deprecated: true description: The amount paid for the service, expressed as a decimal. type: string chargeAmount: description: The submitted service charge, expressed as a decimal. type: string procedureCode: description: The identifying code for the product or service. type: string procedureModifiers: description: Identifies special circumstances related to the performance of the service. items: type: string type: array revenueCode: description: The National Uniform Billing Committee Revenue Code. type: string serviceIdQualifierCode: $ref: '#/components/schemas/ClaimAcknowledgmentServiceIdQualifierCode' description: The code identifying the source of the `procedureCode`. serviceIdQualifierCodeValue: $ref: '#/components/schemas/ClaimAcknowledgmentServiceIdQualifierCodeValue' description: The description of the `serviceIdQualifierCode`. submittedUnits: description: The number of units of service that were submitted, expressed as a decimal. type: string type: object ClaimAcknowledgmentTransactions: properties: claimStatusDetails: description: More detailed status information. This includes information about the patient, provider, and services rendered. items: $ref: '#/components/schemas/ClaimAcknowledgmentDetails' type: array claimTransactionBatchNumber: description: A tracking number Stedi assigns to the corresponding 837 claim. It's returned as the `claimReference.correlationId` in the response from our claim submission endpoints. You can use this value to correlate the 277CA with the original claim. type: string provider: $ref: '#/components/schemas/ClaimAcknowledgmentTransactionsProvider' providerClaimStatuses: description: Overall status information for the claim. items: $ref: '#/components/schemas/ProviderClaimStatus' type: array type: object ClaimAcknowledgmentTransactionsProvider: description: Information about the provider receiving the claim status details. properties: etin: description: The provider's Electronic Transmitter Identification Number. type: string firstName: description: The provider's first name. Can be up to 35 characters. type: string lastName: description: The provider's last name. Can be up to 60 characters. type: string middleName: description: The provider's middle name or initial. Can be up to 25 characters. type: string organizationName: description: The provider's business name. Can be up to 60 characters. type: string type: object ClaimAdjustment: properties: adjustmentDetails: items: $ref: '#/components/schemas/ClaimAdjustmentDetails' maxItems: 6 minItems: 1 type: array adjustmentGroupCode: $ref: '#/components/schemas/AdjustmentGroupCode' required: - adjustmentDetails - adjustmentGroupCode type: object ClaimAdjustmentDetails: description: The adjustment reason codes and amounts. You can include up to six objects in this array to describe a single adjustment group code. properties: adjustmentAmount: description: The dollar amount of the adjustment, expressed as a decimal. For example, `100.50`. pattern: ^\d+(\.\d{1,2})?$ 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 ClaimAdjustmentGroupCode: description: Defines the category of adjustment reason codes that explain why a claim payment was adjusted. These codes categorize adjustments into contractual obligations, payer-initiated reductions, patient responsibilities, and other adjustments. enum: - CO - OA - PI - PR type: string ClaimAdjustments: description: Claim-level adjustments with reason codes and amounts. properties: adjustmentAmount1: description: The amount of the adjustment. A negative amount increases the claim payment and a positive amount decreases the claim payment. type: string adjustmentAmount2: description: The amount of the adjustment. A negative amount increases the claim payment and a positive amount decreases the claim payment. type: string adjustmentAmount3: description: The amount of the adjustment. A negative amount increases the claim payment and a positive amount decreases the claim payment. type: string adjustmentAmount4: description: The amount of the adjustment. A negative amount increases the claim payment and a positive amount decreases the claim payment. type: string adjustmentAmount5: description: The amount of the adjustment. A negative amount increases the claim payment and a positive amount decreases the claim payment. type: string adjustmentAmount6: description: The amount of the adjustment. A negative amount increases the claim payment and a positive amount decreases the claim payment. type: string adjustmentQuantity1: description: The units of service being adjusted. A positive value decreases the covered days and a negative number increases the covered days. type: string adjustmentQuantity2: description: The units of service being adjusted. A positive value decreases the covered days and a negative number increases the covered days. type: string adjustmentQuantity3: description: The units of service being adjusted. A positive value decreases the covered days and a negative number increases the covered days. type: string adjustmentQuantity4: description: The units of service being adjusted. A positive value decreases the covered days and a negative number increases the covered days. type: string adjustmentQuantity5: description: The units of service being adjusted. A positive value decreases the covered days and a negative number increases the covered days. type: string adjustmentQuantity6: description: The units of service being adjusted. A positive value decreases the covered days and a negative number increases the covered days. type: string adjustmentReason1: description: A description identifying the detailed reason the adjustment was made. type: string adjustmentReason2: description: A description identifying the detailed reason the adjustment was made. type: string adjustmentReason3: description: A description identifying the detailed reason the adjustment was made. type: string adjustmentReason4: description: A description identifying the detailed reason the adjustment was made. type: string adjustmentReason5: description: A description identifying the detailed reason the adjustment was made. type: string adjustmentReason6: description: A description identifying the detailed reason the adjustment was made. type: string adjustmentReasonCode1: description: A code identifying the detailed reason the adjustment was made. Visit [Claim Adjustment Reason Codes](https://x12.org/codes/claim-adjustment-reason-codes) in the X12 documentation for a complete list. type: string adjustmentReasonCode2: description: A code identifying the detailed reason the adjustment was made. Visit [Claim Adjustment Reason Codes](https://x12.org/codes/claim-adjustment-reason-codes) in the X12 documentation for a complete list. type: string adjustmentReasonCode3: description: A code identifying the detailed reason the adjustment was made. Visit [Claim Adjustment Reason Codes](https://x12.org/codes/claim-adjustment-reason-codes) in the X12 documentation for a complete list. type: string adjustmentReasonCode4: description: A code identifying the detailed reason the adjustment was made. Visit [Claim Adjustment Reason Codes](https://x12.org/codes/claim-adjustment-reason-codes) in the X12 documentation for a complete list. type: string adjustmentReasonCode5: description: A code identifying the detailed reason the adjustment was made. Visit [Claim Adjustment Reason Codes](https://x12.org/codes/claim-adjustment-reason-codes) in the X12 documentation for a complete list. type: string adjustmentReasonCode6: description: A code identifying the detailed reason the adjustment was made. Visit [Claim Adjustment Reason Codes](https://x12.org/codes/claim-adjustment-reason-codes) in the X12 documentation for a complete list. type: string claimAdjustmentGroupCode: $ref: '#/components/schemas/ClaimAdjustmentGroupCode' description: The code identifying the category of adjustment reason codes. Visit [ERA code lists](https://www.stedi.com/docs/healthcare/claims-code-lists#claim-adjustment-group-code) for a complete list and usage notes. claimAdjustmentGroupCodeValue: description: The description of the `claimAdjustmentGroupCode`. type: string 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 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 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 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 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 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 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 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 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 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 ClaimInformationConditionCodesItem: enum: - AV - NU - S2 - ST type: string 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 ClaimLevelEntityIdentifierCode: description: Entity identifier code for claim level in claim status reports enum: - '03' - '36' - '40' - '41' - '71' - '72' - '73' - '77' - '82' - '85' - '87' - 1P - 1Z - DK - DN - DQ - FA - GB - HK - IL - LI - MSC - PR - PRP - QB - QC - QD - SEP - TL - TTP - TU type: string ClaimLevelEntityIdentifierCodeValue: description: Human-readable descriptions for claim level entity identifier codes enum: - Dependent - Employer - Receiver - Submitter - Attending Physician - Operating Physician - Other Physician - Service Location - Rendering Provider - Billing Provider - Pay-to Provider - Provider - Home Health Care - Ordering Physician - Referring Provider - Supervising Physician - Facility - Other Insured - Subscriber - Insured or Subscriber - Independent Lab - Mammography Screening Center - Payer - Primary Payer - Purchase Service Provider - Patient - Responsible Party - Secondary Payer - Testing Laboratory - Tertiary Payer - Third Party Repricing Organization (TPO) type: string ClaimLevelStatus: properties: entityIdentifierCode: $ref: '#/components/schemas/ClaimLevelEntityIdentifierCode' description: A code indicating the entity that is responsible for the claim. entityIdentifierCodeValue: $ref: '#/components/schemas/ClaimLevelEntityIdentifierCodeValue' description: The description of the `entityIdentifierCode`. healthCareClaimStatusCategoryCode: $ref: '#/components/schemas/HealthCareClaimStatusCategoryCode' healthCareClaimStatusCategoryCodeValue: description: Description of the `healthCareClaimStatusCategoryCode` property. Visit [277CA code lists](https://www.stedi.com/docs/healthcare/claims-code-lists#claim-status-category-code) for a complete list. type: string nationalCouncilForPrescriptionDrugProgramsRejectPaymentCodes: description: A National Council for Prescription Drug Programs (NCPDP) reject code. type: string statusCode: $ref: '#/components/schemas/HealthCareClaimStatusCode' description: A code indicating the status. statusCodeValue: description: The description of the `statusCode`. 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 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 ClaimPaymentAdviceFilingIndicatorCode: description: Identifies the type of health plan or insurance coverage under which the claim was filed. These codes indicate the specific type of insurance arrangement, government program, or coverage type that applies to the claim. enum: - '12' - '13' - '14' - '15' - '16' - '17' - AM - CH - DS - HM - LI - LM - MA - MB - MC - OF - TV - VA - WC - ZZ type: string ClaimPaymentAdvicePayer: description: Information about the payer. properties: address: $ref: '#/components/schemas/ClaimPaymentAdvicePayerAddress' description: The payer's address information. businessContactInformation: $ref: '#/components/schemas/BusinessContactInformation' description: A person or office. centersForMedicareAndMedicaidServicesPlanId: deprecated: true description: Formerly used to report the payer's Health Plan ID (HPID) or Other Entity Identifier (OEID). The Centers for Medicare and Medicaid Services (CMS) no longer uses HPID, so this property will not be populated. type: string healthIndustryNumber: description: The payer's health industry number. type: string name: description: The payer's business name, such as Cigna or Aetna. type: string nationalAssociationOfInsuranceCommissioners: description: The payer's National Association of Insurance Commissioners (NAIC) code. type: string payerIdentificationNumber: description: 'An identifier for the payer. For Medicare carriers or intermediaries, this is the Medicare carrier or intermediary ID number. For Blue Cross and Blue Shield Plans, this is the Blue Cross Blue Shield association plan code. Providers rarely use this identifier in practice.' type: string payerWebSiteUrl: description: The payer's web address. The URL is typically provided without the scheme and separator. For example, `stedi.com`. type: string submitterIdentificationNumber: description: An identifier for the payer. This is used when the original transaction sender is not the payer or has an identifier other than those already provided. type: string technicalContactInformation: description: A person or office. items: $ref: '#/components/schemas/TechnicalContactInformation' type: array type: object ClaimPaymentAdvicePayerAddress: description: Address information for the payer. properties: address1: description: The first line of the address. type: string address2: description: The second line of the address. type: string city: description: The city where the address is located. type: string countryCode: description: The standard code for the country from Part 1 of ISO 3166. type: string countrySubCode: description: The standard code for the country subdivision from Part 2 of ISO 3166. type: string postalCode: description: The postal code for the address, excluding punctuation and blanks. type: string state: description: The standard code for the state or province. For example `PA` for Pennsylvania. type: string type: object ClaimPaymentAdviceResponse: description: The complete claim payment advice response from the payer. properties: controlNumber: description: The control number the payer provided in the claim payment response. This is used to identify the transaction. type: string detailInfo: description: Detailed information about claims in this payment advice. items: $ref: '#/components/schemas/DetailInfo' type: array financialInformation: $ref: '#/components/schemas/ClaimPaymentAdviceResponseFinancialInformation' description: Financial information about the payment including amounts and account details. foreignCurrency: description: The standard ISO code for the country whose currency is being used for payments. If this is not present, the currency is US dollars. type: string payee: $ref: '#/components/schemas/Payee' description: Information about the payee receiving the payment. payer: $ref: '#/components/schemas/ClaimPaymentAdvicePayer' description: Information about the payer making the payment. paymentAndRemitReassociationDetails: $ref: '#/components/schemas/ClaimPaymentAdviceResponsePaymentAndRemitReassociationDetails' description: Payment and remittance reassociation details for transaction tracking. productionDate: description: The end date for the adjudication production cycle for claims included in this ERA. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string providerAdjustments: description: 'Provider-level adjustment information for debit or credit transactions such as: accelerated payments, cost report settlements for a fiscal year, and timeliness report penalties unrelated to a specific claim or service. These adjustments can either decrease the payment (a positive number) or increase the payment (a negative number).' items: $ref: '#/components/schemas/ProviderAdjustments' type: array receiverIdentifier: description: The business identification information for the entity initially receiving the transaction. This is typically included when the receiver of the transaction is not the payee, such as a clearinghouse or billing service. type: string versionIdentification: description: The version number of the adjudication system that generated the claim payments. type: string type: object ClaimPaymentAdviceResponseFinancialInformation: description: Information about a payment, including the payment method, payment amount, and account details for both the sender and receiver. properties: checkIssueOrEFTEffectiveDate: description: The date the payer considers the transaction to be settled. If the payment is made by automated clearinghouse (ACH), this is the date the funds are available to the provider. If the payment is made by check, this is the date the check is issued. If the payment is made by Federal Reserve Funds/wire transfer, this is the date that the payer anticipates the money to move. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string creditOrDebitFlagCode: $ref: '#/components/schemas/CreditDebitFlagCode' description: A code indicating whether the payment is a credit or debit. Can be set to `C` - Credit or `D` - Debit. Visit [ERA code lists](https://www.stedi.com/docs/healthcare/claims-code-lists#credit-or-debit-flag-code) for usage notes. originatingCompanySupplementalCode: description: A code that further identifies the payer by division or region. type: string payerIdentifier: description: A unique identifier for the payer, mutually established between the financial institution and the payer. type: string paymentFormatCode: $ref: '#/components/schemas/PaymentFormatCode' description: A code identifying the payment format. Can be set to `CCP` - Cash Concentration/Disbursement plus Addenda (CCD+) (ACH) or `CTX` - Corporate Trade Exchange (CTX) (ACH). paymentMethodCode: $ref: '#/components/schemas/PaymentMethodCode' description: A code indicating the payment method. For example, `ACH` - Automated Clearing House or `CHK` - Check. Visit [ERA code lists](https://www.stedi.com/docs/healthcare/claims-code-lists#payment-method-code) for a complete list and usage notes. receiverAccountDetails: $ref: '#/components/schemas/ReceiverAccountDetails' description: Account details for the payment receiver. senderAccountDetails: $ref: '#/components/schemas/SenderAccountDetails' description: Account details for the payment sender. totalActualProviderPaymentAmount: description: The total amount of the payment to the provider, expressed as a decimal. type: string transactionHandlingCode: $ref: '#/components/schemas/TransactionHandlingCode' description: A code indicating the actions taken by both the sender and the receiver. For example, `D` - Make Payment Only. Visit [ERA code lists](https://www.stedi.com/docs/healthcare/claims-code-lists#transaction-handling-code) for a complete list and usage notes. type: object ClaimPaymentAdviceResponsePaymentAndRemitReassociationDetails: description: Information to uniquely identify the transaction and help with reassociating payments and remittances that have been separated. properties: checkOrEFTTraceNumber: description: This value uniquely identifies the transaction. This is either the check number, the EFT reference number, or a unique remittance advice identification number (for non-payment ERAs). type: string originatingCompanyIdentifier: description: A unique identifier for the payer. This is a 1 followed by the payer's Employer Identification Number (EIN) or Taxpayer Identification Number (TIN). type: string originatingCompanySupplementalCode: description: A value that identifies a further subdivision within the payer's organization. type: string traceTypeCode: $ref: '#/components/schemas/TraceTypeCode' description: Code that identifies which transaction is being referenced. This can be set to `1` - Current Transaction Trace Numbers. type: object ClaimPaymentAdviceServiceLines: description: Information about specific service lines in the claim payment advice. properties: healthCareCheckRemarkCodes: description: Healthcare check remark codes for this service. items: $ref: '#/components/schemas/HealthCareCheckRemarkCodes' type: array healthCarePolicyIdentification: description: Healthcare policy identification for this service. items: $ref: '#/components/schemas/HealthCarePolicyIdentification' type: array lineItemControlNumber: description: The `providerControlNumber` submitted in the original claim to identify the service line. type: string renderingProviderInformation: $ref: '#/components/schemas/ClaimPaymentAdviceServiceLinesRenderingProviderInformation' description: Information about the provider who rendered this service. serviceAdjustments: description: Adjustments applied to this service line. items: $ref: '#/components/schemas/ClaimAdjustments' type: array serviceDate: description: The date the service was rendered. Used for single-day services. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string serviceEndDate: description: The date the service ended. Used for multi-day services. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string serviceIdentification: $ref: '#/components/schemas/ClaimPaymentAdviceServiceLinesServiceIdentification' description: Service identification details. servicePaymentInformation: $ref: '#/components/schemas/ClaimPaymentAdviceServiceLinesServicePaymentInformation' description: Payment information for this service line. serviceStartDate: description: The date the service began. Used for multi-day services. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string serviceSupplementalAmounts: $ref: '#/components/schemas/ClaimPaymentAdviceServiceLinesServiceSupplementalAmounts' description: Supplemental amount information for this service. serviceSupplementalQuantities: $ref: '#/components/schemas/ClaimPaymentAdviceServiceLinesServiceSupplementalQuantities' description: Supplemental quantity information for this service. type: object ClaimPaymentAdviceServiceLinesRenderingProviderInformation: description: Identifiers for the provider who rendered this service. properties: blueCrossProviderNumber: description: The rendering provider's Blue Cross Provider Number. type: string blueShieldProviderNumber: description: The rendering provider's Blue Shield Provider Number. type: string champusIdentificationNumber: description: The rendering provider's CHAMPUS Identification Number. type: string facilityIdNumber: description: The rendering provider's Facility ID Number. type: string federalTaxpayerIdentificationNumber: description: The rendering provider's Federal Taxpayer Identification Number. type: string medicaidProviderNumber: description: The rendering provider's Medicaid Provider Number. type: string medicareProviderNumber: description: The rendering provider's Medicare Provider Number. type: string nationalCouncilForPrescriptionDrugProgramPharmacyNumber: description: The rendering provider's National Council for Prescription Drug Programs Pharmacy Number. type: string npi: description: The rendering provider's National Provider Identifier (NPI). pattern: ^\d{10}$ type: string providerCommercialNumber: description: The Provider Commercial Number. type: string providerUPINNumber: description: Deprecated; replaced by NPI in 2007. type: string ssn: description: The rendering provider's Social Security Number (SSN). pattern: ^\d{9}$ type: string stateLicenseNumber: description: The rendering provider's State License Number. type: string type: object ClaimPaymentAdviceServiceLinesServiceIdentification: description: Additional identifiers related to the service line. properties: ambulatoryPatientGroupNumber: description: The service line's Ambulatory Patient Group (APG) Number. type: string ambulatoryPaymentClassification: description: The service line's Ambulatory Payment Classification Number. type: string attachmentCode: description: The service line's Attachment Code. type: string authorizationNumber: description: The service line's Authorization Number. type: string locationNumber: description: The payer's identification for the provider location. type: string preDeterminationOfBenefitsIdentificationNumber: description: The service line's Predetermination of Benefits Identification Number. type: string priorAuthorizationNumber: description: The service line's Prior Authorization Number. type: string rateCodeNumber: description: The service line's Rate code number, a percentage that reflects the Ambulatory Surgical Center (ASC) rate for Medicare. This is either 0, 50, 100, or 150. type: string type: object ClaimPaymentAdviceServiceLinesServicePaymentInformation: description: Payment and control information about a provider for a particular service. properties: adjudicatedProcedureCode: description: The adjudicated procedure code - an identifying number for a product or service. type: string adjudicatedProcedureModifierCodes: description: A list of up to four modifiers that identify special circumstances related to the product or service. items: type: string type: array lineItemChargeAmount: description: The submitted service charge, expressed as a decimal. type: string lineItemProviderPaymentAmount: description: "The amount paid for the service, expressed as a decimal. \n\ \n This amount is calculated as follows: \n\n`servicePaymentInformation.lineItemProviderPaymentAmount\ \ =\n servicePaymentInformation.lineItemChargeAmount - (sum(serviceAdjustments[].adjustmentAmount1)\ \ + sum(serviceAdjustments[].adjustmentAmount2) + sum(serviceAdjustments[].adjustmentAmount3)\ \ + sum(serviceAdjustments[].adjustmentAmount4) + sum(serviceAdjustments[].adjustmentAmount5)\ \ + sum(serviceAdjustments[].adjustmentAmount6))`\n\nAll properties in\ \ the formula are within a single `transactions[].detailInfo[].paymentInfo[].serviceLines`\ \ array entry. Note that `serviceAdjustments` is an object array that\ \ could contain up to 99 entries, each with up to 6 adjustment amounts\ \ in separate properties. This allows for up to 594 total adjustments.\n\ \nAdjustments can be either positive or negative. When the adjustment\ \ amounts are positive, the payment decreases. When the adjustment amounts\ \ are negative, the payment amount increases, and will be larger than\ \ the `lineItemChargeAmount`." type: string nationalUniformBillingCommitteeRevenueCode: description: The National Uniform Billing Committee Revenue Code. type: string originalUnitsOfServiceCount: description: The original number of units of service submitted, expressed as a decimal. type: string productOrServiceIDQualifier: $ref: '#/components/schemas/ProductServiceIdQualifier' description: The code identifying the source of the `adjudicatedProcedureCode`. productOrServiceIDQualifierValue: description: The description of the `productOrServiceIDQualifier`. type: string submittedAdjudicatedProcedureCode: description: The submitted adjudicated procedure code - an identifying number for a product or service. type: string submittedAdjudicatedProcedureModifierCodes: description: A list of up to four modifiers that identify special circumstances related to the product or service. items: type: string type: array submittedProcedureCodeDescription: description: A free-form description to further clarify the procedure code and any modifiers. type: string submittedProductOrServiceIDQualifier: $ref: '#/components/schemas/ProductServiceIdQualifier' description: The code identifying the source of the `submittedAdjudicatedProcedureCode`. submittedProductOrServiceIDQualifierValue: description: The description of the `submittedProductOrServiceIDQualifier`. type: string unitsOfServicePaidCount: description: The number of units of service that were paid, expressed as a decimal. If not present, the value is assumed to be one. type: string type: object ClaimPaymentAdviceServiceLinesServiceSupplementalAmounts: description: Information about the service supplemental amount. All values are expressed as decimals. properties: allowedActual: description: The payer payment plus any assigned patient responsibility. type: string deductionAmount: description: This is the late filing reduction amount. type: string federalMedicareOrMedicaidPaymentMandateCategory1: description: Federal Medicare or Medicaid Payment Mandate - Category 1. type: string federalMedicareOrMedicaidPaymentMandateCategory2: description: Federal Medicare or Medicaid Payment Mandate - Category 2. type: string federalMedicareOrMedicaidPaymentMandateCategory3: description: Federal Medicare or Medicaid Payment Mandate - Category 3. type: string federalMedicareOrMedicaidPaymentMandateCategory4: description: Federal Medicare or Medicaid Payment Mandate - Category 4. type: string federalMedicareOrMedicaidPaymentMandateCategory5: description: Federal Medicare or Medicaid Payment Mandate - Category 5. type: string tax: description: The tax amount. type: string totalClaimBeforeTaxes: description: The total amount for the service charge before taxes. type: string type: object ClaimPaymentAdviceServiceLinesServiceSupplementalQuantities: description: Additional quantity information about the service. All values are expressed as decimals. properties: federalMedicareOrMedicaidPaymentMandateCategory1: description: Federal Medicare or Medicaid Payment Mandate - Category 1. type: string federalMedicareOrMedicaidPaymentMandateCategory2: description: Federal Medicare or Medicaid Payment Mandate - Category 2. type: string federalMedicareOrMedicaidPaymentMandateCategory3: description: Federal Medicare or Medicaid Payment Mandate - Category 3. type: string federalMedicareOrMedicaidPaymentMandateCategory4: description: Federal Medicare or Medicaid Payment Mandate - Category 4. type: string federalMedicareOrMedicaidPaymentMandateCategory5: description: Federal Medicare or Medicaid Payment Mandate - Category 5. type: string type: object ClaimPaymentEnrollmentProcess: description: Details about the enrollment process for Electronic Remittance Advice (ERAs). properties: requestedEffectiveDate: $ref: '#/components/schemas/RequestedEffectiveDate' description: "Whether this payer supports specifying a requested effective\ \ date for transaction enrollments.\n - If set to `SUPPORTED`, Stedi\ \ will process [transaction enrollment requests](https://www.stedi.com/docs/healthcare/api-reference/post-enrollment-create-enrollment)\ \ for this payer according to their specified `requestedEffectiveDate`.\n\ \ - This property is only returned when Stedi can determine whether the\ \ payer supports requested effective dates." supportedAggregationPreferences: description: "Aggregation types this payer supports for 835 Electronic Remittance\ \ Advice (ERA) transactions. Payers can aggregate by the provider's NPI,\ \ tax ID (TIN), or both.\n - You can use this information to specify\ \ an `aggregationPreference` when submitting ERA enrollment requests.\n\ \ - This property is only returned when Stedi can determine the payer's\ \ supported aggregation types." items: $ref: '#/components/schemas/SupportedAggregationType' type: array timeframe: $ref: '#/components/schemas/EnrollmentProcessTimeframe' type: $ref: '#/components/schemas/EnrollmentProcessType' type: object 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 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 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 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 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 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 ClaimStatusCode: description: Indicates the status of the claim after adjudication by the payer. These codes determine whether the claim was processed as primary, secondary, tertiary, denied, forwarded to other payers, or represents special processing situations like reversals or predeterminations. enum: - '1' - '2' - '3' - '4' - '19' - '20' - '21' - '22' - '23' - '25' type: string ClaimStatusContactInformation: properties: electronicDataInterChangeAccessNumber: description: The payer's Electronic Data Interchange Access number. type: string email: description: The payer's email address. type: string fax: description: The payer's fax number, without separators. For example, `5551123345` for `555-112-3345` type: string name: description: The payer contact name. type: string phone: description: The payer's telephone number. Phone numbers are formatted as AAABBBCCCC, where AAA represents the area code, BBB represents the telephone number prefix, and CCCC represents the telephone number. Phone numbers are provided without separators, such as dashes or parentheses. For example, `5551123345` for `555-112-3345`. type: string phoneExtension: description: The payer's telephone extension. type: string type: object ClaimStatusEncounter: description: "Information about the referenced claim or claims for which you\ \ want to retrieve status information.\n - We recommend supplying a date\ \ range that is at least plus or minus 7 days from the date of the services\ \ listed in the claim, using the `beginningDateOfService` and `endDateOfService`\ \ properties. The payer may have stored a different date for the encounter\ \ than the one in your records, so providing a date range increases the likelihood\ \ that the payer will find a match.\n - Don't submit future dates - only\ \ submit date ranges up to and including today's date. Some payers reject\ \ requests containing future service dates." properties: beginningDateOfService: description: The date the service began. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string billingType: description: The billing type reference ID. For example, the billing type for inpatient services is `111`. maxLength: 50 minLength: 1 type: string clearingHouseClaimNumber: description: The claim number provided by the clearinghouse. maxLength: 50 minLength: 1 type: string endDateOfService: description: The date the service ended. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string locationIdentifier: description: The application or location identifier. Required if the application or location system identifier is known. maxLength: 50 minLength: 1 type: string patientAccountNumber: description: The patient account number provided by the service provider. maxLength: 50 minLength: 1 type: string pharmacyPrescriptionNumber: description: The patient's pharmacy prescription number. maxLength: 50 minLength: 1 type: string submittedAmount: description: The total charges submitted for the claim. Note that not all payer systems retain the original submitted charges; they are sometimes changed during processing. maxLength: 18 minLength: 1 type: string trackingNumber: description: This is the tracking number assigned to the claim status request. It is returned in the response as `claims[].claimStatus.trackingNumber`. If the payer requires a tracking number and you do not supply one, Stedi generates a tracking number for you from a UUID. maxLength: 50 minLength: 1 type: string tradingPartnerClaimNumber: description: An identifier for the claim, assigned by the payer. maxLength: 50 minLength: 1 type: string type: object ClaimStatusInquiryEnrollmentProcess: description: Details about the enrollment process for real-time claim status requests. properties: requestedEffectiveDate: $ref: '#/components/schemas/RequestedEffectiveDate' description: "Whether this payer supports specifying a requested effective\ \ date for transaction enrollments.\n - If set to `SUPPORTED`, Stedi\ \ will process [transaction enrollment requests](https://www.stedi.com/docs/healthcare/api-reference/post-enrollment-create-enrollment)\ \ for this payer according to their specified `requestedEffectiveDate`.\n\ \ - This property is only returned when Stedi can determine whether the\ \ payer supports requested effective dates." timeframe: $ref: '#/components/schemas/EnrollmentProcessTimeframe' type: $ref: '#/components/schemas/EnrollmentProcessType' type: object ClaimStatusPayer: description: Information about the payer listed in the referenced claim. properties: centersForMedicareAndMedicaidServicePlanId: description: The payer's Health Plan ID (HPID) or Other Entity Identifier (OEID). type: string contactInformation: $ref: '#/components/schemas/ClaimStatusContactInformation' organizationName: description: The payer's organization name. For example `UNITEDHEALTHCARE`. type: string payerIdentification: description: The payer's identification number. This is the `tradingPartnerServiceId`. type: string type: object ClaimStatusProviderType: description: Identifies the type of provider related to the referenced healthcare claim. enum: - BillingProvider - ServiceProvider type: string ClaimStatusRawX12RequestContent: properties: x12: type: string required: - x12 type: object ClaimStatusRawX12ResponseContent: properties: claims: description: 'The status information for the claim referenced in the original claim status request. The payer may return multiple claims in the response if they have more than one claim on file that matches the information you provided.' items: $ref: '#/components/schemas/Claim' type: array controlNumber: description: The control number the payer provided in the claim status response. This is used to identify the transaction. type: string dependent: $ref: '#/components/schemas/Member' description: Information about the dependent listed in the referenced claim. errorResponse: $ref: '#/components/schemas/ErrorResponse' implementationTransactionSetSyntaxError: description: The syntax error code in the 999 Implementation Acknowledgment. It indicates the type of error (if present) in the EDI request syntax. Visit `IK502` in the [Implementation Acknowledgment specification](https://portal.stedi.com/app/guides/view/hipaa/implementation-acknowledgment-x231/01HRF41ES1DVGCA6X1EHSRPFXZ#properties.heading.properties.transaction_set_response_header_AK2_loop.items.properties.transaction_set_response_trailer_IK5.properties.implementation_transaction_set_syntax_error_code_02) for a complete list. type: string meta: $ref: '#/components/schemas/ClaimStatusResponseMeta' payer: $ref: '#/components/schemas/ClaimStatusPayer' providers: description: Information about the billing and/or service providers related to the referenced claim. items: $ref: '#/components/schemas/StatusResponseProvider' type: array reassociationKey: description: The control number for the transaction. type: string status: description: The status of the entire claim. type: string subscriber: $ref: '#/components/schemas/ClaimStatusSubscriber' description: Information about the subscriber listed in the referenced claim. tradingPartnerServiceId: description: An ID for the payer you identified in the original claim status request. 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 transactionSetAcknowledgement: description: The acknowledgment code in the 999 Implementation Acknowledgment, an EDI file generated by the payer to acknowledge receipt of the claim status request. It indicates whether the claim status request was accepted or rejected due to errors in the EDI request syntax. type: string x12: description: The raw X12 EDI response, which is either a 277 Status Request Response or a 999 Implementation Acknowledgment. A 999 indicates that the request data failed validation. Common failure reasons are missing required segments and invalid values. type: string type: object ClaimStatusRequestContent: properties: controlNumber: deprecated: true description: Stedi generates a control number for each claim status check, so you don’t need to include this property in your request. maxLength: 9 minLength: 9 type: string dependent: $ref: '#/components/schemas/Member' description: Information about the dependent listed in the referenced claim. You must submit the dependent's `firstName`, `lastName`, `dateOfBirth`, and `gender` (if known). If the claim set the dependent's gender to `U` for unknown, you should omit the `gender` property. encounter: $ref: '#/components/schemas/ClaimStatusEncounter' providers: description: "Information about the billing provider and (optionally) service\ \ providers related to the referenced claim.\n - Exactly one billing\ \ provider is **required** in this array. Requests that include only a\ \ service provider are rejected with a `400` error.\n - For each provider,\ \ you must set the `providerType` and one of the following identifiers:\ \ `npi`, `taxId`, or `etin`.\n - When the `providerType` = `BillingProvider`,\ \ we recommend setting `etin` as the identifier." items: $ref: '#/components/schemas/StatusRequestProvider' description: "Information about the billing provider and (optionally)\ \ service providers related to the referenced claim.\n - Exactly one\ \ billing provider is **required** in this array. Requests that include\ \ only a service provider are rejected with a `400` error.\n - For\ \ each provider, you must set the `providerType` and one of the following\ \ identifiers: `npi`, `taxId`, or `etin`.\n - When the `providerType`\ \ = `BillingProvider`, we recommend setting `etin` as the identifier." maxItems: 2147483647 minItems: 1 type: array serviceLineInformation: $ref: '#/components/schemas/ServiceLineInformation' deprecated: true serviceLinesInformation: items: $ref: '#/components/schemas/ServiceLineInformation' minItems: 1 type: array subscriber: $ref: '#/components/schemas/ClaimStatusSubscriber' tradingPartnerName: description: This is the payer name, such as Cigna or Aetna. type: string 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`." maxLength: 80 minLength: 2 type: string required: - providers - subscriber - tradingPartnerServiceId type: object ClaimStatusResponseContent: properties: claims: description: 'The status information for the claim referenced in the original claim status request. The payer may return multiple claims in the response if they have more than one claim on file that matches the information you provided.' items: $ref: '#/components/schemas/Claim' type: array controlNumber: description: The control number the payer provided in the claim status response. This is used to identify the transaction. type: string dependent: $ref: '#/components/schemas/Member' description: Information about the dependent listed in the referenced claim. errorResponse: $ref: '#/components/schemas/ErrorResponse' implementationTransactionSetSyntaxError: description: The syntax error code in the 999 Implementation Acknowledgment. It indicates the type of error (if present) in the EDI request syntax. Visit `IK502` in the [Implementation Acknowledgment specification](https://portal.stedi.com/app/guides/view/hipaa/implementation-acknowledgment-x231/01HRF41ES1DVGCA6X1EHSRPFXZ#properties.heading.properties.transaction_set_response_header_AK2_loop.items.properties.transaction_set_response_trailer_IK5.properties.implementation_transaction_set_syntax_error_code_02) for a complete list. type: string meta: $ref: '#/components/schemas/ClaimStatusResponseMeta' payer: $ref: '#/components/schemas/ClaimStatusPayer' providers: description: Information about the billing and/or service providers related to the referenced claim. items: $ref: '#/components/schemas/StatusResponseProvider' type: array reassociationKey: description: The control number for the transaction. type: string status: description: The status of the entire claim. type: string subscriber: $ref: '#/components/schemas/ClaimStatusSubscriber' description: Information about the subscriber listed in the referenced claim. tradingPartnerServiceId: description: An ID for the payer you identified in the original claim status request. This value may differ from the `tradingPartnerServiceId` you submitted in the original request because it reflects the payer's internal concept of their ID, not necessarily the ID Stedi uses to route requests to this payer. type: string transactionSetAcknowledgement: description: The acknowledgment code in the 999 Implementation Acknowledgment, an EDI file generated by the payer to acknowledge receipt of the claim status request. It indicates whether the claim status request was accepted or rejected due to errors in the EDI request syntax. type: string x12: description: The raw X12 response from the payer. type: string type: object ClaimStatusResponseMeta: description: Metadata about the response. properties: applicationMode: description: Identifies where this request can be found for support. type: string billerId: description: The biller ID assigned to this request. type: string senderId: description: The sender ID assigned to this request. type: string submitterId: description: The submitter ID assigned to this request. type: string traceId: description: The unique ID assigned to this request within Stedi. type: string type: object ClaimStatusSubscriber: description: 'Information about the subscriber listed in the referenced claim. - You must set both the `dateOfBirth` and `gender` properties when the subscriber is the patient unless the gender is unknown. Stedi determines that the subscriber is the patient when the `dependent` object is not included in the request. - If either `dateOfBirth` or `gender` is set, you must include both properties unless the gender is unknown.' properties: dateOfBirth: description: The subscriber's date of birth. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string firstName: description: The subscriber's first name as specified on their policy. maxLength: 35 minLength: 1 type: string gender: $ref: '#/components/schemas/ClaimStatusSubscriberGender' groupNumber: description: The group number associated with the subscriber's insurance policy. maxLength: 50 minLength: 1 type: string lastName: description: The subscriber's last name as specified on their policy. The subscriber can be an individual or a business entity. maxLength: 60 minLength: 1 type: string memberId: description: The subscriber's insurance member ID. This is the unique identifier for the subscriber on the insurance policy. maxLength: 80 minLength: 2 type: string suffix: description: The subscriber's name suffix, such as Jr., Sr., 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 - memberId type: object ClaimStatusSubscriberGender: description: A code indicating the subscriber's gender. If the claim set the subscriber's gender to `U` for unknown, you should omit this property from the claim status request. enum: - M - F 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: $ref: '#/components/schemas/ServiceAuthorizationExceptionCode' type: object ClaimsAddress: properties: address1: description: The first line of the street address. This typically contains the building number and street name. type: string address2: description: The second line of the street address. This typically contains the apartment or suite number. type: string city: description: The city name. type: string countryCode: description: Use the alpha-2 country codes from Part 1 of ISO 3166. type: string countrySubDivisionCode: description: Use the country subdivision codes from Part 2 of ISO 3166. type: string postalCode: description: The postal zone or zip code. Exclude punctuation and spaces. type: string state: description: The state or province code. Only required when the city is in the Unites States and Canada. type: string required: - address1 - city type: object ClaimsClaimStatus: properties: billTypeIdentifier: description: The bill type identification. type: string claimServiceBeginDate: description: The starting date of the service. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string claimServiceDate: description: The date of the service. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string claimServiceEndDate: description: The ending date of the service. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string clearinghouseTraceNumber: description: The identifier the clearinghouse assigned to the original claim. type: string informationClaimStatuses: description: Claim status information. items: $ref: '#/components/schemas/InformationClaimStatus' type: array patientAccountNumber: deprecated: true description: The patient control number provided in the original claim. Please use `referencedTransactionTraceNumber` to correlate the payer's response with the original claim. type: string pharmacyPrescriptionNumber: deprecated: true description: Not used. type: string referencedTransactionTraceNumber: description: "The patient control number provided in the original claim.\ \ It's the same as:\n - Box 26 (Patient's Account No.) on the CMS-1500\ \ submission form.\n - The `claimInformation.patientControlNumber` in\ \ JSON claim submissions.\n\nWe recommend using this value to correlate\ \ the payer's response with the original claim. When matching transactions,\ \ treat the patient control number as case-insensitive, even if the submitted\ \ value included both lower and uppercase characters." type: string tradingPartnerClaimNumber: description: The payer's unique identifier for the claim. type: string voucherIdentifier: deprecated: true description: Not used. type: string type: object 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 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 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 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 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 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 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 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 ClaimsRawX12SubmissionRequestContent: properties: x12: type: string required: - x12 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 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 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 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 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 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 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 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 CodeListQualifierCode: description: Payers may sometimes return other non-compliant values. enum: - GR - NI - ZZ type: string CommunicationMode: description: Payers may sometimes return other non-compliant values. enum: - Electronic Data Interchange Access Number - Electronic Mail - Facsimile - Telephone - Uniform Resource Locator (URL) - Telephone Extension - Work Phone Number type: string ComponentsSchemasClaimStatus: description: The status, required action, and paid information of a claim or service line. properties: amountPaid: description: The total amount paid for the claim. May be zero when no payment is being made. Some payers can provide the adjudicated payment amount before they issue the remittance. type: string checkIssueDate: description: 'The date the payer issued the check for payment. This may also contain a non-payment remittance advice date, if available from the payer. This value is returned in ISO 8601 date format (YYYY-MM-DD). For example: 2026-03-04.' pattern: ^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$ type: string checkNumber: description: The check identification number or electronic funds transfer (EFT) trace number. This number is used to track the payment. This may also contain a non-payment remittance advice Trace Number (835 or paper), if available from the payer. type: string claimServiceDate: description: Either a single date (formatted as `YYYYMMDD`) or a range of dates (formatted as `YYYYMMDD-YYYYMMDD`) identifying the period of service related to the claim. This property is derived from the service level dates. type: string clearingHouseClaimNumber: description: The claim number provided by the clearinghouse. type: string effectiveDate: description: 'The date the claim was placed in this status by the payer''s adjudication process. This value is returned in ISO 8601 date format (YYYY-MM-DD). For example: 2026-03-04.' pattern: ^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$ type: string entity: $ref: '#/components/schemas/Entity' description: The description of the `entityCode`. For example, `Home Health Care`. entityCode: $ref: '#/components/schemas/EntityCode' description: 'Code identifying the organizational entity, physical location, property, or individual associated with the `statusCode`. For example `1G` - Oncology Center. Visit [Claims code lists](https://www.stedi.com/docs/healthcare/claims-code-lists#entity-identifiers) for a complete list.' paidDate: description: 'This is the date of denial or approval for the claim. This date may or may not be the same as the issue date of the check, EFT, or non-payment remittance. Some payers can provide this date before they issue the remittance. This value is returned in ISO 8601 date format (YYYY-MM-DD). For example: 2026-03-04.' pattern: ^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$ type: string patientAccountNumber: description: The patient account number provided by the service provider in the original claim. You can use this value to correlate the claim status response to the original claim. type: string statusCategoryCode: description: The status category code. Visit [Claim Status Category Codes](https://x12.org/codes/claim-status-category-codes) in the official X12 documentation for a complete list. type: string statusCategoryCodeValue: description: The description of the `statusCategoryCode`. type: string statusCode: description: "The status code used to identify the status of an entire claim\ \ or a service line. For example, `20` - Accepted for Processing. \n\n\ This is either a Health Care Claim Status Code or a National Council for\ \ Prescription Drug Programs (NCPDP) Reject/Payment Code, when the status\ \ is related to pharmacy claims.\n\n Visit [Claim Status Codes]([Health\ \ Care Claim Status Code](https://x12.org/codes/claim-status-codes) in\ \ the official X12 documentation or the [NCPDP website](https://ncpdp.org/)\ \ for a complete list of codes and their values." type: string statusCodeValue: description: The description of the `statusCode`. type: string submittedAmount: description: The total charges submitted for the claim. The total claim charge may change from the submitted claim total charge based on claims processing instructions, such as claim splitting. Some payers may not store the original submitted charge. Some HMO encounters supply zero as the amount of original charges. type: string trackingNumber: description: This is the trace or reference number of the original claim status request. type: string tradingPartnerClaimNumber: description: An identifier for the claim, assigned by the payer. type: string 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 CompositeMedicalProcedureIdentifier: description: Identifies relevant medical procedures by their standard codes and modifiers (if applicable). properties: diagnosisCodePointer: description: The diagnosis code pointer. items: type: string type: array procedureCode: description: The procedure code. Many payers do not support eligibility checks for specific procedure codes. If the payer does not support procedure codes, they return a generic benefits response for the service type code `30`. type: string procedureModifiers: description: Procedure modifiers that provides additional information related to the performance of the service. items: type: string type: array productOrServiceID: description: The product or service ID. This value represents the end of the range of applicable procedure codes. The beginning of the range is listed in `procedureCode`. type: string productOrServiceIDQualifier: description: The name of the `productOrServiceIDQualifierCode`. For example, `American Dental Association`. type: string productOrServiceIDQualifierCode: description: Identifies the external code list used to provide the specified procedure or service codes. Can be `AD` - American Dental Association, `CJ` - Current Procedural Terminology (CPT) codes, `HC` - Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes, `ID` - International Classification of Diseases 9th Revision, Clinical Modification (ICD-9-CM) - Procedure, `IV` - Home Infusion EDI Coalition (HIEC) Product/Service Code, `N4` - National Drug Code in 5-4-2 Format, or `ZZ` - Mutually Defined 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 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 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 ConditionIndicatorDurableMedicalEquipmentCertificationConditionIndicator: description: Code indicating whether there is a certification. Can be set to `N` - No or `Y` - Yes. enum: - Y - N type: string ConditionInformation: description: HI properties: conditionCodes: description: An array of condition codes. items: type: string maxItems: 12 minItems: 1 type: array required: - conditionCodes type: object Confidence: properties: level: $ref: '#/components/schemas/ConfidenceLevel' description: The confidence level for the match. reason: description: A reason for the confidence level. For example, `This record was identified as a low confidence match due to a DOB partial match`. type: string type: object ConfidenceLevel: enum: - REVIEW_NEEDED - HIGH 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 ContactInformation: properties: contacts: description: The contact information. items: $ref: '#/components/schemas/Contacts' type: array name: description: The name of the contact person. type: string 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 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 ContactMethod: properties: email: description: The email address. type: string fax: description: The fax number. type: string phone: description: The telephone number including the area code (if applicable). Phone numbers are formatted as AAABBBCCCC, where AAA represents the area code, BBB represents the telephone number prefix, and CCCC represents the telephone number. Phone numbers are provided without separators, such as dashes or parentheses. For example, `5551123345` for `555-112-3345`. type: string phoneExtension: description: The telephone extension, if applicable. type: string type: object ContactMethods: properties: electronicDataInterChangeAccessNumber: description: The Electronic Data Interchange Access Number. type: string email: description: The email address. type: string fax: description: The fax number. type: string phone: description: The telephone number including the area code (if applicable). Phone numbers are formatted as AAABBBCCCC, where AAA represents the area code, BBB represents the telephone number prefix, and CCCC represents the telephone number. Phone numbers are provided without separators, such as dashes or parentheses. For example, `5551123345` for `555-112-3345`. type: string phoneExtension: description: The telephone extension, if applicable. type: string type: object Contacts: description: Contacts properties: communicationMode: $ref: '#/components/schemas/CommunicationMode' description: 'The type of communication number provided. Payers may sometimes return other non-compliant values.' communicationNumber: description: "The communication number referenced in `communicationMode`.\ \ It includes the country or area code when applicable. \n \n Note that\ \ phone numbers are formatted as AAABBBCCCC, where AAA represents the\ \ area code, BBB represents the telephone number prefix, and CCCC represents\ \ the telephone number. Phone numbers are provided without separators,\ \ such as dashes or parentheses. For example, `5551123345` for `555-112-3345`." type: string type: object ContractInformation: description: Required when the submitter is contractually obligated to supply this information on post-adjudicated claims. properties: contractAmount: description: The total dollar amount of the contract, expressed as a decimal. For example, `100.50`. pattern: ^\d+(\.\d{1,2})?$ 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 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 ConvertReport277ResponseContent: properties: meta: $ref: '#/components/schemas/Meta' transactions: description: The payer's 277 response. items: $ref: '#/components/schemas/ReportsClaimAcknowledgmentResponse' type: array required: - meta type: object ConvertReport835ResponseContent: description: Transaction response structure for claim payment advice. properties: meta: $ref: '#/components/schemas/Meta' description: Metadata that helps Stedi track and debug the response. transactions: description: The payer's 835 response. items: $ref: '#/components/schemas/ClaimPaymentAdviceResponse' type: array required: - meta type: object CoordinationOfBenefits400ErrorResponseContent: oneOf: - $ref: '#/components/schemas/BadRequestException' - $ref: '#/components/schemas/ValidationException' CoordinationOfBenefitsEnrollmentProcess: description: Details about the enrollment process for coordination of benefits (COB) checks. properties: requestedEffectiveDate: $ref: '#/components/schemas/RequestedEffectiveDate' description: "Whether this payer supports specifying a requested effective\ \ date for transaction enrollments.\n - If set to `SUPPORTED`, Stedi\ \ will process [transaction enrollment requests](https://www.stedi.com/docs/healthcare/api-reference/post-enrollment-create-enrollment)\ \ for this payer according to their specified `requestedEffectiveDate`.\n\ \ - This property is only returned when Stedi can determine whether the\ \ payer supports requested effective dates." timeframe: $ref: '#/components/schemas/EnrollmentProcessTimeframe' type: $ref: '#/components/schemas/EnrollmentProcessType' type: object CoordinationOfBenefitsRequestContent: properties: dependent: $ref: '#/components/schemas/COBDependent' encounter: $ref: '#/components/schemas/COBEncounter' provider: $ref: '#/components/schemas/COBProvider' description: An object containing information about the entity requesting the COB check. This may be an individual practitioner, a medical group, a hospital, or another type of healthcare provider. You must provide the `organizationName` (if the entity is an organization) or `firstName` and `lastName` (if the provider is an individual). You must also provide the provider's [National Provider Identifier](https://www.stedi.com/docs/healthcare/national-provider-identifier) (`npi`). subscriber: $ref: '#/components/schemas/COBSubscriber' tradingPartnerServiceId: description: "The payer ID. Visit the [Payer Network](https://www.stedi.com/healthcare/network)\ \ for a complete list of supported payers for COB checks.\n - Each check\ \ **must** be for a participating health plan for which the patient has\ \ coverage. For example, if the patient has coverage from Cigna and UnitedHealthcare,\ \ a COB check to Aetna will return an error.\n - Medicare and Medicare\ \ Advantage plans aren't supported. If you submit a COB check for a Medicare\ \ or Medicare Advantage plan, the request will fail with an `AAA` = `75`\ \ error (Subscriber/Insured Not Found).\n - Ensure that you're sending\ \ the request to the correct payer entity. For example, Blue Cross Blue\ \ Shield (BCBS) has multiple entities that operate in different states.\ \ If you send a request to the wrong entity, the request will fail with\ \ an `AAA` = `75` error (Subscriber/Insured Not Found).\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`." maxLength: 80 minLength: 1 type: string required: - encounter - provider - subscriber - tradingPartnerServiceId type: object CoordinationOfBenefitsResponseContent: properties: benefitsInformation: description: 'Information about the patient''s healthcare benefits, including: - Active coverage with the health plan identified in the COB request - Coverage overlap (if it exists) with one or more payers - Payer primacy details (if Stedi was able to determine) - Benefits details, such as coverage dates and service types' items: $ref: '#/components/schemas/COBBenefitsInformation' type: array coordinationOfBenefits: $ref: '#/components/schemas/COB' description: An overview of the COB response. It indicates whether there is a coverage overlap, whether that overlap creates a coordination of benefits instance, and whether Stedi was able to identify payer primacy (when a COB instance exists). dependent: $ref: '#/components/schemas/COBResponseDependent' description: Information about the dependent listed in the original COB request. errors: description: If the COB request fails, the COB response contains one or more `AAA` errors that specify the reasons for the rejection and any recommended follow-up actions. items: $ref: '#/components/schemas/EligibilityCheckError' type: array meta: $ref: '#/components/schemas/COBMetaData' description: Metadata about the response. Stedi uses this data for tracking and troubleshooting. payer: $ref: '#/components/schemas/COBPayer' description: Information about the payer listed in the COB request. planDateInformation: $ref: '#/components/schemas/COBPlanDateInformation' provider: $ref: '#/components/schemas/COBResponseProvider' description: Information about the entity that submitted the original coordination of benefits request. This may be an individual practitioner, a medical group, a hospital, or another type of healthcare provider. This object will always include the provider's [NPI](https://www.stedi.com/docs/healthcare/national-provider-identifier). subscriber: $ref: '#/components/schemas/COBResponseSubscriber' description: Information about the primary policyholder for the insurance plan listed in the COB request. type: object CopayStatusCode: description: Code indicating whether co-payment requirements were met. Can be set to `O` - Copay exempt. enum: - '0' type: string CorrectedPriorityPayer: description: Information about the corrected priority payer. Used when the current payer believes that another payer has priority for making a payment and the claim is not being automatically transferred to that payer. properties: blueCrossBlueShieldAssociationPlanCode: description: The provider's Blue Cross Blue Shield Association Plan Code. type: string centersForMedicareAndMedicaidServicesPlanId: description: Used to report the provider's Health Plan ID (HPID) or Other Entity Identifier (OEID). type: string nationalAssociationOfInsuranceCommissionersIdentification: description: The provider's National Association of Insurance Commissioners (NAIC) number. type: string organizationName: description: The provider's business name (when the provider is not an individual) or the provider's last name (when the provider is an individual). type: string payorId: description: The provider's Payer Identification number. type: string pharmacyProcessorNumber: description: The provider's Pharmacy Processor Number. type: string taxId: description: The provider's Federal Tax Identification Number. pattern: ^\d{9}$ type: string type: object CoverageType: description: The types of insurance coverage that a payer can provide. Used to indicate whether a payer supports transactions for medical coverage, dental coverage, vision coverage, or a combination of these. enum: - medical - dental - vision type: string CreditDebitFlagCode: description: Indicates whether a financial transaction represents a credit or debit to the provider's account. Used to specify the direction of money flow in payment transactions. enum: - C - D type: string CrossoverCarrier: description: Information about the crossover carrier. The crossover carrier is defined as any payer to which the claim is transferred for further payment after the current payer has finalized it. properties: blueCrossBlueShieldAssociationPlanCode: description: The provider's Blue Cross Blue Shield Association Plan Code. type: string centersForMedicareAndMedicaidServicesPlanId: description: Used to report the provider's Health Plan ID (HPID) or Other Entity Identifier (OEID). type: string nationalAssociationOfInsuranceCommissionersIdentification: description: The provider's National Association of Insurance Commissioners (NAIC) number. type: string organizationName: description: The provider's business name (when the provider is not an individual) or the provider's last name (when the provider is an individual). type: string payorId: description: The provider's Payer Identification number. type: string pharmacyProcessorNumber: description: The provider's Pharmacy Processor Number. type: string taxId: description: The provider's Federal Tax Identification Number. pattern: ^\d{9}$ type: string type: object DateTimePeriodFormatQualifier: description: Payers may sometimes return other non-compliant values. enum: - D8 - RD8 type: string 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 DeliveryOrCalendarPatternQualifier: description: 'The name of the `deliveryOrCalendarPatternCode`. For example, `Last Working Day of Period`. Payers may sometimes return other non-compliant values.' enum: - 1st Week of the Month - 2nd Week of the Month - 3rd Week of the Month - 4th Week of the Month - 5th Week of the Month - 1st & 3rd Week of the Month - 2nd & 4th Week of the Month - 1st Working Day of Period - Last Working Day of Period - Monday through Friday - Monday through Saturday - Monday through Sunday - Monday - Tuesday - Wednesday - Thursday - Friday - Saturday - Sunday - Monday through Thursday - Immediately - As Directed - Daily Mon. Through Fri. - 1/2 Mon. & 1/2 Tues. - 1/2 Tues. & 1/2 Thurs. - 1/2 Wed. & 1/2 Fri. - Once Anytime Mon. through Fri. - Tuesday through Friday - Monday, Tuesday and Thursday - Monday, Tuesday and Friday - Wednesday and Thursday - Monday, Wednesday and Thursday - Tuesday, Thursday and Friday - 1/2 Tues. & 1/2 Fri. - 1/2 Mon. & 1/2 Wed. - 1/3 Mon., 1/3 Wed., 1/3 Fri. - Whenever Necessary - 1/2 By Wed. Bal. By Fri. - None (Also Used to Cancel or Override a Previous Pattern) type: string DeliveryOrCalendarPatternQualifierCode: description: 'Code that specifies the routine shipments, deliveries, or calendar pattern. For example `9` - Last Working Day of Period. Visit [Eligibility code lists](https://www.stedi.com/docs/healthcare/eligibility-code-lists#delivery-frequency-codes) for a complete list. Payers may sometimes return other non-compliant values.' enum: - '1' - '2' - '3' - '4' - '5' - '6' - '7' - '8' - '9' - A - B - C - D - E - F - G - H - J - K - L - M - N - O - P - Q - R - S - SG - SL - SP - SX - SY - SZ - T - U - V - W - X - Y type: string DeliveryPatternTimeQualifier: description: 'The name of the `deliveryPatternTimeCode`. Payers may sometimes return other non-compliant values.' enum: - 1st Shift (Normal Working Hours) - 2nd Shift - 3rd Shift - A.M. - P.M. - As Directed - Any Shift - None (Also Used to Cancel or Override a Previous Pattern) type: string DeliveryPatternTimeQualifierCode: description: 'A code specifying the time for routine shipments or deliveries. Payers may sometimes return other non-compliant values.' enum: - A - B - C - D - E - F - G - Y type: string 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 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: $ref: '#/components/schemas/DentalContractTypeCode' contractVersionIdentifier: description: An additional identifer for the contract. Identifies the revision level of a particular format, program, technique or algorithm. type: string termsDiscountPercentage: description: Terms discount percentage, expressed as a percent, available to the purchaser if an invoice is paid on or before the Terms Discount Due Date. type: string required: - contractTypeCode type: object DentalClaimDateInformation: properties: accidentDate: description: The date of the accident related to this claim. Required when `relatedCausesCode` is set to `AA` - Auto Accident or `OA` - Other Accident. Also required when `relatedCausesCode` is set to `EM` - Employment and this claim is the result of an accident. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ 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 DentalClaimEnrollmentProcess: description: Details about the enrollment process for dental claim submission. properties: requestedEffectiveDate: $ref: '#/components/schemas/RequestedEffectiveDate' description: "Whether this payer supports specifying a requested effective\ \ date for transaction enrollments.\n - If set to `SUPPORTED`, Stedi\ \ will process [transaction enrollment requests](https://www.stedi.com/docs/healthcare/api-reference/post-enrollment-create-enrollment)\ \ for this payer according to their specified `requestedEffectiveDate`.\n\ \ - This property is only returned when Stedi can determine whether the\ \ payer supports requested effective dates." timeframe: $ref: '#/components/schemas/EnrollmentProcessTimeframe' type: $ref: '#/components/schemas/EnrollmentProcessType' type: object 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 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 DentalClaimsRawX12SubmissionRequestContent: properties: x12: type: string required: - x12 type: object 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 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 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: $ref: '#/components/schemas/ClaimsWarning' type: array x12: description: 'A [277CA claim acknowledgment](https://www.stedi.com/docs/healthcare/claim-responses-overview#277ca-claim-acknowledgment) acceptance or rejection from Stedi in X12 EDI format. It indicates whether the claim has passed Stedi''s claim edits. When the claim fails one or more edits, the 277CA contains `STC` segments with information about each error. These are the same error codes that appear in the `errors` array. Note that this 277CA only indicates whether Stedi has accepted or rejected the claim submission. You may receive additional 277CA acceptances or rejections as the claim is routed to the payer.' type: string type: object DentalContractInformation: description: Required when the submitter is contractually obligated to supply this information on post-adjudicated claims. properties: contractAmount: description: The total dollar amount of the contract, expressed as a decimal. For example, `100.50`. pattern: ^\d+(\.\d{1,2})?$ 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 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 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 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 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 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: $ref: '#/components/schemas/DentalDiagnosisTypeCode' required: - diagnosisCode - diagnosisTypeCode type: object DentalLineAdjudicationInformation: description: Includes service line adjudication information for coordination of benefits between the initial payers of a health care claim and all subsequent payers. properties: adjudicationOrPaymentDate: description: The date the other payer adjudicated or paid the claim. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ 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 DentalLineAdjudicationInformationServiceIdQualifier: enum: - AD - ER type: string DentalMeasurementUnitCode: enum: - UN type: string 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 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 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 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: $ref: '#/components/schemas/OtherInsuredQualifier' required: - otherInsuredIdentifier - otherInsuredIdentifierTypeCode - otherInsuredLastName - otherInsuredQualifier type: object DentalPlanParticipationCode: enum: - A - C type: string DentalReportInformation: properties: attachmentControlNumber: description: "A control number assigned to the attachment. The payer uses\ \ this identifier to match the attachment to the claim.\n - You must\ \ include either this property or `attachmentId` in the request, but not\ \ both. Including both properties will result in an error.\n - We recommend\ \ using a ULID or UUID of up to 50 characters.\n - Stedi autogenerates\ \ a control number if you don't provide one." type: string attachmentId: description: "The unique identifier for the attachment file you previously\ \ uploaded to Stedi. This value is returned in the `attachmentId` property\ \ of the [Create Claim Attachment (275) JSON](https://www.stedi.com/docs/healthcare/api-reference/post-healthcare-submit-claim-attachment)\ \ response. Stedi uses it to generate and submit the 275 claim attachment\ \ transaction to the payer.\n - This property is **required** when you're\ \ submitting attachment files through Stedi.\n - You must include either\ \ this property or `attachmentControlNumber` in the request, but not both.\ \ Including both properties will result in an error." maxLength: 36 minLength: 36 pattern: ^[0-9a-fA-F]{8}-[0-9a-fA-F]{4}-[0-9a-fA-F]{4}-[0-9a-fA-F]{4}-[0-9a-fA-F]{12}$ type: string attachmentReportTypeCode: $ref: '#/components/schemas/DentalAttachmentReportTypeCode' attachmentTransmissionCode: $ref: '#/components/schemas/ReportInformationAttachmentTransmissionCode' required: - attachmentReportTypeCode - attachmentTransmissionCode type: object 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 DentalServiceIdQualifier: enum: - AD 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: $ref: '#/components/schemas/ToothInformation' type: array required: - dentalService type: object DentalServiceLineAssistantSurgeon: properties: commercialNumber: description: The provider's commercial number. type: string firstName: description: The provider's first name. maxLength: 35 minLength: 1 type: string lastName: description: The provider's last name. maxLength: 60 minLength: 1 type: string locationNumber: description: The provider's location number. type: string middleName: description: The provider's middle name or initial. maxLength: 25 minLength: 1 type: string npi: description: The individual National Provider Identifier (NPI) assigned to the provider. pattern: ^\d{10}$ 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 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 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 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: $ref: '#/components/schemas/PriorAuthorization' maxItems: 5 minItems: 1 type: array referralNumber: description: Required when this service line involved a referral number that is different than the number reported at the claim level. You can include up to five objects in this array. items: type: string maxItems: 5 minItems: 1 type: array repricedLineItemReferenceNumber: description: Required when a repricing (pricing) organization needs to have an identifying number on the service line. Only completed by repricing organizations. type: string type: object DentalServiceLineRenderingProvider: properties: commercialNumber: description: The provider's commercial number. type: string firstName: description: The provider's first name. maxLength: 35 minLength: 1 type: string lastName: description: The provider's last name. maxLength: 60 minLength: 1 type: string locationNumber: description: The provider's location number. type: string middleName: description: The provider's middle name or initial. maxLength: 25 minLength: 1 type: string npi: description: The National Provider Identifier (NPI) assigned to the provider. pattern: ^\d{10}$ 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 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 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 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 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 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 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 DependentInsuredIndicator: description: Indicates the status of the insured. For the dependent, this is always `N`. enum: - N type: string DependentRelationship: description: The name of the `relationToSubscriberCode`. For example, `Child` when the code is `19`. enum: - Spouse - Child - Employee - Unknown - Organ Donor - Cadaver Donor - Life Partner - Other Relationship type: string DependentRelationshipCode: description: For the dependent, this can be `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 - Unknown type: string DetailInfo: description: Information about the claim or service line. properties: assignedNumber: description: A unique ID assigned to identify this set of claim information within the response. type: string paymentInfo: description: Information relevant to the claim and claim payment, including the subscriber, providers, and service lines. Note that the amount paid may not match the claim amount, even when the claim was not denied. This can happen for several reasons, including adjustments and corrected balances due from other claims. items: $ref: '#/components/schemas/PaymentInfo' type: array providerSummaryInformation: $ref: '#/components/schemas/ProviderSummaryInformation' description: Summary information about the provider. providerSupplementalSummaryInformation: $ref: '#/components/schemas/ProviderSupplementalSummaryInformation' description: Supplemental summary information about the provider. type: object DfiIdNumberQualifier: description: Identifies the type of Depository Financial Institution (DFI) identification number being used. This specifies the format and country of the bank routing information. enum: - '01' - '04' type: string DiagnosisRelatedGroupInformation: properties: drugRelatedGroupCode: description: The diagnosis related group code. maxLength: 30 type: string required: - drugRelatedGroupCode type: object DiagnosisTypeCode: description: "The type of diagnosis code you are providing. You can set to `BK`\ \ - International Classification of Diseases Clinical Modification (ICD-9-CM)\ \ Principal Diagnosis, `ABK` - International Classification of Diseases Clinical\ \ Modification (ICD-10-CM) Principal Diagnosis, `BF`- International Classification\ \ of Diseases Clinical Modification (ICD-9-CM) Diagnosis, or `ABF`- International\ \ Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis.\ \ \n\n Note that ICD-9 codes are **deprecated** and should no longer be used\ \ in eligibility checks." enum: - BK - ABK - BF - ABF type: string DiscoveryBenefitsInformation: properties: additionalInformation: description: A free-form message containing additional information about the benefits in the response. items: $ref: '#/components/schemas/AdditionalInformation' type: array authOrCertIndicator: $ref: '#/components/schemas/AuthOrCertIndicator' description: "Code indicating whether the benefit is subject to prior authorization\ \ or certification. Can be `Y` - Yes, `N` - No, or `U` - Unknown.\n -\ \ When this property is set to `U`, it means the payer can't determine\ \ in real time whether prior authorization is required for the service.\ \ They may require additional details, like diagnosis or place of service\ \ to make a determination. Check the `additionalInformation[].description`\ \ property for any additional clarification. You can also contact the\ \ payer directly or use their provider portal to get more information.\n\ \ - Some payers may send additional notes about prior authorization rules\ \ in the `additionalInformation[].description` property. Payers may also\ \ send prior authorization notes in a separate `benefitsInformation` object\ \ with a code of `1` (Active coverage), `CB` (Coverage Benefit), or `D`\ \ (Benefit Description).\n\nVisit our [patient benefits docs](https://www.stedi.com/docs/healthcare/eligibility-network-status-authorization-referrals#is-prior-authorization-required)\ \ to learn more about prior authorization.\n\nPayers may sometimes return\ \ other non-compliant values." benefitAmount: description: "The monetary benefit amount, such as a patient's co-pay or\ \ deductible. This value is expressed as a decimal, such as 100.00. \n\ \ \n The payer will always send a value in this property when the `benefitsInformation[].code`\ \ = `B` - Co-Payment, `C` - Deductible, `G` - Out of Pocket (Stop Loss),\ \ `J` - Cost Containment, or `Y` - Spend Down. For those codes, this value\ \ represents the patient's portion of responsibility. \n \n The payer\ \ will **never** send this value when `benefitsInformation[].code` = `A`\ \ - Co-Insurance. This property can contain zero when the patient has\ \ no responsibility. \n \n Learn more about [patient costs](https://www.stedi.com/docs/healthcare/eligibility-patient-responsibility-benefits)." type: string benefitPercent: description: "The percentage of the benefit, such as co-insurance. This\ \ property can contain zero when the patient has no responsibility. \n\ \ \n The payer will always send a value in this property when `benefitsInformation[].code`\ \ = `A` - Co-Insurance. For this code, this value represents the patient's\ \ portion of the responsibility. The percentage is expressed as a decimal,\ \ such as `0.80` represents 80%. \n \n The payer will **never** send a\ \ value in this property when `benefitsInformation[].code` = `B` - Co-Payment,\ \ `C` - Deductible, `G` - Out of Pocket (Stop Loss), `J` - Cost Containment,\ \ or `Y` - Spend Down. \n \n Learn more about [patient costs](https://www.stedi.com/docs/healthcare/eligibility-patient-responsibility-benefits)." type: string benefitQuantity: description: The quantity of the benefit, qualified by the type specified in `quantityQualifier`. For example, `10` when the `quantityQualifier` is `Visits`. type: string benefitsAdditionalInformation: $ref: '#/components/schemas/BenefitsAdditionalInformation' benefitsDateInformation: $ref: '#/components/schemas/BenefitsDateInformation' benefitsRelatedEntities: description: 'Other entities associated with the eligibility or benefits. This could be a provider, an individual, an organization, or another payer. When present, this array typically contains information about the patient''s primary care provider (PCP), another organization that handles a specific benefit type (such as telehealth mental health services), or another health plan for the patient (coordination of benefits scenarios). - This is where information for a crossover carrier such as Medicaid or Medicare is provided, if it''s applicable to the patient and the payer supports it. - For Blue Cross Blue Shield (BCBS) payers, Stedi returns an entry containing information about the patient''s home plan - the plan that actually verified the coverage. In this object, the `entityIdentifier` property is set to `Party Performing Verification`. [Learn more](https://www.stedi.com/docs/healthcare/eligibility-active-coverage-benefits#bcbs-home-plan)' items: $ref: '#/components/schemas/BenefitsRelatedEntity' type: array benefitsServiceDelivery: items: $ref: '#/components/schemas/BenefitsServiceDelivery' type: array code: $ref: '#/components/schemas/BenefitsInformationCode' compositeMedicalProcedureIdentifier: $ref: '#/components/schemas/CompositeMedicalProcedureIdentifier' coverageLevel: $ref: '#/components/schemas/BenefitsInformationCoverageLevelName' coverageLevelCode: $ref: '#/components/schemas/BenefitsInformationCoverageLevelCode' eligibilityAdditionalInformationList: description: Used when there are multiple Nature of Injury Codes or a Facility Type Codes included in the response. items: $ref: '#/components/schemas/EligibilityAdditionalInformation' type: array headerLoopIdentifierCode: description: The loop header identifier number in the `LS` segment of the original X12 EDI transaction. type: string inPlanNetworkIndicator: $ref: '#/components/schemas/InPlanNetworkIndicatorName' inPlanNetworkIndicatorCode: $ref: '#/components/schemas/InPlanNetworkIndicatorCode' insuranceType: $ref: '#/components/schemas/InsuranceTypeName' insuranceTypeCode: $ref: '#/components/schemas/InsuranceTypeCode' description: 'Code identifying the type of insurance policy. Visit [Eligibility code lists](https://www.stedi.com/docs/healthcare/eligibility-code-lists#insurance-type-codes) for a complete list. Payers may sometimes return other non-compliant values.' name: $ref: '#/components/schemas/BenefitsInformationName' planCoverage: description: 'The specific product name or special program name for an insurance plan. For example `Gold 1-2-3`. Payers are normally required to send the plan name when `benefitsInformation[].code` is set to values `1` - `8` and the `benefitsInformation[].serviceTypeCodes` contains `30` (Health Benefit Plan Coverage). However, behavior may vary by payer, so don''t rely on this information being present in the response. Note that the plan name returned in this property may not exactly match the name the payer uses in official plan documents or marketing literature. Visit [What''s the plan name?](https://www.stedi.com/docs/healthcare/eligibility-active-coverage-benefits#what’s-the-plan-name%3F) in the benefits response documentation for more details.' type: string quantityQualifier: $ref: '#/components/schemas/QuantityQualifierName' description: 'The name of the `quantityQualifierCode`. Payers may sometimes return other non-compliant values.' quantityQualifierCode: $ref: '#/components/schemas/QuantityQualifierCode' description: 'Code indicating the type of quantity for the benefit. Visit [Eligibility code lists](https://www.stedi.com/docs/healthcare/eligibility-code-lists#quantity-qualifier-codes) for a complete list. Payers may sometimes return other non-compliant values.' serviceTypeCodes: description: 'Service Type Codes (STCs) related to the benefit type. For example, `7` - Anesthesia. Visit [Service Type Codes](https://www.stedi.com/docs/healthcare/send-eligibility-checks#service-type-codes) for a complete list. This list is specific to X12 version 005010, which is the mandated version for eligibility checks. It differs from the current [X12 Service Type Codes](https://x12.org/codes/service-type-codes) list, which applies to X12 versions later than 005010. Payers may sometimes return other non-compliant values.' items: $ref: '#/components/schemas/ResponseEligibilityServiceTypeCode' type: array serviceTypes: description: 'The names of the Service Type Codes listed in the `serviceTypeCodes` array. Visit [Service Type Codes](https://www.stedi.com/docs/healthcare/send-eligibility-checks#service-type-codes) for a complete list of codes and their names. The word physician in service type codes refers to any healthcare provider, including physician assistants, nurse practitioners, and other types of healthcare professionals. Payers may sometimes return other non-compliant values.' items: $ref: '#/components/schemas/ResponseEligibilityServiceType' type: array timeQualifier: $ref: '#/components/schemas/TimeQualifierName' description: 'The name of the `timeQualifierCode`. Payers may sometimes return other non-compliant values.' timeQualifierCode: $ref: '#/components/schemas/TimeQualifierCode' description: 'Code indicating the time period for the benefit information. Visit [Eligibility code lists](https://www.stedi.com/docs/healthcare/eligibility-code-lists#time-qualifier-codes) for a complete list. Payers may sometimes return other non-compliant values.' trailerLoopIdentifierCode: description: The loop trailer identifier number in the `LE` segment of the original X12 EDI transaction. type: string type: object DiscoveryPayer: properties: centersForMedicareAndMedicaidPlanId: description: The payer's Centers for Medicare and Medicaid Services PlanID. type: string contactInformation: $ref: '#/components/schemas/ContactInformation' description: 'The payer''s contact information. Note that when `contacts[].communicationMode` is set to `UR`, the `communicationNumber` property may not contain a valid URL. Most payers provide a partial web address for their provider portal, or something similar, such as `www.example.com/portal`. You must add the appropriate scheme and separators, such as `https://` or `http://`, to make it a valid URL.' entityIdentifier: $ref: '#/components/schemas/PayerEntityIdentifier' entityType: $ref: '#/components/schemas/EntityTypeQualifier' description: 'The entity type qualifier for the payer. Can be set to `Person` (not commonly used) or `Non-Person Entity` (most common). Payers may sometimes return other non-compliant values.' etin: description: The payer's Electronic Transmitter Identification Number (ETIN). type: string federalTaxpayersIdNumber: description: The payer's federal taxpayer's identification number. pattern: ^\d{9}$ type: string firstName: description: The payer's first name, when the payer is an individual (not commonly used). type: string lastName: description: The payer's last name. Used when the payer is an individual (not commonly used). type: string middleName: description: The payer's middle name or initial, when the payer is an individual (not commonly used). type: string naic: description: The payer's National Association of Insurance Commissioners (NAIC) identification number. type: string name: description: The payer's business name, when the payer is not a person. type: string npi: description: The payer's [National Provider Identifier (NPI)](https://www.stedi.com/docs/healthcare/national-provider-identifier). pattern: ^\d{10}$ type: string x-meta: title: National Provider Identifier (NPI) payorIdentification: description: The payor identification. type: string suffix: description: The payer's name suffix, such as Jr. or III. Used when the payer is an individual (not commonly used). type: string type: object DiscoveryPlanDateInformation: properties: added: description: Added date. Payers may return this information in the case of retroactive eligibility. 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 admission: description: The admission date or 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 certification: description: The certification date. 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 cobraBegin: description: The date when COBRA coverage begins. 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 cobraEnd: description: The date when COBRA coverage ends. 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 dateOfDeath: description: The date of death. Payers may return this information in the case of a deceased subscriber or dependent. 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 dateOfLastUpdate: description: The date when the plan information was last updated. 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 discharge: description: The discharge date. 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 effectiveDateOfChange: description: The effective date of change. 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 eligibility: description: Plan eligibility 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 eligibilityBegin: description: The date when the patient is first eligible for benefits under the plan. 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 eligibilityEnd: description: The date when the patient is no longer eligible for benefits under the plan. 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 enrollment: description: The date when the patient is enrolled in the plan. 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 issue: description: The issue date. 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 plan: description: Plan effective 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 planBegin: description: The date coverage from the plan begins. 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 planEnd: description: The date coverage from the plan ends. 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 policyEffective: description: The date when the policy becomes effective. 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 policyExpiration: description: The date when the policy expires. 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 premiumPaidToDateBegin: description: The start of the period when the plan premium was paid in full. 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 premiumPaidToDateEnd: description: The end of period when the plan premium payments are up-to-date. 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 service: description: The service date or 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 status: description: The status date. 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 DiscoveryResponseDependent: description: Common fields shared between subscriber and dependent structures in the eligibility response. properties: address: $ref: '#/components/schemas/Address' birthSequenceNumber: description: The number assigned to each family member born with the same birth date, such as twins or triplets. Indicates the birth order when there are multiple births associated with the provided birth date. type: string dateOfBirth: description: The member's date of birth. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string dateTimePeriod: description: The military service date. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string dateTimePeriodFormatQualifier: $ref: '#/components/schemas/DateTimePeriodFormatQualifier' description: 'The format of the military service date and time period. Can be `D8` - Date or `RD8` - Range of Dates. Payers may sometimes return other non-compliant values.' description: description: Context that identifies the exact military unit. Used to report military service data. type: string employmentStatusCode: $ref: '#/components/schemas/EmploymentStatusCode' description: 'The member''s employment status code, used to report military service data. Visit [Eligibility code lists](https://www.stedi.com/docs/healthcare/eligibility-code-lists#employment-status-codes) for a complete list. Payers may sometimes return other non-compliant values.' endDateTimePeriod: description: The military service end date. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string entityIdentifier: $ref: '#/components/schemas/ResponseDependentEntityIdentifier' entityType: $ref: '#/components/schemas/EntityTypeQualifier' description: 'The entity type for the member. It can technically be set to `Person` or `Non-Person Entity`. In practice, our customers only receive `Person`. Payers may sometimes return other non-compliant values.' firstName: description: The member's first name. type: string gender: $ref: '#/components/schemas/GenderWithUnknown' description: Code indicating the patient's gender. governmentServiceAffiliationCode: $ref: '#/components/schemas/GovernmentServiceAffiliationCode' description: 'The member''s government service affiliation code, used to report military service data. Visit [Eligibility code lists](https://www.stedi.com/docs/healthcare/eligibility-code-lists#government-service-affiliation-codes) for a complete list. Payers may sometimes return other non-compliant values.' groupDescription: description: Group name type: string groupNumber: description: The group number associated with the insurance policy. type: string healthCareDiagnosisCodes: items: $ref: '#/components/schemas/HealthCareDiagnosisCode' type: array informationStatusCode: $ref: '#/components/schemas/InformationStatusCode' description: 'The status of the member''s information, used to report military service data. Visit [Eligibility code lists](https://www.stedi.com/docs/healthcare/eligibility-code-lists#information-status-codes) for a complete list. Payers may sometimes return other non-compliant values.' insuredIndicator: $ref: '#/components/schemas/DependentInsuredIndicator' lastName: description: The member's last name. type: string maintenanceReasonCode: $ref: '#/components/schemas/MaintenanceReasonCode' maintenanceTypeCode: $ref: '#/components/schemas/MaintenanceTypeCode' memberId: deprecated: true description: This property will never be populated. Please use `subscriber.memberId` instead. type: string middleName: description: The member's middle name or initial. type: string militaryServiceRankCode: $ref: '#/components/schemas/MilitaryServiceRankCode' description: 'The member''s military service rank code. Visit [Eligibility code lists](https://www.stedi.com/docs/healthcare/eligibility-code-lists#military-service-rank-codes) for a complete list. Payers may sometimes return other non-compliant values.' planDescription: description: Plan name type: string planNetworkDescription: description: Plan network name type: string planNetworkIdNumber: description: The network identification number associated with the insurance policy. type: string planNumber: description: The plan number associated with the insurance policy. type: string relationToSubscriber: $ref: '#/components/schemas/DependentRelationship' relationToSubscriberCode: $ref: '#/components/schemas/DependentRelationshipCode' responseProvider: $ref: '#/components/schemas/ResponseProvider' ssn: description: The member's Social Security Number (SSN). pattern: ^\d{9}$ type: string startDateTimePeriod: description: The military service start date. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string suffix: description: The name suffix, such as Jr., Sr., or III. type: string uniqueHealthIdentifier: description: The member's unique health identifier. type: string type: object DiscoveryResponseProvider: properties: address: $ref: '#/components/schemas/Address' description: The provider's contact information. entityIdentifier: $ref: '#/components/schemas/ResponseProviderEntityIdentifier' entityType: $ref: '#/components/schemas/EntityTypeQualifier' federalTaxpayersIdNumber: description: The Federal Taxpayer Identification Number (also known as an EIN). pattern: ^\d{9}$ type: string middleName: description: The provider's middle name. This applies to providers that are an individual. type: string npi: description: The provider's [National Provider Identifier (NPI)](https://www.stedi.com/docs/healthcare/national-provider-identifier). pattern: ^\d{10}$ type: string payorIdentification: description: The Payor Identification. type: string pharmacyProcessorNumber: description: The pharmacy processor number. type: string providerCode: $ref: '#/components/schemas/ResponseProviderCode' description: 'A code that communicates the provider''s role in the type of benefits information in the response. Visit [Eligibility code lists](https://www.stedi.com/docs/healthcare/eligibility-code-lists#provider-codes) for a complete list. Payers may sometimes return other non-compliant values.' providerFirstName: description: The provider's first name. This applies to providers that are an individual. type: string providerName: description: The provider's last name. This applies to providers that are an individual. type: string providerOrgName: description: The provider's organization name. type: string referenceIdentification: description: The Health Care Provider Taxonomy Code. type: string serviceProviderNumber: description: The service provider number. This is an identification number assigned by the payer. type: string servicesPlanID: description: The Centers for Medicare and Medicaid Services (CMS) Plan ID. type: string ssn: description: The Social Security Number (SSN). pattern: ^\d{9}$ type: string suffix: description: The provider's name suffix, such as Jr., Sr., or III. type: string type: object DiscoveryResponseSubscriber: description: Common fields shared between subscriber and dependent structures in the eligibility response. properties: address: $ref: '#/components/schemas/Address' birthSequenceNumber: description: The number assigned to each family member born with the same birth date, such as twins or triplets. Indicates the birth order when there are multiple births associated with the provided birth date. type: string dateOfBirth: description: The member's date of birth. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string dateTimePeriod: description: The military service date. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string dateTimePeriodFormatQualifier: $ref: '#/components/schemas/DateTimePeriodFormatQualifier' description: 'The format of the military service date and time period. Can be `D8` - Date or `RD8` - Range of Dates. Payers may sometimes return other non-compliant values.' description: description: Context that identifies the exact military unit. Used to report military service data. type: string employmentStatusCode: $ref: '#/components/schemas/EmploymentStatusCode' description: 'The member''s employment status code, used to report military service data. Visit [Eligibility code lists](https://www.stedi.com/docs/healthcare/eligibility-code-lists#employment-status-codes) for a complete list. Payers may sometimes return other non-compliant values.' endDateTimePeriod: description: The military service end date. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string entityIdentifier: $ref: '#/components/schemas/ResponseSubscriberEntityIdentifier' entityType: $ref: '#/components/schemas/EntityTypeQualifier' description: 'The entity type for the member. It can technically be set to `Person` or `Non-Person Entity`. In practice, our customers only receive `Person`. Payers may sometimes return other non-compliant values.' firstName: description: The member's first name. type: string gender: $ref: '#/components/schemas/GenderWithUnknown' description: Code indicating the patient's gender. governmentServiceAffiliationCode: $ref: '#/components/schemas/GovernmentServiceAffiliationCode' description: 'The member''s government service affiliation code, used to report military service data. Visit [Eligibility code lists](https://www.stedi.com/docs/healthcare/eligibility-code-lists#government-service-affiliation-codes) for a complete list. Payers may sometimes return other non-compliant values.' groupDescription: description: Group name type: string groupNumber: description: The group number associated with the insurance policy. type: string healthCareDiagnosisCodes: items: $ref: '#/components/schemas/HealthCareDiagnosisCode' type: array informationStatusCode: $ref: '#/components/schemas/InformationStatusCode' description: 'The status of the member''s information, used to report military service data. Visit [Eligibility code lists](https://www.stedi.com/docs/healthcare/eligibility-code-lists#information-status-codes) for a complete list. Payers may sometimes return other non-compliant values.' insuredIndicator: $ref: '#/components/schemas/SubscriberInsuredIndicator' lastName: description: The member's last name. type: string maintenanceReasonCode: $ref: '#/components/schemas/MaintenanceReasonCode' maintenanceTypeCode: $ref: '#/components/schemas/MaintenanceTypeCode' memberId: description: The member ID for the insurance policy. type: string middleName: description: The member's middle name or initial. type: string militaryServiceRankCode: $ref: '#/components/schemas/MilitaryServiceRankCode' description: 'The member''s military service rank code. Visit [Eligibility code lists](https://www.stedi.com/docs/healthcare/eligibility-code-lists#military-service-rank-codes) for a complete list. Payers may sometimes return other non-compliant values.' planDescription: description: Plan name type: string planNetworkDescription: description: Plan network name type: string planNetworkIdNumber: description: The network identification number associated with the insurance policy. type: string planNumber: description: The plan number associated with the insurance policy. type: string relationToSubscriber: $ref: '#/components/schemas/SubscriberRelationship' relationToSubscriberCode: $ref: '#/components/schemas/SubscriberRelationshipCode' responseProvider: $ref: '#/components/schemas/ResponseProvider' ssn: description: The member's Social Security Number (SSN). pattern: ^\d{9}$ type: string startDateTimePeriod: description: The military service start date. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string suffix: description: The name suffix, such as Jr., Sr., or III. type: string uniqueHealthIdentifier: description: The member's unique health identifier. type: string type: object DiscoveryStatus: enum: - PENDING - COMPLETE - ERROR type: string 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: $ref: '#/components/schemas/DrugIdentificationServiceIdQualifier' required: - measurementUnitCode - nationalDrugCode - nationalDrugUnitCount - serviceIdQualifier type: object DrugIdentificationServiceIdQualifier: description: Code indicating the source of the drug code or product number. Visit [Claims code lists](https://www.stedi.com/docs/healthcare/claims-code-lists#drug-identification-product-or-service-id-qualifier-codes) for a complete list. enum: - EN - EO - HI - N4 - 'ON' - UK - UP type: string DtpDate: properties: date: description: A single date. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string endDate: description: The end date of a range. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string startDate: description: The beginning date of a range. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string 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 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 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 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 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 EligibilityAdditionalInformation: properties: codeCategory: $ref: '#/components/schemas/InjuryCodeCategory' description: 'The code category. Always set to `44` - Nature of Injury. Payers may sometimes return other non-compliant values.' codeListQualifier: description: The name of the `codeListQualifierCode`. For example `Mutually Defined` when the code is set to `ZZ`. type: string codeListQualifierCode: $ref: '#/components/schemas/CodeListQualifierCode' description: "Identifies a specific industry code list. Can be `GR` - National\ \ Council on Compensation Insurance (NCCI) Nature of Injury Code, `NI`\ \ - Nature of Injury Code, or `ZZ` - Mutually Defined.\n\n When this is\ \ set to `ZZ`, the `industryCode` property will be set to a place of service\ \ code.\n\nPayers may sometimes return other non-compliant values." industry: description: The name of the `industryCode`. For example `Pharmacy` when the code is `01`. type: string industryCode: description: The specific industry code. When `codeListQualifierCode` is set to `ZZ` - Mutually Defined, this property will be set to a place of service code. Visit the [Place of Service Code Set](https://www.cms.gov/medicare/coding-billing/place-of-service-codes/code-sets) for a complete list of these codes and their descriptions. type: string injuredBodyPartName: description: Description of injured body parts. type: string type: object EligibilityCheck400ErrorResponseContent: oneOf: - $ref: '#/components/schemas/EligibilityCheckOutputValidationErrors' - $ref: '#/components/schemas/ValidationException' EligibilityCheckDependentError: description: When a payer rejects your eligibility check, the response contains one or more `AAA` errors that specify the reasons for the rejection and any recommended follow-up actions. Common reasons for rejection at the `subscriber` or `dependent` level include missing or incorrect identifying information and that the payer was unable to locate the patient in their system. [Learn more](https://www.stedi.com/docs/healthcare/eligibility-troubleshooting#payer-aaa-errors) properties: code: $ref: '#/components/schemas/EligibilityCheckDependentErrorCode' description: 'The error code. Payers may sometimes return other non-compliant values.' description: description: The error description. type: string field: description: The error type, `AAA`. type: string followupAction: $ref: '#/components/schemas/EligibilityCheckProviderAndMemberFollowupAction' description: 'Recommended follow-up action based on the rejection reason code. **Note**: `Resubmission Not Allowed` doesn''t mean you should never resubmit the request. Intermediary clearinghouses may send this code when they''ve temporarily lost connection to the payer, so this code indicates that you should wait at least a few minutes before retrying instead of retrying immediately. Payers may sometimes return other non-compliant values.' location: description: The location of the error within the original X12 EDI response. type: string possibleResolutions: description: 'Information to help you correct the error. We periodically update this guidance, so these strings may change at any time and may differ between eligibility responses. **Don''t build programmatic logic that depends on matching these strings exactly.**' type: string type: object EligibilityCheckDependentErrorCode: description: Payers may sometimes return other non-compliant values. enum: - '15' - '33' - '35' - '42' - '43' - '45' - '47' - '48' - '49' - '51' - '52' - '53' - '54' - '55' - '56' - '57' - '58' - '60' - '61' - '62' - '63' - '64' - '65' - '66' - '67' - '68' - '69' - '70' - '71' - '77' - '98' - AA - AE - AF - AG - AO - CI - E8 - IA - MA type: string EligibilityCheckError: description: When a payer rejects your eligibility check, the response contains one or more AAA errors that specify the reasons for the rejection and any recommended follow-up actions. [Learn more](https://www.stedi.com/docs/healthcare/eligibility-troubleshooting#payer-aaa-errors) properties: code: $ref: '#/components/schemas/EligibilityCheckErrorCode' description: 'The error code. Visit [Eligibility troubleshooting](https://www.stedi.com/docs/healthcare/eligibility-troubleshooting#payer-aaa-errors) for a complete list of all possible error codes and descriptions. Payers may sometimes return other non-compliant values.' description: description: The error description. type: string field: description: The error type, `AAA`. type: string followupAction: $ref: '#/components/schemas/EligibilityCheckFollowupAction' description: 'Recommended follow-up action based on the rejection reason code. **Note**: `Resubmission Not Allowed` doesn''t mean you should never resubmit the request. Intermediary clearinghouses may send this code when they''ve temporarily lost connection to the payer, so this code indicates that you should wait at least a few minutes before retrying instead of retrying immediately. Payers may sometimes return other non-compliant values.' location: description: The location of the error within the original X12 EDI response. type: string possibleResolutions: description: 'Information to help you correct the error. We periodically update this guidance, so these strings may change at any time and may differ between eligibility responses. **Don''t build programmatic logic that depends on matching these strings exactly.**' type: string type: object EligibilityCheckErrorCode: description: 'This is a superset of all the possible codes in the sub-loops, as all errors are bubbled up to the top level of the response Payers may sometimes return other non-compliant values.' enum: - '04' - '15' - '33' - '35' - '41' - '42' - '43' - '44' - '45' - '46' - '47' - '48' - '49' - '50' - '51' - '52' - '53' - '54' - '55' - '56' - '57' - '58' - '60' - '61' - '62' - '63' - '64' - '65' - '66' - '67' - '68' - '69' - '70' - '71' - '72' - '73' - '74' - '75' - '76' - '77' - '78' - '79' - '80' - '97' - '98' - AA - AE - AF - AG - AO - CI - E8 - IA - MA - T4 type: string EligibilityCheckFollowupAction: description: Payers may sometimes return other non-compliant values. enum: - Please Correct and Resubmit - Resubmission Not Allowed - Please Resubmit Original Transaction - Resubmission Allowed - Do Not Resubmit; Inquiry Initiated to a Third Party - Please Wait 30 Days and Resubmit - Please Wait 10 Days and Resubmit - Do Not Resubmit; We Will Hold Your Request and Respond Again Shortly type: string EligibilityCheckOutputValidationErrors: properties: controlNumber: deprecated: true description: An identifier for the payer's response. type: string eligibilitySearchId: description: 'An identifier that allows Stedi to group eligibility checks for the same patient into a unified record in the Stedi portal called an [eligibility search](https://www.stedi.com/docs/healthcare/eligibility-searches-view). This property is for use by Stedi tools only, such as Stedi''s MCP server.' type: string errors: description: 'When a payer rejects your eligibility check, the response contains one or more [`AAA` errors](https://www.stedi.com/docs/healthcare/eligibility-troubleshooting#payer-aaa-errors) that specify the reasons for the rejection and any recommended follow-up actions. Any errors that occur at the `payer`, `provider`, `subscriber`, or `dependents` levels are also included in this array, allowing you to review all errors in a central location. If there are no `AAA` errors, this array will be empty.' items: $ref: '#/components/schemas/EligibilityCheckError' type: array id: description: 'A globally unique identifier for this eligibility check across all Stedi accounts. It''s formatted as `ec_`. For example: `ec_550e8400-e29b-41d4-a716-446655440000`. You can use this ID to track this eligibility check and to construct deep links to eligibility checks in the Stedi portal.' type: string implementationTransactionSetSyntaxError: description: The implementation transaction set error code provided in `IK502` of the 999 transaction. type: string meta: $ref: '#/components/schemas/EligibilityMetaDataJSON' payer: $ref: '#/components/schemas/Payer' planDateInformation: $ref: '#/components/schemas/PlanDateInformation' planInformation: $ref: '#/components/schemas/PlanInformation' provider: $ref: '#/components/schemas/ResponseProvider' reassociationKey: deprecated: true type: string status: description: Errors Stedi encountered when generating or sending the final X12 EDI transaction to the payer. These can include validation errors and payer unavailable errors that prevent delivery. type: string subscriber: $ref: '#/components/schemas/ResponseSubscriber' subscriberTraceNumbers: description: 'A unique identifier for the eligibility request. It''s used to trace the transaction. Stedi always generates a trace number for internal tracking, and the payer may generate one as well. Stedi returns both its internal trace number and the payer''s trace number (if present) in this array. You can''t set your own trace number when submitting eligibility checks through this endpoint.' items: $ref: '#/components/schemas/SubscriberTraceNumber' type: array tradingPartnerServiceId: description: An ID for the payer you identified in the original eligibility check request. 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 transactionSetAcknowledgement: description: The transaction set acknowledgment code provided in in the [X12 EDI 999 response](https://portal.stedi.com/app/guides/view/hipaa/implementation-acknowledgment-x231/01HRF41ES1DVGCA6X1EHSRPFXZ#properties.heading.properties.transaction_set_response_header_AK2_loop.items.properties.transaction_set_response_trailer_IK5). type: string warnings: description: Warnings indicate non-fatal issues with your eligibility check or a non-standard response from the payer. items: $ref: '#/components/schemas/Warning' type: array x12: description: 'Typically this property contains the raw X12 EDI [271 Eligibility Benefit Response](https://portal.stedi.com/app/guides/view/hipaa/health-care-eligibility-benefit-response-x279a1/01GS66YHZPB37ABF34DBPSR213) from the payer. In some circumstances, this property may contain a [999 Implementation Acknowledgment](https://portal.stedi.com/app/guides/view/hipaa/implementation-acknowledgment-x231a1/01HMRQV0N8SPHG58M4ZG1CRHH0) instead of a 271. A 999 indicates validation errors in the X12 EDI transaction, such as improper formatting or missing or invalid values. If the 999 is returned in this property, many of the other response properties will be empty, as they are mapped to information in the 271.' type: string type: object EligibilityCheckPayerError: description: When a payer rejects your eligibility check, the response contains one or more `AAA` errors that specify the reasons for the rejection and any recommended follow-up actions. Common reasons for rejection at the `payer` level include issues with payer enrollment and that the payer's system is down or experiencing issues. [Learn more](https://www.stedi.com/docs/healthcare/eligibility-troubleshooting#payer-aaa-errors) properties: code: $ref: '#/components/schemas/EligibilityCheckPayerErrorCode' description: 'The error code. Payers may sometimes return other non-compliant values.' description: description: The error description. type: string field: description: The error type, `AAA`. type: string followupAction: $ref: '#/components/schemas/EligibilityCheckFollowupAction' description: 'Recommended follow-up action based on the rejection reason code. **Note**: `Resubmission Not Allowed` doesn''t mean you should never resubmit the request. Intermediary clearinghouses may send this code when they''ve temporarily lost connection to the payer, so this code indicates that you should wait at least a few minutes before retrying instead of retrying immediately. Payers may sometimes return other non-compliant values.' location: description: The location of the error within the original X12 EDI response. type: string possibleResolutions: description: 'Information to help you correct the error. We periodically update this guidance, so these strings may change at any time and may differ between eligibility responses. **Don''t build programmatic logic that depends on matching these strings exactly.**' type: string type: object EligibilityCheckPayerErrorCode: description: Payers may sometimes return other non-compliant values. enum: - '04' - '41' - '42' - '79' - '80' - T4 type: string EligibilityCheckProviderAndMemberFollowupAction: description: Payers may sometimes return other non-compliant values. enum: - Please Correct and Resubmit - Resubmission Not Allowed - Resubmission Allowed - Do Not Resubmit; Inquiry Initiated to a Third Party - Please Wait 30 Days and Resubmit - Please Wait 10 Days and Resubmit - Do Not Resubmit; We Will Hold Your Request and Respond Again Shortly type: string EligibilityCheckProviderError: description: When a payer rejects your eligibility check, the response contains one or more `AAA` errors that specify the reasons for the rejection and any recommended follow-up actions. Common reasons for rejection at the `provider` level include missing or incorrect information and issues with the provider's NPI registration with the payer. [Learn more](https://www.stedi.com/docs/healthcare/eligibility-troubleshooting#payer-aaa-errors) properties: code: $ref: '#/components/schemas/EligibilityCheckProviderErrorCode' description: 'The error code. Payers may sometimes return other non-compliant values.' description: description: The error description. type: string field: description: The error type, `AAA`. type: string followupAction: $ref: '#/components/schemas/EligibilityCheckProviderAndMemberFollowupAction' description: 'Recommended follow-up action based on the rejection reason code. **Note**: `Resubmission Not Allowed` doesn''t mean you should never resubmit the request. Intermediary clearinghouses may send this code when they''ve temporarily lost connection to the payer, so this code indicates that you should wait at least a few minutes before retrying instead of retrying immediately. Payers may sometimes return other non-compliant values.' location: description: The location of the error within the original X12 EDI response. type: string possibleResolutions: description: 'Information to help you correct the error. We periodically update this guidance, so these strings may change at any time and may differ between eligibility responses. **Don''t build programmatic logic that depends on matching these strings exactly.**' type: string type: object EligibilityCheckProviderErrorCode: description: Payers may sometimes return other non-compliant values. enum: - '15' - '41' - '43' - '44' - '45' - '46' - '47' - '48' - '50' - '51' - '79' - '97' - T4 type: string EligibilityCheckRequestContent: properties: controlNumber: deprecated: true description: Stedi generates a control number for each eligibility check, so you don’t need to include this property in your request. maxLength: 9 minLength: 9 type: string dependents: description: 'A dependent for which you want to retrieve benefits information. - You can only submit one dependent per eligibility check. - Only include the patient''s information here when they are listed as a dependent on the subscriber''s insurance plan AND the payer cannot uniquely identify them through information outside the subscriber''s policy. For example, if the dependent has their own member ID number, you should identify them in the `subscriber` object instead. This includes member IDs that differ only by a suffix, such as `01`, because the patient can still be uniquely identified. - Most Medicaid plans don''t support dependents, with a [few exceptions](https://www.stedi.com/docs/healthcare/send-eligibility-checks#medicaid-dependents). Sending this array to payers that don''t support dependents will either cause an error, or the payer may ignore the information and return results for the subscriber instead. - Each payer has different requirements, so you should supply the fields necessary for each payer to identify the dependent in their system. However, we **strongly recommend** including the dependent''s date of birth in the request when available because many payers return errors without it. - Enter the patient''s name exactly as written on their insurance card, if available, including any special or punctuation characters such as apostrophes, hyphens (dashes), or spaces. Visit [patient names](https://www.stedi.com/docs/healthcare/send-eligibility-checks#patient-names) for all best practices to avoid unnecessary failures.' items: $ref: '#/components/schemas/RequestDependent' maxItems: 1 minItems: 1 type: array eligibilitySearchId: description: 'An identifier that allows Stedi to group eligibility checks for the same patient into a unified record in the Stedi portal called an [eligibility search](https://www.stedi.com/docs/healthcare/eligibility-searches-view). This property is for use by Stedi tools only, such as Stedi''s MCP server.' type: string encounter: $ref: '#/components/schemas/Encounter' externalPatientId: description: A unique identifier for the patient that Stedi uses to identify and correlate historical eligibility checks for the same individual. We recommend including this value in all requests. maxLength: 36 type: string informationReceiverName: $ref: '#/components/schemas/InformationReceiverName' deprecated: true description: Use the corresponding properties in the `provider` object instead. portalPassword: description: The password that the provider uses to log in to the payer's portal. For payers Medicaid California, AltaMed, and Kern Family Health Care, this property is **required** and should be the [provider's PIN](https://www.stedi.com/docs/healthcare/eligibility-troubleshooting#portal-credentials). Otherwise, this is not commonly used. maxLength: 50 minLength: 1 type: string portalUsername: description: The username that the provider uses to log in to the payer's portal. This is not commonly used. maxLength: 50 minLength: 1 type: string provider: $ref: '#/components/schemas/Provider' description: "Information about the entity requesting the eligibility check.\ \ This may be an individual practitioner, a medical group, a hospital,\ \ or another type of healthcare provider.\n - You must provide the `organizationName`\ \ (if the entity is an organization), or `firstName` and `lastName` (if\ \ the provider is an individual).\n - You must also provide an identifier\ \ - this is typically the provider's [National Provider Identifier](https://www.stedi.com/docs/healthcare/national-provider-identifier)\ \ (`npi`). If the provider doesn't have an NPI, you can supply an alternative,\ \ such as their `taxId` or `ssn`.\n - Don't include additional properties,\ \ such as `taxId` or `address`, unless they are specifically required\ \ or suggested by the payer." submitterTransactionIdentifier: description: This property is only relevant for asynchronous batch eligibility checks. type: string subscriber: $ref: '#/components/schemas/RequestSubscriber' tradingPartnerName: description: The payer's name, such as Cigna or Aetna. maxLength: 60 minLength: 1 type: string 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`." maxLength: 80 minLength: 1 type: string required: - provider - subscriber - tradingPartnerServiceId type: object EligibilityCheckResponseContent: properties: benefitsInformation: description: "Information about the patient's healthcare benefits, such\ \ as coverage level (individual vs. family), coverage type (deductibles,\ \ co-pays, etc.), out of pocket maximums, and more. \n \n Payers typically\ \ return at least the following properties: `code`, `coverageLevelCode`,\ \ `serviceTypeCodes`, and either `benefitAmount` or `benefitPercent`.\ \ However, the exact properties returned in this object are up to the\ \ payer's discretion.\n\nThe payer may send benefits information for service\ \ type codes (STCs) you didn't request - this is expected. The STC you\ \ send in the request tells the payer the types of benefits information\ \ you want, but they aren't required to respond with exactly the same\ \ STC(s) in the response. Receiving different STCs than you requested\ \ can also mean that the payer is ignoring the STC you sent, which is\ \ why we recommend [testing payers](https://www.stedi.com/docs/healthcare/eligibility-stc-procedure-codes#test-payer-stc-support)\ \ to determine their support for specific STCs.\n\nVisit [Determine patient\ \ benefits](https://www.stedi.com/docs/healthcare/eligibility-active-coverage-benefits)\ \ for more information about benefit types, details about how to interpret\ \ the `benefitsInformation` array, and additional examples." items: $ref: '#/components/schemas/BenefitsInformation' type: array controlNumber: deprecated: true description: An identifier for the payer's response. type: string dependents: description: "Information about the patient when they are a dependent. When\ \ the patient is a dependent, this array will contain a single object\ \ with the patient's information. When the patient is a subscriber, or\ \ considered to be a subscriber because they have a unique member ID,\ \ their information is returned in the `subscriber` object, and this array\ \ will be empty.\n\n When present, this object will always include the\ \ dependent's name for identification, but many payers will also return\ \ the date of birth and other identifying information." items: $ref: '#/components/schemas/ResponseDependent' type: array eligibilitySearchId: description: 'An identifier that allows Stedi to group eligibility checks for the same patient into a unified record in the Stedi portal called an [eligibility search](https://www.stedi.com/docs/healthcare/eligibility-searches-view). This property is for use by Stedi tools only, such as Stedi''s MCP server.' type: string errors: description: 'When a payer rejects your eligibility check, the response contains one or more [`AAA` errors](https://www.stedi.com/docs/healthcare/eligibility-troubleshooting#payer-aaa-errors) that specify the reasons for the rejection and any recommended follow-up actions. Any errors that occur at the `payer`, `provider`, `subscriber`, or `dependents` levels are also included in this array, allowing you to review all errors in a central location. If there are no `AAA` errors, this array will be empty.' items: $ref: '#/components/schemas/EligibilityCheckError' type: array id: description: 'A globally unique identifier for this eligibility check across all Stedi accounts. It''s formatted as `ec_`. For example: `ec_550e8400-e29b-41d4-a716-446655440000`. You can use this ID to track this eligibility check and to construct deep links to eligibility checks in the Stedi portal.' type: string implementationTransactionSetSyntaxError: description: The implementation transaction set error code provided in `IK502` of the 999 transaction. type: string meta: $ref: '#/components/schemas/EligibilityMetaDataJSON' payer: $ref: '#/components/schemas/Payer' planDateInformation: $ref: '#/components/schemas/PlanDateInformation' planInformation: $ref: '#/components/schemas/PlanInformation' planStatus: deprecated: true description: Please use `benefitsInformation` instead. items: $ref: '#/components/schemas/PlanStatus' deprecated: true type: array provider: $ref: '#/components/schemas/ResponseProvider' reassociationKey: deprecated: true type: string status: description: Errors Stedi encountered when generating or sending the final X12 EDI transaction to the payer. These can include validation errors and payer unavailable errors that prevent delivery. type: string subscriber: $ref: '#/components/schemas/ResponseSubscriber' subscriberTraceNumbers: description: 'A unique identifier for the eligibility request. It''s used to trace the transaction. Stedi always generates a trace number for internal tracking, and the payer may generate one as well. Stedi returns both its internal trace number and the payer''s trace number (if present) in this array. You can''t set your own trace number when submitting eligibility checks through this endpoint.' items: $ref: '#/components/schemas/SubscriberTraceNumber' type: array tradingPartnerServiceId: description: An ID for the payer you identified in the original eligibility check request. 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 transactionSetAcknowledgement: description: The transaction set acknowledgment code provided in in the [X12 EDI 999 response](https://portal.stedi.com/app/guides/view/hipaa/implementation-acknowledgment-x231/01HRF41ES1DVGCA6X1EHSRPFXZ#properties.heading.properties.transaction_set_response_header_AK2_loop.items.properties.transaction_set_response_trailer_IK5). type: string warnings: description: Warnings indicate non-fatal issues with your eligibility check or a non-standard response from the payer. items: $ref: '#/components/schemas/Warning' type: array x12: description: 'Typically this property contains the raw X12 EDI [271 Eligibility Benefit Response](https://portal.stedi.com/app/guides/view/hipaa/health-care-eligibility-benefit-response-x279a1/01GS66YHZPB37ABF34DBPSR213) from the payer. In some circumstances, this property may contain a [999 Implementation Acknowledgment](https://portal.stedi.com/app/guides/view/hipaa/implementation-acknowledgment-x231a1/01HMRQV0N8SPHG58M4ZG1CRHH0) instead of a 271. A 999 indicates validation errors in the X12 EDI transaction, such as improper formatting or missing or invalid values. If the 999 is returned in this property, many of the other response properties will be empty, as they are mapped to information in the 271.' type: string type: object EligibilityCheckSubscriberError: description: When a payer rejects your eligibility check, the response contains one or more `AAA` errors that specify the reasons for the rejection and any recommended follow-up actions. Common reasons for rejection at the `subscriber` or `dependent` level include missing or incorrect identifying information and that the payer was unable to locate the patient in their system. [Learn more](https://www.stedi.com/docs/healthcare/eligibility-troubleshooting#payer-aaa-errors) properties: code: $ref: '#/components/schemas/EligibilityCheckSubscriberErrorCode' description: 'The error code. Payers may sometimes return other non-compliant values.' description: description: The error description. type: string field: description: The error type, `AAA`. type: string followupAction: $ref: '#/components/schemas/EligibilityCheckProviderAndMemberFollowupAction' description: 'Recommended follow-up action based on the rejection reason code. **Note**: `Resubmission Not Allowed` doesn''t mean you should never resubmit the request. Intermediary clearinghouses may send this code when they''ve temporarily lost connection to the payer, so this code indicates that you should wait at least a few minutes before retrying instead of retrying immediately. Payers may sometimes return other non-compliant values.' location: description: The location of the error within the original X12 EDI response. type: string possibleResolutions: description: 'Information to help you correct the error. We periodically update this guidance, so these strings may change at any time and may differ between eligibility responses. **Don''t build programmatic logic that depends on matching these strings exactly.**' type: string type: object EligibilityCheckSubscriberErrorCode: description: Payers may sometimes return other non-compliant values. enum: - '15' - '33' - '35' - '42' - '43' - '45' - '47' - '48' - '49' - '51' - '52' - '53' - '54' - '55' - '56' - '57' - '58' - '60' - '61' - '62' - '63' - '69' - '70' - '71' - '72' - '73' - '74' - '75' - '76' - '78' - '98' - AA - AE - AF - AG - AO - CI - E8 - IA - MA type: string EligibilityInquiryEnrollmentProcess: description: Details about the enrollment process for eligibility checks. properties: requestedEffectiveDate: $ref: '#/components/schemas/RequestedEffectiveDate' description: "Whether this payer supports specifying a requested effective\ \ date for transaction enrollments.\n - If set to `SUPPORTED`, Stedi\ \ will process [transaction enrollment requests](https://www.stedi.com/docs/healthcare/api-reference/post-enrollment-create-enrollment)\ \ for this payer according to their specified `requestedEffectiveDate`.\n\ \ - This property is only returned when Stedi can determine whether the\ \ payer supports requested effective dates." timeframe: $ref: '#/components/schemas/EnrollmentProcessTimeframe' type: $ref: '#/components/schemas/EnrollmentProcessType' type: object EligibilityMetaDataJSON: description: Metadata about the response. Stedi uses this data for tracking and troubleshooting. properties: applicationMode: $ref: '#/components/schemas/ApplicationModes' description: 'The type of data in the request. This is either `production` when you send a request with a standard API key or `test` when you send a request in test mode with a [test API key](https://www.stedi.com/docs/api-reference/index#api-key-types). The `information` value is not currently used. Payers may sometimes return other non-compliant values.' billerId: description: The biller ID Stedi assigns to this request. type: string outboundTraceId: description: 'A unique identifier Stedi assigns to this check. Instead of this property, we recommend using `id` to identify and track eligibility checks. An eligibility check''s `id` is guaranteed to be globally unique, and you can use it to deep link to the eligibility check''s results within the Stedi portal.' type: string senderId: description: The sender ID Stedi assigns to this request. type: string submitterId: description: The submitter ID Stedi assigns to this request. type: string traceId: description: The transaction identifier the payer sends in the response. This should be the same as the `outboundTraceId`. type: string type: object EligibilityMetaDataRawX12: description: Metadata about the response. Stedi uses this data for tracking and troubleshooting. properties: applicationMode: $ref: '#/components/schemas/ApplicationModes' description: 'The type of data in the request. This is either `production` when you send a request with a standard API key or `test` when you send a request in test mode with a [test API key](https://www.stedi.com/docs/api-reference/index#api-key-types). The `information` value is not currently used. Payers may sometimes return other non-compliant values.' billerId: description: The biller ID Stedi assigns to this request. type: string outboundTraceId: description: The transaction identifier in the request's `BHT03` element. This identifier isn't guaranteed to be globally unique. We recommend using the `id` property to identify and track eligibility checks instead. type: string senderId: description: The sender ID Stedi assigns to this request. type: string submitterId: description: The submitter ID Stedi assigns to this request. type: string traceId: description: The transaction identifier in the response's `BHT03` element. This should be the same as the `outboundTraceId`. type: string type: object EligibilityRawX12Check400ErrorResponseContent: oneOf: - $ref: '#/components/schemas/RawEligibilityResponseValidationErrors' - $ref: '#/components/schemas/ValidationException' EligibilityRawX12CheckRequestContent: properties: eligibilitySearchId: description: 'An identifier that allows Stedi to group eligibility checks for the same patient into a unified record in the Stedi portal called an [eligibility search](https://www.stedi.com/docs/healthcare/eligibility-searches-view). This property is for use by Stedi tools only, such as Stedi''s MCP server.' type: string externalPatientId: description: A unique identifier for the patient that Stedi uses to identify and correlate historical eligibility checks for the same individual. We recommend including this value in all requests. maxLength: 36 type: string x12: type: string required: - x12 type: object EligibilityRawX12CheckResponseContent: properties: benefitsInformation: description: "Information about the patient's healthcare benefits, such\ \ as coverage level (individual vs. family), coverage type (deductibles,\ \ co-pays, etc.), out of pocket maximums, and more. \n \n Payers typically\ \ return at least the following properties: `code`, `coverageLevelCode`,\ \ `serviceTypeCodes`, and either `benefitAmount` or `benefitPercent`.\ \ However, the exact properties returned in this object are up to the\ \ payer's discretion.\n\nThe payer may send benefits information for service\ \ type codes (STCs) you didn't request - this is expected. The STC you\ \ send in the request tells the payer the types of benefits information\ \ you want, but they aren't required to respond with exactly the same\ \ STC(s) in the response. Receiving different STCs than you requested\ \ can also mean that the payer is ignoring the STC you sent, which is\ \ why we recommend [testing payers](https://www.stedi.com/docs/healthcare/eligibility-stc-procedure-codes#test-payer-stc-support)\ \ to determine their support for specific STCs.\n\nVisit [Determine patient\ \ benefits](https://www.stedi.com/docs/healthcare/eligibility-active-coverage-benefits)\ \ for more information about benefit types, details about how to interpret\ \ the `benefitsInformation` array, and additional examples." items: $ref: '#/components/schemas/BenefitsInformation' type: array controlNumber: deprecated: true description: An identifier for the payer's response. type: string dependents: description: "Information about the patient when they are a dependent. When\ \ the patient is a dependent, this array will contain a single object\ \ with the patient's information. When the patient is a subscriber, or\ \ considered to be a subscriber because they have a unique member ID,\ \ their information is returned in the `subscriber` object, and this array\ \ will be empty.\n\n When present, this object will always include the\ \ dependent's name for identification, but many payers will also return\ \ the date of birth and other identifying information." items: $ref: '#/components/schemas/ResponseDependent' type: array eligibilitySearchId: description: 'An identifier that allows Stedi to group eligibility checks for the same patient into a unified record in the Stedi portal called an [eligibility search](https://www.stedi.com/docs/healthcare/eligibility-searches-view). This property is for use by Stedi tools only, such as Stedi''s MCP server.' type: string errors: description: 'When a payer rejects your eligibility check, the response contains one or more [`AAA` errors](https://www.stedi.com/docs/healthcare/eligibility-troubleshooting#payer-aaa-errors) that specify the reasons for the rejection and any recommended follow-up actions. Any errors that occur at the `payer`, `provider`, `subscriber`, or `dependents` levels are also included in this array, allowing you to review all errors in a central location. If there are no `AAA` errors, this array will be empty.' items: $ref: '#/components/schemas/EligibilityCheckError' type: array id: description: 'A globally unique identifier for this eligibility check across all Stedi accounts. It''s formatted as `ec_`. For example: `ec_550e8400-e29b-41d4-a716-446655440000`. You can use this ID to track this eligibility check and to construct deep links to eligibility checks in the Stedi portal.' type: string implementationTransactionSetSyntaxError: description: The implementation transaction set error code provided in `IK502` of the 999 transaction. type: string meta: $ref: '#/components/schemas/EligibilityMetaDataRawX12' payer: $ref: '#/components/schemas/Payer' planDateInformation: $ref: '#/components/schemas/PlanDateInformation' planInformation: $ref: '#/components/schemas/PlanInformation' planStatus: deprecated: true description: Please use `benefitsInformation` instead. items: $ref: '#/components/schemas/PlanStatus' deprecated: true type: array provider: $ref: '#/components/schemas/ResponseProvider' reassociationKey: deprecated: true type: string status: description: Errors Stedi encountered when generating or sending the final X12 EDI transaction to the payer. These can include validation errors and payer unavailable errors that prevent delivery. type: string subscriber: $ref: '#/components/schemas/ResponseSubscriber' subscriberTraceNumbers: description: 'A unique identifier for the eligibility request. It''s used to trace the transaction. Stedi always generates a trace number for internal tracking, and the payer may generate one as well. You can also optionally [supply your own trace number](https://www.stedi.com/docs/healthcare/send-eligibility-checks#trn) in a `TRN` segment. Stedi returns its internal trace number in this array as well as the trace numbers from you and the payer (if provided).' items: $ref: '#/components/schemas/SubscriberTraceNumber' type: array tradingPartnerServiceId: description: An ID for the payer you identified in the original eligibility check request. 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 transactionSetAcknowledgement: description: The transaction set acknowledgment code provided in in the [X12 EDI 999 response](https://portal.stedi.com/app/guides/view/hipaa/implementation-acknowledgment-x231/01HRF41ES1DVGCA6X1EHSRPFXZ#properties.heading.properties.transaction_set_response_header_AK2_loop.items.properties.transaction_set_response_trailer_IK5). type: string warnings: description: Warnings indicate non-fatal issues with your eligibility check or a non-standard response from the payer. items: $ref: '#/components/schemas/Warning' type: array x12: description: 'Typically this property contains the raw X12 EDI [271 Eligibility Benefit Response](https://portal.stedi.com/app/guides/view/hipaa/health-care-eligibility-benefit-response-x279a1/01GS66YHZPB37ABF34DBPSR213) from the payer. In some circumstances, this property may contain a [999 Implementation Acknowledgment](https://portal.stedi.com/app/guides/view/hipaa/implementation-acknowledgment-x231a1/01HMRQV0N8SPHG58M4ZG1CRHH0) instead of a 271. A 999 indicates validation errors in the X12 EDI transaction, such as improper formatting or missing or invalid values. If the 999 is returned in this property, many of the other response properties will be empty, as they are mapped to information in the 271.' type: string 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 EmploymentStatusCode: description: Payers may sometimes return other non-compliant values. enum: - AE - AO - AS - AT - AU - CC - DD - HD - IR - LX - PE - RE - RM - RR - RU type: string Encounter: description: 'Details about the eligibility or benefit information you are requesting for the patient. - If you don''t specify either `serviceTypeCodes` or a `procedureCode` and `productOrServiceIDQualifier`, Stedi defaults to using `30` (Plan coverage and general benefits) as the only `serviceTypeCodes` value. - You can specify either a single `dateOfService` or a `beginningDateOfService` and `endDateOfService`. The payer defaults to using the current date in their timezone if you don''t include one. - When checking eligibility for today, omit the `dateOfService` property to ensure consistent behavior across payers. - We recommend submitting dates up to 12 months in the past or up to the end of the current month. Payers aren''t required to support dates outside these ranges. However, some payers such as the Centers for Medicare and Medicaid Services (CMS) do support requests for dates further in the future - especially the next calendar month. Check the payer''s documentation to determine their specific behavior.' properties: beginningDateOfService: description: The beginning date of service. If you include this value, you must also include the `endDateOfService`. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string dateOfService: description: The date of service. You can use this value to specify a single occasion, such as a doctor's visit. If you don't specify a service date (either a single day or a range of dates), the payer defaults to using the current date in their timezone. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string diagnosisCodePointer: description: Diagnosis code pointers in order of importance to the service. These pointers are an index to the ICD-10 codes you included in the `subscriber.healthCareCodeInformation` or `dependents.healthCareCodeInformation` object arrays. The pointer values can be from 1 - 8 (integer numbers). If you are including diagnosis codes, you **must** set at least one pointer here for the primary diagnosis. Then, you can add up to three additional pointers (up to four in total). Don't put ICD-10 codes here. items: type: string maxItems: 4 minItems: 1 type: array endDateOfService: description: The end date of service. If you include this value, you must also include the `beginningDateOfService`. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string industryCode: $ref: '#/components/schemas/IndustryCode' medicalProcedures: description: Use only when you need to send multiple procedure codes in a single request. Otherwise, use the `encounter.procedureCode` and `encounter.productOrServiceIDQualifier` properties. items: $ref: '#/components/schemas/MedicalProcedure' maxItems: 98 minItems: 1 type: array priorAuthorizationOrReferralNumber: description: The prior authorization or referral number for a particular benefit or procedure. type: string procedureCode: description: The procedure code. maxLength: 48 minLength: 1 type: string procedureModifiers: description: The procedure modifier that provides additional information related to the performance of the service. items: type: string maxItems: 4 minItems: 1 type: array productOrServiceIDQualifier: $ref: '#/components/schemas/EncounterProductOrServiceIDQualifier' referenceIdentificationQualifier: $ref: '#/components/schemas/EncounterReferenceIdentificationQualifier' serviceTypeCodes: description: 'One or more codes classifying the type of services for which you want to receive benefits information. If you don''t specify a service type code or a `procedureCode` and `productOrServiceIDQualifier`, Stedi defaults to using `30` - Health Benefit Plan Coverage. Visit [Service Type Codes](https://www.stedi.com/docs/healthcare/eligibility-stc-procedure-codes#full-stc-list) for a complete list. Not all payers support all service type codes, and not all payers support multiple service type codes in the same request. We recommend including one service type code per request unless you''re sure the payer supports multiple. Payers aren''t required to respond with exactly the same STC(s) in the response, so you may receive benefits information for STCs you didn''t request. However, receiving different STCs can mean that the payer is ignoring the STC you sent, which is why we recommend [testing payers](https://www.stedi.com/docs/healthcare/eligibility-stc-procedure-codes#test-payer-stc-support) to determine their support for specific STCs.' items: $ref: '#/components/schemas/RequestEligibilityServiceTypeCode' maxItems: 99 minItems: 1 type: array type: object EncounterProductOrServiceIDQualifier: description: Code identifying the type/source of the `procedureCode`. You can set this to `AD` - American Dental Association Codes, `CJ` - Current Procedural Terminology (CPT) Codes, `HC` - Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes, `ID` - International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) - Procedure, `IV` - Home Infusion EDI Coalition (HIEC) Product/Service Code, `N4` - National Drug Code in 5-4-2 Format, or `ZZ` - Mutually Defined. enum: - AD - CJ - HC - ID - IV - N4 - ZZ type: string EncounterReferenceIdentificationQualifier: description: The type of information you provided in the `priorAuthorizationOrReferralNumber` property. You can set this to `9F` - Referral Number or `G1` - Prior Authorization Number. enum: - 9F - G1 type: string EnrollmentInfo: description: Information about enrollment requirements for the payer properties: ptanRequired: description: 'Whether a PTAN (Provider Transaction Access Number) is required for transaction enrollment. The Provider Transaction Access Number (PTAN) is a Medicare-issued number given to providers upon enrollment with Medicare. This number is usually six digits and is assigned based on the type of service and the location of the provider. Upon enrollment, Medicare Administrating Contracting (MAC) providers should receive their assigned PTAN number in their approval letter.' type: boolean transactionEnrollmentProcesses: $ref: '#/components/schemas/TransactionEnrollmentProcesses' description: 'Enrollment details for specific transaction types. Stedi only returns this object when information about the enrollment process is available for one or more transaction types. When this object isn''t included in the response, it **doesn''t** mean no transaction types require enrollment. Refer to the `transactionSupport` object for details about which transaction types require enrollment.' type: object EnrollmentProcessTimeframe: description: Stedi's expected timeframe for completing the transaction enrollment process. `INSTANT` indicates that the enrollment will be in `LIVE` status within minutes of submitting the request. enum: - INSTANT - HOURS - DAYS - WEEKS type: string EnrollmentProcessType: description: "Whether transaction enrollment is single or multi-step.\n - `ONE_CLICK`\ \ indicates that once you submit the transaction enrollment request, Stedi\ \ can complete the rest of the enrollment process without any further action\ \ from you.\n - `MULTI_STEP` indicates that you must complete additional\ \ steps to finish the enrollment process. Customer support will reach out\ \ with clear instructions explaining how to complete any remaining steps." enum: - ONE_CLICK - MULTI_STEP type: string Entity: description: Entity descriptions corresponding to Entity Identifier codes. enum: - Health Maintenance Organization (HMO) - Oncology Center - Kidney Dialysis Unit - Preferred Provider Organization (PPO) - Acute Care Hospital - Provider - Military Facility - University, College or School - Outpatient Surgicenter - Physician, Clinic or Group Practice - Long Term Care Facility - Extended Care Facility - Psychiatric Health Facility - Laboratory - Retail Pharmacy - Home Health Care - Federal, State, County or City Facility - Third-Party Administrator - Miscellaneous Health Care Facility - Non-Health Care Miscellaneous Facility - Church Operated Facility - Partnership - Public Health Service Facility - Veterans Administration Facility - Public Health Service Indian Service Facility - Hospital Unit of an Institution (prison hospital, college infirmary, etc.) - Dependent - Hospital Unit Within an Institution for the Mentally Retarded - Tuberculosis and Other Respiratory Diseases Facility - Obstetrics and Gynecology Facility - Eye, Ear, Nose and Throat Facility - Rehabilitation Facility - Orthopedic Facility - Chronic Disease Facility - Other Specialty Facility - Children's General Facility - Children's Hospital Unit of an Institution - Children's Psychiatric Facility - Children's Tuberculosis and Other Respiratory Diseases Facility - Children's Eye, Ear, Nose and Throat Facility - Children's Rehabilitation Facility - Children's Orthopedic Facility - Children's Chronic Disease Facility - Children's Other Specialty Facility - Institution for Mental Retardation - Alcoholism and Other Chemical Dependency Facility - General Inpatient Care for AIDS/ARC Facility - AIDS/ARC Unit - Specialized Outpatient Program for AIDS/ARC - Alcohol/Drug Abuse or Dependency Inpatient Unit - Alcohol/Drug Abuse or Dependency Outpatient Services - Arthritis Treatment Center - Birthing Room/LDRP Room - Burn Care Unit - Cardiac Catherization Laboratory - Open-Heart Surgery Facility - Cardiac Intensive Care Unit - Angioplasty Facility - Chronic Obstructive Pulmonary Disease Service Facility - Emergency Department - Trauma Center (Certified) - Extracorporeal Shock-Wave Lithotripter (ESWL) Unit - Genetic Counseling/Screening Services - Adult Day Care Program Facility - Alzheimer's Diagnostic/Assessment Services - Comprehensive Geriatric Assessment Facility - Emergency Response (Geriatric) Unit - Geriatric Acute Care Unit - Geriatric Clinics - Respite Care Facility - Patient Education Unit - Community Health Promotion Facility - Worksite Health Promotion Facility - Hemodialysis Facility - Home Health Services - Hospice - Medical Surgical or Other Intensive Care Unit - Histopathology Laboratory - Blood Bank - Neonatal Intensive Care Unit - Obstetrics Unit - Occupational Health Services - Organized Outpatient Services - Pediatric Acute Inpatient Unit - Psychiatric Child/Adolescent Services - Psychiatric Consultation-Liaison Services - Psychiatric Education Services - Psychiatric Emergency Services - Psychiatric Geriatric Services - Psychiatric Inpatient Unit - Psychiatric Outpatient Services - Psychiatric Partial Hospitalization Program - Megavoltage Radiation Therapy Unit - Radioactive Implants Unit - Therapeutic Radioisotope Facility - X-Ray Radiation Therapy Unit - CT Scanner Unit - Diagnostic Radioisotope Facility - Magnetic Resonance Imaging (MRI) Facility - Ultrasound Unit - Rehabilitation Inpatient Unit - Rehabilitation Outpatient Services - Reproductive Health Services - Skilled Nursing or Other Long-Term Care Unit - Single Photon Emission Computerized Tomography (SPECT) Unit - Organized Social Work Service Facility - Outpatient Social Work Services - Emergency Department Social Work Services - Sports Medicine Clinic/Services - Hospital Auxiliary Unit - Patient Representative Services - Volunteer Services Department - Outpatient Surgery Services - Organ/Tissue Transplant Unit - Orthopedic Surgery Facility - Occupational Therapy Services - Physical Therapy Services - Recreational Therapy Services - Respiratory Therapy Services - Speech Therapy Services - Women's Health Center/Services - Cardiac Rehabilitation Program Facility - Non-Invasive Cardiac Assessment Services - Emergency Medical Technician - Disciplinary Contact - Case Manager - Place of Occurrence - Contracted Service Provider - Consultant's Office - Subcontractor - Service Supplier - Employer - Receiver - Claimant Authorized Representative - Data Processing Service Bureau - Performed At - Attending Physician - Operating Physician - Other Physician - Corrected Insured - Service Location - Hospital - Rendering Provider - Subscriber's Employer - Billing Provider - Pay-to Provider - Research Institute - Pharmacist - Admitting Surgeon - Commercial Insurer - Assistant Surgeon - Consulting Physician - Ordering Physician - Referring Provider - Dependent Name - Supervising Physician - Person or Other Entity Legally Responsible for a Child - Person or Other Entity With Whom a Child Resides - Previous Employer - Participating Laboratory - Facility - Physical Address - Mail Address - Dependent Insured - Clinic - Other Insured - Guardian - Paramedic - Paramedical Company - Previous Insured - Spouse Insured - Treatment Facility - Healthcare Professional Shortage Area (HPSA) Facility - Home Health Agency - Independent Physicians Association (IPA) - Injection Point - Insured or Subscriber - Insurer - Independent Lab - Legal Representative - Medical Insurance Carrier - Mammography Screening Center - Ordered By - Doctor of Optometry - Oxygen Therapy Facility - Patient Facility - Primary Insured or Subscriber - Primary Care Provider - Prior Insurance Carrier - Third Party Reviewing Preferred Provider Organization (PPO) - Third Party Repricing Preferred Provider Organization (PPO) - Primary Payer - Party to Receive Test Report - Party performing certification - Pickup Address - Pharmacy - Purchase Service Provider - Patient - Responsible Party - Policyholder - Physician - Managed Care - Chiropractor - Dentist - Doctor of Osteopathy - Podiatrist - Group Practice - Medical Doctor - Receiving Location - Rural Health Clinic - Skilled Nursing Facility - Secondary Payer - Service Provider - Supplier/Manufacturer - Transfer Point - Testing Laboratory - Third Party Reviewing Organization (TPO) - Transfer To - Tertiary Payer - Third Party Repricing Organization (TPO) - Nursing Home - Utilization Management Organization - Spouse - Durable Medical Equipment Supplier - Mutually Defined type: string EntityCode: description: Entity Identifier codes used to identify organizational entities, physical locations, properties, or individuals. enum: - 1E - 1G - 1H - 1I - 1O - 1P - 1Q - 1R - 1S - 1T - 1U - 1V - 1W - 1X - 1Y - 1Z - 2A - 2B - 2D - 2E - 2I - 2K - 2P - 2Q - 2S - 2Z - '03' - 3A - 3C - 3D - 3E - 3F - 3G - 3H - 3I - 3J - 3K - 3L - 3M - 3N - 3O - 3P - 3Q - 3R - 3S - 3T - 3U - 3V - 3W - 3X - 3Y - 3Z - 4A - 4B - 4C - 4D - 4E - 4F - 4G - 4H - 4I - 4J - 4L - 4M - 4N - 4O - 4P - 4Q - 4R - 4S - 4U - 4V - 4W - 4X - 4Y - 4Z - 5A - 5B - 5C - 5D - 5E - 5F - 5G - 5H - 5I - 5J - 5K - 5L - 5M - 5N - 5O - 5P - 5Q - 5R - 5S - 5T - 5U - 5V - 5W - 5X - 5Y - 5Z - 6A - 6B - 6C - 6D - 6E - 6F - 6G - 6H - 6I - 6J - 6K - 6L - 6M - 6N - 6O - 6P - 6Q - 6R - 6S - 6U - 6V - 6W - 6X - 6Y - 7C - '13' - '17' - '28' - '30' - '36' - '40' - '43' - '44' - '61' - '71' - '72' - '73' - '74' - '77' - '80' - '82' - '84' - '85' - '87' - '95' - CK - CZ - D2 - DD - DJ - DK - DN - DO - DQ - E1 - E2 - E7 - E9 - FA - FD - FE - G0 - G3 - GB - GD - GI - GJ - GK - GM - GY - HF - HH - I3 - IJ - IL - IN - LI - LR - MR - MSC - OB - OD - OX - P0 - P2 - P3 - P4 - P6 - P7 - PRP - PT - PV - PW - QA - QB - QC - QD - QE - QH - QK - QL - QN - QO - QS - QV - QY - RC - RW - S4 - SEP - SJ - SU - T4 - TL - TQ - TT - TTP - TU - UH - X3 - X4 - X5 - ZZ type: string EntityIdentificationCode: description: Code identifying the type of `entityIdentificationValue`. enum: - MI - PI type: string EntityIdentifierName: description: Identifies the type of `benefitsInformation[].benefitsRelatedEntities`. enum: - Insured or Subscriber - Payer - Primary Payer - Secondary Payer - Tertiary Payer type: string EntityTypeQualifier: description: 'The type of entity. Payers may sometimes return other non-compliant values.' enum: - Person - Non-Person Entity 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 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 EpsdtReferralConditionCodesItem: enum: - AV - NU - S2 - ST type: string ErrorDetail: properties: code: description: The error code. type: string description: description: The description of the error code. type: string field: description: The attribute that caused the error. type: string followupAction: description: Follow-up actions to correct the error. type: string location: description: Where the error occurred within the request syntax. If this is a network or system error, there is no location attribute. type: string value: description: The value that caused the error. type: string type: object ErrorResponse: properties: code: type: string description: type: string errors: items: $ref: '#/components/schemas/ErrorDetail' type: array transactionIdentifier: $ref: '#/components/schemas/TransactionIdentifier' type: object ExportPDF400ErrorResponseContent: oneOf: - $ref: '#/components/schemas/MissingParameter' - $ref: '#/components/schemas/ValidationException' ExportPDF403ErrorResponseContent: oneOf: - $ref: '#/components/schemas/MaximumResponseSizeExceeded' - $ref: '#/components/schemas/AccessDeniedException' ExportPDF404ErrorResponseContent: oneOf: - $ref: '#/components/schemas/NoTransactionsFound' - $ref: '#/components/schemas/ResourceNotFoundException' 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 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 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 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 Failure: description: Currently not used. properties: code: type: string description: type: string type: object FamilyPlanningIndicator: description: Code indicating whether the service was related to family planning. Can be set to `Y` - Yes. enum: - Y 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 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 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 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 Gender: enum: - M - F type: string GenderWithUnknown: enum: - M - F - U type: string GetElectronicRemittanceAdvicePdfOutputPayload: contentEncoding: byte description: 'A binary blob containing the Electronic Remittance Advice (ERA) PDF. You MUST send the ''accept: application/pdf'' header to get back the pdf content. Otherwise, the response will be base64-encoded and you must first decode it. To render the PDF, you must save the output to a file with a `.pdf` extension.' type: string GetInsuranceDiscoveryCheckResponseContent: properties: coveragesFound: description: The number of potential coverage matches for the patient. This will be `0` if Stedi didn't find any matching coverage. type: integer discoveryId: description: A unique ID for this insurance discovery check. You can use it to retrieve the results asynchronously through the [Insurance Discovery Check Results](https://www.stedi.com/docs/healthcare/api-reference/get-insurance-discovery-results) endpoint. type: string errors: description: 'When a payer rejects your eligibility check, the response contains one or more [`AAA` errors](https://www.stedi.com/docs/healthcare/eligibility-troubleshooting#payer-aaa-errors) that specify the reasons for the rejection and any recommended follow-up actions. Any errors that occur at the `payer`, `provider`, `subscriber`, or `dependents` levels are also included in this array, allowing you to review all errors in a central location. If there are no `AAA` errors, this array will be empty.' items: $ref: '#/components/schemas/EligibilityCheckError' type: array items: description: An array of potential coverage matches for the patient. This will only be populated if the insurance discovery check `status` is `COMPLETE`. Each item in the array contains information about a potential match, including the provider, subscriber, payer, and plan information. items: $ref: '#/components/schemas/InsuranceDiscoveryResponseFields' type: array meta: $ref: '#/components/schemas/InsuranceDiscoveryMetadata' status: $ref: '#/components/schemas/DiscoveryStatus' description: "The status of the discovery check. This is either `PENDING`\ \ or `COMPLETE`.\n - If the status is `COMPLETE`, the `items` array\ \ will contain any potential coverage matches Stedi found for the patient.\n\ \ - If the status is `PENDING`, the check is still in progress. You\ \ can immediately begin polling the [Insurance Discovery Check Results](https://www.stedi.com/docs/healthcare/api-reference/get-insurance-discovery-results)\ \ endpoint to retrieve the results asynchronously." warnings: description: Issues with your insurance discovery check that may affect the results. For example, Stedi issues a warning when enrolling with a payer would improve the results for future requests. items: $ref: '#/components/schemas/Warning' type: array 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 GetPayerRecordResponseContent: properties: payer: $ref: '#/components/schemas/PayerRecord' description: The payer record matching the provided Stedi payer ID. The record includes the payer's display name and aliases as well as supported transaction types and details about the payer's [transaction enrollment](https://www.stedi.com/docs/healthcare/transaction-enrollment) process. required: - payer type: object GovernmentServiceAffiliationCode: description: Payers may sometimes return other non-compliant values. enum: - A - B - C - D - E - F - G - H - I - J - K - L - M - N - O - Q - R - S - U - W type: string HealthCareCheckRemarkCodes: description: Standard codes used to communicate informational remarks. properties: codeListQualifierCode: description: Code identifying the specific industry code list containing the `remarkCode`. Can be `HE` - Claim Payment Remark Codes or `RX` - National Council for Prescription Drug Programs Reject/Payment Codes. type: string codeListQualifierCodeValue: description: The description of the `codeListQualifierCode`. Can be `Claim Payment Remark Codes` or `National Council for Prescription Drug Programs Reject/Payment Codes`. type: string remark: description: The human readable description of the remark code. type: string remarkCode: description: 'The code identifying the specific remark. This property can either be a [Remittance Advice Remark Code (RARC)](https://x12.org/codes/remittance-advice-remark-codes) (`codeListQualifierCode` set to `HE`) or a National Council for Prescription Drug Programs Reject/Payment Code (`codeListQualifierCode` set to `RX`).' type: string type: object HealthCareClaimStatusCategoryCode: description: Code indicating the status category of the `statusCode` property. Visit [277CA code lists](https://www.stedi.com/docs/healthcare/claims-code-lists#claim-status-category-code) for a complete list. enum: - A0 - A1 - A2 - A3 - A4 - A5 - A6 - A7 - A8 - DR01 - DR02 - DR03 - DR04 - DR05 - DR06 - DR07 - DR08 - P0 - P1 - P2 - P3 - P4 - P5 - F0 - F1 - F2 - F3 - F3F - F3N - F4 - R0 - R1 - R3 - R4 - R5 - R6 - R7 - R8 - R9 - R10 - R11 - R12 - R13 - R14 - R15 - R16 - R17 - E0 - E1 - E2 - E3 - E4 - D0 type: string HealthCareClaimStatusCode: enum: - '0' - '1' - '2' - '3' - '6' - '12' - '15' - '16' - '17' - '18' - '19' - '20' - '21' - '23' - '24' - '25' - '26' - '27' - '29' - '30' - '31' - '32' - '33' - '34' - '35' - '37' - '38' - '39' - '40' - '41' - '42' - '44' - '45' - '46' - '47' - '49' - '50' - '51' - '52' - '53' - '54' - '55' - '56' - '57' - '59' - '60' - '61' - '64' - '65' - '66' - '72' - '73' - '78' - '81' - '83' - '84' - '85' - '86' - '88' - '89' - '90' - '91' - '92' - '93' - '94' - '95' - '96' - '97' - '98' - '99' - '100' - '101' - '102' - '103' - '104' - '105' - '106' - '107' - '109' - '110' - '111' - '114' - '116' - '117' - '121' - '123' - '124' - '125' - '126' - '127' - '128' - '129' - '130' - '131' - '132' - '133' - '134' - '135' - '136' - '137' - '138' - '139' - '140' - '141' - '142' - '143' - '144' - '145' - '146' - '147' - '148' - '149' - '150' - '152' - '153' - '154' - '155' - '156' - '157' - '158' - '159' - '160' - '161' - '162' - '163' - '164' - '165' - '166' - '167' - '168' - '170' - '171' - '172' - '173' - '174' - '175' - '176' - '177' - '178' - '179' - '180' - '181' - '182' - '183' - '184' - '185' - '186' - '187' - '188' - '189' - '190' - '191' - '192' - '193' - '194' - '195' - '196' - '197' - '198' - '199' - '200' - '201' - '202' - '203' - '204' - '205' - '206' - '207' - '208' - '209' - '210' - '211' - '212' - '213' - '214' - '215' - '216' - '217' - '218' - '219' - '222' - '223' - '224' - '225' - '226' - '227' - '228' - '229' - '230' - '231' - '232' - '233' - '234' - '235' - '236' - '237' - '238' - '239' - '240' - '241' - '242' - '243' - '244' - '245' - '246' - '247' - '249' - '250' - '251' - '252' - '254' - '255' - '256' - '257' - '258' - '259' - '260' - '261' - '262' - '263' - '264' - '265' - '266' - '267' - '268' - '269' - '270' - '271' - '272' - '273' - '274' - '275' - '276' - '277' - '279' - '281' - '282' - '283' - '284' - '286' - '287' - '288' - '290' - '291' - '292' - '293' - '294' - '295' - '296' - '297' - '298' - '299' - '300' - '301' - '305' - '306' - '307' - '308' - '310' - '311' - '312' - '313' - '314' - '315' - '316' - '318' - '319' - '320' - '322' - '323' - '324' - '325' - '326' - '327' - '329' - '330' - '331' - '333' - '334' - '335' - '336' - '337' - '339' - '340' - '341' - '342' - '343' - '344' - '345' - '346' - '352' - '353' - '354' - '360' - '363' - '364' - '365' - '366' - '374' - '375' - '380' - '382' - '383' - '384' - '385' - '386' - '387' - '388' - '389' - '390' - '391' - '394' - '395' - '396' - '397' - '398' - '400' - '401' - '402' - '403' - '406' - '407' - '408' - '409' - '414' - '417' - '419' - '420' - '428' - '430' - '431' - '432' - '433' - '434' - '435' - '441' - '442' - '443' - '449' - '450' - '451' - '452' - '453' - '454' - '455' - '456' - '457' - '458' - '459' - '460' - '464' - '465' - '466' - '467' - '468' - '469' - '470' - '471' - '472' - '473' - '474' - '475' - '476' - '477' - '478' - '479' - '480' - '481' - '483' - '484' - '485' - '486' - '487' - '488' - '489' - '490' - '491' - '492' - '493' - '494' - '495' - '496' - '497' - '498' - '499' - '500' - '501' - '502' - '503' - '504' - '505' - '506' - '507' - '508' - '509' - '510' - '511' - '512' - '513' - '514' - '515' - '516' - '517' - '518' - '519' - '520' - '521' - '522' - '523' - '524' - '525' - '526' - '527' - '528' - '529' - '530' - '531' - '532' - '533' - '534' - '535' - '536' - '537' - '538' - '539' - '540' - '541' - '542' - '543' - '544' - '545' - '546' - '547' - '548' - '549' - '550' - '551' - '552' - '553' - '554' - '555' - '556' - '557' - '558' - '559' - '560' - '561' - '562' - '563' - '564' - '565' - '566' - '567' - '568' - '569' - '571' - '572' - '573' - '574' - '575' - '576' - '577' - '578' - '579' - '580' - '581' - '582' - '583' - '584' - '585' - '586' - '587' - '588' - '589' - '590' - '591' - '592' - '593' - '594' - '595' - '596' - '597' - '598' - '599' - '600' - '601' - '602' - '603' - '604' - '605' - '606' - '607' - '608' - '609' - '610' - '611' - '612' - '613' - '614' - '615' - '616' - '617' - '618' - '619' - '620' - '621' - '622' - '623' - '624' - '625' - '626' - '627' - '628' - '629' - '630' - '631' - '632' - '633' - '634' - '635' - '636' - '637' - '638' - '639' - '640' - '642' - '643' - '644' - '645' - '646' - '647' - '648' - '649' - '650' - '651' - '652' - '653' - '654' - '655' - '656' - '657' - '658' - '659' - '660' - '661' - '662' - '663' - '664' - '665' - '666' - '667' - '668' - '669' - '670' - '671' - '672' - '673' - '674' - '675' - '676' - '677' - '678' - '679' - '680' - '681' - '682' - '683' - '684' - '685' - '686' - '687' - '688' - '689' - '690' - '691' - '692' - '693' - '694' - '695' - '696' - '697' - '698' - '699' - '700' - '701' - '702' - '703' - '704' - '705' - '706' - '707' - '708' - '709' - '710' - '711' - '712' - '713' - '714' - '715' - '716' - '717' - '718' - '719' - '720' - '721' - '722' - '723' - '724' - '725' - '726' - '727' - '728' - '729' - '730' - '731' - '732' - '733' - '734' - '735' - '736' - '737' - '738' - '739' - '740' - '741' - '742' - '743' - '744' - '745' - '746' - '747' - '748' - '749' - '750' - '751' - '752' - '753' - '754' - '755' - '756' - '757' - '758' - '759' - '760' - '761' - '762' - '763' - '764' - '765' - '766' - '767' - '768' - '769' - '770' - '771' - '772' - '773' - '774' - '775' - '776' - '777' - '778' - '779' - '780' - '781' - '782' - '783' - '784' - '785' - '786' - '787' - '788' - '789' - '790' - '791' - '792' - '793' - '794' - '795' - '796' - '798' - '799' - '800' - '801' - '802' - '803' type: string HealthCareDiagnosisCode: description: Information about the patient's healthcare diagnosis. properties: diagnosisCode: description: The diagnosis code. The decimal points are omitted in diagnosis codes - the decimal point is assumed. type: string diagnosisTypeCode: description: The type of diagnosis code provided. It can be `ABK` - International Classification of Diseases Clinical Modification (ICD-10-CM) Principal Diagnosis or `BK` - International Classification of Diseases Clinical Modification (ICD-9-CM) Principal Diagnosis. type: string type: object HealthCareInformation: properties: diagnosisCode: description: The diagnosis code. Omit the decimal points in diagnosis codes - the decimal point is assumed. maxLength: 30 minLength: 1 pattern: ^[A-Za-z0-9]+$ type: string diagnosisTypeCode: $ref: '#/components/schemas/DiagnosisTypeCode' required: - diagnosisCode - diagnosisTypeCode type: object HealthCarePolicyIdentification: description: Included when the payer adjusted the payment in accordance with a published healthcare policy code list. properties: policyFormIdentifyingNumber: description: The identifying number for the policy form. 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 InPlanNetworkIndicatorCode: description: "Code indicating whether the benefit is in-network or out-of-network.\ \ Can be `Y` - Yes, `N` - No, `U` - Unknown, or `W` - Not Applicable\n\n Code\ \ `U` indicates that it is unknown whether the benefits are in or out-of-network.\ \ Code `W` indicates that the benefit applies to both in and out-of-network\ \ providers. \n \n Note that this property **doesn't indicate** whether the\ \ provider is in or out-of-network for the patient. To determine that, you\ \ must check with the payer directly.\n\nPayers may sometimes return other\ \ non-compliant values." enum: - Y - N - U - W type: string InPlanNetworkIndicatorName: description: 'The name of the in-plan network indicator code. Payers may sometimes return other non-compliant values.' enum: - 'Yes' - 'No' - Unknown - Not Applicable type: string IndividualRelationshipCode: description: The dependent's relationship to the subscriber. You can set this to `01` - Spouse, `19` - Child, `34` - Other Adult. enum: - '01' - '19' - '34' type: string IndustryCode: description: The type of facility where the service was provided. You can set this to one of the [place of service codes](https://www.cms.gov/medicare/coding-billing/place-of-service-codes/code-sets). 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' - '31' - '32' - '33' - '34' - '41' - '42' - '49' - '50' - '51' - '52' - '53' - '54' - '55' - '56' - '57' - '58' - '60' - '61' - '62' - '65' - '71' - '72' - '81' - '99' type: string InformationClaimStatus: properties: adjudicatedFinalizedDate: deprecated: true description: Not used. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string claimPaymentAmount: deprecated: true description: Not used. type: string informationStatuses: items: $ref: '#/components/schemas/ClaimLevelStatus' type: array remittanceDate: deprecated: true description: Not used. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string remittanceTraceNumber: deprecated: true description: Not used. type: string statusInformationEffectiveDate: description: The effective date of the status information. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string statusMessage: description: Additional free-form information about the claim status. type: string totalClaimChargeAmount: description: The total amount of charges in the original claim, expressed as a decimal. This may differ from the total charges submitted due to claims processing instructions, such as claim splitting. Note that some HMO encounters supply zero as the amount of original charges. type: string type: object InformationReceiverName: deprecated: true properties: address: $ref: '#/components/schemas/RequestProviderAddress' deprecated: true contactNumber: deprecated: true maxLength: 50 minLength: 1 type: string contractNumber: deprecated: true maxLength: 50 minLength: 1 type: string devicePinNumber: deprecated: true maxLength: 50 minLength: 1 type: string facilityIdNumber: deprecated: true maxLength: 50 minLength: 1 type: string facilityNetworkIdNumber: deprecated: true maxLength: 50 minLength: 1 type: string federalTaxpayerIdentificationNumber: deprecated: true maxLength: 50 minLength: 1 type: string informationReceiverAdditionalIdentifierState: deprecated: true maxLength: 80 minLength: 1 type: string medicaidProviderNumber: deprecated: true description: The provider's Medicaid provider number. maxLength: 50 minLength: 1 type: string medicareProviderNumber: deprecated: true maxLength: 50 minLength: 1 type: string nationalProviderIdentifier: deprecated: true maxLength: 50 minLength: 1 type: string x-meta: title: National Provider Identifier (NPI) priorIdentifierNumber: deprecated: true maxLength: 50 minLength: 1 type: string providerPlanNetworkIdNumber: deprecated: true maxLength: 50 minLength: 1 type: string socialSecurityNumber: deprecated: true maxLength: 50 minLength: 1 type: string x-meta: title: Social Security Number (SSN) stateLicenceNumber: deprecated: true maxLength: 50 minLength: 1 type: string submitterIdNumber: deprecated: true maxLength: 50 minLength: 1 type: string type: object InformationStatusCode: description: Payers may sometimes return other non-compliant values. enum: - A - C - L - O - P - S - T type: string InjuryCodeCategory: description: Payers may sometimes return other non-compliant values. enum: - '44' type: string 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 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 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: $ref: '#/components/schemas/InstitutionalClaimAdjustmentDetails' maxItems: 6 minItems: 1 type: array required: - adjustmentGroupCode type: object InstitutionalClaimAdjustmentDetails: properties: adjustmentAmount: description: The dollar amount of the adjustment, expressed as a decimal. type: string adjustmentQuantity: description: The units of service being adjusted, expressed as a decimal. type: string adjustmentReasonCode: description: Code identifying the detailed reason the adjustment was made. Visit the X12 [Claim Adjustment Reason Codes](https://x12.org/codes/claim-adjustment-reason-codes) for a complete list. type: string required: - adjustmentAmount - adjustmentReasonCode type: object InstitutionalClaimDateInformation: description: Dates and times related to the claim. For example, when the patient was discharged from the hospital. properties: admissionDateAndHour: description: When the patient was admitted to the hospital or facility. This property is **required** on inpatient claims. Can be expressed as a date and time (YYYYMMDDHHMM) or a single date (YYYYMMDD). pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])([01]\d|2[0-3])[0-5]\d$|^\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 InstitutionalClaimEnrollmentProcess: description: Details about the enrollment process for institutional claim submission. properties: requestedEffectiveDate: $ref: '#/components/schemas/RequestedEffectiveDate' description: "Whether this payer supports specifying a requested effective\ \ date for transaction enrollments.\n - If set to `SUPPORTED`, Stedi\ \ will process [transaction enrollment requests](https://www.stedi.com/docs/healthcare/api-reference/post-enrollment-create-enrollment)\ \ for this payer according to their specified `requestedEffectiveDate`.\n\ \ - This property is only returned when Stedi can determine whether the\ \ payer supports requested effective dates." timeframe: $ref: '#/components/schemas/EnrollmentProcessTimeframe' type: $ref: '#/components/schemas/EnrollmentProcessType' type: object 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 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 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 InstitutionalClaimInformationBenefitsAssignmentCertificationIndicator: enum: - N - W - Y 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 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 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 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 InstitutionalClaimsRawX12SubmissionRequestContent: properties: x12: type: string required: - x12 type: object 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 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 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 InstitutionalConditionInformation: properties: conditionCode: description: The condition code. maxLength: 30 type: string required: - conditionCode 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 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 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 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 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 InstitutionalIndividualRelationshipCode: enum: - '01' - '18' - '19' - '20' - '21' - '39' - '40' - '53' - G8 type: string 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 InstitutionalMeasurementUnit: description: The unit of measurement for the service. Can be set to `DA` - Days or `UN` - Unit. enum: - DA - UN type: string 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 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 InstitutionalOtherInsuredQualifier: description: Code identifying the type of entity. Can be set to `1` - Person or `2` - Non-Person Entity. enum: - '1' - '2' type: string 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 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 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 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 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 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 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 InstitutionalOtherSubscriberInformationBenefitsAssignmentCertificationIndicator: enum: - N - Y - W type: string InstitutionalOtherSubscriberInformationPaymentResponsibilityLevelCode: enum: - A - B - C - D - E - F - G - H - P - S - T - U type: string 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 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 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 InstitutionalProviderType: enum: - BillingProvider - AttendingProvider - ReferringProvider - RenderingProvider 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 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 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 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 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 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 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: $ref: '#/components/schemas/InstitutionalReportInformationAttachmentTransmissionCode' description: 'Code identifying the method by which the provider''s report is attached. Can be set to `AA` - Available on Request at Provider Site, `BM` - By Mail, `EL` - Electronically Only, `EM` - E-Mail, `FT` - File Transfer, or `FX` - By Fax. Set this to `EL` when you plan to submit attachments electronically through Stedi APIs.' required: - attachmentReportTypeCode - attachmentTransmissionCode type: object InstitutionalReportInformationAttachmentTransmissionCode: description: Code identifying the method by which the provider's report is attached. Can be set to `AA` - Available on Request at Provider Site, `BM` - By Mail, `EL` - Electronically Only, `EM` - E-Mail, `FT` - File Transfer, or `FX` - By Fax. enum: - AA - BM - EL - EM - FT - FX type: string InstitutionalResponseMeta: description: Metadata from Stedi about the request. properties: applicationMode: description: Indicates where this request can be found for support. type: string billerId: description: The biller ID assigned to this request. type: string senderId: description: The sender ID assigned to this request. type: string submitterId: description: The submitter ID assigned to this request. type: string traceId: description: The file execution ID, a unique identifier assigned to the processed file within the Stedi platform. type: string type: object InstitutionalService: properties: description: description: The description of the procedure identified in `procedureCode`. type: string lineItemChargeAmount: description: The amount charged for the service line, expressed as a decimal. This should include the provider's base charge and any applicable tax amounts reported within the service line. pattern: ^\d+(\.\d{1,2})?$ 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 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 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: $ref: '#/components/schemas/ServiceFacilityLocationSecondaryIdentificationQualifierCode' secondaryIdentifier: description: 'The identifier specified in `secondaryIdentifierQualifierCode`. You can only include one secondary identifier for the service facility.' maxLength: 50 type: string required: - address - organizationName type: object InstitutionalServiceLine: properties: adjustedRepricedLineItemReferenceNumber: description: Required when a repricing (pricing) organization needs to have an identifying number on an adjusted service line in their submission to their payer organization. Providers shouldn't complete this property. maxLength: 50 type: string assignedNumber: deprecated: true description: Stedi assigns this value automatically. It's a unique number identifying the service line within the claim. maxLength: 6 pattern: ^\d+$ 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 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 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 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 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 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 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 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 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 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 InsuranceDiscoveryCheckRequestContent: properties: dependent: $ref: '#/components/schemas/InsuranceDiscoveryDependent' encounter: $ref: '#/components/schemas/InsuranceDiscoveryEncounter' provider: $ref: '#/components/schemas/InsuranceDiscoveryProvider' subscriber: $ref: '#/components/schemas/InsuranceDiscoverySubscriber' required: - provider - subscriber type: object InsuranceDiscoveryCheckResponseContent: properties: coveragesFound: description: The number of potential coverage matches for the patient. This will be `0` if Stedi didn't find any matching coverage. type: integer discoveryId: description: A unique ID for this insurance discovery check. You can use it to retrieve the results asynchronously through the [Insurance Discovery Check Results](https://www.stedi.com/docs/healthcare/api-reference/get-insurance-discovery-results) endpoint. type: string errors: description: 'When a payer rejects your eligibility check, the response contains one or more [`AAA` errors](https://www.stedi.com/docs/healthcare/eligibility-troubleshooting#payer-aaa-errors) that specify the reasons for the rejection and any recommended follow-up actions. Any errors that occur at the `payer`, `provider`, `subscriber`, or `dependents` levels are also included in this array, allowing you to review all errors in a central location. If there are no `AAA` errors, this array will be empty.' items: $ref: '#/components/schemas/EligibilityCheckError' type: array items: description: An array of potential coverage matches for the patient. This will only be populated if the insurance discovery check `status` is `COMPLETE`. Each item in the array contains information about a potential match, including the provider, subscriber, payer, and plan information. items: $ref: '#/components/schemas/InsuranceDiscoveryResponseFields' type: array meta: $ref: '#/components/schemas/InsuranceDiscoveryMetadata' status: $ref: '#/components/schemas/DiscoveryStatus' description: "The status of the discovery check. This is either `PENDING`\ \ or `COMPLETE`.\n - If the status is `COMPLETE`, the `items` array\ \ will contain any potential coverage matches Stedi found for the patient.\n\ \ - If the status is `PENDING`, the check is still in progress. You\ \ can immediately begin polling the [Insurance Discovery Check Results](https://www.stedi.com/docs/healthcare/api-reference/get-insurance-discovery-results)\ \ endpoint to retrieve the results asynchronously." warnings: description: Issues with your insurance discovery check that may affect the results. For example, Stedi issues a warning when enrolling with a payer would improve the results for future requests. items: $ref: '#/components/schemas/Warning' type: array type: object InsuranceDiscoveryDependent: description: 'Demographic information for the patient when they are a dependent on a health plan. - We **strongly recommend** providing as much information as possible to improve the probability of finding matching coverage. We especially recommend providing the dependent''s Social Security Number and their address - particularly their ZIP Code. - You should provide information for both the subscriber and the dependent in the request when possible. - If you only have the dependent''s information, you should identify them in the `subscriber` object instead and leave this object empty. Note that some payers require information about both the dependent and the subscriber, so providing only the dependent''s information limits Stedi''s ability to return coverage matches for those payers.' properties: address: $ref: '#/components/schemas/Address' description: 'The dependent''s address. We strongly recommend providing this information if possible to improve the probability of finding matching coverage. We especially recommend providing the patient’s ZIP Code, as this helps narrow down the list of probable payers. ZIP Code search isn’t an exact match, so even the first 3-4 digits of the patient’s current ZIP Code can help improve the results. If the patient’s current address isn’t available, you can try a full or partial ZIP Code from one of the patient’s previous addresses or even one in close proximity.' dateOfBirth: description: The dependent's date of birth (DOB), formatted as YYYYMMDD. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string firstName: description: The dependent's first name. maxLength: 25 minLength: 1 type: string gender: $ref: '#/components/schemas/Gender' description: The dependent's gender. This can be set to either `M` - Male or `F` - Female. lastName: description: The dependent's last name. maxLength: 25 minLength: 1 type: string middleName: description: The dependent's middle name or initial. maxLength: 25 minLength: 1 type: string ssn: description: The dependent's Social Security Number (SSN). We strongly recommend providing this information if possible to improve the probability of finding matching coverage. pattern: ^(?:\d{9}|\d{3}-\d{2}-\d{4}|\d{4})$ type: string x-meta: title: Social Security Number (SSN) required: - firstName - lastName type: object InsuranceDiscoveryEncounter: description: "The date range for the service being requested. If you don't specify\ \ a service date (either a single day or a range of dates), Stedi defaults\ \ to the current date.\n\n You can specify either a single `dateOfService`\ \ or a `beginningDateOfService` and `endDateOfService`." properties: beginningDateOfService: description: The beginning date, formatted as YYYYMMDD. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string dateOfService: description: The date of service, formatted as YYYYMMDD. You can use this value to specify a single occasion. If you don't specify a service date (either a single day or a range of dates), Stedi defaults to the current date. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string endDateOfService: description: The end date, formatted as YYYYMMDD. If you don't specify an end date, Stedi defaults to the same date as `beginningDateOfService`. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string type: object InsuranceDiscoveryMetadata: description: Metadata about the response. Stedi uses this data for tracking and troubleshooting. properties: applicationMode: $ref: '#/components/schemas/ApplicationModes' description: 'The type of data in the request. This is always `production`. Payers may sometimes return other non-compliant values.' traceId: description: The unique ID Stedi assigns to this request. type: string type: object InsuranceDiscoveryProvider: description: Information about the provider requesting the insurance discovery check. properties: npi: description: The provider's [National Provider Identifier (NPI)](https://www.stedi.com/docs/healthcare/national-provider-identifier). maxLength: 15 minLength: 10 pattern: ^[12].*$ type: string x-meta: title: National Provider Identifier (NPI) required: - npi type: object InsuranceDiscoveryResponseFields: properties: benefitsInformation: description: "Information about the patient's healthcare benefits, such\ \ as coverage level (individual vs. family), coverage type (deductibles,\ \ copays, etc.), out of pocket maximums, and more. This is the same information\ \ you would get from a standard eligibility check.\n \n Payers typically\ \ return at least the following properties: `code`, `coverageLevelCode`,\ \ `serviceTypeCodes`, and either `benefitAmount` or `benefitPercent`.\ \ However, the exact properties returned in this object are up to the\ \ payer's discretion.\n \n Visit [Determine patient benefits](https://www.stedi.com/docs/healthcare/eligibility-active-coverage-benefits)\ \ in our eligibility check documentation for more information about benefit\ \ types, details about how to interpret the response, and additional examples." items: $ref: '#/components/schemas/DiscoveryBenefitsInformation' type: array confidence: $ref: '#/components/schemas/Confidence' description: "Information indicating how likely it is that this coverage\ \ is a match for the patient submitted in the insurance discovery request.\ \ \n\n Even if the confidence level is high, you **must** always check\ \ the subscriber information to confirm that the coverage is a match for\ \ the patient." dependent: $ref: '#/components/schemas/DiscoveryResponseDependent' description: Information about the dependent for this coverage. You should **always** review this information to ensure that the coverage Stedi found is a match for the patient. payer: $ref: '#/components/schemas/DiscoveryPayer' description: Information about the payer for this coverage. Note that payer names and IDs aren't normalized, so you'll need to handle matching these results to Stedi's Payer Network or your own internal payer list. planDateInformation: $ref: '#/components/schemas/DiscoveryPlanDateInformation' description: "Contains the dates associated with coverage for this health\ \ plan. This information can help you determine the patient's eligibility\ \ for benefits.\n - All dates are formatted as YYYYMMDD (for single\ \ dates) or as YYYYMMDD-YYYYMMDD (for date ranges).\n - Properties\ \ contain a single date unless otherwise noted.\n - Most payers return\ \ either `plan` or `planBegin` and `planEnd`, but the exact dates returned\ \ depend on the payer's discretion and the specific health plan.\n \ \ - If the date of service is after the earliest ending `plan`, `eligibility`,\ \ `planEnd`, `eligibilityEnd`, `policyEffective`, or `policyExpiration`\ \ value, the patient likely doesn't have active coverage." planInformation: $ref: '#/components/schemas/PlanInformation' description: Additional identification for the patient's health plan. provider: $ref: '#/components/schemas/DiscoveryResponseProvider' description: Information about the provider who requested the insurance discovery check. subscriber: $ref: '#/components/schemas/DiscoveryResponseSubscriber' description: Information about the subscriber for this coverage. You should **always** review this information to ensure that the coverage Stedi found is a match for the patient. type: object InsuranceDiscoverySubscriber: description: 'Demographic information for the patient when they are the health plan subscriber. We strongly recommend providing as much information as possible to improve the probability of finding matching coverage. We especially recommend providing the subscriber''s Social Security Number and their address - particularly their ZIP Code.' properties: address: $ref: '#/components/schemas/Address' description: 'The subscriber''s current or previous address. We strongly recommend providing this information if possible to improve the probability of finding matching coverage. We especially recommend providing the patient’s ZIP Code, as this helps narrow down the list of probable payers. ZIP Code search isn’t an exact match, so even the first 3-4 digits of the patient’s current ZIP Code can help improve the results. If the patient’s current address isn’t available, you can try a full or partial ZIP Code from one of the patient’s previous addresses or even one in close proximity.' dateOfBirth: description: The subscriber's date of birth (DOB), formatted as YYYYMMDD. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string firstName: description: The subscriber's first name. maxLength: 25 minLength: 1 type: string gender: $ref: '#/components/schemas/Gender' description: The subscriber's gender. This can be set to either `M` - Male or `F` - Female. lastName: description: The subscriber's last name. maxLength: 25 minLength: 1 type: string middleName: description: The subscriber's middle name or initial. maxLength: 25 minLength: 1 type: string ssn: description: The subscriber's Social Security Number (SSN). We strongly recommend providing this information if possible to improve the probability of finding matching coverage. The patient's full SSN is preferred, but even the last 4 digits of the SSN can help narrow down matching coverage. pattern: ^(?:\d{9}|\d{3}-\d{2}-\d{4}|\d{4})$ type: string x-meta: title: Social Security Number (SSN) required: - firstName - lastName type: object InsuranceTypeCode: description: 'Code identifying the type of insurance policy. Payers may sometimes return other non-compliant values.' enum: - '12' - '13' - '14' - '15' - '16' - '41' - '42' - '43' - '47' - AP - C1 - CO - CP - D - DB - EP - FF - GP - HM - HN - HS - IN - IP - LC - LD - LI - LT - MA - MB - MC - MH - MI - MP - OT - PE - PL - PP - PR - PS - QM - RP - SP - TF - WC - WU type: string InsuranceTypeName: description: 'The full name of the insurance type code. Payers may sometimes return other non-compliant values.' enum: - Medicare Secondary Working Aged Beneficiary or Spouse with Employer Group Health Plan - Medicare Secondary End-Stage Renal Disease Beneficiary in the Mandated Coordination Period with an Employer's Group Health Plan - Medicare Secondary, No-fault Insurance including Auto is Primary - Medicare Secondary Worker's Compensation - Medicare Secondary Public Health Service (PHS)or Other Federal Agency - Medicare Secondary Black Lung - Medicare Secondary Veteran's Administration - Medicare Secondary Disabled Beneficiary Under Age 65 with Large Group Health Plan (LGHP) - Medicare Secondary, Other Liability Insurance is Primary - Auto Insurance Policy - Commercial - Consolidated Omnibus Budget Reconciliation Act (COBRA) - Medicare Conditionally Primary - Disability - Disability Benefits - Exclusive Provider Organization - Family or Friends - Group Policy - Health Maintenance Organization (HMO) - Health Maintenance Organization (HMO) - Medicare Risk - Special Low Income Medicare Beneficiary - Indemnity - Individual Policy - Long Term Care - Long Term Policy - Life Insurance - Litigation - Medicare Part A - Medicare Part B - Medicaid - Medigap Part A - Medigap Part B - Medicare Primary - Other - Property Insurance - Personal - Personal - Personal Payment (Cash - No Insurance) - Preferred Provider Organization (PPO) - Point of Service (POS) - Qualified Medicare Beneficiary - Property Insurance - Real - Supplemental Policy - Tax Equity Fiscal Responsibility Act (TEFRA) - Workers Compensation - Wrap Up Policy type: string 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 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 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 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 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 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 ListPayerRecordsCsvOutputPayload: description: 'All supported payer records in CSV format. The first row contains the header with field names, and subsequent rows contain the payer data. To render this data as a CSV file, you must save it to a file with a `.csv` extension.' type: string ListPayerRecordsResponseContent: description: Common output structure for list operations with pagination support. properties: items: description: Payers that Stedi supports for each transaction type. Results are returned in alphabetical order of the Stedi ID. items: $ref: '#/components/schemas/PayerRecord' type: array nextPageToken: description: Token that you can supply in subsequent requests to retrieve the next page of results. If not returned, there are no more results. maxLength: 1024 minLength: 1 type: string required: - items type: object MaintenanceReasonCode: description: 'Code identifying the reason for the changes to subscriber identifying information, such as name, date of birth, or address. This is always `25` Payers may sometimes return other non-compliant values.' enum: - '25' type: string MaintenanceTypeCode: description: 'The maintenance type code. Used to acknowledge a change in the identifying elements for the subscriber from those submitted in the original eligibility check request. It can also be included when the payer used the birth sequence number from the original request to locate the subscriber in their system. This is always `001` Payers may sometimes return other non-compliant values.' enum: - '001' type: string Matches: description: 'Shows which properties in the payer record match the search query. This information helps you understand why Stedi returned this payer and which parts of the payer record matched the search terms. It''s also especially useful for debugging search queries and building user interfaces that display matching text. - Matching text is wrapped in `` HTML tags for highlighting. - This object only contains properties with matching text. For example, if none of the payer''s aliases matched the search query, this object will not include the `aliases` property.' properties: aliases: description: 'The parts of the payer''s aliases that match the search query. Each alias that contains matching text is included as a separate entry, with matching portions wrapped in `` tags. For example, searching for `XYZ` might return: [`XYZ123`, `ABCXYZ`].' items: type: string type: array displayName: description: 'The part of the payer''s display name that matched the search query. For example, searching for `Blue` might return: `Blue Cross Blue Shield`.' type: string names: description: 'The parts of the payer''s other names that match the search query. Each name that contains matching text is included as a separate entry, with matching portions wrapped in `` tags. For example, searching for `Health` might return: [`Community Health Plan`, `Health Partners`].' items: type: string type: array primaryPayerId: description: 'The part of the primary payer ID that matched the search query. For example, if you search for ''12345'', the results for a payer with primary payer ID `12345ABC` would return: `12345ABC`.' type: string stediId: description: 'The part of the payer''s Stedi payer ID that matched the search query. Stedi payer IDs only support exact substring matching (no prefix or fuzzy matching). For example, if you search for `KRP`, the results for a payer with Stedi payer ID ''KRPCH'' would be: `KRPCH`.' type: string type: object MaximumResponseSizeExceeded: properties: code: type: string details: type: string message: type: string type: object 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 MeasurementReferenceIdentificationCode: description: Code identifying the type of measurement. Can be set to `OG` - Original or `TR` - Test Results. enum: - OG - TR type: string 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 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 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 MedicalProcedure: properties: diagnosisCodePointer: description: The diagnosis code pointer. items: type: string maxItems: 4 minItems: 1 type: array procedureCode: description: The procedure code. maxLength: 48 minLength: 1 type: string procedureModifiers: description: Procedure modifiers that provide additional information related to the service. items: type: string maxItems: 4 minItems: 1 type: array productOrServiceIDQualifier: $ref: '#/components/schemas/MedicalProcedureProductOrServiceIDQualifier' required: - procedureCode - productOrServiceIDQualifier type: object MedicalProcedureProductOrServiceIDQualifier: description: Code identifying the type/source of the `procedureCode`. You can set this to `AD` - American Dental Association Codes, `CJ` - Current Procedural Terminology (CPT) Codes, `HC` - Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes, `ID` - International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) - Procedure, `IV` - Home Infusion EDI Coalition (HIEC) Product/Service Code, `N4` - National Drug Code in 5-4-2 Format, or `ZZ` - Mutually Defined. enum: - AD - CJ - HC - ID - IV - N4 - ZZ type: string 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 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 Member: properties: dateOfBirth: description: The dependent'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 dependent's first name as specified on their insurance policy. maxLength: 35 minLength: 1 type: string gender: $ref: '#/components/schemas/MemberGender' groupNumber: description: The group number associated with the subscriber and dependent's insurance policy. maxLength: 50 minLength: 1 type: string lastName: description: The dependent's last name as specified on their insurance policy. maxLength: 60 minLength: 1 type: string suffix: description: The dependent's name suffix, such as Sr. or III. Only include the dependent's personal name suffix - **don't** include professional or academic titles, such as M.D. or MBA. maxLength: 10 minLength: 1 type: string required: - firstName - lastName type: object MemberGender: description: A code indicating the dependent's gender. If the claim set the dependent's gender to `U` for unknown, you should omit this property from the claim status request. enum: - M - F type: string Meta: description: Metadata that helps Stedi track and debug the response. properties: applicationMode: description: Whether this is a test or production ERA. type: string senderId: description: An identifier for the most recent sender of the ERA. This is usually not the original sender, so this value is unlikely to be a payer ID. When Stedi processes and delivers ERAs through the clearinghouse, this value is always `STEDI`. type: string traceId: description: Not currently used. type: string transactionId: description: The Stedi transaction identifier. maxLength: 36 minLength: 36 pattern: ^[0-9a-fA-F]{8}-[0-9a-fA-F]{4}-[0-9a-fA-F]{4}-[0-9a-fA-F]{4}-[0-9a-fA-F]{12}$ type: string type: object MilitaryServiceRankCode: description: Payers may sometimes return other non-compliant values. enum: - A1 - A2 - A3 - B1 - B2 - C1 - C2 - C3 - C4 - C5 - C6 - C7 - C8 - C9 - E1 - F1 - F2 - F3 - F4 - G1 - G4 - L1 - L2 - L3 - L4 - L5 - L6 - M1 - M2 - M3 - M4 - M5 - M6 - P1 - P2 - P3 - P4 - P5 - R1 - R2 - S1 - S2 - S3 - S4 - S5 - S6 - S7 - S8 - S9 - SA - SB - SC - T1 - V1 - W1 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 NoTransactionsFound: properties: code: type: string details: type: string message: type: string type: object NotSupportedBreakdown: properties: total: description: Total number of matching payers that don't support this transaction type. minimum: 0 type: integer required: - total type: object 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 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 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 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 OperatingStateCode: description: US state codes, territories, or `NATIONAL` indicating the geographic regions where a payer operates. When set to `NATIONAL`, the payer operates throughout the entire United States. enum: - AL - AK - AZ - AR - CA - CO - CT - DE - FL - GA - HI - ID - IL - IN - IA - KS - KY - LA - ME - MD - MA - MI - MN - MS - MO - MT - NE - NV - NH - NJ - NM - NY - NC - ND - OH - OK - OR - PA - RI - SC - SD - TN - TX - UT - VT - VA - WA - WV - WI - WY - DC - PR - VI - GU - AS - MP - NATIONAL type: string 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 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 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 OtherDiagnosisInformationPresentOnAdmissionIndicator: enum: - N - Y - U - W 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 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 OtherInsuredQualifier: description: Code identifying the type of entity. Can be set to `1` - Person or `2` - Non-Person Entity. enum: - '1' - '2' type: string 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 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 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 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 OtherPayerBillingProviderEntityTypeQualifier: description: Code identifying the type of entity. Can be set to `1` - Person or `2` - Non-Person Entity. enum: - '1' - '2' type: string 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 OtherPayerEntityTypeQualifier: enum: - '1' - '2' type: string 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 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 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 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 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 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 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 OtherPayerRenderingProviderEntityTypeQualifier: description: Code identifying the type of entity. Can be set to `1` - Person or `2` - Non-Person Entity. enum: - '1' - '2' type: string 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 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 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 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 OtherPayerSupervisingProvider: description: Information about the supervising provider. properties: otherPayerSupervisingProviderIdentifier: description: Identifiers for the supervising provider. items: $ref: '#/components/schemas/OtherPayerSupervisingProviderIdentifierItem' maxItems: 3 minItems: 1 type: array required: - otherPayerSupervisingProviderIdentifier type: object OtherPayerSupervisingProviderIdentifierItem: properties: identifier: description: The identifier. The format and length of this value depends on the `qualifier` you set. type: string otherIdentifier: deprecated: true description: The identifier for the other payer who provided this reference number. This is only required when the reference number is provided by the non-destination payer. The value must match the `claimInformation.otherSubscriberInformation[].otherPayerName.otherPayerIdentifier` property. type: string qualifier: description: Set to `0B` - State License Number, `1G` - Provider UPIN Number, `LU` - Location Number or `G2` - Provider Commercial Number. Note that UPIN is deprecated and shouldn't be used for new claims. type: string required: - identifier - qualifier type: object OtherProcedureInformation: properties: otherProcedureCode: description: The code from the code set specified in `qualifierCode`. Don't submit the decimal for ICD codes; the decimal is implied. maxLength: 30 type: string otherProcedureDate: description: The date when the procedure was performed. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string qualifierCode: $ref: '#/components/schemas/OtherProcedureInformationQualifierCode' description: 'Identifies an industry code list. This can be set to `BBQ`: International Classification of Diseases Clinical Modification (ICD-10-PCS) Other Procedure Codes or `BQ`: International Classification of Diseases Clinical Modification (ICD-9-CM) Other Procedure Codes. Note that ICD-9-CM codes are deprecated and shouldn''t be used in new claim submissions.' required: - otherProcedureCode - qualifierCode type: object OtherProcedureInformationQualifierCode: enum: - BBQ - BQ type: string OtherSubscriber: description: Information about the other subscriber, when a corrected priority payer has been identified. properties: firstName: description: The subscriber's first name. type: string lastName: description: The subscriber's last name. type: string memberId: description: The subscriber's member ID for their health plan. type: string middleName: description: The subscriber's middle name or initial. type: string organizationName: description: The subscriber's business name, if the subscriber is not an individual. type: string standardUniqueHealthIdentifierForEachIndividualInTheUnitedStates: description: Deprecated type: string suffix: description: The subscriber's name suffix, such as Jr. or III. type: string taxId: description: The subscriber's Federal Taxpayer's Identification Number. Only used when the subscriber is a business entity and not an individual. pattern: ^\d{9}$ type: string type: object 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 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 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 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 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: $ref: '#/components/schemas/OtherInsuredQualifier' required: - otherInsuredIdentifier - otherInsuredIdentifierTypeCode - otherInsuredLastName - otherInsuredQualifier type: object PDFData: properties: data: contentEncoding: byte description: A base64 encoded string of the CMS-1500 Claim Form PDF. To render the PDF, you must decode the base64 string and save it to a file with a `.pdf` extension. type: string transactionId: description: "A unique identifier for the processed claim associated with\ \ the specified `businessId`. \n\nThis ID is included in the transaction\ \ processed event for each claim, which you can receive automatically\ \ through Stedi [webhooks](https://www.stedi.com/docs/healthcare/configure-webhooks).\ \ You can also retrieve this ID through the [Poll Transactions endpoint](https://www.stedi.com/docs/healthcare/api-reference/get-poll-transactions)\ \ or from the transaction's details page within Stedi." maxLength: 36 minLength: 36 pattern: ^[0-9a-fA-F]{8}-[0-9a-fA-F]{4}-[0-9a-fA-F]{4}-[0-9a-fA-F]{4}-[0-9a-fA-F]{12}$ type: string type: object 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 PatientClaimStatusDetails: description: Patient information and the status of claims related to the patient. You can use the `claims[].claimStatus.referencedTransactionTraceNumber` in this object to correlate the 277CA with the original claim. properties: claims: description: Status information for the claim or service line. items: $ref: '#/components/schemas/ReportsClaims' type: array dependent: $ref: '#/components/schemas/PatientClaimStatusDetailsDependent' deprecated: true description: The patient's information will always be returned in the `subscriber` object, regardless of whether they are a subscriber or dependent. subscriber: $ref: '#/components/schemas/PatientClaimStatusDetailsSubscriber' description: Information about the patient who received services related to the claim. type: object PatientClaimStatusDetailsDependent: description: Information about a dependent who received services related to the claim. properties: firstName: deprecated: true description: The first name of the dependent. Can be up to 35 characters. type: string lastName: deprecated: true description: The last name of the dependent. Can be up to 60 characters. type: string middleName: deprecated: true description: The middle name or initial of the dependent. Can be up to 25 characters. type: string suffix: deprecated: true description: The suffix of the dependent, such as Jr or III. Can be up to 10 characters. type: string type: object PatientClaimStatusDetailsSubscriber: description: Information about the primary policy holder for the health plan. properties: employerIdentificationNumber: deprecated: true description: The subscriber's employer identification number. This may be used in conjunction with a worker's compensation claim. type: string firstName: description: The first name of the subscriber. Can be up to 35 characters. type: string lastName: description: The last name of the subscriber. Can be up to 60 characters. type: string memberId: description: The subscriber's member ID for their health plan. type: string middleName: description: The middle name or initial of the subscriber. Can be up to 25 characters. type: string organizationName: description: The subscriber's business name. Applicable when an employer submitted a worker's compensation claim, or other situations when an employer is the subscriber. type: string standardUniqueHealthIdentifierForEachIndividualInTheUnitedStates: description: Deprecated; do not use. type: string suffix: description: The suffix of the subscriber, such as Jr or III. Can be up to 10 characters. type: string type: object PatientConditionCode: description: A code indicating the nature of a patient's condition. enum: - A - C - D - E - F - G - M 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 PatientConditionInformationVisionCertificationConditionIndicator: description: Code indicating whether there is a certification. Can be set to `N` - No or `Y` - Yes. enum: - N - Y 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 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 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 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 PayToAddressNameEntityTypeQualifier: description: Code identifying the type of entity. Can be set to `2` - Non-Person Entity. enum: - '2' type: string 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 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 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 Payee: description: Information about the provider receiving the payment. properties: address: $ref: '#/components/schemas/PayeeAddress' description: The payee's address information. centersForMedicareAndMedicaidServicesPlanId: deprecated: true description: Formerly used to report the payee's Centers for Medicare and Medicaid Services (CMS) Plan ID. This used to report the Health Plan ID (HPID) or Other Entity Identifier (OEID). The Centers for Medicare and Medicaid Services (CMS) no longer uses HPID, so this property will not be populated. type: string federalTaxPayersIdentificationNumber: description: The payee's Federal Taxpayer's Identification Number (when the payee is a business) or the payee's social security number (when the payee is an individual provider). type: string name: description: The payee's name. This can be the name of an individual or an organization. type: string nationalCouncilForPrescriptionDrugProgramsPharmacyNumber: description: The payee's National Council for Prescription Drugs Pharmacy Number. type: string npi: description: The payee's National Provider Identifier (NPI). pattern: ^\d{10}$ type: string payeeIdentification: description: Other information necessary to identify the payee. type: string remittanceDeliveryMethod: $ref: '#/components/schemas/PayeeRemittanceDeliveryMethod' description: Method for delivering remittance advice to the payee. stateLicenseNumber: description: The payee's State License Number. type: string taxId: description: The payee's Federal Tax Identification Number (TIN). pattern: ^\d{9}$ type: string type: object PayeeAddress: description: Address information for the payee. properties: address1: description: The first line of the address. type: string address2: description: The second line of the address. type: string city: description: The city where the address is located. type: string countryCode: description: The standard code for the country from Part 1 of ISO 3166. type: string countrySubCode: description: The standard code for the country subdivision from Part 2 of ISO 3166. type: string postalCode: description: The postal code for the address, excluding punctuation and blanks. type: string state: description: The standard code for the state or province. For example `PA` for Pennsylvania. type: string type: object PayeeRemittanceDeliveryMethod: description: The method by which the remittance advice is delivered. This is used when the remittance is separate from the payment. properties: email: description: The email address. type: string ftp: description: Information for file transfer deliveries, such as SFTP, FTP, or FTPS. type: string name: description: The name of the third party processor, if required, that would be the first recipient of the remittance. type: string onLine: description: The web address of the online portal for secure hosted or other electronic delivery. The URL is typically provided without the scheme and separator. For example, `stedi.com`. type: string type: object Payer: description: Information about the payer providing the benefits information. The response will always include the payer's business name and an identifier, such as the payer's tax ID. Most payers also include contact information. properties: aaaErrors: items: $ref: '#/components/schemas/EligibilityCheckPayerError' type: array centersForMedicareAndMedicaidPlanId: description: The payer's Centers for Medicare and Medicaid Services PlanID. type: string contactInformation: $ref: '#/components/schemas/ContactInformation' description: 'The payer''s contact information. Note that when `contacts[].communicationMode` is set to `UR`, the `communicationNumber` property may not contain a valid URL. Most payers provide a partial web address for their provider portal, or something similar, such as `www.example.com/portal`. You must add the appropriate scheme and separators, such as `https://` or `http://`, to make it a valid URL.' employersId: deprecated: true description: 'Deprecated; The payer''s identification number for the entity receiving the benefits information. This shape is deprecated: This property is no longer used.' type: string entityIdentifier: $ref: '#/components/schemas/PayerEntityIdentifier' entityType: $ref: '#/components/schemas/EntityTypeQualifier' description: 'The entity type qualifier for the payer. Can be set to `Person` (not commonly used) or `Non-Person Entity` (most common). Payers may sometimes return other non-compliant values.' etin: description: The payer's Electronic Transmitter Identification Number (ETIN). type: string federalTaxpayersIdNumber: description: The payer's federal taxpayer's identification number. pattern: ^\d{9}$ type: string firstName: description: The payer's first name, when the payer is an individual (not commonly used). type: string lastName: description: The payer's last name. Used when the payer is an individual (not commonly used). type: string middleName: description: The payer's middle name or initial, when the payer is an individual (not commonly used). type: string naic: description: The payer's National Association of Insurance Commissioners (NAIC) identification number. type: string name: description: The payer's business name, when the payer is not a person. type: string npi: description: The payer's [National Provider Identifier (NPI)](https://www.stedi.com/docs/healthcare/national-provider-identifier). pattern: ^\d{10}$ type: string x-meta: title: National Provider Identifier (NPI) payorIdentification: description: The payor identification. type: string suffix: description: The payer's name suffix, such as Jr. or III. Used when the payer is an individual (not commonly used). type: string type: object PayerContactInformation: description: The payer's business contact information. properties: contactMethods: description: Each contact will have a single property set, except for phone with extension. items: $ref: '#/components/schemas/ContactMethods' type: array contactName: description: The name of the contact person or entity. type: string type: object PayerEntityIdentifier: description: 'The entity identifier code for the payer. Payers may sometimes return other non-compliant values.' enum: - Third-Party Administrator - Employer - Gateway Provider - Plan Sponsor - Payer type: string PayerEntityIdentifierCode: description: Entity identifier code for payers in claim status reports enum: - AY - PR type: string PayerEntityIdentifierCodeValue: description: Human-readable descriptions for payer entity identifier codes enum: - Clearinghouse - Payer type: string PayerRecord: properties: aliases: description: Alternative IDs associated with a payer. If a payer changes their `primaryPayerId`, aliases allow you to continue sending transactions to the payer using the old ID uninterrupted. items: type: string type: array avatarUrl: description: 'A URL pointing to an image file (`.png`, `.jpeg`, or `.jpg`) with the payer''s logo. This is the same logo Stedi displays in the [Payer Network](https://www.stedi.com/healthcare/network). You can use this property to display payer logos in your system or application. This property is only returned when a payer logo is available.' type: string coverageTypes: description: 'A list of insurance coverage types that indicates whether this payer supports transactions for medical coverage, dental coverage, vision coverage, or a combination of these. For example: `["medical"]` or `["medical", "dental"]`. When this array isn''t in the response, it means Stedi hasn''t classified the payer''s coverage types yet, **not** that the payer doesn''t support any coverage types.' items: $ref: '#/components/schemas/CoverageType' type: array displayName: description: The payer's business name, such as Cigna or Aetna. This is the name most commonly used to identify the payer. type: string employerIdentificationNumbers: description: Employer Identification Numbers (EINs) associated with this payer. items: description: A valid Employer Identification Number (EIN) in the format XX-XXXXXXX pattern: ^[0-9]{2}-[0-9]{7}$ type: string type: array enrollment: $ref: '#/components/schemas/EnrollmentInfo' description: Details about the [transaction enrollment process](https://www.stedi.com/docs/healthcare/transaction-enrollment) for this payer, if available. This object may not be returned for some payers. names: description: Alternative names associated with a payer. These additional names help you search for and identify payers using the name most familiar to your organization. items: type: string type: array operatingStates: description: 'A list of US state codes, territories, or `NATIONAL` that indicates the geographic regions where this payer operates. For example: `["CA", "OR"]` for a regional payer, or `["NATIONAL"]` for a payer that operates throughout the entire United States. When this array isn''t in the response, it means Stedi hasn''t classified the payer''s operating states yet.' items: $ref: '#/components/schemas/OperatingStateCode' type: array parentPayerGroupId: description: The payer's parent payer group entity. This is metadata Stedi uses internally. It doesn't necessarily relate to the payer's enrollment process or other capabilities. type: string primaryPayerId: description: The most commonly used ID for a payer. This value often corresponds to the name the payer uses internally and provides to patients on member ID cards. type: string stediId: description: A unique ID that Stedi assigned to this payer and uses internally for routing requests. This ID will not change even if the `primaryPayerId` is updated. type: string transactionSupport: $ref: '#/components/schemas/TransactionSupport' urls: $ref: '#/components/schemas/PayerUrls' description: URLs associated with this payer, such as their website. This object is only returned when URL information is available for the payer. required: - aliases - displayName - names - primaryPayerId - stediId - transactionSupport type: object PayerUrls: description: URLs associated with a payer. properties: website: description: The payer's website URL. type: string type: object PaymentFormatCode: description: Identifies the specific electronic payment format used for ACH transactions. These formats determine the structure and content of the electronic payment message. enum: - CCP - CTX type: string PaymentInfo: description: Detailed payment information for a specific claim. properties: claimAdjustments: description: Adjustments applied to this claim. items: $ref: '#/components/schemas/ClaimAdjustments' type: array claimContactInformation: description: Contact information for claim-related communications. items: $ref: '#/components/schemas/ReportsContactInformation' type: array claimPaymentInfo: $ref: '#/components/schemas/PaymentInfoClaimPaymentInfo' description: Basic claim payment information including amounts and status. claimReceivedDate: description: The date the claim was received by the payer. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string claimStatementPeriodEnd: description: The claim period end date in ISO 8601 format (YYYY-MM-DD). This format is intentionally inconsistent with other date properties to maintain backwards compatibility. pattern: ^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$ type: string claimStatementPeriodStart: description: 'The claim period start date in ISO 8601 format (YYYY-MM-DD). This format is intentionally inconsistent with other date properties to maintain backwards compatibility. If the response doesn’t include a `claimStatementPeriodEnd`, you should assume the end date is the same as the start date.' pattern: ^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$ type: string claimSupplementalInformation: $ref: '#/components/schemas/PaymentInfoClaimSupplementalInformation' description: Supplemental information about the claim. claimSupplementalInformationQuantities: $ref: '#/components/schemas/PaymentInfoClaimSupplementalInformationQuantities' description: Supplemental quantity information about the claim. correctedPatientOrInsuredName: $ref: '#/components/schemas/PaymentInfoCorrectedPatientOrInsuredName' description: Corrected patient or insured name information. correctedPriorityPayer: $ref: '#/components/schemas/CorrectedPriorityPayer' description: Corrected priority payer information. coverageExpirationDate: description: The expiration date of the patient's coverage. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string crossoverCarrier: $ref: '#/components/schemas/CrossoverCarrier' description: Crossover carrier information. inpatientAdjudication: $ref: '#/components/schemas/PaymentInfoInpatientAdjudication' description: Inpatient adjudication information. otherClaimRelatedIdentification: $ref: '#/components/schemas/PaymentInfoOtherClaimRelatedIdentification' description: Other claim-related identification numbers. otherSubscriber: $ref: '#/components/schemas/OtherSubscriber' description: Other subscriber information. outpatientAdjudication: $ref: '#/components/schemas/PaymentInfoOutpatientAdjudication' description: Outpatient adjudication information. patientName: $ref: '#/components/schemas/PaymentInfoPatientName' description: Patient name information. renderingProvider: $ref: '#/components/schemas/PaymentInfoRenderingProvider' description: Information about the provider who rendered services. renderingProviderIdentification: $ref: '#/components/schemas/PaymentInfoRenderingProviderIdentification' description: Rendering provider identification information. serviceLines: description: Service lines included in this claim. items: $ref: '#/components/schemas/ClaimPaymentAdviceServiceLines' type: array subscriber: $ref: '#/components/schemas/PaymentInfoSubscriber' description: Subscriber information for the insurance policy. type: object PaymentInfoClaimPaymentInfo: description: Claim payment information for the payment info structure. properties: claimFilingIndicatorCode: $ref: '#/components/schemas/ClaimPaymentAdviceFilingIndicatorCode' description: A code identifying the type of claim. For example `DS` - Disability. Visit [ERA code lists](https://www.stedi.com/docs/healthcare/claims-code-lists#claim-filing-indicator-code) for a complete list and usage notes. claimFrequencyCode: description: A code identifying the frequency of the claim. It matches what the payer received in the original claim. Visit [Bill Type Frequency Codes](https://www.nubc.org/system/files/media/file/2019/06/billTypeFrequencyCodes837.pdf) for a complete list and definitions. type: string claimPaymentAmount: description: The total amount of the claim payment, expressed as a decimal. This value can be positive, zero, or negative. type: string claimStatusCode: $ref: '#/components/schemas/ClaimStatusCode' description: The status of the claim. For example, `1` - Processed as Primary. Visit [ERA code lists](https://www.stedi.com/docs/healthcare/claims-code-lists#claim-status-code) for a complete list and usage notes. diagnosisRelatedGroupDRGCode: description: Code indicating a patient's diagnosis group based on their medical symptoms. type: string diagnosisRelatedGroupDRGWeight: description: The adjudicated diagnosis-related group (DRG) weight. type: string dischargeFraction: description: The adjudicated discharge fraction. type: string facilityTypeCode: description: A code identifying where services were or may be performed. This is the [Place of Service Codes](https://www.cms.gov/medicare/coding-billing/place-of-service-codes/code-sets) for Professional or Dental Services. type: string patientControlNumber: description: The patient control number provided in the original claim. You can use this value to correlate the payer's response with the original claim. type: string patientResponsibilityAmount: description: The amount the patient is responsible for paying. This can include the deductible, non-covered services, co-pay, and co-insurance. This is not used for reversals. type: string payerClaimControlNumber: description: The payer's internal control number for the claim. type: string totalClaimChargeAmount: description: The total amount of submitted charges for this claim, expressed as a decimal. This can be positive, zero, or negative. For example, this may contain a negative charge for a reversal claim. type: string type: object PaymentInfoClaimSupplementalInformation: description: Additional information about the claim payment. All values are expressed as decimals. properties: coverageAmount: description: The total covered charges. This is the sum of the original submitted provider charges that are considered for payment under the health plan. This excludes charges considered not covered, but includes reductions to payments of covered services, such as patient deductibles. type: string discountAmount: description: This is the Prompt Pay Discount Amount. type: string federalMedicareOrMedicaidPaymentMandateCategory1: description: Federal Medicare or Medicaid Payment Mandate - Category 1. type: string federalMedicareOrMedicaidPaymentMandateCategory2: description: Federal Medicare or Medicaid Payment Mandate - Category 2. type: string federalMedicareOrMedicaidPaymentMandateCategory3: description: Federal Medicare or Medicaid Payment Mandate - Category 3. type: string federalMedicareOrMedicaidPaymentMandateCategory4: description: Federal Medicare or Medicaid Payment Mandate - Category 4. type: string federalMedicareOrMedicaidPaymentMandateCategory5: description: Federal Medicare or Medicaid Payment Mandate - Category 5. type: string interest: description: The interest amount. type: string negativeLedgerBalance: description: The negative ledger balance. Only used by Medicare Part A and Medicare Part B. type: string patientAmountPaid: description: The amount the patient has already paid. type: string perDayLimit: description: The per day limit. type: string tax: description: The total taxes. type: string totalClaimBeforeTaxes: description: The total claim amount before taxes. type: string type: object PaymentInfoClaimSupplementalInformationQuantities: description: Additional quantity information about the claim payment. All values are expressed as decimals. properties: coInsuredActual: description: The actual amount of co-insurance designated by the health plan. type: string coveredActual: description: The number of days covered. type: string federalMedicareOrMedicaidPaymentMandateCategory1: description: Federal Medicare or Medicaid Payment Mandate - Category 1. type: string federalMedicareOrMedicaidPaymentMandateCategory2: description: Federal Medicare or Medicaid Payment Mandate - Category 2. type: string federalMedicareOrMedicaidPaymentMandateCategory3: description: Federal Medicare or Medicaid Payment Mandate - Category 3. type: string federalMedicareOrMedicaidPaymentMandateCategory4: description: Federal Medicare or Medicaid Payment Mandate - Category 4. type: string federalMedicareOrMedicaidPaymentMandateCategory5: description: Federal Medicare or Medicaid Payment Mandate - Category 5. type: string lifeTimeReserveActual: description: The actual lifetime reserve days. type: string lifeTimeReserveEstimated: description: The estimated lifetime reserve days. type: string nonCoveredEstimated: description: The non-covered estimated amount. type: string notReplacedBloodUnits: description: The number of non-replaced blood units. type: string outlierDays: description: The number of outlier days. type: string prescription: description: The prescription. type: string visits: description: The number of visits. type: string type: object PaymentInfoCorrectedPatientOrInsuredName: description: Used to provide corrected information about the insured. properties: firstName: description: The insured's first name. type: string insuredsChangedUniqueIdentificationNumber: description: The insured's changed unique identification number. type: string lastName: description: The insured's last name. type: string middleName: description: The insured's middle name or initial of the insured. type: string organizationName: description: The business name of the insured when they are not an individual. type: string suffix: description: The insured's name suffix, such as Jr. or III. type: string type: object PaymentInfoInpatientAdjudication: description: Information about the adjudication of inpatient claims. properties: claimDRGAmount: description: The Diagnosis Related Group (DRG) amount. type: string claimDisproportionateShareAmount: description: The Disproportionate Share amount. type: string claimIndirectTeachingAmount: description: The indirect teaching amount. type: string claimMSPPassThroughAmount: description: The Medicare Secondary Payer (MSP) pass-through amount. type: string claimPPSCapitalAmount: description: The total Prospective Payment System (PPS) capital amount. type: string claimPPSCapitalOutlierAmount: description: The Prospective Payment System (PPS) Capital Outlier amount. type: string claimPaymentRemarkCode1: description: The [Claim Payment Remark Code](https://x12.org/codes/remittance-advice-remark-codes). type: string claimPaymentRemarkCode2: description: A [Claim Payment Remark Code](https://x12.org/codes/remittance-advice-remark-codes). type: string claimPaymentRemarkCode3: description: A [Claim Payment Remark Code](https://x12.org/codes/remittance-advice-remark-codes). type: string claimPaymentRemarkCode4: description: A [Claim Payment Remark Code](https://x12.org/codes/remittance-advice-remark-codes). type: string claimPaymentRemarkCode5: description: A [Claim Payment Remark Code](https://x12.org/codes/remittance-advice-remark-codes). type: string costReportDayCount: description: The number of cost report days. type: string coveredDaysOrVisitsCount: description: The number of days or visits covered by the health plan. type: string lifetimePsychiatricDaysCount: description: The number of psychiatric days for the patient's lifetime. type: string nonPayableProfessionalComponentAmount: description: The professional component amount billed but not payable. type: string oldCapitalAmount: description: The old capital amount. type: string ppsCapitalDSHDRGAmount: description: The Prospective Payment System (PPS) capital, disproportionate share, hospital Diagnosis Related Group (DRG) amount. type: string ppsCapitalExceptionAmount: description: The capital exception amount. type: string ppsCapitalFSPDRGAmount: description: The Prospective Payment System (PPS) capital, federal specific portion, Diagnosis Related Group (DRG) amount. type: string ppsCapitalHSPDRGAmount: description: The Prospective Payment System (PPS) capital, hospital specific portion, Diagnosis Related Group (DRG), amount. type: string ppsCapitalIMEAmount: description: The Prospective Payment System (PPS) capital indirect medical education claim amount. type: string ppsOperatingFederalSpecificDRGAmount: description: The federal specific Diagnosis Related Group (DRG) amount. type: string ppsOperatingHospitalSpecificDRGAmount: description: The hospital specific Diagnosis Related Group (DRG) Amount. type: string ppsOperatingOutlierAmount: description: The Prospective Payment System (PPS) Operating Outlier amount, expressed as a decimal. type: string type: object PaymentInfoOtherClaimRelatedIdentification: description: Additional reference numbers to identify the specific claim. properties: adjustedRePricedClaimReferenceNumber: description: The adjusted repriced claim reference number. type: string authorizationNumber: description: An authorization number assigned by the adjudication process that was not provided prior to the services. type: string classOfContractCode: description: The class of contract code. type: string classOfContractCodes: description: A list of class of contract codes when multiple codes are applicable. items: type: string type: array employeeIdentificationNumber: description: The employee identification number. type: string groupNumber: description: The other insured group number. type: string groupOrPolicyNumber: description: The group or policy number for the health plan. type: string insurancePolicyNumber: description: The insurance policy number. type: string medicalRecordIdentificationNumber: description: The medical record identification number. type: string memberIdentificationNumber: description: The health plan member identification number. type: string originalReferenceNumber: description: The reference number for the original claim. This is included for correction claims. type: string predeterminationOfBenefitsIdentificationNumber: description: The predetermination of benefits identification number. type: string priorAuthorizationNumber: description: The prior authorization number. type: string rePricedClaimReferenceNumber: description: The repriced claim reference number. type: string ssn: description: The social security number (SSN). pattern: ^\d{9}$ type: string type: object PaymentInfoOutpatientAdjudication: description: Information about the adjudication of claims not related to an inpatient setting. properties: claimESRDPaymentAmount: description: The End Stage Renal Disease (ESRD) payment amount. type: string claimHCPCSPayableAmount: description: The claim Health Care Financing Administration Common Procedural Coding System (HCPCS) payable amount, expressed as a decimal. type: string claimPaymentRemarkCode1: description: A [Claim Payment Remark Code](https://x12.org/codes/remittance-advice-remark-codes). type: string claimPaymentRemarkCode2: description: A [Claim Payment Remark Code](https://x12.org/codes/remittance-advice-remark-codes). type: string claimPaymentRemarkCode3: description: A [Claim Payment Remark Code](https://x12.org/codes/remittance-advice-remark-codes). type: string claimPaymentRemarkCode4: description: A [Claim Payment Remark Code](https://x12.org/codes/remittance-advice-remark-codes). type: string claimPaymentRemarkCode5: description: A [Claim Payment Remark Code](https://x12.org/codes/remittance-advice-remark-codes). type: string nonPayableProfessionalComponentAmount: description: The professional component amount billed but not payable. type: string reimbursementRate: description: The reimbursement rate, expressed as a decimal. type: string type: object PaymentInfoPatientName: description: Information about the individual who received medical services. properties: firstName: description: The patient's first name. type: string healthInsuranceClaimNumber: description: The patient's Health Insurance Claim (HIC) Number. type: string lastName: description: The patient's last name. type: string medicaidRecipientIdentificationNumber: description: The patient's Medicaid Recipient Identification Number. type: string memberId: description: The patient's member ID number for their health plan. type: string middleName: description: The patient's middle name or initial. type: string ssn: description: The patient's Social Security Number (SSN). pattern: ^\d{9}$ type: string standardUniqueHealthIdentifierForEachIndividualInTheUnitedStates: description: Deprecated. type: string suffix: description: The patient's name suffix, such as Jr or III. type: string type: object PaymentInfoRenderingProvider: description: Information about the provider who rendered the services. properties: blueCrossProviderNumber: description: The rendering provider's Blue Cross Provider Number. type: string blueShieldProviderNumber: description: The rendering provider's Blue Shield Provider Number. type: string firstName: description: The rendering provider's first name. type: string lastName: description: The rendering provider's last name. type: string medicaidProviderNumber: description: The rendering provider's Medicare Provider Number. type: string middleName: description: The rendering provider's middle name or initial. type: string npi: description: The rendering provider's National Provider Identifier (NPI). pattern: ^\d{10}$ type: string organizationName: description: The rendering provider's business name. type: string providerCommercialNumber: description: The rendering provider's Provider Commercial Number. type: string stateLicenseNumber: description: The rendering provider's State License Number. type: string suffix: description: The rendering provider's name suffix, such as Jr. or III. type: string taxId: description: The rendering provider's Federal Taxpayer Identification Number. pattern: ^\d{9}$ type: string uniquePhysicianIdentificationNumber: description: Deprecated; replaced by NPI in 2007. type: string type: object PaymentInfoRenderingProviderIdentification: description: Additional identifiers for the rendering provider. properties: blueCrossProviderNumber: description: The rendering provider's Blue Cross Provider Number. type: string blueShieldProviderNumber: description: The rendering provider's Blue Shield Provider Number. type: string champusIdentificationNumber: description: The rendering provider's CHAMPUS Identification Number. type: string facilityIdNumber: description: The rendering provider's Facility ID Number. type: string locationNumber: description: The rendering provider's Location Number. type: string medicaidProviderNumber: description: The rendering provider's Medicaid Provider Number. type: string medicareProviderNumber: description: The rendering provider's Medicare Provider Number. type: string nationalCouncilForPrescriptionDrugProgramPharmacyNumber: description: The rendering provider's National Council for Prescription Drug Program Pharmacy Number. type: string providerCommercialNumber: description: The rendering provider's Provider Commercial Number. type: string providerUPINNumber: description: Deprecated; replaced by NPI in 2007. type: string stateLicenseNumber: description: The rendering provider's State License Number. type: string type: object PaymentInfoSubscriber: description: Information about the primary policyholder for the health plan. This may or may not be the patient. properties: firstName: description: The subscriber's first name. type: string lastName: description: The subscriber's last name. type: string memberId: description: The subscriber's member ID for their health plan. type: string middleName: description: The subscriber's middle name or initial. type: string organizationName: description: The subscriber's business name, if the subscriber is not an individual. type: string standardUniqueHealthIdentifierForEachIndividualInTheUnitedStates: description: Deprecated type: string suffix: description: The subscriber's name suffix, such as Jr. or III. type: string taxId: description: The subscriber's Federal Taxpayer's Identification Number. Only used when the subscriber is a business entity and not an individual. pattern: ^\d{9}$ type: string type: object PaymentMethodCode: description: Specifies the method used to deliver payment to the provider. This determines how the payment will be transmitted, such as electronically through ACH, by physical check, or wire transfer. enum: - ACH - BOP - CHK - FWT - NON type: string 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 PlanDateInformation: description: 'Contains the dates associated with the subscriber and dependents'' (if applicable) insurance plan. This information is used to determine their eligibility for benefits. - Most fields contain a single date, but some can contain either a single date or a date range. Each field''s documentation specifies its format. - Fields that can contain either a single date or date range include: `plan`, `eligibility`, `planBegin`, `admission`, and `service`. - The provided dates apply to every benefit within the patient''s health plan unless specifically noted within a `benefitsInformation[].benefitsDateInformation` object. - If the payer sends back date(s) that are different for the subscriber and dependents, Stedi includes only the dates for the dependent in this object and omits the subscriber''s date(s). Dependents can have different coverage dates than the subscriber due to qualifying life events, such as starting a new job or passing the age limit for coverage through their parent''s plan. - Most payers return either `plan` or `planBegin` and `planEnd`, but the exact dates returned depend on the payer''s discretion and the patient''s insurance plan. - If the date of service is after the earliest ending `plan`, `eligibility`, `planEnd`, `eligibilityEnd`, `policyEffective`, or `policyExpiration` value, the patient likely doesn''t have active coverage.' properties: added: description: Added date. Payers may return this information in the case of retroactive eligibility. 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 admission: description: The admission date or 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 benefit: deprecated: true description: The benefit date. 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 benefitBegin: deprecated: true description: The benefit begin date. 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 benefitEnd: deprecated: true description: The benefit end date. 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 certification: description: The certification date. 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 cobraBegin: description: The date when COBRA coverage begins. 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 cobraEnd: description: The date when COBRA coverage ends. 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 completion: deprecated: true description: The completion date. 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 coordinationOfBenefits: deprecated: true description: The coordination of benefits date. 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 dateOfDeath: description: The date of death. Payers may return this information in the case of a deceased subscriber or dependent. 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 dateOfLastUpdate: description: The date when the plan information was last updated. 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 discharge: description: The discharge date. 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 effectiveDateOfChange: description: The effective date of change. 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 eligibility: description: Plan eligibility 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 eligibilityBegin: description: The date when the patient is first eligible for benefits under the plan. 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 eligibilityEnd: description: The date when the patient is no longer eligible for benefits under the plan. 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 enrollment: description: The date when the patient is enrolled in the plan. 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 issue: description: The issue date. 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 latestVisitOrConsultation: deprecated: true description: The latest visit or consultation date. 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 periodEnd: deprecated: true description: The end of a period. 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 periodStart: deprecated: true description: The start of a period. 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 plan: description: Plan effective 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 planBegin: description: The date coverage from the plan begins. 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 planEnd: description: The date coverage from the plan ends. 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 policyEffective: description: The date when the policy becomes effective. 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 policyExpiration: description: The date when the policy expires. 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 premiumPaidToDateBegin: description: The start of the period when the plan premium was paid in full. 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 premiumPaidToDateEnd: description: The end of period when the plan premium payments are up-to-date. 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 primaryCareProvider: deprecated: true description: The primary care provider date. 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 service: description: The service date or 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 status: description: The status date. 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 PlanInformation: description: Additional identification for the subscriber's healthcare plan. properties: agencyClaimNumber: description: The agency claim number, only used when the information source is a Property and Casualty payer. type: string alternativeListId: description: The alternative list ID - identifies a list of alternative drugs with the associated formulary status for the patient. type: string caseNumber: description: The case number type: string centersForMedicareAndMedicaidServicesNPI: description: The [National Provider Identifier (NPI)](https://www.stedi.com/docs/healthcare/national-provider-identifier) assigned by the Centers for Medicare and Medicaid Services pattern: ^\d{10}$ type: string classOfContractCode: description: The class of contract code - used to identify the applicable class of contract for claims processing. type: string contractNumber: description: The contract number of a contract between the payer and the provider that requested the eligibility check. type: string coverageListId: description: The coverage list ID - identifies a list of drugs that have coverage limitations for the patient. type: string drugFormularyNumber: description: The drug formulary number type: string electronicDevicePin: description: The electronic device pin number type: string eligibilityCategory: description: The eligibility category type: string facilityIdNumber: description: The facility ID number type: string facilityNetworkIdentificationNumber: description: The facility network identification number type: string familyUnitNumber: description: The family unit number type: string federalTaxpayersIdentificationNumber: description: The federal taxpayer's identification number type: string groupDescription: description: The group description type: string groupNumber: description: The group number type: string hicNumber: description: The health insurance claim number (HICN). Note that CMS previously used the HICN to uniquely identify Medicare beneficiaries. However, they have since transitioned to a new, randomized Medicare Beneficiary Identifier (MBI) format. The HICN is no longer used for Medicare transactions but this property is now used by some payers to return MBI. If you receive a value in this property that matches the format specified in the [Medicare Beneficiary Identifier documentation](https://www.cms.gov/training-education/partner-outreach-resources/new-medicare-card/medical-beneficiary-identifiers-mbis), the number is likely an MBI and we recommend sending a follow-up eligibility check to CMS for additional benefits data. This most commonly occurs with patients who are covered by both Medicare and Medicaid. type: string idCardNumber: description: The identity card number, used when the Identity Card Number is different than the Member Identification Number. type: string idCardSerialNumber: description: The identification card serial number. The Identification Card Serial Number uniquely identifies the identification card when multiple cards have been or will be issued to a member, such as a replacement card. type: string insurancePolicyNumber: description: The insurance policy number type: string issueNumber: description: The issue number type: string medicaidProviderNumber: description: The Medicaid provider number type: string medicaidRecipientIdNumber: description: The Medicaid recipient identification number type: string medicalAssistanceCategory: description: The medical assistance category type: string medicalRecordIdentificationNumber: description: The medical record identification number type: string medicareProviderNumber: description: The Medicare provider number type: string memberId: description: The member identification number - only used when checking eligibility with a Workers' Compensation or Property and Casualty insurer. type: string patientAccountNumber: description: The patient account number. If you included this value in the original eligibility request, the payer will return the same value here in the response. type: string personalIdentificationNumber: description: The personal identification number (PIN) type: string planDescription: description: The plan description type: string planNetworkIdDescription: description: The plan, group, or plan network name type: string planNetworkIdNumber: description: The plan network identification number type: string planNumber: description: The plan number type: string policyNumber: description: The group or policy number type: string priorAuthorizationNumber: description: The prior authorization number type: string priorIdNumber: description: The prior identifier number type: string referralNumber: description: The referral number type: string socialSecurityNumber: description: The social security number type: string x-meta: title: Social Security Number (SSN) stateLicenseNumber: description: The state license number type: string submitterIdentificationNumber: description: The submitter identification number type: string userIdentification: description: The user identification type: string 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 PlanStatus: deprecated: true properties: planDetails: deprecated: true type: string serviceTypeCodes: deprecated: true description: 'Service Type Codes (STCs) related to the benefit type. For example, `7` - Anesthesia. Visit [Service Type Codes](https://www.stedi.com/docs/healthcare/send-eligibility-checks#service-type-codes) for a complete list. This list is specific to X12 version 005010, which is the mandated version for eligibility checks. It differs from the current [X12 Service Type Codes](https://x12.org/codes/service-type-codes) list, which applies to X12 versions later than 005010. Payers may sometimes return other non-compliant values.' items: $ref: '#/components/schemas/ResponseEligibilityServiceTypeCode' type: array status: deprecated: true type: string statusCode: deprecated: true type: string type: object PolicyComplianceCode: enum: - '1' - '2' - '3' - '4' - '5' 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 PregnancyIndicator: description: Code indicating whether the patient is pregnant. Can be set to `Y` - Yes. enum: - Y type: string 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 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 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: $ref: '#/components/schemas/PrincipalDiagnosisQualifierCode' required: - principalDiagnosisCode - qualifierCode type: object PrincipalDiagnosisPresentOnAdmissionIndicator: description: Indicates whether the principal diagnosis was present on admission. Can be set to `N` - No (onset did NOT occur prior to admission to the hospital), `Y` - Yes (onset occurred prior to admission to the hospital), `U` - Unknown, or `W` - Not Applicable. enum: - N - Y - U - W type: string PrincipalDiagnosisQualifierCode: description: Code identifying the type of diagnosis code used. Can be set to `ABK` - International Classification of Diseases Clinical Modification Principal Diagnosis or `BK` - International Classification of Diseases Clinical Modification (ICD-9-CM) Principal Diagnosis. Note that ICD-9 is deprecated and cannot be used in new claims. enum: - ABK - BK type: string PrincipalProcedureInformation: properties: principalProcedureCode: description: The principal procedure code for the patient. It must be a valid code from the appropriate coding system. **Don't** submit the decimal for ICD codes; the decimal is implied. maxLength: 30 type: string principalProcedureDate: description: The date when the procedure was performed. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string qualifierCode: $ref: '#/components/schemas/PrincipalProcedureInformationQualifierCode' required: - principalProcedureCode - qualifierCode type: object 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 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 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 ProductOrServiceIDQualifier: description: A code identifying the type/source of the descriptive number used in Product/Service ID. Visit [Claims code lists](https://www.stedi.com/docs/healthcare/claims-code-lists#product-or-service-id-qualifier) for a complete list. enum: - AD - ER - HC - HP - IV - N4 - NU - WK type: string ProductServiceIdQualifier: description: Identifies the coding system or classification used to describe medical products, services, or procedures. These qualifiers specify which standardized code set is being used to identify the healthcare service or product. enum: - HC - AD - ER - IV - N4 - NU - WK type: string ProfessionalClaimEnrollmentProcess: description: Details about the enrollment process for professional claim submission. properties: requestedEffectiveDate: $ref: '#/components/schemas/RequestedEffectiveDate' description: "Whether this payer supports specifying a requested effective\ \ date for transaction enrollments.\n - If set to `SUPPORTED`, Stedi\ \ will process [transaction enrollment requests](https://www.stedi.com/docs/healthcare/api-reference/post-enrollment-create-enrollment)\ \ for this payer according to their specified `requestedEffectiveDate`.\n\ \ - This property is only returned when Stedi can determine whether the\ \ payer supports requested effective dates." timeframe: $ref: '#/components/schemas/EnrollmentProcessTimeframe' type: $ref: '#/components/schemas/EnrollmentProcessType' type: object 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 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 Provider: description: "Information about the entity requesting the eligibility check.\ \ This may be an individual practitioner, a medical group, a hospital, or\ \ another type of healthcare provider.\n - You must provide the `organizationName`\ \ (if the entity is an organization), or `firstName` and `lastName` (if the\ \ provider is an individual).\n - You must also provide an identifier - this\ \ is typically the provider's [National Provider Identifier](https://www.stedi.com/docs/healthcare/national-provider-identifier)\ \ (`npi`). If the provider doesn't have an NPI, you can supply an alternative,\ \ such as their `taxId` or `ssn`.\n - Don't include additional properties,\ \ such as `taxId` or `address`, unless they are specifically required or suggested\ \ by the payer." properties: address: $ref: '#/components/schemas/RequestProviderAddress' contactNumber: deprecated: true description: 'The provider''s contract number. Only include when required by a payer. This shape is deprecated: Use `contractNumber` instead.' maxLength: 50 minLength: 1 type: string contractNumber: description: The provider's contract number. Only include when required by a payer. maxLength: 50 minLength: 1 type: string devicePinNumber: description: The provider's electronic device pin number. Only include when required by a payer. maxLength: 50 minLength: 1 type: string employersId: deprecated: true description: 'Deprecated; The submitter''s Employer''s Identification Number (EIN). Only use when an employer is checking the eligibility and benefits of their employees. This shape is deprecated: This property is no longer used.' maxLength: 80 minLength: 2 type: string facilityIdNumber: description: The ID number for the provider's facility. Only include when required by a payer. maxLength: 50 minLength: 1 type: string facilityNetworkIdNumber: description: The provider's facility network identification number. Only include when required by a payer. maxLength: 50 minLength: 1 type: string firstName: description: The provider's first name. This property is required if the provider is an individual. maxLength: 35 minLength: 1 type: string informationReceiverAdditionalIdentifierState: description: The two-character state ID of the state that assigned the `stateLicenseNumber`. Only include when required by a payer. maxLength: 80 minLength: 1 type: string lastName: description: The provider's last name. This property is required if the provider is an individual. maxLength: 60 minLength: 1 type: string medicaidProviderNumber: description: The provider's Medicaid provider number. Only include when required by a payer. maxLength: 50 minLength: 1 type: string medicareProviderNumber: description: The provider's Medicare provider number. Only include when required by a payer. maxLength: 50 minLength: 1 type: string npi: description: The provider's [National Provider Identifier (NPI)](https://www.stedi.com/docs/healthcare/national-provider-identifier). This identifier is required for all healthcare providers who are eligible to receive an NPI. Some non-traditional providers such as transportation services, durable medical equipment (DME) suppliers, or alternative medicine practitioners are not eligible to receive an NPI. If the provider doesn't have an NPI, requests with alternate IDs are virtually never supported. In the rare circumstance that a payer has instructed you to use an alternate ID, the payer will typically require you to supply either their `taxId` or `ssn` instead. pattern: ^\d{10}$ type: string x-meta: title: National Provider Identifier (NPI) organizationName: description: The provider's business name. This property is required if the provider is not an individual. maxLength: 60 minLength: 1 type: string payorId: description: Only used for payer-to-payer transactions, which are not currently supported. Do not use. maxLength: 80 minLength: 2 type: string pharmacyProcessorNumber: description: The provider's pharmacy processor number. Only include when specifically instructed by a payer - for example, when the provider doesn't have an [NPI](https://www.stedi.com/docs/healthcare/national-provider-identifier). This use case is very rarely supported, and is typically when the provider is a non-medical provider, such as a social worker, home health aide, or transportation service. maxLength: 80 minLength: 2 type: string priorIdentifierNumber: description: The provider's prior identifier number. Only include when required by a payer. maxLength: 50 minLength: 1 type: string providerCode: $ref: '#/components/schemas/RequestProviderCode' description: Communicate the provider's role in the type of benefits specified in the request. Visit [Eligibility code lists](https://www.stedi.com/docs/healthcare/eligibility-code-lists#provider-codes) for a complete list. Only include when required by a payer. providerPlanNetworkIdNumber: description: The provider's plan network identification number. Only include when required by a payer. maxLength: 50 minLength: 1 type: string providerType: $ref: '#/components/schemas/ProviderType' referenceIdentification: description: The provider's [Taxonomy Code](https://x12.org/codes/provider-taxonomy-codes). Only used when the provider's taxonomy code is relevant to the eligibility/benefit inquiry. For example, an institutional provider such as a hospital may need to use a taxonomy code to specify a specific unit or department. type: string serviceProviderNumber: description: The provider's service provider number. Only include when specifically instructed by a payer - for example, when the provider doesn't have an [NPI](https://www.stedi.com/docs/healthcare/national-provider-identifier). This use case is very rarely supported, and is typically when the provider is a non-medical provider, such as a social worker, home health aide, or transportation service. maxLength: 80 minLength: 2 type: string servicesPlanID: deprecated: true maxLength: 80 minLength: 2 type: string ssn: description: "The provider's Social Security Number (SSN).\n - Only include\ \ when specifically instructed by a payer - for example, if the provider\ \ doesn't have an [NPI](https://www.stedi.com/docs/healthcare/national-provider-identifier).\ \ This use case is very rarely supported, and is typically when the provider\ \ is a non-medical provider, such as a social worker, home health aide,\ \ or transportation service.\n - If the payer has instructed you to\ \ send an EIN but the provider operates using their SSN, use provider.taxId\ \ instead of this field.\n - Don't use this for Federally-administered\ \ programs, such as Medicare." pattern: ^\d{9}$ type: string x-meta: title: Social Security Number (SSN) stateLicenceNumber: description: The provider's state license number. If you include this information, you must also include the `informationReceiverAdditionalIdentifierState`. Only include when required by a payer. maxLength: 50 minLength: 1 type: string submitterIdNumber: description: The provider's submitter identification number. Only include when required by a payer. maxLength: 50 minLength: 1 type: string taxId: description: The provider's Federal Taxpayer Identification Number. This is typically the provider's EIN (Employer Identification Number), but the provider's SSN may be used if the provider does not have an EIN. Only include if required by the payer. pattern: ^\d{9}$ type: string type: object ProviderAdjustments: description: Provider-level adjustments unrelated to specific claims. properties: adjustments: description: List of adjustments applied to the provider. items: $ref: '#/components/schemas/Adjustments' type: array fiscalPeriodDate: description: The last day of the provider's fiscal year. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string providerIdentifier: description: This is the provider's NPI. type: string type: object ProviderClaimStatus: properties: providerStatuses: description: The status of the entire claim. items: $ref: '#/components/schemas/ProviderStatus' type: array statusInformationEffectiveDate: description: The date the claim status information is effective. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string type: object ProviderEntityIdentifierCode: description: Entity identifier code for providers in claim status reports enum: - '36' - '40' - '41' - AY - PR type: string ProviderEntityIdentifierCodeValue: description: Human-readable descriptions for provider entity identifier codes enum: - Employer - Receiver - Submitter - Clearinghouse - Payer type: string ProviderInformation: properties: providerCode: $ref: '#/components/schemas/ResponseProviderCode' description: 'A code that communicates the provider''s role in the type of benefits information in the response. Visit [Eligibility code lists](https://www.stedi.com/docs/healthcare/eligibility-code-lists#provider-codes) for a complete list. Payers may sometimes return other non-compliant values.' referenceIdentification: description: The provider's taxonomy code. type: string type: object ProviderStatus: properties: entityIdentifierCode: $ref: '#/components/schemas/ProviderEntityIdentifierCode' description: Code indicating the entity that the status is related to. entityIdentifierCodeValue: $ref: '#/components/schemas/ProviderEntityIdentifierCodeValue' description: The description of the `entityIdentifierCode`. healthCareClaimStatusCategoryCode: $ref: '#/components/schemas/HealthCareClaimStatusCategoryCode' healthCareClaimStatusCategoryCodeValue: description: Description of the `healthCareClaimStatusCategoryCode` property. Visit [277CA code lists](https://www.stedi.com/docs/healthcare/claims-code-lists#claim-status-category-code) for a complete list. type: string statusCode: $ref: '#/components/schemas/HealthCareClaimStatusCode' description: Code indicating the status. statusCodeValue: description: The description of the `statusCode`. type: string type: object ProviderSummaryInformation: description: Summary information about the provider, including the provider's identifier, where the services were performed, and total claim charge amounts. properties: facilityTypeCode: description: A code identifying the type of facility where services were performed. This is the [Place of Service Codes](https://www.cms.gov/medicare/coding-billing/place-of-service-codes/code-sets) for Professional or Dental Services. type: string fiscalPeriodDate: description: The last day of the provider's fiscal year. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string providerIdentifier: description: The provider number. type: string totalClaimChargeAmount: description: The total of the charges reported for all claims, expressed as a decimal. type: string totalClaimCount: description: The total number of claims. type: string totalHCPCSPayableAmount: description: The total of the charges reported for all HCPCS codes that are payable, expressed as a decimal. type: string totalHCPCSReportedChargeAmount: description: The total of the charges reported for all Health Care Financing Administration Common Procedural Coding System (HCPCS) codes, expressed as a decimal. type: string totalMSPPatientLiabilityMetAmount: description: The total Medicare Secondary Payer (MSP) patient liability met, expressed as a decimal. type: string totalMSPPayerAmount: description: The total Medicare Secondary Payer (MSP) primary payer amount, expressed as a decimal. type: string totalNonLabChargeAmount: description: The total of non-laboratory charges, expressed as a decimal. type: string totalPIPAdjustmentAmount: description: The total periodic interim payment (PIP) adjustment amount, expressed as a decimal. type: string totalPIPClaimCount: description: The total periodic interim payment (PIP) number of claims, expressed as a decimal. type: string totalPatientReimbursementAmount: description: The total patient reimbursement amount, expressed as a decimal. type: string totalProfessionalComponentAmount: description: The total of the professional component charges, expressed as a decimal. type: string type: object ProviderSupplementalSummaryInformation: description: Additional summary information about the provider and the charges in the claim. All values are expressed as decimals. properties: averageDRGLengthOfStay: description: The average length of stay for diagnosis related group (DRG) claims. type: string averageDRGWeight: description: The average diagnosis-related group (DRG) weight. type: string totalCapitalAmount: description: 'The total capital amount. This includes: capital federal-specfic amount, hospital federal-specfic amount, hold harmless amount, Indirect Medical Education amount, Disproportionate Share Hospital amount, and the exception amount. It does not include any capital outlier amount.' type: string totalCostOutlierAmount: description: The total cost outlier amount. type: string totalCostReportDayCount: description: The total number of cost report days. type: string totalCoveredDayCount: description: The total number of covered days. type: string totalDRGAmount: description: The total of the charges reported for all diagnosis-related group (DRG) codes. type: string totalDayOutlierAmount: description: The total day outlier amount. type: string totalDischargeCount: description: The total number of discharges. type: string totalDisproportionateShareAmount: description: The total disproportionate share amount. type: string totalFederalSpecificAmount: description: The total federal specific amount. type: string totalHospitalSpecificAmount: description: The total hospital specific amount. type: string totalIndirectMedicalEducationAmount: description: The total indirect medical education amount. type: string totalMSPPassThroughAmount: description: The total Medicare Secondary Payer (MSP) pass-through amount, calculated for a non-Medicare payer. type: string totalNonCoveredDayCount: description: The total number of non-covered days. type: string totalOutlierDayCount: description: The total number of outlier days. type: string totalPPSCapitalFSPDRGAmount: description: The total prospective payment system (PPS) capital, federal-specific portion, diagnosis-related group (DRG) amount. type: string totalPPSCapitalHSPDRGAmount: description: The total prospective payment system (PPS) capital, hospital-specific portion, diagnosis-related group (DRG) amount. type: string totalPPSDSHDRGAmount: description: The total prospective payment system (PPS) disproportionate share, hospital diagnosis-related group (DRG) amount. type: string type: object ProviderType: description: Identify the type of provider. enum: - payer - third-party administrator - employer - hospital - facility - gateway provider - plan sponsor - provider type: string 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 QuantityQualifierCode: description: 'Code indicating the type of quantity for the benefit. Payers may sometimes return other non-compliant values.' enum: - 8H - '99' - CA - CE - D3 - DB - DY - HS - LA - LE - M2 - MN - P6 - QA - S7 - S8 - VS - YY type: string QuantityQualifierName: description: 'The name of the quantity qualifier code. Payers may sometimes return other non-compliant values.' enum: - Minimum - Quantity Used - Covered - Actual - Covered - Estimated - Number of Co-insurance Days - Deductible Blood Units - Days - Hours - Life-time Reserve - Actual - Life-time Reserve - Estimated - Maximum - Month - Number of Services or Procedures - Quantity Approved - Age, High Value - Age, Low Value - Visits - Years type: string 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 RawEligibilityResponseValidationErrors: properties: benefitsInformation: description: "Information about the patient's healthcare benefits, such\ \ as coverage level (individual vs. family), coverage type (deductibles,\ \ co-pays, etc.), out of pocket maximums, and more. \n \n Payers typically\ \ return at least the following properties: `code`, `coverageLevelCode`,\ \ `serviceTypeCodes`, and either `benefitAmount` or `benefitPercent`.\ \ However, the exact properties returned in this object are up to the\ \ payer's discretion.\n\nThe payer may send benefits information for service\ \ type codes (STCs) you didn't request - this is expected. The STC you\ \ send in the request tells the payer the types of benefits information\ \ you want, but they aren't required to respond with exactly the same\ \ STC(s) in the response. Receiving different STCs than you requested\ \ can also mean that the payer is ignoring the STC you sent, which is\ \ why we recommend [testing payers](https://www.stedi.com/docs/healthcare/eligibility-stc-procedure-codes#test-payer-stc-support)\ \ to determine their support for specific STCs.\n\nVisit [Determine patient\ \ benefits](https://www.stedi.com/docs/healthcare/eligibility-active-coverage-benefits)\ \ for more information about benefit types, details about how to interpret\ \ the `benefitsInformation` array, and additional examples." items: $ref: '#/components/schemas/BenefitsInformation' type: array controlNumber: deprecated: true description: An identifier for the payer's response. type: string dependents: description: "Information about the patient when they are a dependent. When\ \ the patient is a dependent, this array will contain a single object\ \ with the patient's information. When the patient is a subscriber, or\ \ considered to be a subscriber because they have a unique member ID,\ \ their information is returned in the `subscriber` object, and this array\ \ will be empty.\n\n When present, this object will always include the\ \ dependent's name for identification, but many payers will also return\ \ the date of birth and other identifying information." items: $ref: '#/components/schemas/ResponseDependent' type: array eligibilitySearchId: description: 'An identifier that allows Stedi to group eligibility checks for the same patient into a unified record in the Stedi portal called an [eligibility search](https://www.stedi.com/docs/healthcare/eligibility-searches-view). This property is for use by Stedi tools only, such as Stedi''s MCP server.' type: string errors: description: 'When a payer rejects your eligibility check, the response contains one or more [`AAA` errors](https://www.stedi.com/docs/healthcare/eligibility-troubleshooting#payer-aaa-errors) that specify the reasons for the rejection and any recommended follow-up actions. Any errors that occur at the `payer`, `provider`, `subscriber`, or `dependents` levels are also included in this array, allowing you to review all errors in a central location. If there are no `AAA` errors, this array will be empty.' items: $ref: '#/components/schemas/EligibilityCheckError' type: array id: description: 'A globally unique identifier for this eligibility check across all Stedi accounts. It''s formatted as `ec_`. For example: `ec_550e8400-e29b-41d4-a716-446655440000`. You can use this ID to track this eligibility check and to construct deep links to eligibility checks in the Stedi portal.' type: string implementationTransactionSetSyntaxError: description: The implementation transaction set error code provided in `IK502` of the 999 transaction. type: string meta: $ref: '#/components/schemas/EligibilityMetaDataRawX12' payer: $ref: '#/components/schemas/Payer' planDateInformation: $ref: '#/components/schemas/PlanDateInformation' planInformation: $ref: '#/components/schemas/PlanInformation' planStatus: deprecated: true description: Please use `benefitsInformation` instead. items: $ref: '#/components/schemas/PlanStatus' deprecated: true type: array provider: $ref: '#/components/schemas/ResponseProvider' reassociationKey: deprecated: true type: string status: description: Errors Stedi encountered when generating or sending the final X12 EDI transaction to the payer. These can include validation errors and payer unavailable errors that prevent delivery. type: string subscriber: $ref: '#/components/schemas/ResponseSubscriber' subscriberTraceNumbers: description: 'A unique identifier for the eligibility request. It''s used to trace the transaction. Stedi always generates a trace number for internal tracking, and the payer may generate one as well. You can also optionally [supply your own trace number](https://www.stedi.com/docs/healthcare/send-eligibility-checks#trn) in a `TRN` segment. Stedi returns its internal trace number in this array as well as the trace numbers from you and the payer (if provided).' items: $ref: '#/components/schemas/SubscriberTraceNumber' type: array tradingPartnerServiceId: description: An ID for the payer you identified in the original eligibility check request. 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 transactionSetAcknowledgement: description: The transaction set acknowledgment code provided in in the [X12 EDI 999 response](https://portal.stedi.com/app/guides/view/hipaa/implementation-acknowledgment-x231/01HRF41ES1DVGCA6X1EHSRPFXZ#properties.heading.properties.transaction_set_response_header_AK2_loop.items.properties.transaction_set_response_trailer_IK5). type: string warnings: description: Warnings indicate non-fatal issues with your eligibility check or a non-standard response from the payer. items: $ref: '#/components/schemas/Warning' type: array x12: description: 'Typically this property contains the raw X12 EDI [271 Eligibility Benefit Response](https://portal.stedi.com/app/guides/view/hipaa/health-care-eligibility-benefit-response-x279a1/01GS66YHZPB37ABF34DBPSR213) from the payer. In some circumstances, this property may contain a [999 Implementation Acknowledgment](https://portal.stedi.com/app/guides/view/hipaa/implementation-acknowledgment-x231a1/01HMRQV0N8SPHG58M4ZG1CRHH0) instead of a 271. A 999 indicates validation errors in the X12 EDI transaction, such as improper formatting or missing or invalid values. If the 999 is returned in this property, many of the other response properties will be empty, as they are mapped to information in the 271.' type: string type: object Receiver: description: The entity responsible for the payment of the claim, such as an insurance company or government agency. properties: organizationName: description: The business name of the payer receiving the claim, such as Aetna or Cigna. maxLength: 60 minLength: 1 type: string receiverId: description: The ID of the receiver. The only accepted value is `BPUMR` for drop-to-paper claims; omit otherwise. pattern: ^BPUMR$ type: string required: - organizationName type: object ReceiverAccountDetails: description: Financial institution account details for the payment receiver. properties: receiverAccountNumber: description: The provider's account number. type: string receiverAccountNumberQualifier: $ref: '#/components/schemas/AccountNumberQualifier' description: The code identifying the type of account. Can be either `DA` - Demand Deposit or `SA` - Savings. receiverDfiIdNumberQualifier: $ref: '#/components/schemas/DfiIdNumberQualifier' description: The code identifying the type of identification number of the Depository Financial Institution (DFI). Can be either `01` - ABA Transit Routing Number Including Check Digits (9 digits) or `04` - Canadian Bank Branch Institution Number. receiverDfiIdentificationNumber: description: The identification number specified in `receiverDfiIdNumberQualifier`. type: string 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 ReferringProviderType: description: Defines the referring provider type. enum: - ReferringProvider type: string 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 RejectReasonCode: enum: - T1 - T2 - T3 - T4 - T5 - T6 type: string RelatedEntityIdentifierName: description: "Code identifying an organizational entity, a physical location,\ \ property or an individual. \n - `PPO` is used to identify a PPO by name\ \ or identification number, and also may also be used if identifying the Network\ \ that benefits are restricted to for In-Network benefits.\n\nPayers may sometimes\ \ return other non-compliant values." enum: - Contracted Service Provider - Preferred Provider Organization (PPO) - Provider - Third-Party Administrator - Employer - Other Physician - Facility - Gateway Provider - Group - Independent Physicians Association (IPA) - Insured or Subscriber - Legal Representative - Origin Carrier - Primary Care Provider - Prior Insurance Carrier - Plan Sponsor - Payer - Primary Payer - Secondary Payer - Tertiary Payer - Party Performing Verification - Vendor - Organization Completing Configuration Change - Utilization Management Organization - Managed Care Organization type: string RelationToSubscriberCode: description: The code indicating the dependent's relationship to the subscriber. enum: - '01' - '19' - '20' - '21' - '39' - '40' - '53' - G8 type: string RelationToSubscriberCodeName: description: The name of the `relationToSubscriberCode`. enum: - Spouse - Child - Employee - Unknown - Organ Donor - Cadaver Donor - Life Partner - Other Relationship type: string 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 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 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 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 RenderingProviderType: description: Defines the rendering provider type. enum: - RenderingProvider 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 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 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 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 ReportsClaimAcknowledgmentResponse: properties: controlNumber: description: The control number the payer provided in the claim status response. This is used to identify the transaction. type: string payers: description: Information about the payer (or intermediary clearinghouse) and the claim status transactions included in the response. items: $ref: '#/components/schemas/ClaimAcknowledgmentPayer' type: array referenceIdentification: description: A number the payer assigns to the transaction to identify it within their system. type: string transactionSetCreationDate: description: The date the payer created the transaction. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string transactionSetCreationTime: description: 'The time the payer created the transaction, expressed in 24-hour clock time. May be formatted as HHMM, HHMMSS, HHMMSSD, or HHMMSSDD, where H = hours (00-23), M = minutes (00-59), S = integer seconds (00-59) and DD = decimal seconds; decimal seconds are expressed as follows: D = tenths (0-9) and DD = hundredths (00-99).' pattern: ^([01]\d|2[0-3])[0-5]\d$|^([01]\d|2[0-3])[0-5]\d[0-5]\d$|^([01]\d|2[0-3])[0-5]\d[0-5]\d\d$|^([01]\d|2[0-3])[0-5]\d[0-5]\d\d\d$ type: string type: object ReportsClaims: properties: claimStatus: $ref: '#/components/schemas/ClaimsClaimStatus' description: Status information for the claim. This object includes the `referencedTransactionTraceNumber` you can use to correlate the 277CA with the original claim. serviceLines: description: Information about specific services within a claim. This object is only included in the 277CA when the claim is rejected because of errors with the service line information provided. items: $ref: '#/components/schemas/ClaimAcknowledgmentServiceLines' type: array type: object ReportsContactInformation: properties: contactMethods: items: $ref: '#/components/schemas/ContactMethod' type: array contactName: description: The name of the contact person or entity. type: string 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 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 RequestDependent: properties: additionalIdentification: $ref: '#/components/schemas/AdditionalIdentificationDependent' address: $ref: '#/components/schemas/RequestDependentAddress' beginningCardIssueDate: description: The date the insurance card was issued. Use when you need to specify a date range. Provide the end of the range in the `endCardIssueDate` property. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string beginningPlanIssueDate: description: The date the insurance plan begins. Use when you need to specify a date range. Provide the end of the range in the `endPlanIssueDate` property. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string birthSequenceNumber: description: The number assigned to each family member born with the same birth date, such as twins or triplets. Use to indicate the birth order when there are multiple births associated with the provided birth date. maxLength: 9 minLength: 1 pattern: ^[0-9]+$ type: string dateOfBirth: description: The dependent's date of birth (DOB). We **strongly recommend** including the DOB in your request. Many payers need this information to identify the patient in their system and will immediately return an error when it's not provided. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string eligibilityCategory: description: The eligibility category for the dependent. maxLength: 50 minLength: 1 type: string endCardIssueDate: description: The date the insurance card expires. Use when you need to specify a date range. Provide the start of the range in the `beginningCardIssueDate` property. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string endPlanIssueDate: description: The date the insurance plan ends. Use when you need to specify a date range. Provide the start of the range in the `beginningPlanIssueDate` property. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string firstName: description: The dependent's first name. maxLength: 35 minLength: 1 type: string gender: $ref: '#/components/schemas/Gender' description: Code indicating the dependent's gender. groupNumber: description: The group number for the dependent's insurance plan. maxLength: 50 minLength: 1 type: string healthCareCodeInformation: description: "Information about the dependent's health care diagnosis. You\ \ can include up to eight entries in this array. \n\nThe first array entry\ \ must have `diagnosisTypeCode` set to `ABK`. All subsequent entries must\ \ have `diagnosisTypeCode` set to `ABF`." items: $ref: '#/components/schemas/HealthCareInformation' maxItems: 8 minItems: 1 type: array idCard: description: The dependent's insurance card number. maxLength: 50 minLength: 1 type: string idCardIssueDate: description: The date the insurance card was issued. Use to specify a single date. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string individualRelationshipCode: $ref: '#/components/schemas/IndividualRelationshipCode' issueNumber: description: The issue number for the dependent's insurance policy. maxLength: 50 minLength: 1 type: string lastName: description: The dependent's last name. **Don't** include the dependent's name suffix, such as Jr. or III. Use the designated `suffix` property instead. maxLength: 60 minLength: 1 type: string memberId: deprecated: true description: 'This shape is deprecated: This property is no longer used.' maxLength: 80 minLength: 2 pattern: ^[A-Za-z0-9- ]+$ type: string middleName: description: The dependent's middle name or middle initial. maxLength: 25 minLength: 1 type: string planIssueDate: description: The date the insurance plan begins. Use to specify a single date. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string providerCode: $ref: '#/components/schemas/RequestDependentProviderCode' providerIdentifier: description: The provider identifier you specified in the `referenceIdentificationQualifier` property. For example, the provider's National Provider ID or Federal Taxpayer Identification number. If you set the `referenceIdentificationQualifier` to `PXC`, then this property should contain the provider's taxonomy code. maxLength: 50 minLength: 1 pattern: ^[A-Za-z0-9]+$ type: string referenceIdentificationQualifier: $ref: '#/components/schemas/RequestDependentReferenceIdentificationQualifier' ssn: description: The dependent's social security number. Don't use this for Federally-administered programs, such as Medicare. pattern: ^\d{9}$ type: string x-meta: title: Social Security Number (SSN) suffix: description: The dependent's name suffix, such as Sr. or III. Only include the dependent's personal name suffix - **don't** include professional or academic titles, such as M.D. or MBA. maxLength: 10 minLength: 1 type: string type: object RequestDependentAddress: description: Address information for the dependent. When providing address information, we recommend including `state` for member identification in addition to the required `address1` and `city` properties. properties: address1: description: The first line of the address. maxLength: 55 minLength: 1 type: string address2: description: The second line of the address. maxLength: 55 minLength: 1 type: string city: description: The city. maxLength: 30 minLength: 2 type: string countryCode: description: The two-letter country code from [Part 1 of ISO 3166](https://en.wikipedia.org/wiki/ISO_3166-1_alpha-2). maxLength: 2 minLength: 2 type: string countrySubDivisionCode: description: The country subdivision code from [Part 2 of ISO 3166](https://en.wikipedia.org/wiki/ISO_3166-2). maxLength: 3 minLength: 1 type: string postalCode: description: The United States or Canadian postal code, excluding punctuation and blanks. maxLength: 9 minLength: 5 type: string state: $ref: '#/components/schemas/RequestStateOrProvinceCode' description: The state or province code. required: - address1 - city type: object RequestDependentProviderCode: description: "Use this for providers that are not requesting the eligibility\ \ check - the requestor is specified in the `provider` object. For example,\ \ if you are a hospital making an eligibility request, this is where you would\ \ specify information about a referring provider's role. \n\n You can use\ \ one of the following: `AD` - Admitting, `AT` - Attending, `BI` - Billing,\ \ `CO` - Consulting, `CV` - Covering, `H` - Hospital, `HH` - Home Health Care,\ \ `LA` - Laboratory, `OT` - Other Physician, `P1` - Pharmacist, `P2` - Pharmacy,\ \ `PC` - Primary Care Physician, `PE`- Performing, `R`- Rural Health Clinic,\ \ `RF` - Referring, `SB` - Submitting, `SK` - Skilled Nursing Facility, `SU`\ \ - Supervising" enum: - AD - AT - BI - CO - CV - H - HH - LA - OT - P1 - P2 - PC - PE - R - RF - SK - SU type: string RequestDependentReferenceIdentificationQualifier: description: "The type of `providerIdentifier` you are using. Use for providers\ \ that are not requesting the eligibility check, such as the referring provider.\n\ - Set to `HPI` when the National Provider ID is mandated for use.\n- Set to\ \ `PXC` if you're identifying a type of specialty associated with services\ \ provided to the dependent. \n \n Otherwise, you can set to the following:\ \ `9K` - Servicer, `D3` - National Council for Prescription Drug Programs\ \ Pharmacy Number, `EI` - Employer's Identification Number, `HPI` - Centers\ \ for Medicare and Medicaid Services National Provider Identifier, `PXC` -\ \ Health Care Provider Taxonomy Code, `SY` - Social Security Number, `TJ`\ \ - Federal Taxpayer's Identification Number" enum: - 9K - D3 - EI - HPI - PXC - SY - TJ type: string RequestEligibilityServiceTypeCode: enum: - '1' - '2' - '3' - '4' - '5' - '6' - '7' - '8' - '9' - '10' - '11' - '12' - '13' - '14' - '15' - '16' - '17' - '18' - '19' - '20' - '21' - '22' - '23' - '24' - '25' - '26' - '27' - '28' - '30' - '32' - '33' - '34' - '35' - '36' - '37' - '38' - '39' - '40' - '41' - '42' - '43' - '44' - '45' - '46' - '47' - '48' - '49' - '50' - '51' - '52' - '53' - '54' - '55' - '56' - '57' - '58' - '59' - '60' - '61' - '62' - '63' - '64' - '65' - '66' - '67' - '68' - '69' - '70' - '71' - '72' - '73' - '74' - '75' - '76' - '77' - '78' - '79' - '80' - '81' - '82' - '83' - '84' - '85' - '86' - '87' - '88' - '89' - '90' - '91' - '92' - '93' - '94' - '95' - '96' - '97' - '98' - '99' - A0 - A1 - A2 - A3 - A4 - A5 - A6 - A7 - A8 - A9 - AA - AB - AC - AD - AE - AF - AG - AH - AI - AJ - AK - AL - AM - AN - AO - AQ - AR - B1 - B2 - B3 - BA - BB - BC - BD - BE - BF - BG - BH - BI - BJ - BK - BL - BM - BN - BP - BQ - BR - BS - BT - BU - BV - BW - BX - BY - BZ - C1 - CA - CB - CC - CD - CE - CF - CG - CH - CI - CJ - CK - CL - CM - CN - CO - CP - CQ - DG - DM - DS - GF - GN - GY - IC - MH - NI - 'ON' - PT - PU - RN - RT - TC - TN - UC type: string RequestProviderAddress: description: "Address information for the provider.\n - Only include when specifically\ \ instructed by a payer, such as when the provider has multiple locations\ \ and you need to identify the specific location making the request.\n -\ \ You must include at least the `address1` and `city` properties." properties: address1: description: The first line of the address. maxLength: 55 minLength: 1 type: string address2: description: The second line of the address. maxLength: 55 minLength: 1 type: string city: description: The city. maxLength: 30 minLength: 2 type: string countryCode: description: The two-letter country code from [Part 1 of ISO 3166](https://en.wikipedia.org/wiki/ISO_3166-1_alpha-2). maxLength: 2 minLength: 2 type: string countrySubDivisionCode: description: The country subdivision code from [Part 2 of ISO 3166](https://en.wikipedia.org/wiki/ISO_3166-2). maxLength: 3 minLength: 1 type: string postalCode: description: The United States or Canadian postal code, excluding punctuation and blanks. maxLength: 9 minLength: 5 type: string state: $ref: '#/components/schemas/RequestStateOrProvinceCode' description: The state or province code. required: - address1 - city type: object RequestProviderCode: enum: - AD - AT - BI - CO - CV - H - HH - LA - OT - P1 - P2 - PC - PE - R - RF - SB - SK - SU type: string RequestStateOrProvinceCode: description: The US state or Canadian province code. For example, `TN` for Tennessee or `NB` for New Brunswick. enum: - NL - PE - NS - NB - QC - 'ON' - MB - SK - AB - BC - YT - NT - NU - DC - AS - GU - MP - PR - UM - VI - AA - AE - AP - AK - AL - AR - AZ - CA - CO - CT - DE - FL - GA - HI - IA - ID - IL - IN - KS - KY - LA - MA - MD - ME - MI - MN - MO - MS - MT - NC - ND - NE - NH - NJ - NM - NV - NY - OH - OK - OR - PA - RI - SC - SD - TN - TX - UT - VA - VT - WA - WI - WV - WY type: string RequestSubscriber: description: 'The primary policyholder for the insurance plan _or_ a dependent with a unique member ID. If a dependent has a unique member ID, include their information here and leave `dependents` empty. - At a minimum, our API requires that you supply at least one of these fields in the request: `memberId`, `dateOfBirth`, or `lastName`. However, each payer has different requirements, so you should supply the fields necessary for each payer to identify the subscriber in their system. - When you provide all four of `memberId`, `dateOfBirth`, `firstName`, and `lastName`, payers are required to return a response if the member is in their database. Some payers may be able to search with less information, but this varies by payer. - We recommend always including the patient''s member ID when possible. - Enter the patient''s name exactly as written on their insurance card, if available, including any special or punctuation characters such as apostrophes, hyphens (dashes), or spaces. Visit [patient names](https://www.stedi.com/docs/healthcare/send-eligibility-checks#patient-names) for all best practices to avoid unnecessary failures.' properties: additionalIdentification: $ref: '#/components/schemas/AdditionalIdentificationSubscriber' address: $ref: '#/components/schemas/RequestSubscriberAddress' beginningCardIssueDate: description: The date the subscriber's insurance card was issued. Use when you need to specify a date range. Provide the end of the range in the `endCardIssueDate` property. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string beginningPlanIssueDate: description: The date the subscriber's insurance plan begins. Use when you need to specify a date range. Provide the end of the range in the `endPlanIssueDate` property. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string birthSequenceNumber: description: The number assigned to each family member born with the same birth date, such as twins or triplets. Use to indicate the birth order when there are multiple births associated with the provided birth date. maxLength: 9 minLength: 1 pattern: ^[0-9]$ type: string caseNumber: description: The case number associated with the subscriber. maxLength: 50 minLength: 1 pattern: ^[A-Za-z0-9]+$ type: string coverageLevelCode: description: This property is no longer used. type: string dateOfBirth: description: The subscriber's date of birth. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string endCardIssueDate: description: The date the subscriber's insurance card expires. Use when you need to specify a date range. Provide the start of the range in the `beginningCardIssueDate` property. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string endPlanIssueDate: description: The date the subscriber's insurance plan ends. Use when you need to specify a date range. Provide the start of the range in the `beginningPlanIssueDate` property. 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/Gender' description: Code indicating the subscriber's gender. groupNumber: description: The group number associated with the subscriber's insurance policy. maxLength: 50 minLength: 1 type: string healthCareCodeInformation: description: "Information about the subscriber's health care diagnosis.\ \ You can include up to eight entries in this array. \n\nThe first array\ \ entry must have `diagnosisTypeCode` set to `ABK`. All subsequent entries\ \ must have `diagnosisTypeCode` set to `ABF`." items: $ref: '#/components/schemas/HealthCareInformation' maxItems: 8 minItems: 1 type: array idCard: description: The subscriber's identification card number. Include this property when this number is different than the subscriber's member ID. This is common in Medicaid. maxLength: 50 minLength: 1 type: string idCardIssueDate: description: The date the subscriber's insurance card was issued. Use to specify a single date. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ 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 medicaidRecipientIdentificationNumber: description: The Medicaid Recipient Identification Number. You can provide this number to identify the subscriber when it is the primary number the payer knows a member by (such as for Medicare or Medicaid). Do not supply this value unless it is different from the `memberId`. maxLength: 50 minLength: 1 pattern: ^[A-Za-z0-9]+$ type: string memberId: description: The member ID for the subscriber's insurance policy. maxLength: 80 minLength: 2 pattern: ^[A-Za-z0-9- ]+$ type: string middleName: description: The patient's middle name or middle initial. maxLength: 25 minLength: 1 type: string planIssueDate: description: The date the subscriber's insurance plan begins. Use to specify a single date. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string providerCode: $ref: '#/components/schemas/RequestSubscriberProviderCode' providerIdentifier: description: "The provider identifier you specified in the `referenceIdentificationQualifier`\ \ property. It is **required** if you set the `referenceIdentificationQualifier`.\ \ For example, this property could contain the provider's National Provider\ \ ID or Federal Taxpayer Identification number.\n\n If you set the `referenceIdentificationQualifier`\ \ to `PXC`, then this property should contain the provider's taxonomy\ \ code." maxLength: 50 minLength: 1 pattern: ^[A-Za-z0-9]+$ type: string referenceIdentificationQualifier: $ref: '#/components/schemas/RequestSubscriberReferenceIdentificationQualifier' spendDownAmount: description: Identify the dollar amount the subscriber will apply toward their spend down amount, if required. For some Medicaid programs, individuals must pay a certain amount towards their healthcare cost (spend down) before coverage starts. maxLength: 15 minLength: 1 type: string spendDownTotalBilledAmount: description: The subscriber's spend down total billed amount. maxLength: 15 minLength: 1 type: string ssn: description: The subscriber's Social Security Number (SSN). Many commercial and government payers ignore this property due to concerns about member privacy. However, some Medicaid programs support alternative searches using the patient's Social Security Number, instead of the member ID. pattern: ^\d{9}$ type: string x-meta: title: Social Security Number (SSN) suffix: description: The name suffix, such as Jr., Sr., 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 type: object RequestSubscriberAddress: description: "Address information for the subscriber. When providing address\ \ information:\n - The `address1` and `city` properties are **required**\ \ for standard eligibility checks and MBI lookups with SSN. We also recommend\ \ including `state` for member identification.\n - When performing an [MBI\ \ lookup without SSN](https://www.stedi.com/docs/healthcare/mbi-lookup) (Payer\ \ ID: `MBILUNOSSN`), only `state` is required. You can omit `address1` and\ \ `city`." properties: address1: description: The first line of the address. Required for all payers except payer ID `MBILUNOSSN`. maxLength: 55 minLength: 1 type: string address2: description: The second line of the address. maxLength: 55 minLength: 1 type: string city: description: The city. Required for all payers except payer ID `MBILUNOSSN`. maxLength: 30 minLength: 2 type: string countryCode: description: The two-letter country code from [Part 1 of ISO 3166](https://en.wikipedia.org/wiki/ISO_3166-1_alpha-2). maxLength: 2 minLength: 2 type: string countrySubDivisionCode: description: The country subdivision code from [Part 2 of ISO 3166](https://en.wikipedia.org/wiki/ISO_3166-2). maxLength: 3 minLength: 1 type: string postalCode: description: The United States or Canadian postal code, excluding punctuation and blanks. maxLength: 9 minLength: 5 type: string state: $ref: '#/components/schemas/RequestStateOrProvinceCode' description: The state or province code. Required for payer ID `MBILUNOSSN`. 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 RequestSubscriberProviderCode: description: "Use this for providers that are not requesting the eligibility\ \ check - the requestor is specified in the `provider` object. For example,\ \ if you are a hospital making an eligibility request, this is where you would\ \ specify information about a referring provider's role. \n\n This property\ \ is **required** when the `providerIdentifier` and `referenceIdentificationQualifier`\ \ properties are populated. \n\n You can use one of the following: `AD` -\ \ Admitting, `AT` - Attending, `BI` - Billing, `CO` - Consulting, `CV` - Covering,\ \ `H` - Hospital, `HH` - Home Health Care, `LA` - Laboratory, `OT` - Other\ \ Physician, `P1` - Pharmacist, `P2` - Pharmacy, `PC` - Primary Care Physician,\ \ `PE` - Performing, `R` - Rural Health Clinic, `RF` - Referring, `SB` - Submitting,\ \ `SK` - Skilled Nursing Facility, `SU` - Supervising" enum: - AD - AT - BI - CO - CV - H - HH - LA - OT - P1 - P2 - PC - PE - R - RF - SK - SU type: string RequestSubscriberReferenceIdentificationQualifier: description: "Use this for providers that are not requesting the eligibility\ \ check. This is the type of `providerIdentifier` you are providing.\n- Set\ \ to `HPI` when the National Provider ID is mandated for use.\n- Set to `PXC`\ \ if you're identifying a type of specialty associated with services provided\ \ to the subscriber. \n \n Otherwise, you can set to the following: `9K` -\ \ Servicer, `D3` - National Council for Prescription Drug Programs Pharmacy\ \ Number, `EI` - Employer's Identification Number, `HPI` - Centers for Medicare\ \ and Medicaid Services National Provider Identifier, `PXC` - Health Care\ \ Provider Taxonomy Code, `SY - Social Security Number, `TJ` - Federal Taxpayer's\ \ Identification Number" enum: - 9K - D3 - EI - HPI - PXC - SY - TJ type: string RequestedEffectiveDate: description: Whether a payer supports specifying a requested effective date for transaction enrollments. enum: - SUPPORTED - NOT_SUPPORTED 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 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 ResponseDependent: description: Information about the dependent listed in the original eligibility check request. Note that a dependent submitted in the request may be returned in the subscriber object. When present, this object will always include the dependent's name for identification, but many payers will also return the date of birth and other identifying information. properties: aaaErrors: items: $ref: '#/components/schemas/EligibilityCheckDependentError' type: array address: $ref: '#/components/schemas/Address' birthSequenceNumber: description: The number assigned to each family member born with the same birth date, such as twins or triplets. Indicates the birth order when there are multiple births associated with the provided birth date. type: string dateOfBirth: description: The member's date of birth. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string dateTimePeriod: description: The military service date. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string dateTimePeriodFormatQualifier: $ref: '#/components/schemas/DateTimePeriodFormatQualifier' description: 'The format of the military service date and time period. Can be `D8` - Date or `RD8` - Range of Dates. Payers may sometimes return other non-compliant values.' description: description: Context that identifies the exact military unit. Used to report military service data. type: string employmentStatusCode: $ref: '#/components/schemas/EmploymentStatusCode' description: 'The member''s employment status code, used to report military service data. Visit [Eligibility code lists](https://www.stedi.com/docs/healthcare/eligibility-code-lists#employment-status-codes) for a complete list. Payers may sometimes return other non-compliant values.' endDateTimePeriod: description: The military service end date. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string entityIdentifier: $ref: '#/components/schemas/ResponseDependentEntityIdentifier' entityType: $ref: '#/components/schemas/EntityTypeQualifier' description: 'The entity type for the member. It can technically be set to `Person` or `Non-Person Entity`. In practice, our customers only receive `Person`. Payers may sometimes return other non-compliant values.' firstName: description: The member's first name. type: string gender: $ref: '#/components/schemas/GenderWithUnknown' description: Code indicating the patient's gender. governmentServiceAffiliationCode: $ref: '#/components/schemas/GovernmentServiceAffiliationCode' description: 'The member''s government service affiliation code, used to report military service data. Visit [Eligibility code lists](https://www.stedi.com/docs/healthcare/eligibility-code-lists#government-service-affiliation-codes) for a complete list. Payers may sometimes return other non-compliant values.' groupDescription: description: Group name type: string groupNumber: description: The group number associated with the insurance policy. type: string healthCareDiagnosisCodes: items: $ref: '#/components/schemas/HealthCareDiagnosisCode' type: array informationStatusCode: $ref: '#/components/schemas/InformationStatusCode' description: 'The status of the member''s information, used to report military service data. Visit [Eligibility code lists](https://www.stedi.com/docs/healthcare/eligibility-code-lists#information-status-codes) for a complete list. Payers may sometimes return other non-compliant values.' insuredIndicator: $ref: '#/components/schemas/DependentInsuredIndicator' lastName: description: The member's last name. type: string maintenanceReasonCode: $ref: '#/components/schemas/MaintenanceReasonCode' maintenanceTypeCode: $ref: '#/components/schemas/MaintenanceTypeCode' memberId: deprecated: true description: This property will never be populated. Please use `subscriber.memberId` instead. type: string middleName: description: The member's middle name or initial. type: string militaryServiceRankCode: $ref: '#/components/schemas/MilitaryServiceRankCode' description: 'The member''s military service rank code. Visit [Eligibility code lists](https://www.stedi.com/docs/healthcare/eligibility-code-lists#military-service-rank-codes) for a complete list. Payers may sometimes return other non-compliant values.' planDescription: description: Plan name type: string planNetworkDescription: description: Plan network name type: string planNetworkIdNumber: description: The network identification number associated with the insurance policy. type: string planNumber: description: The plan number associated with the insurance policy. type: string relationToSubscriber: $ref: '#/components/schemas/DependentRelationship' relationToSubscriberCode: $ref: '#/components/schemas/DependentRelationshipCode' responseProvider: $ref: '#/components/schemas/ResponseProvider' ssn: description: The member's Social Security Number (SSN). pattern: ^\d{9}$ type: string startDateTimePeriod: description: The military service start date. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string suffix: description: The name suffix, such as Jr., Sr., or III. type: string uniqueHealthIdentifier: description: The member's unique health identifier. type: string type: object ResponseDependentEntityIdentifier: description: The entity identifier for the dependent. enum: - Dependent type: string ResponseEligibilityServiceType: description: 'The name of a Service Type Code listed in the `serviceTypeCodes` array. Visit [Service Type Codes](https://www.stedi.com/docs/healthcare/send-eligibility-checks#service-type-codes) for a complete list of codes and their names. The word physician in service type codes refers to any healthcare provider, including physician assistants, nurse practitioners, and other types of healthcare professionals. Payers may sometimes return other non-compliant values.' enum: - Medical Care - Surgical - Consultation - Diagnostic X-Ray - Diagnostic Lab - Radiation Therapy - Anesthesia - Surgical Assistance - Other Medical - Blood Charges - Used Durable Medical Equipment - Durable Medical Equipment Purchase - Ambulatory Service Center Facility - Renal Supplies in the Home - Alternate Method Dialysis - Chronic Renal Disease (CRD) Equipment - Pre-Admission Testing - Durable Medical Equipment Rental - Pneumonia Vaccine - Second Surgical Opinion - Third Surgical Opinion - Social Work - Diagnostic Dental - Periodontics - Restorative - Endodontics - Maxillofacial Prosthetics - Adjunctive Dental Services - Health Benefit Plan Coverage - Plan Waiting Period - Chiropractic - Chiropractic Office Visits - Dental Care - Dental Crowns - Dental Accident - Orthodontics - Prosthodontics - Oral Surgery - Routine (Preventive) Dental - Home Health Care - Home Health Prescriptions - Home Health Visits - Hospice - Respite Care - Hospital - Hospital - Inpatient - Hospital - Room and Board - Hospital - Outpatient - Hospital - Emergency Accident - Hospital - Emergency Medical - Hospital - Ambulatory Surgical - Long Term Care - Major Medical - Medically Related Transportation - Air Transportation - Cabulance - Licensed Ambulance - General Benefits - In-vitro Fertilization - MRI/CAT Scan - Donor Procedures - Acupuncture - Newborn Care - Pathology - Smoking Cessation - Well Baby Care - Maternity - Transplants - Audiology Exam - Inhalation Therapy - Diagnostic Medical - Private Duty Nursing - Prosthetic Device - Dialysis - Otological Exam - Chemotherapy - Allergy Testing - Immunizations - Routine Physical - Family Planning - Infertility - Abortion - AIDS - Emergency Services - Cancer - Pharmacy - Free Standing Prescription Drug - Mail Order Prescription Drug - Brand Name Prescription Drug - Generic Prescription Drug - Podiatry - Podiatry - Office Visits - Podiatry - Nursing Home Visits - Professional (Physician) - Anesthesiologist - Professional (Physician) Visit - Office - Professional (Physician) Visit - Inpatient - Professional (Physician) Visit - Outpatient - Professional (Physician) Visit - Nursing Home - Professional (Physician) Visit - Skilled Nursing Facility - Professional (Physician) Visit - Home - Psychiatric - Psychiatric - Room and Board - Psychotherapy - Psychiatric - Inpatient - Psychiatric - Outpatient - Rehabilitation - Rehabilitation - Room and Board - Rehabilitation - Inpatient - Rehabilitation - Outpatient - Occupational Therapy - Physical Medicine - Speech Therapy - Skilled Nursing Care - Skilled Nursing Care - Room and Board - Substance Abuse - Alcoholism - Drug Addiction - Vision (Optometry) - Frames - Routine Exam - Lenses - Nonmedically Necessary Physical - Experimental Drug Therapy - Burn Care - Brand Name Prescription Drug - Formulary - Brand Name Prescription Drug - Non-Formulary - Independent Medical Evaluation - Partial Hospitalization (Psychiatric) - Day Care (Psychiatric) - Cognitive Therapy - Massage Therapy - Pulmonary Rehabilitation - Cardiac Rehabilitation - Pediatric - Nursery - Skin - Orthopedic - Cardiac - Lymphatic - Gastrointestinal - Endocrine - Neurology - Eye - Invasive Procedures - Gynecological - Obstetrical - Obstetrical/Gynecological - 'Mail Order Prescription Drug: Brand Name' - 'Mail Order Prescription Drug: Generic' - 'Physician Visit - Office: Sick' - 'Physician Visit - Office: Well' - Coronary Care - Private Duty Nursing - Inpatient - Private Duty Nursing - Home - Surgical Benefits - Professional (Physician) - Surgical Benefits - Facility - Mental Health Provider - Inpatient - Mental Health Provider - Outpatient - Mental Health Facility - Inpatient - Mental Health Facility - Outpatient - Substance Abuse Facility - Inpatient - Substance Abuse Facility - Outpatient - Screening X-ray - Screening laboratory - Mammogram, High Risk Patient - Mammogram, Low Risk Patient - Flu Vaccination - Eyewear and Eyewear Accessories - Case Management - Dermatology - Durable Medical Equipment - Diabetic Supplies - Generic Prescription Drug - Formulary - Generic Prescription Drug - Non-Formulary - Allergy - Intensive Care - Mental Health - Neonatal Intensive Care - Oncology - Physical Therapy - Pulmonary - Renal - Residential Psychiatric Treatment - Transitional Care - Transitional Nursery Care - Urgent Care - Diagnostic Imaging - Fixed Prosthodontics - Removable Prosthodontics - Intraoral Images - Complete Series - Oral Evaluation - Dental Prophylaxis - Panoramic Images - Sealants - Fluoride Treatments - Dental Implants - Temporomandibular Joint Dysfunction - Prescription Fluoride Toothpaste - Antimicrobial Rinse - Major Oral Surgery - Orthognathics - Amalgam Restorations - Posterior Composite Restorations - Simple Extraction - Bridges - Bitewing X-Rays - Occlusal & Extraoral X-Rays - Periapical X-Ray - Full Mouth X-Rays - Space Maintenance - Occlusal Adjustments - Restorative - Major - Restorative - Routine - Additional Diagnostic and Preventive - Surgical Periodontics - Non-Surgical Periodontics - Repair Crown - Recement Crown - Basic - Denture Adjust, Rebase, Reline, Repair - Restorative - Other - Root Planing & Scaling - Simple Restorations - Stainless Crowns - Crowns - Harmful Habits Appliance - Buildups / Post and Core - Inlay / Onlay - Amalgam / Composite Restorations - Dentures - Dentures - Repair - Dentures - Reline - Dentures - Rebase - Full Mouth / Panoramic X-Rays - Composites - Stainless Steel, Resin, Acrylic Crowns - Root Canal / Retreatment - Dentures - Adjustments - Dentures - Reline / Rebase - Tissue Conditioning - Cosmetic - Emergency Care type: string ResponseEligibilityServiceTypeCode: description: 'A code identifying a type of service. Visit [Service Type Codes](https://www.stedi.com/docs/healthcare/send-eligibility-checks#service-type-codes) for a complete list. This list is specific to X12 version 005010, which is the mandated version for eligibility checks. It differs from the current [X12 Service Type Codes](https://x12.org/codes/service-type-codes) list, which applies to X12 versions later than 005010. Payers may sometimes return other non-compliant values.' enum: - '1' - '2' - '3' - '4' - '5' - '6' - '7' - '8' - '9' - '10' - '11' - '12' - '13' - '14' - '15' - '16' - '17' - '18' - '19' - '20' - '21' - '22' - '23' - '24' - '25' - '26' - '27' - '28' - '30' - '32' - '33' - '34' - '35' - '36' - '37' - '38' - '39' - '40' - '41' - '42' - '43' - '44' - '45' - '46' - '47' - '48' - '49' - '50' - '51' - '52' - '53' - '54' - '55' - '56' - '57' - '58' - '59' - '60' - '61' - '62' - '63' - '64' - '65' - '66' - '67' - '68' - '69' - '70' - '71' - '72' - '73' - '74' - '75' - '76' - '77' - '78' - '79' - '80' - '81' - '82' - '83' - '84' - '85' - '86' - '87' - '88' - '89' - '90' - '91' - '92' - '93' - '94' - '95' - '96' - '97' - '98' - '99' - A0 - A1 - A2 - A3 - A4 - A5 - A6 - A7 - A8 - A9 - AA - AB - AC - AD - AE - AF - AG - AH - AI - AJ - AK - AL - AM - AN - AO - AQ - AR - B1 - B2 - B3 - BA - BB - BC - BD - BE - BF - BG - BH - BI - BJ - BK - BL - BM - BN - BP - BQ - BR - BS - BT - BU - BV - BW - BX - BY - BZ - C1 - CA - CB - CC - CD - CE - CF - CG - CH - CI - CJ - CK - CL - CM - CN - CO - CP - CQ - DG - DM - DS - GF - GN - GY - IC - MH - NI - 'ON' - PT - PU - RN - RT - TC - TN - UC - EA - EB - EC - ED - EE - EF - EG - EH - EI - EJ - EK - FA - FB - V3 - V4 - V5 - V6 - V7 - V8 - V9 - V10 - V11 - V12 - V13 - V14 - V15 - V16 - V17 - V18 - V19 - V20 - V21 - V22 - V23 - V24 - V25 - V26 - V27 - V28 - V29 - V30 - V31 - V32 - V33 - V34 - V35 - V36 - V37 - V38 - V39 - V40 - V41 - V42 - V43 - V44 - V45 type: string 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 ResponseProvider: description: Information about the entity that submitted the original eligibility check request. This may be an individual practitioner, a medical group, a hospital, or another type of healthcare provider. This object will always include at least one identifier, such as the provider's [NPI](https://www.stedi.com/docs/healthcare/national-provider-identifier), tax ID, or EIN. properties: aaaErrors: items: $ref: '#/components/schemas/EligibilityCheckProviderError' type: array address: $ref: '#/components/schemas/Address' description: The provider's contact information. employersId: deprecated: true description: 'Deprecated; The provider''s identification number for the entity receiving the benefits information. This shape is deprecated: This property is no longer used.' type: string entityIdentifier: $ref: '#/components/schemas/ResponseProviderEntityIdentifier' entityType: $ref: '#/components/schemas/EntityTypeQualifier' federalTaxpayersIdNumber: description: The Federal Taxpayer Identification Number (also known as an EIN). pattern: ^\d{9}$ type: string middleName: description: The provider's middle name. This applies to providers that are an individual. type: string npi: description: The provider's [National Provider Identifier (NPI)](https://www.stedi.com/docs/healthcare/national-provider-identifier). pattern: ^\d{10}$ type: string payorIdentification: description: The Payor Identification. type: string pharmacyProcessorNumber: description: The pharmacy processor number. type: string providerCode: $ref: '#/components/schemas/ResponseProviderCode' description: 'A code that communicates the provider''s role in the type of benefits information in the response. Visit [Eligibility code lists](https://www.stedi.com/docs/healthcare/eligibility-code-lists#provider-codes) for a complete list. Payers may sometimes return other non-compliant values.' providerFirstName: description: The provider's first name. This applies to providers that are an individual. type: string providerName: description: The provider's last name. This applies to providers that are an individual. type: string providerOrgName: description: The provider's organization name. type: string referenceIdentification: description: The Health Care Provider Taxonomy Code. type: string serviceProviderNumber: description: The service provider number. This is an identification number assigned by the payer. type: string servicesPlanID: description: The Centers for Medicare and Medicaid Services (CMS) Plan ID. type: string ssn: description: The Social Security Number (SSN). pattern: ^\d{9}$ type: string suffix: description: The provider's name suffix, such as Jr., Sr., or III. type: string type: object ResponseProviderCode: description: 'A code indicating the type of provider. Visit [Eligibility code lists](https://www.stedi.com/docs/healthcare/eligibility-code-lists#provider-codes) for a complete list. Payers may sometimes return other non-compliant values.' enum: - AD - AT - BI - CO - CV - H - HH - LA - OT - P1 - P2 - PC - PE - R - RF - SB - SK - SU type: string ResponseProviderEntityIdentifier: description: 'A code identifying the type of provider. Payers may sometimes return other non-compliant values.' enum: - Provider - Third-Party Administrator - Employer - Hospital - Facility - Gateway Provider - Plan Sponsor - Payer type: string ResponseStateOrProvinceCode: description: 'The US state or Canadian province code with unknown option. For example, `TN` for Tennessee or `NB` for New Brunswick. Payers may sometimes return other non-compliant values.' enum: - NL - PE - NS - NB - QC - 'ON' - MB - SK - AB - BC - YT - NT - NU - DC - AS - GU - MP - PR - UM - VI - AA - AE - AP - AK - AL - AR - AZ - CA - CO - CT - DE - FL - GA - HI - IA - ID - IL - IN - KS - KY - LA - MA - MD - ME - MI - MN - MO - MS - MT - NC - ND - NE - NH - NJ - NM - NV - NY - OH - OK - OR - PA - RI - SC - SD - TN - TX - UT - VA - VT - WA - WI - WV - WY type: string ResponseSubscriber: description: Information about the primary policyholder for the insurance plan listed in the original eligibility check request. The response will always include either the subscriber's name or member ID for identification, but most payers will also return the subscriber's date of birth and other identifying information. properties: aaaErrors: items: $ref: '#/components/schemas/EligibilityCheckSubscriberError' type: array address: $ref: '#/components/schemas/Address' birthSequenceNumber: description: The number assigned to each family member born with the same birth date, such as twins or triplets. Indicates the birth order when there are multiple births associated with the provided birth date. type: string dateOfBirth: description: The member's date of birth. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string dateTimePeriod: description: The military service date. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string dateTimePeriodFormatQualifier: $ref: '#/components/schemas/DateTimePeriodFormatQualifier' description: 'The format of the military service date and time period. Can be `D8` - Date or `RD8` - Range of Dates. Payers may sometimes return other non-compliant values.' description: description: Context that identifies the exact military unit. Used to report military service data. type: string employmentStatusCode: $ref: '#/components/schemas/EmploymentStatusCode' description: 'The member''s employment status code, used to report military service data. Visit [Eligibility code lists](https://www.stedi.com/docs/healthcare/eligibility-code-lists#employment-status-codes) for a complete list. Payers may sometimes return other non-compliant values.' endDateTimePeriod: description: The military service end date. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string entityIdentifier: $ref: '#/components/schemas/ResponseSubscriberEntityIdentifier' entityType: $ref: '#/components/schemas/EntityTypeQualifier' description: 'The entity type for the member. It can technically be set to `Person` or `Non-Person Entity`. In practice, our customers only receive `Person`. Payers may sometimes return other non-compliant values.' firstName: description: The member's first name. type: string gender: $ref: '#/components/schemas/GenderWithUnknown' description: Code indicating the patient's gender. governmentServiceAffiliationCode: $ref: '#/components/schemas/GovernmentServiceAffiliationCode' description: 'The member''s government service affiliation code, used to report military service data. Visit [Eligibility code lists](https://www.stedi.com/docs/healthcare/eligibility-code-lists#government-service-affiliation-codes) for a complete list. Payers may sometimes return other non-compliant values.' groupDescription: description: Group name type: string groupNumber: description: The group number associated with the insurance policy. type: string healthCareDiagnosisCodes: items: $ref: '#/components/schemas/HealthCareDiagnosisCode' type: array informationStatusCode: $ref: '#/components/schemas/InformationStatusCode' description: 'The status of the member''s information, used to report military service data. Visit [Eligibility code lists](https://www.stedi.com/docs/healthcare/eligibility-code-lists#information-status-codes) for a complete list. Payers may sometimes return other non-compliant values.' insuredIndicator: $ref: '#/components/schemas/SubscriberInsuredIndicator' lastName: description: The member's last name. type: string maintenanceReasonCode: $ref: '#/components/schemas/MaintenanceReasonCode' maintenanceTypeCode: $ref: '#/components/schemas/MaintenanceTypeCode' memberId: description: The member ID for the insurance policy. type: string middleName: description: The member's middle name or initial. type: string militaryServiceRankCode: $ref: '#/components/schemas/MilitaryServiceRankCode' description: 'The member''s military service rank code. Visit [Eligibility code lists](https://www.stedi.com/docs/healthcare/eligibility-code-lists#military-service-rank-codes) for a complete list. Payers may sometimes return other non-compliant values.' planDescription: description: Plan name type: string planNetworkDescription: description: Plan network name type: string planNetworkIdNumber: description: The network identification number associated with the insurance policy. type: string planNumber: description: The plan number associated with the insurance policy. type: string relationToSubscriber: $ref: '#/components/schemas/SubscriberRelationship' relationToSubscriberCode: $ref: '#/components/schemas/SubscriberRelationshipCode' responseProvider: $ref: '#/components/schemas/ResponseProvider' ssn: description: The member's Social Security Number (SSN). pattern: ^\d{9}$ type: string startDateTimePeriod: description: The military service start date. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string suffix: description: The name suffix, such as Jr., Sr., or III. type: string uniqueHealthIdentifier: description: The member's unique health identifier. type: string type: object ResponseSubscriberEntityIdentifier: description: The entity identifier for the subscriber. enum: - Insured or Subscriber type: string SearchPayerRecord: properties: aliases: description: Alternative IDs associated with a payer. If a payer changes their `primaryPayerId`, aliases allow you to continue sending transactions to the payer using the old ID uninterrupted. items: type: string type: array avatarUrl: description: 'A URL pointing to an image file (`.png`, `.jpeg`, or `.jpg`) with the payer''s logo. This is the same logo Stedi displays in the [Payer Network](https://www.stedi.com/healthcare/network). You can use this property to display payer logos in your system or application. This property is only returned when a payer logo is available.' type: string coverageTypes: description: 'A list of insurance coverage types that indicates whether this payer supports transactions for medical coverage, dental coverage, vision coverage, or a combination of these. For example: `["medical"]` or `["medical", "dental", "vision"]`. When this array isn''t in the response, it means Stedi hasn''t classified the payer''s coverage types yet, **not** that the payer doesn''t support any coverage types.' items: $ref: '#/components/schemas/CoverageType' type: array displayName: description: The payer's business name, such as Cigna or Aetna. This is the name most commonly used to identify the payer. type: string employerIdentificationNumbers: description: Employer Identification Numbers (EINs) associated with this payer. items: description: A valid Employer Identification Number (EIN) in the format XX-XXXXXXX pattern: ^[0-9]{2}-[0-9]{7}$ type: string type: array enrollment: $ref: '#/components/schemas/EnrollmentInfo' description: Information about the [transaction enrollment process](https://www.stedi.com/docs/healthcare/transaction-enrollment) for this payer. names: description: Alternative names associated with a payer. These additional names help you search for and identify payers using the name most familiar to your organization. items: type: string type: array operatingStates: description: 'A list of US state codes, territories, or `NATIONAL` that indicates the geographic regions where this payer operates. For example: `["CA", "OR"]` for a regional payer, or `["NATIONAL"]` for a payer that operates throughout the entire United States. When this array isn''t in the response, it means Stedi hasn''t classified the payer''s operating states yet.' items: $ref: '#/components/schemas/OperatingStateCode' type: array parentPayerGroupId: description: The parent payer group entity this payer belongs to. This is for metadata purposes and doesn't necessarily relate to the payer's enrollment process or other capabilities. type: string primaryPayerId: description: The most commonly used ID for a payer. This value often corresponds to the name the payer uses internally and provides to patients on member ID cards. type: string stediId: description: A unique ID that Stedi assigned to this payer and uses internally for routing requests. This ID will not change even if the `primaryPayerId` is updated. type: string transactionSupport: $ref: '#/components/schemas/SearchPayerTransactionSupport' urls: $ref: '#/components/schemas/PayerUrls' description: URLs associated with this payer, such as their website. This object is only returned when URL information is available for the payer. required: - aliases - displayName - names - primaryPayerId - stediId - transactionSupport type: object SearchPayerTransactionSupport: description: 'Whether the following transaction types are supported: 270 eligibility checks, 276/277 claim status requests, 837 claims (professional, dental, institutional), 835 ERAs (claim payments), 275 unsolicited claim attachments, and coordination of benefits checks. If the value is `ENROLLMENT_REQUIRED`, Stedi supports the transaction type, but you must [enroll with the payer](https://www.stedi.com/docs/healthcare/supported-payers#enrollment) first.' properties: claimPayment: $ref: '#/components/schemas/TransactionSupportValue' description: Whether you can receive 835 Electronic Remittance Advice (ERA) transactions from this payer. claimStatus: $ref: '#/components/schemas/TransactionSupportValue' description: Whether you can send 276 claim status requests to this payer. coordinationOfBenefits: $ref: '#/components/schemas/TransactionSupportValue' description: Coordination of Benefits (COB) support. dentalClaimSubmission: $ref: '#/components/schemas/TransactionSupportValue' description: Whether you can send 837D dental claims to this payer. eligibilityCheck: $ref: '#/components/schemas/TransactionSupportValue' description: Whether you can send 270 eligibility checks to this payer. institutionalClaimSubmission: $ref: '#/components/schemas/TransactionSupportValue' description: Whether you can send 837I institutional claims to this payer. professionalClaimSubmission: $ref: '#/components/schemas/TransactionSupportValue' description: Whether you can send 837P professional claims to this payer. unsolicitedClaimAttachment: $ref: '#/components/schemas/TransactionSupportValue' description: Whether you can send unsolicited claim attachments to this payer. required: - claimPayment - claimStatus - coordinationOfBenefits - dentalClaimSubmission - eligibilityCheck - institutionalClaimSubmission - professionalClaimSubmission - unsolicitedClaimAttachment type: object SearchPayersResponseContent: description: Common output structure for list operations with pagination support. properties: items: description: Matching payers sorted by relevance, with the most relevant matches listed first. items: $ref: '#/components/schemas/SearchResult' type: array nextPageToken: description: Token that you can supply in subsequent requests to retrieve the next page of results. If not returned, there are no more results. maxLength: 1024 minLength: 1 type: string stats: $ref: '#/components/schemas/SearchResultsStats' description: Statistics about the search results, including the total number of payers matching the search query and the number of payers supported per transaction type. required: - items - stats type: object SearchResult: properties: matches: $ref: '#/components/schemas/Matches' description: 'Shows which properties in the payer record match the search query. This information helps you understand why Stedi returned this payer and which parts of the payer record matched the search terms. It''s also especially useful for debugging search queries and building user interfaces that display matching text. - Matching text is wrapped in `` HTML tags for highlighting. - This object only contains properties with matching text. For example, if none of the payer''s aliases matched the search query, this object will not include the `aliases` property.' payer: $ref: '#/components/schemas/SearchPayerRecord' description: A payer record matching the search query. score: deprecated: true description: A relevance score indicating how well this payer matched the search query. Higher scores are better matches. The minimum score is 0. format: double type: number required: - payer - score type: object SearchResultsStats: properties: total: description: Total number of payers matching the search query. minimum: 0 type: integer transactionSupport: $ref: '#/components/schemas/TransactionSupportStats' deprecated: true description: 'Number of matching payers supported per transaction type. The categories for each transaction type are mutually exclusive. For example, to calculate the total number of payers that support eligibility checks, regardless of whether enrollment is required, you must add the `supported` and `enrollmentRequired` counts together. **DEPRECATED** This shape is deprecated since 2025-06-24: Use the `transactionSupportCounts` property instead.' transactionSupportCounts: $ref: '#/components/schemas/TransactionSupportCounts' description: 'Number of matching payers for each supported transaction type. To get the total number of payers that support each transaction type, with additional detail on whether enrollment is required, use `supported.total` instead.' required: - total - transactionSupport - transactionSupportCounts type: object 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 SenderAccountDetails: description: Financial institution account details for the payment sender. properties: senderAccountNumber: description: The account number for the company originating the payment. type: string senderAccountNumberQualifier: $ref: '#/components/schemas/AccountNumberQualifier' description: The code identifying the type of account the payment is being made from. Can be `DA` - Demand Deposit. senderDFIIdentifier: description: The identifier specified by the `senderDfiIdNumberQualifier`. type: string senderDfiIdNumberQualifier: $ref: '#/components/schemas/DfiIdNumberQualifier' description: The code identifying the type of identification number of the Depository Financial Institution (DFI). Can be either `01` - ABA Transit Routing Number Including Check Digits (9 digits) or `04` - Canadian Bank Branch Institution Number. type: object Service: description: Information about a service line listed in the referenced claim. properties: amountPaid: description: The amount paid for the service line, expressed as a decimal. For example, `100.00`. type: string procedureId: description: Identifying number for product or service. type: string procedureModifiers: description: Procedure modifier codes that provide additional information about the service performed. items: type: string maxItems: 4 minItems: 1 type: array revenueCode: description: The National Uniform Billing Committee revenue code. type: string serviceIdQualifier: description: The definition of the `serviceIdQualifierCode`. For example, `American Dental Association Codes`. type: string serviceIdQualifierCode: $ref: '#/components/schemas/ServiceIdQualifierCode' submittedAmount: description: The amount submitted for the service line, expressed as a decimal. For example, `100.00`. This is the line item total on the current claim service status. type: string submittedUnits: description: The number of units of service submitted. type: string type: object 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 ServiceClaimStatus: properties: effectiveDate: deprecated: true description: The date the status information is effective. type: string serviceStatuses: description: The status of the service. items: $ref: '#/components/schemas/ServiceLineStatus' type: array type: object ServiceDetail: properties: service: $ref: '#/components/schemas/Service' status: description: Information about the status, required action, and paid information of a service line. items: $ref: '#/components/schemas/Status' type: array type: object ServiceEntityIdentifierCode: description: Entity identifier code for service lines in claim status reports enum: - '03' - '36' - '40' - '41' - '71' - '72' - '73' - '77' - '82' - '85' - '87' - 1P - 1Z - DK - DN - DQ - FA - GB - HK - IL - LI - MSC - PR - PRP - QB - QC - QD - SEP - TL - TTP - TU type: string ServiceEntityIdentifierCodeValue: description: Human-readable descriptions for service entity identifier codes enum: - Dependent - Employer - Receiver - Submitter - Attending Physician - Operating Physician - Other Physician - Service Location - Rendering Provider - Billing Provider - Pay-to Provider - Provider - Home Health Care - Ordering Physician - Referring Provider - Supervising Physician - Facility - Other Insured - Subscriber - Insured or Subscriber - Independent Lab - Mammography Screening Center - Payer - Primary Payer - Purchase Service Provider - Patient - Responsible Party - Secondary Payer - Testing Laboratory - Tertiary Payer - Third Party Repricing Organization (TPO) type: string 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 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 ServiceIdQualifierCode: description: A code identifying the type/source of the `procedureId`. Visit [Claims code lists](https://www.stedi.com/docs/healthcare/claims-code-lists#product-or-service-id-qualifier) for a complete list. enum: - AD - ER - HC - HP - IV - N4 - NU - WK type: string 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: $ref: '#/components/schemas/Measurements' maxItems: 5 minItems: 1 type: array thirdPartyOrganizationNotes: description: Required when the TPO/repricer needs to forward additional information to the payer. Providers shouldn't complete this property. type: string required: - professionalService - serviceDate type: object ServiceLineDateInformation: description: Identify specific dates related to the service rendered. properties: beginTherapyDate: description: Required when a Durable Medical Equipment Regional Carrier Certificate of Medical Necessity (DMERC CMN) or DMERC Information Form (DIF), or Oxygen Therapy Certification is included on this service line. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ 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 ServiceLineInformation: description: Identify a service line listed in the referenced claim. Used to request status for a specific service line. properties: lineItemChargeAmount: description: The original submitted charge for the service line, expressed as a decimal. For example, `100.00`. type: string lineItemControlNumber: description: An identifier for the service line. This matches the `claimInformation.serviceLines[].providerControlNumber` submitted for the service line in the original claim. type: string procedureCode: description: The procedure code. type: string procedureModifiers: description: A modifier code that clarifies or improves the reporting accuracy of the associated `procedureCode`. If not required, do not send. items: type: string maxItems: 4 minItems: 1 type: array productOrServiceIDQualifier: $ref: '#/components/schemas/ProductOrServiceIDQualifier' description: Code identifying the specific industry code list used for the `procedureCode`. Visit [Claims code lists](https://www.stedi.com/docs/healthcare/claims-code-lists#product-or-service-id-qualifier) for a complete list. revenueCode: description: The revenue code for the service line. This is the National Uniform Billing Committee revenue code. type: string serviceLineDate: description: The date the service line began. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string serviceLineEndDate: description: The date the service line ended. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ type: string unitsOfServiceCount: description: The number of units of service for the service line. type: string required: - lineItemChargeAmount - procedureCode - productOrServiceIDQualifier - serviceLineDate - unitsOfServiceCount 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 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 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 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 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 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 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 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 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 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 ServiceLineStatus: properties: entityIdentifierCode: $ref: '#/components/schemas/ServiceEntityIdentifierCode' description: A code indicating the entity that is responsible for the service line. entityIdentifierCodeValue: $ref: '#/components/schemas/ServiceEntityIdentifierCodeValue' description: The description of the `entityIdentifierCode`. healthCareClaimStatusCategoryCode: $ref: '#/components/schemas/HealthCareClaimStatusCategoryCode' healthCareClaimStatusCategoryCodeValue: description: Description of the `healthCareClaimStatusCategoryCode` property. Visit [277CA code lists](https://www.stedi.com/docs/healthcare/claims-code-lists#claim-status-category-code) for a complete list. type: string nationalCouncilForPrescriptionDrugProgramsRejectPaymentCodes: deprecated: true description: A National Council for Prescription Drug Programs (NCPDP) reject code. type: string statusCode: $ref: '#/components/schemas/HealthCareClaimStatusCode' description: A code indicating the status. statusCodeValue: description: The description of the `statusCode`. type: string 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 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 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 ServiceProviderClaimStatus: properties: serviceProviderStatuses: description: The status of claims related to this provider. items: $ref: '#/components/schemas/ProviderStatus' type: array statusInformationEffectiveDate: deprecated: true description: The date the status information is effective. 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 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 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 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: $ref: '#/components/schemas/PatientConditionCode' description: A code indicating the nature of a patient's condition. Can be set to `A` - Acute Condition, `C` - Chronic Condition, `D`- Non-acute, `E` - Non-Life Threatening, `F` - Routine, `G` - Symptomatic, or `M` - Acute Manifestation of a Chronic Condition. patientConditionDescription1: description: The description of the patient's condition. type: string patientConditionDescription2: description: Additional description of the patient's condition type: string required: - patientConditionCode type: object Status: description: Information about the status, required action, and paid information of a service line. properties: effectiveDate: description: 'The date the service line was placed in this status by the payer''s adjudication process. This value is returned in ISO 8601 date format (YYYY-MM-DD). For example: 2026-03-04.' pattern: ^\d{4}-(0[1-9]|1[0-2])-(0[1-9]|[12]\d|3[01])$ type: string entity: $ref: '#/components/schemas/Entity' description: The description of the `entityCode`. For example, `Public Health Service Facility`. entityCode: $ref: '#/components/schemas/EntityCode' description: 'The code identifying the organizational entity, physical location, property, or individual associated with the `statusCode`. For example, `4H` - Emergency Department. Visit [Claims code lists](https://www.stedi.com/docs/healthcare/claims-code-lists#entity-identifiers) for a complete list.' statusCategoryCode: description: The category code for the status. Visit [Claim Status Category Codes](https://x12.org/codes/claim-status-category-codes) in the official X12 documentation for a complete list. type: string statusCategoryCodeValue: description: The description of the `statusCategoryCode`. type: string statusCode: description: The status code used to identify the status of an entire service line. This is either a [Health Care Claim Status Code](https://x12.org/codes/claim-status-codes) or a National Council for Prescription Drug Programs Reject/Payment Code, when the status is related to pharmacy claims. type: string statusCodeValue: description: The description of the `statusCode`. type: string type: object StatusRequestProvider: properties: etin: description: The Electronic Transmitter Identification Number (ETIN). This identifier is preferred if the payer specifically assigned one for the provider. If not, most payers will accept the provider's [NPI](https://www.stedi.com/docs/healthcare/national-provider-identifier) or TIN instead. maxLength: 80 minLength: 2 type: string x-meta: title: Electronic Transmitter Identification Number (ETIN) firstName: description: The provider's first name. Use when the provider is an individual. maxLength: 35 minLength: 1 type: string lastName: description: The provider's last name. Use when the provider is an individual. maxLength: 60 minLength: 1 type: string npi: description: The [National Provider Identification (NPI)](https://www.stedi.com/docs/healthcare/national-provider-identifier) number. pattern: ^\d{10}$ type: string x-meta: title: National Provider Identifier (NPI) organizationName: description: The provider's organization name. Use when the provider is not an individual, such as a hospital or clinic. maxLength: 60 minLength: 1 type: string providerType: $ref: '#/components/schemas/ClaimStatusProviderType' description: Identifies the type of provider related to the referenced healthcare claim. You can include both a billing provider and a service provider if both are relevant to the request. spn: deprecated: true description: Deprecated; The service provider number. Use `npi` to identify the service provider instead. maxLength: 80 minLength: 2 type: string x-meta: title: Service Provider Number (SPN) taxId: description: The Taxpayer Identification Number (TIN). pattern: ^\d{9}$ type: string x-meta: title: Taxpayer Identification Number (TIN) tin: maxLength: 80 minLength: 2 type: string x-meta: title: Taxpayer Identification Number (TIN) required: - providerType type: object StatusResponseProvider: properties: etin: description: The Electronic Transmitter Identification Number (ETIN). maxLength: 80 minLength: 2 type: string x-meta: title: Electronic Transmitter Identification Number (ETIN) 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 npi: description: The [National Provider Identification (NPI)](https://www.stedi.com/docs/healthcare/national-provider-identifier) number. pattern: ^\d{10}$ type: string x-meta: title: National Provider Identifier (NPI) organizationName: description: The provider's organization name. maxLength: 60 minLength: 1 type: string providerType: $ref: '#/components/schemas/ClaimStatusProviderType' description: Identifies the type of provider related to the referenced healthcare claim. spn: deprecated: true description: The service provider number. maxLength: 80 minLength: 2 type: string x-meta: title: Service Provider Number (SPN) taxId: description: The Taxpayer Identification Number (TIN). pattern: ^\d{9}$ type: string x-meta: title: Taxpayer Identification Number (TIN) tin: maxLength: 80 minLength: 2 type: string x-meta: title: Taxpayer Identification Number (TIN) required: - providerType type: object 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 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 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 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 SubscriberInsuredIndicator: description: Indicates the status of the insured. For the subscriber, this is always `Y`. enum: - Y type: string 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 SubscriberRelationship: description: The name of the `relationToSubscriberCode`. For the subscriber, this is always `Self`. enum: - Self type: string SubscriberRelationshipCode: description: For the subscriber, this is always `18` for Self. enum: - '18' type: string SubscriberTraceNumber: properties: originatingCompanyIdentifier: description: The identifier of the organization that assigned the trace number. type: string referenceIdentification: description: The unique trace number assigned to the transaction. type: string secondaryReferenceIdentification: description: Identifies a subdivision within the organization that assigned the trace number. type: string traceType: description: The full name of the `traceTypeCode`. For example `Current Transaction Trace Numbers`. type: string traceTypeCode: description: The code that identifies the type of trace number. Can be `1` - Current Transaction Trace Numbers (refers to trace numbers assigned by the payer) or `2` - Referenced Trace Numbers (refers to numbers sent in the original eligibility check request). type: string type: object 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 SupportedAggregationType: description: 'Aggregation types a payer supports for 835 Electronic Remittance Advice (ERA) transactions. Payers can aggregate by the provider''s NPI, tax ID (TIN), or both. You can use this information to specify an `aggregationPreference` when submitting ERA enrollment requests.' enum: - NPI - TIN type: string SupportedBreakdown: properties: enrollmentNotRequired: description: Number of matching payers that support this transaction type and don't require transaction enrollment. minimum: 0 type: integer enrollmentRequired: description: Number of matching payers that support this transaction type and require [transaction enrollment](https://www.stedi.com/docs/healthcare/transaction-enrollment). minimum: 0 type: integer total: description: Total number of matching payers that support this transaction type (`enrollmentRequired` + `enrollmentNotRequired`). minimum: 0 type: integer required: - enrollmentNotRequired - enrollmentRequired - total type: object 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 TechnicalContactInformation: description: Technical contact information for the payer. properties: contactMethods: description: Available contact methods for technical support. items: $ref: '#/components/schemas/TechnicalContactMethod' type: array contactName: description: The name of the contact person or entity. type: string type: object TechnicalContactMethod: description: Contact method details for technical support. properties: email: description: The contact email address. type: string fax: description: The contact fax number. type: string phone: description: The contact telephone number including the area code. Phone numbers are formatted as AAABBBCCCC, where AAA represents the area code, BBB represents the telephone number prefix, and CCCC represents the telephone number. Phone numbers are provided without separators, such as dashes or parentheses. For example, `5551123345` for `555-112-3345`. type: string phoneExtension: description: The contact telephone extension, if applicable. type: string url: description: A web address to contact the person or entity. The URL is typically provided without the scheme and separator. For example, `stedi.com`. 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 TimePeriodQualifier: description: 'The name of the `timePeriodQualifierCode`. For example, `Calendar Year`. Payers may sometimes return other non-compliant values.' enum: - Hour - Day - Years - Service Year - Calendar Year - Year to Date - Contract - Episode - Visit - Outlier - Remaining - Exceeded - Not Exceeded - Lifetime - Lifetime Remaining - Month - Week type: string TimePeriodQualifierCode: description: 'Code specifying the time period for the benefit information. Payers may sometimes return other non-compliant values.' enum: - '6' - '7' - '21' - '22' - '23' - '24' - '25' - '26' - '27' - '28' - '29' - '30' - '31' - '32' - '33' - '34' - '35' type: string TimeQualifierCode: description: 'Code indicating the time period for the benefit information. Payers may sometimes return other non-compliant values.' enum: - '6' - '7' - '13' - '21' - '22' - '23' - '24' - '25' - '26' - '27' - '28' - '29' - '30' - '31' - '32' - '33' - '34' - '35' - '36' type: string TimeQualifierName: description: "The name of the time period qualifier code. \n \n Note that for\ \ the patient's deductible, `Calendar Year` indicates the patient's total\ \ deductible amount for the year, while `Remaining` indicates the amount left\ \ to meet the deductible. Visit [Payer benefit response](https://www.stedi.com/docs/healthcare/eligibility-patient-responsibility-benefits#deductible)\ \ to learn more about deductibles.\n\nPayers may sometimes return other non-compliant\ \ values." enum: - Hour - Day - 24 Hours - Years - Service Year - Calendar Year - Year to Date - Contract - Episode - Visit - Outlier - Remaining - Exceeded - Not Exceeded - Lifetime - Lifetime Remaining - Month - Week - Admission type: string 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 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 ToothStatusCode: description: Can be set to `E` - To Be Extracted, `M` - Missing. enum: - E - M type: string ToothSurfaceCode: enum: - B - D - F - I - L - M - O type: string TraceTypeCode: description: Identifies the type of trace number used to uniquely identify and track payment transactions. This helps reassociate payments with their corresponding remittance advice. enum: - '1' type: string 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 TransactionEnrollmentProcesses: description: Information about the transaction enrollment requirements and expected timeframes for each transaction type. properties: claimPayment: $ref: '#/components/schemas/ClaimPaymentEnrollmentProcess' description: Details about the enrollment process for Electronic Remittance Advice (ERAs) with this payer. claimStatusInquiry: $ref: '#/components/schemas/ClaimStatusInquiryEnrollmentProcess' description: Details about the enrollment process for real-time claim status requests with this payer. coordinationOfBenefits: $ref: '#/components/schemas/CoordinationOfBenefitsEnrollmentProcess' description: Details about the enrollment process for coordination of benefits (COB) checks with this payer. dentalClaim: $ref: '#/components/schemas/DentalClaimEnrollmentProcess' description: Details about the enrollment process for dental claim submission with this payer. eligibilityInquiry: $ref: '#/components/schemas/EligibilityInquiryEnrollmentProcess' description: Details about the enrollment process for eligibility checks with this payer. institutionalClaim: $ref: '#/components/schemas/InstitutionalClaimEnrollmentProcess' description: Details about the enrollment process for institutional claim submission with this payer. professionalClaim: $ref: '#/components/schemas/ProfessionalClaimEnrollmentProcess' description: Details about the enrollment process for professional claim submission with this payer. unsolicitedClaimAttachment: $ref: '#/components/schemas/UnsolicitedClaimAttachmentEnrollmentProcess' description: Details about the enrollment process for unsolicited claim attachments with this payer. type: object TransactionFilterValue: description: Transaction support filter values. When multiple transaction filters are specified, they are combined with AND logic (payers must satisfy **all** criteria). enum: - SUPPORTED - NOT_SUPPORTED - ENROLLMENT_REQUIRED - EITHER type: string TransactionHandlingCode: description: Indicates the actions that should be taken by both the sender and receiver of the payment transaction. This determines whether payment should be made, remittance sent, or both. enum: - C - D - H - I - P - U - X type: string TransactionIdentifier: properties: customerTransactionId: type: string transactionId: type: string type: object TransactionSupport: description: 'Whether the following transaction types are supported: 270 eligibility checks, 276 claim status requests, 837 professional claims, and 835 ERAs (claim payments). If the value is `ENROLLMENT_REQUIRED`, Stedi supports the transaction type, but you must [enroll with the payer](https://www.stedi.com/docs/healthcare/supported-payers#enrollment) first.' properties: claimPayment: $ref: '#/components/schemas/TransactionSupportValue' description: Whether you can receive 835 Electronic Remittance Advice (ERA) transactions from this payer. claimStatus: $ref: '#/components/schemas/TransactionSupportValue' description: Whether you can send 276 claim status requests to this payer. claimSubmission: $ref: '#/components/schemas/TransactionSupportValue' deprecated: true description: 'Whether you can send 837 professional claims to this payer. This shape is deprecated since 2024-11-13: This `claimSubmission` property is deprecated and will be removed in a future release. Instead, use the `professionalClaimSubmission` property.' coordinationOfBenefits: $ref: '#/components/schemas/TransactionSupportValue' description: Coordination of Benefits (COB) support. dentalClaimSubmission: $ref: '#/components/schemas/TransactionSupportValue' description: Whether you can send 837p dental claims to this payer. eligibilityCheck: $ref: '#/components/schemas/TransactionSupportValue' description: Whether you can send 270 eligibility checks to this payer. institutionalClaimSubmission: $ref: '#/components/schemas/TransactionSupportValue' description: Whether you can send 837i institutional claims to this payer. professionalClaimSubmission: $ref: '#/components/schemas/TransactionSupportValue' description: Whether you can send 837p professional claims to this payer. unsolicitedClaimAttachment: $ref: '#/components/schemas/TransactionSupportValue' description: Whether you can send unsolicited claim attachments to this payer. required: - claimPayment - claimStatus - claimSubmission - coordinationOfBenefits - dentalClaimSubmission - eligibilityCheck - institutionalClaimSubmission - professionalClaimSubmission - unsolicitedClaimAttachment type: object TransactionSupportCounts: properties: claimPayment: $ref: '#/components/schemas/TransactionSupportCountsItem' description: Number of matching payers that support 835 Electronic Remittance Advices (ERAs). claimStatus: $ref: '#/components/schemas/TransactionSupportCountsItem' description: Number of matching payers that support 276/277 real-time claim status. coordinationOfBenefits: $ref: '#/components/schemas/TransactionSupportCountsItem' description: Number of matching payers that support 270/271 coordination of benefits (COB) checks. dentalClaimSubmission: $ref: '#/components/schemas/TransactionSupportCountsItem' description: Number of matching payers that support 837D dental claims. eligibilityCheck: $ref: '#/components/schemas/TransactionSupportCountsItem' description: Number of matching payers that support 270/271 eligibility checks. institutionalClaimSubmission: $ref: '#/components/schemas/TransactionSupportCountsItem' description: Number of matching payers that support 837I institutional claims. professionalClaimSubmission: $ref: '#/components/schemas/TransactionSupportCountsItem' description: Number of matching payers that support 837P professional claims. unsolicitedClaimAttachment: $ref: '#/components/schemas/TransactionSupportCountsItem' description: Number of matching payers that support 275 unsolicited claim attachments. required: - claimPayment - claimStatus - coordinationOfBenefits - dentalClaimSubmission - eligibilityCheck - institutionalClaimSubmission - professionalClaimSubmission - unsolicitedClaimAttachment type: object TransactionSupportCountsItem: properties: notSupported: $ref: '#/components/schemas/NotSupportedBreakdown' description: Number of matching payers that don't support this transaction type. supported: $ref: '#/components/schemas/SupportedBreakdown' description: Number of matching payers that support this transaction type, broken down by enrollment requirements. required: - notSupported - supported type: object TransactionSupportStats: properties: claimPayment: $ref: '#/components/schemas/TransactionSupportStatsItem' description: Number of matching payers that support 835 Electronic Remittance Advices (ERAs). claimStatus: $ref: '#/components/schemas/TransactionSupportStatsItem' description: Number of matching payers that support 276/277 real-time claim status. coordinationOfBenefits: $ref: '#/components/schemas/TransactionSupportStatsItem' description: Number of matching payers that support 270/271 coordination of benefits (COB) checks. dentalClaimSubmission: $ref: '#/components/schemas/TransactionSupportStatsItem' description: Number of matching payers that support 837D dental claims. eligibilityCheck: $ref: '#/components/schemas/TransactionSupportStatsItem' description: Number of matching payers that support 270/271 eligibility checks. institutionalClaimSubmission: $ref: '#/components/schemas/TransactionSupportStatsItem' description: Number of matching payers that support 837I institutional claims. professionalClaimSubmission: $ref: '#/components/schemas/TransactionSupportStatsItem' description: Number of matching payers that support 837P professional claims. unsolicitedClaimAttachment: $ref: '#/components/schemas/TransactionSupportStatsItem' description: Number of matching payers that support 275 unsolicited claim attachments. required: - claimPayment - claimStatus - coordinationOfBenefits - dentalClaimSubmission - eligibilityCheck - institutionalClaimSubmission - professionalClaimSubmission - unsolicitedClaimAttachment type: object TransactionSupportStatsItem: properties: enrollmentRequired: description: Number of matching payers that require [transaction enrollment](https://www.stedi.com/docs/healthcare/transaction-enrollment) for this transaction type. minimum: 0 type: integer notSupported: description: Number of matching payers that don't support this transaction type. minimum: 0 type: integer supported: description: Number of matching payers that support this transaction type. minimum: 0 type: integer required: - enrollmentRequired - notSupported - supported type: object TransactionSupportValue: enum: - SUPPORTED - NOT_SUPPORTED - ENROLLMENT_REQUIRED type: string UnauthorizedExceptionResponseContent: description: The server response when the authorizer failed to authenticate the caller. properties: code: description: Error classification code type: string message: description: Human-readable error message type: string required: - message type: object UnitForMeasurement: description: 'The name of the `unitForMeasurementQualifierCode`. For example, `Days`. Payers may sometimes return other non-compliant values.' enum: - Days - Months - Visits - Week - Years type: string UnitForMeasurementCode: description: 'Code specifying the unit of measurement for the quantity. Payers may sometimes return other non-compliant values.' enum: - DA - MO - VS - WK - YR type: string UnsolicitedClaimAttachmentEnrollmentProcess: description: Details about the enrollment process for unsolicited claim attachments. properties: requestedEffectiveDate: $ref: '#/components/schemas/RequestedEffectiveDate' description: "Whether this payer supports specifying a requested effective\ \ date for transaction enrollments.\n - If set to `SUPPORTED`, Stedi\ \ will process [transaction enrollment requests](https://www.stedi.com/docs/healthcare/api-reference/post-enrollment-create-enrollment)\ \ for this payer according to their specified `requestedEffectiveDate`.\n\ \ - This property is only returned when Stedi can determine whether the\ \ payer supports requested effective dates." timeframe: $ref: '#/components/schemas/EnrollmentProcessTimeframe' type: $ref: '#/components/schemas/EnrollmentProcessType' type: object 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: $ref: '#/components/schemas/ValidationExceptionField' type: array message: description: A summary of the validation failure. type: string required: - message title: ValidationException type: object ValidationExceptionField: description: Describes one specific validation failure for an input member. properties: message: description: A detailed description of the validation failure. type: string path: description: A JSONPointer expression to the structure member whose value failed to satisfy the modeled constraints. type: string required: - message - path type: object ValidationExceptionResponseContent: description: 'A standard error for input validation failures. Thrown when a member of the input structure falls outside of the modeled or documented constraints.' properties: code: description: A code describing the type of validation failure. type: string message: description: A message describing the causes of the validation failure. There may be more than one. type: string required: - message type: object ValueInformation: properties: valueCode: description: The value code. maxLength: 30 type: string valueCodeAmount: description: The monetary amount associated with the value code, expressed as a decimal. pattern: ^\d+(\.\d{1,2})?$ type: string required: - valueCode - valueCodeAmount type: object Warning: properties: code: description: The warning code. type: string description: description: The warning description. type: string type: object securitySchemes: httpApiKeyAuth: description: A [Stedi API Key](https://portal.stedi.com/app/settings/api-keys) for authentication. in: header name: Authorization type: apiKey info: contact: email: healthcare@stedi.com license: name: Proprietary url: https://stedi.com title: Stedi Healthcare version: '2024-04-01' openapi: 3.0.3 paths: /change/medicalnetwork/claimstatus/v2: post: description: Submit a 276/277 real-time claim status check in JSON format externalDocs: description: Developer guide url: https://www.stedi.com/docs/healthcare/check-claim-status operationId: ClaimStatus requestBody: content: application/json: examples: ClaimStatus_example1: description: '' summary: Accepted claim value: encounter: beginningDateOfService: '20250630' endDateOfService: '20250702' providers: - npi: '1999999984' organizationName: Provider Name providerType: BillingProvider subscriber: dateOfBirth: '19710101' firstName: Jane lastName: Doe memberId: UHC123456 tradingPartnerServiceId: '87726' ClaimStatus_example2: description: '' summary: Denied claim value: dependent: dateOfBirth: '20010714' firstName: JORDAN lastName: DOE encounter: beginningDateOfService: '20250804' endDateOfService: '20250806' providers: - npi: '1999999984' organizationName: PROVIDER NAME providerType: BillingProvider subscriber: dateOfBirth: '19710101' firstName: JANE lastName: DOE memberId: AETNA12345 tradingPartnerName: AETNA tradingPartnerServiceId: '60054' ClaimStatus_example3: description: '' summary: No claims found value: encounter: beginningDateOfService: '20250526' endDateOfService: '20250601' providers: - npi: '1999999984' organizationName: Provider Name providerType: BillingProvider subscriber: dateOfBirth: '19910202' firstName: JAMES lastName: JONES memberId: CIGNA12345 tradingPartnerServiceId: Cigna schema: $ref: '#/components/schemas/ClaimStatusRequestContent' required: true responses: '200': content: application/json: examples: ClaimStatus_example1: description: '' summary: Accepted claim value: claims: - claimStatus: amountPaid: '108.77' checkIssueDate: '2025-07-17' checkNumber: '123456789' claimServiceDate: '20250701' effectiveDate: '2025-07-17' paidDate: '2025-07-15' patientAccountNumber: '12345678' statusCategoryCode: F1 statusCategoryCodeValue: Finalized/Payment - The claim/line has been paid. statusCode: '65' statusCodeValue: Claim/line has been paid. submittedAmount: '267.54' trackingNumber: 0123456789 tradingPartnerClaimNumber: 0123456789 serviceDetails: - service: amountPaid: '108.77' procedureId: '90837' serviceIdQualifier: Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes serviceIdQualifierCode: HC submittedAmount: '267.54' submittedUnits: '1' status: - effectiveDate: '2025-07-17' statusCategoryCode: F1 statusCategoryCodeValue: Finalized/Payment - The claim/line has been paid. statusCode: '107' statusCodeValue: Processed according to contract provisions (Contract refers to provisions that exist between the Health Plan and a Provider of Health Care Services). controlNumber: '123456789' payer: organizationName: UNITEDHEALTHCARE payerIdentification: '87726' providers: - npi: '1999999984' organizationName: Provider Name providerType: BillingProvider subscriber: firstName: Jane lastName: Doe memberId: UHC123456 tradingPartnerServiceId: '87726' x12: ISA*00* *00* *ZZ*STEDI *01*117151744 *250912*1718*^*00501*123456789*0*P*:~GS*HN*STEDI*117151744*20250912*171842*1*X*005010X212~ST*277*1001*005010X212~BHT*0010*08*0123456789*20250912*171841*DG~HL*1**20*1~NM1*PR*2*UNITEDHEALTHCARE*****PI*87726~HL*2*1*21*1~NM1*41*2*PROVIDER NAME*****46*1234567890~HL*3*2*19*1~NM1*1P*2*PROVIDER NAME*****XX*1999999984~HL*4*3*22*0~NM1*IL*1*DOE*JANE****MI*UHC123456~TRN*2*0123456789~STC*F1:65*20250717**267.54*108.77*20250715**20250717*123456789~REF*1K*0123456789~REF*EJ*12345678~DTP*472*D8*20250701~SVC*HC:90837:GT*267.54*108.77****1~STC*F1:107*20250717~DTP*472*D8*20250701~SE*19*1001~GE*1*1~IEA*1*123456789~ ClaimStatus_example2: description: '' summary: Denied claim value: claims: - claimStatus: amountPaid: '0' checkIssueDate: '2025-08-14' checkNumber: '123456789' claimServiceDate: '20250805' effectiveDate: '2025-09-12' paidDate: '2025-08-09' patientAccountNumber: '123456789' statusCategoryCode: F2 statusCategoryCodeValue: Finalized/Denial - The claim/line has been denied. statusCode: '585' statusCodeValue: Denied Charge or Non-covered Charge. submittedAmount: '1101' trackingNumber: '123456789' tradingPartnerClaimNumber: '123456789' serviceDetails: - service: amountPaid: '0' procedureId: D1120 serviceIdQualifier: American Dental Association Codes serviceIdQualifierCode: AD submittedAmount: '141' submittedUnits: '1' status: - effectiveDate: '2025-09-12' statusCategoryCode: F2 statusCategoryCodeValue: Finalized/Denial - The claim/line has been denied. statusCode: '585' statusCodeValue: Denied Charge or Non-covered Charge. - service: amountPaid: '0' procedureId: D0801 serviceIdQualifier: American Dental Association Codes serviceIdQualifierCode: AD submittedAmount: '274' submittedUnits: '1' status: - effectiveDate: '2025-09-12' statusCategoryCode: F2 statusCategoryCodeValue: Finalized/Denial - The claim/line has been denied. statusCode: '585' statusCodeValue: Denied Charge or Non-covered Charge. - service: amountPaid: '0' procedureId: D0603 serviceIdQualifier: American Dental Association Codes serviceIdQualifierCode: AD submittedAmount: '161' submittedUnits: '1' status: - effectiveDate: '2025-09-12' statusCategoryCode: F2 statusCategoryCodeValue: Finalized/Denial - The claim/line has been denied. statusCode: '585' statusCodeValue: Denied Charge or Non-covered Charge. - service: amountPaid: '0' procedureId: D0603 serviceIdQualifier: American Dental Association Codes serviceIdQualifierCode: AD submittedAmount: '161' submittedUnits: '1' status: - effectiveDate: '2025-09-12' statusCategoryCode: F2 statusCategoryCodeValue: Finalized/Denial - The claim/line has been denied. statusCode: '585' statusCodeValue: Denied Charge or Non-covered Charge. - service: amountPaid: '0' procedureId: D0603 serviceIdQualifier: American Dental Association Codes serviceIdQualifierCode: AD submittedAmount: '161' submittedUnits: '1' status: - effectiveDate: '2025-09-12' statusCategoryCode: F2 statusCategoryCodeValue: Finalized/Denial - The claim/line has been denied. statusCode: '585' statusCodeValue: Denied Charge or Non-covered Charge. - service: amountPaid: '0' procedureId: D0603 serviceIdQualifier: American Dental Association Codes serviceIdQualifierCode: AD submittedAmount: '161' submittedUnits: '1' status: - effectiveDate: '2025-09-12' statusCategoryCode: F2 statusCategoryCodeValue: Finalized/Denial - The claim/line has been denied. statusCode: '585' statusCodeValue: Denied Charge or Non-covered Charge. - service: amountPaid: '0' procedureId: D0350 serviceIdQualifier: American Dental Association Codes serviceIdQualifierCode: AD submittedAmount: '145' submittedUnits: '1' status: - effectiveDate: '2025-09-12' statusCategoryCode: F2 statusCategoryCodeValue: Finalized/Denial - The claim/line has been denied. statusCode: '585' statusCodeValue: Denied Charge or Non-covered Charge. - service: amountPaid: '0' procedureId: D0350 serviceIdQualifier: American Dental Association Codes serviceIdQualifierCode: AD submittedAmount: '145' submittedUnits: '1' status: - effectiveDate: '2025-09-12' statusCategoryCode: F2 statusCategoryCodeValue: Finalized/Denial - The claim/line has been denied. statusCode: '585' statusCodeValue: Denied Charge or Non-covered Charge. - service: amountPaid: '0' procedureId: D0330 serviceIdQualifier: American Dental Association Codes serviceIdQualifierCode: AD submittedAmount: '235' submittedUnits: '1' status: - effectiveDate: '2025-09-12' statusCategoryCode: F2 statusCategoryCodeValue: Finalized/Denial - The claim/line has been denied. statusCode: '585' statusCodeValue: Denied Charge or Non-covered Charge. controlNumber: '123456789' dependent: firstName: JORDAN lastName: DOE payer: organizationName: AETNA payerIdentification: '60054' providers: - npi: '1999999984' organizationName: Provider Name providerType: BillingProvider subscriber: firstName: JANE lastName: DOE memberId: AETNA12345 tradingPartnerServiceId: '60054' x12: ISA*00* *00* *ZZ*STEDI *01*117151744 *250911*1726*^*00501*123456789*0*P*:~GS*HN*STEDI*117151744*20250911*1226*123456789*X*005010X212~ST*277*123456789*005010X212~BHT*0010*08*1234567890*20250911*13263006*DG~HL*1**20*1~NM1*PR*2*AETNA*****PI*60054~PER*IC*Aetna*TE*1234567890~HL*2*1*21*1~NM1*41*2*PROVIDER NAME*****46*1234567890~HL*3*2*19*1~NM1*1P*2*PROVIDER NAME*****XX*1999999984~HL*4*3*22*1~NM1*IL*1*DOE*JANE****MI*AETNA12345~HL*5*4*23~NM1*QC*1*DOE*JORDAN~TRN*2*123456789~STC*F2:585*20250911**1101*0*20250809**20250814*123456789*F2:107~REF*1K*123456789~REF*EJ*123456789~DTP*472*D8*20250805~SVC*AD:D1120*141*0****1~STC*F2:585*20250911~DTP*472*D8*20250805~SVC*AD:D0801*274*0****1~STC*F2:585*20250911~DTP*472*D8*20250805~SVC*AD:D0603*161*0****1~STC*F2:107*20250911********F2:735~DTP*472*D8*20250805~SVC*AD:D0350*145*0****1~STC*F2:585*20250911~DTP*472*D8*20250805~SVC*AD:D0350*145*0****1~STC*F2:585*20250911~DTP*472*D8*20250805~SE*34*123456789~GE*1*123456789~IEA*1*123456789~ ClaimStatus_example3: description: '' summary: No claims found value: claims: - claimStatus: amountPaid: '0' claimServiceDate: 20250526-20250601 effectiveDate: '2025-09-12' entity: Insurer entityCode: IN statusCategoryCode: D0 statusCategoryCodeValue: Data Search Unsuccessful - The payer is unable to return status on the requested claim(s) based on the submitted search criteria. statusCode: '97' statusCodeValue: Patient eligibility not found with entity. submittedAmount: '0' trackingNumber: '123456789' controlNumber: '123456789' payer: organizationName: CHLIC payerIdentification: CIGNA providers: - npi: '1999999984' organizationName: Provider Name providerType: BillingProvider subscriber: firstName: JAMES lastName: JONES memberId: CIGNA12345 tradingPartnerServiceId: CIGNA x12: ISA*00* *00* *ZZ*STEDI *01*117151744 *250825*2004*^*00501*123456789*0*P*:~GS*HN*STEDI*117151744*20250825*1504*123456789*X*005010X212~ST*277*123456789*005010X212~BHT*0010*08*123456789*20250825*160450*DG~HL*1**20*1~NM1*PR*2*CHLIC*****PI*CIGNA~PER*IC*CHC Medical*TE*8002725713~HL*2*1*21*1~NM1*41*2*PROVIDER NAME*****46*123456789~HL*3*2*19*1~NM1*1P*2*PROVIDER NAME*****XX*1999999984~HL*4*3*22*0~NM1*IL*1*JONES*JAMES****MI*CIGNA12345~TRN*2*123456789~STC*D0:97:IN*20250825**0*0~DTP*472*RD8*20250526-20250601~SE*15*123456789~GE*1*123456789~IEA*1*123456789~ schema: $ref: '#/components/schemas/ClaimStatusResponseContent' description: ClaimStatus 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: - Real-time claim status /change/medicalnetwork/claimstatus/v2/raw-x12: post: description: Submit a 276/277 real-time claim status check in raw X12 EDI format externalDocs: description: Developer guide url: https://www.stedi.com/docs/healthcare/check-claim-status operationId: ClaimStatusRawX12 requestBody: content: application/json: examples: ClaimStatusRawX12_example1: description: '' summary: Accepted claim value: x12: ISA*00* *00* *ZZ*SENDER *ZZ*RECEIVER *250916*2048*^*00501*000000001*0*T*>~GS*HR*SENDERGS*RECEIVERGS*20250916*204811*1*X*005010X212~ST*276*0001*005010X212~BHT*0010*13*ABC276XXX*20250915*1425~HL*1**20*1~NM1*PR*2*UNITEDHEALTHCARE*****PI*87726~HL*2*1*21*1~NM1*41*2*PROVIDER NAME*****46*123456789~HL*3*2*19*1~NM1*1P*2*PROVIDER NAME*****XX*1999999984~HL*4*3*22*0~DMG*D8*19710101~NM1*IL*1*DOE*JANE****MI*UHC123456~TRN*1*123456789~DTP*472*RD8*20250630-20250702~SE*14*0001~GE*1*1~IEA*1*000000001~ ClaimStatusRawX12_example2: description: '' summary: Denied claim value: x12: ISA*00* *00* *ZZ*SENDER *ZZ*RECEIVER *250916*2048*^*00501*000000001*0*T*>~GS*HR*SENDERGS*RECEIVERGS*20250916*204811*1*X*005010X212~ST*276*0001*005010X212~BHT*0010*13*ABC276XXX*20250915*1425~HL*1**20*1~NM1*PR*2*AETNA*****PI*60054~HL*2*1*21*1~NM1*41*2*PROVIDER NAME*****46*123456789~HL*3*2*19*1~NM1*1P*2*PROVIDER NAME*****XX*1999999984~HL*4*3*22*0~DMG*D8*19710101~NM1*IL*1*DOE*JANE****MI*AETNA12345~HL*5*4*23*0~DMG*D8*20010714~NM1*QC*1*DOE*JORDAN*~TRN*1*123456789~DTP*472*RD8*20250804-20250806~SE*17*0001~GE*1*1~IEA*1*000000001~ ClaimStatusRawX12_example3: description: '' summary: No claims found value: x12: ISA*00* *00* *ZZ*SENDER *ZZ*RECEIVER *250916*2048*^*00501*000000001*0*T*>~GS*HR*SENDERGS*RECEIVERGS*20250916*204811*1*X*005010X212~ST*276*0001*005010X212~BHT*0010*13*ABC276XXX*20250915*1425~HL*1**20*1~NM1*PR*2*CIGNA*****PI*62308~HL*2*1*21*1~NM1*41*2*PROVIDER NAME*****46*123456789~HL*3*2*19*1~NM1*1P*2*PROVIDER NAME*****XX*1999999984~HL*4*3*22*0~DMG*D8*19910202~NM1*IL*1*JONES*JAMES****MI*CIGNA12345~TRN*1*123456789~DTP*472*RD8*20250526-20250601~SE*14*0001~GE*1*1~IEA*1*000000001~ ClaimStatusRawX12_example4: description: '' summary: Validation errors (999) value: x12: ISA*00* *00* *ZZ*SENDER *ZZ*STEDI *210101*1200*^*00501*000000001*0*P*>~GS*HR*SENDER*STEDI*20210101*120000*1*X*005010X212~ST*276*0001*005010X212~SE*1*0001~GE*1*1~IEA*1*000000001~ schema: $ref: '#/components/schemas/ClaimStatusRawX12RequestContent' required: true responses: '200': content: application/json: examples: ClaimStatusRawX12_example1: description: '' summary: Accepted claim value: claims: - claimStatus: amountPaid: '108.77' checkIssueDate: '2025-07-17' checkNumber: '123456789' claimServiceDate: '20250701' effectiveDate: '2025-07-17' paidDate: '2025-07-15' patientAccountNumber: '12345678' statusCategoryCode: F1 statusCategoryCodeValue: Finalized/Payment - The claim/line has been paid. statusCode: '65' statusCodeValue: Claim/line has been paid. submittedAmount: '267.54' trackingNumber: 0123456789 tradingPartnerClaimNumber: 0123456789 serviceDetails: - service: amountPaid: '108.77' procedureId: '90837' serviceIdQualifier: Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes serviceIdQualifierCode: HC submittedAmount: '267.54' submittedUnits: '1' status: - effectiveDate: '2025-07-17' statusCategoryCode: F1 statusCategoryCodeValue: Finalized/Payment - The claim/line has been paid. statusCode: '107' statusCodeValue: Processed according to contract provisions (Contract refers to provisions that exist between the Health Plan and a Provider of Health Care Services). controlNumber: '123456789' payer: organizationName: UNITEDHEALTHCARE payerIdentification: '87726' providers: - npi: '1999999984' organizationName: Provider Name providerType: BillingProvider subscriber: firstName: Jane lastName: Doe memberId: UHC123456 tradingPartnerServiceId: '87726' x12: ISA*00* *00* *ZZ*RECEIVER *ZZ*SENDER *250912*1718*^*00501*123456789*0*T*:~GS*HN*RECEIVERGS*SENDERGS*20250912*171842*1*X*005010X212~ST*277*1001*005010X212~BHT*0010*08*0123456789*20250912*171841*DG~HL*1**20*1~NM1*PR*2*UNITEDHEALTHCARE*****PI*87726~HL*2*1*21*1~NM1*41*2*PROVIDER NAME*****46*1234567890~HL*3*2*19*1~NM1*1P*2*PROVIDER NAME*****XX*1999999984~HL*4*3*22*0~NM1*IL*1*DOE*JANE****MI*UHC123456~TRN*2*0123456789~STC*F1:65*20250717**267.54*108.77*20250715**20250717*123456789~REF*1K*0123456789~REF*EJ*12345678~DTP*472*D8*20250701~SVC*HC:90837:GT*267.54*108.77****1~STC*F1:107*20250717~DTP*472*D8*20250701~SE*19*1001~GE*1*1~IEA*1*123456789~ ClaimStatusRawX12_example2: description: '' summary: Denied claim value: claims: - claimStatus: amountPaid: '0' checkIssueDate: '2025-08-14' checkNumber: '123456789' claimServiceDate: '20250805' effectiveDate: '2025-09-12' paidDate: '2025-08-09' patientAccountNumber: '123456789' statusCategoryCode: F2 statusCategoryCodeValue: Finalized/Denial - The claim/line has been denied. statusCode: '585' statusCodeValue: Denied Charge or Non-covered Charge. submittedAmount: '1101' trackingNumber: '123456789' tradingPartnerClaimNumber: '123456789' serviceDetails: - service: amountPaid: '0' procedureId: D1120 serviceIdQualifier: American Dental Association Codes serviceIdQualifierCode: AD submittedAmount: '141' submittedUnits: '1' status: - effectiveDate: '2025-09-12' statusCategoryCode: F2 statusCategoryCodeValue: Finalized/Denial - The claim/line has been denied. statusCode: '585' statusCodeValue: Denied Charge or Non-covered Charge. - service: amountPaid: '0' procedureId: D0801 serviceIdQualifier: American Dental Association Codes serviceIdQualifierCode: AD submittedAmount: '274' submittedUnits: '1' status: - effectiveDate: '2025-09-12' statusCategoryCode: F2 statusCategoryCodeValue: Finalized/Denial - The claim/line has been denied. statusCode: '585' statusCodeValue: Denied Charge or Non-covered Charge. - service: amountPaid: '0' procedureId: D0603 serviceIdQualifier: American Dental Association Codes serviceIdQualifierCode: AD submittedAmount: '161' submittedUnits: '1' status: - effectiveDate: '2025-09-12' statusCategoryCode: F2 statusCategoryCodeValue: Finalized/Denial - The claim/line has been denied. statusCode: '585' statusCodeValue: Denied Charge or Non-covered Charge. - service: amountPaid: '0' procedureId: D0603 serviceIdQualifier: American Dental Association Codes serviceIdQualifierCode: AD submittedAmount: '161' submittedUnits: '1' status: - effectiveDate: '2025-09-12' statusCategoryCode: F2 statusCategoryCodeValue: Finalized/Denial - The claim/line has been denied. statusCode: '585' statusCodeValue: Denied Charge or Non-covered Charge. - service: amountPaid: '0' procedureId: D0603 serviceIdQualifier: American Dental Association Codes serviceIdQualifierCode: AD submittedAmount: '161' submittedUnits: '1' status: - effectiveDate: '2025-09-12' statusCategoryCode: F2 statusCategoryCodeValue: Finalized/Denial - The claim/line has been denied. statusCode: '585' statusCodeValue: Denied Charge or Non-covered Charge. - service: amountPaid: '0' procedureId: D0603 serviceIdQualifier: American Dental Association Codes serviceIdQualifierCode: AD submittedAmount: '161' submittedUnits: '1' status: - effectiveDate: '2025-09-12' statusCategoryCode: F2 statusCategoryCodeValue: Finalized/Denial - The claim/line has been denied. statusCode: '585' statusCodeValue: Denied Charge or Non-covered Charge. - service: amountPaid: '0' procedureId: D0350 serviceIdQualifier: American Dental Association Codes serviceIdQualifierCode: AD submittedAmount: '145' submittedUnits: '1' status: - effectiveDate: '2025-09-12' statusCategoryCode: F2 statusCategoryCodeValue: Finalized/Denial - The claim/line has been denied. statusCode: '585' statusCodeValue: Denied Charge or Non-covered Charge. - service: amountPaid: '0' procedureId: D0350 serviceIdQualifier: American Dental Association Codes serviceIdQualifierCode: AD submittedAmount: '145' submittedUnits: '1' status: - effectiveDate: '2025-09-12' statusCategoryCode: F2 statusCategoryCodeValue: Finalized/Denial - The claim/line has been denied. statusCode: '585' statusCodeValue: Denied Charge or Non-covered Charge. - service: amountPaid: '0' procedureId: D0330 serviceIdQualifier: American Dental Association Codes serviceIdQualifierCode: AD submittedAmount: '235' submittedUnits: '1' status: - effectiveDate: '2025-09-12' statusCategoryCode: F2 statusCategoryCodeValue: Finalized/Denial - The claim/line has been denied. statusCode: '585' statusCodeValue: Denied Charge or Non-covered Charge. controlNumber: '123456789' dependent: firstName: JORDAN lastName: DOE payer: organizationName: AETNA payerIdentification: '60054' providers: - npi: '1999999984' organizationName: Provider Name providerType: BillingProvider subscriber: firstName: JANE lastName: DOE memberId: AETNA12345 tradingPartnerServiceId: '60054' x12: ISA*00* *00* *ZZ*RECEIVER *ZZ*SENDER *250911*1726*^*00501*123456789*0*T*:~GS*HN*RECEIVERGS*SENDERGS*20250911*1226*123456789*X*005010X212~ST*277*123456789*005010X212~BHT*0010*08*1234567890*20250911*13263006*DG~HL*1**20*1~NM1*PR*2*AETNA*****PI*60054~PER*IC*Aetna*TE*1234567890~HL*2*1*21*1~NM1*41*2*PROVIDER NAME*****46*1234567890~HL*3*2*19*1~NM1*1P*2*PROVIDER NAME*****XX*1999999984~HL*4*3*22*1~NM1*IL*1*DOE*JANE****MI*AETNA12345~HL*5*4*23~NM1*QC*1*DOE*JORDAN~TRN*2*123456789~STC*F2:585*20250911**1101*0*20250809**20250814*123456789*F2:107~REF*1K*123456789~REF*EJ*123456789~DTP*472*D8*20250805~SVC*AD:D1120*141*0****1~STC*F2:585*20250911~DTP*472*D8*20250805~SVC*AD:D0801*274*0****1~STC*F2:585*20250911~DTP*472*D8*20250805~SVC*AD:D0603*161*0****1~STC*F2:107*20250911********F2:735~DTP*472*D8*20250805~SVC*AD:D0350*145*0****1~STC*F2:585*20250911~DTP*472*D8*20250805~SVC*AD:D0350*145*0****1~STC*F2:585*20250911~DTP*472*D8*20250805~SE*34*123456789~GE*1*123456789~IEA*1*123456789~ ClaimStatusRawX12_example3: description: '' summary: No claims found value: claims: - claimStatus: amountPaid: '0' claimServiceDate: 20250526-20250601 effectiveDate: '2025-09-12' entity: Insurer entityCode: IN statusCategoryCode: D0 statusCategoryCodeValue: Data Search Unsuccessful - The payer is unable to return status on the requested claim(s) based on the submitted search criteria. statusCode: '97' statusCodeValue: Patient eligibility not found with entity. submittedAmount: '0' trackingNumber: '123456789' controlNumber: '123456789' payer: organizationName: CHLIC payerIdentification: CIGNA providers: - npi: '1999999984' organizationName: Provider Name providerType: BillingProvider subscriber: firstName: JAMES lastName: JONES memberId: CIGNA12345 tradingPartnerServiceId: CIGNA x12: ISA*00* *00* *ZZ*RECEIVER *ZZ*SENDER *250825*2004*^*00501*123456789*0*T*:~GS*HN*RECEIVERGS*SENDERGS*20250825*1504*123456789*X*005010X212~ST*277*123456789*005010X212~BHT*0010*08*123456789*20250825*160450*DG~HL*1**20*1~NM1*PR*2*CHLIC*****PI*CIGNA~PER*IC*CHC Medical*TE*8002725713~HL*2*1*21*1~NM1*41*2*PROVIDER NAME*****46*123456789~HL*3*2*19*1~NM1*1P*2*PROVIDER NAME*****XX*1999999984~HL*4*3*22*0~NM1*IL*1*JONES*JAMES****MI*CIGNA12345~TRN*2*123456789~STC*D0:97:IN*20250825**0*0~DTP*472*RD8*20250526-20250601~SE*15*123456789~GE*1*123456789~IEA*1*123456789~ ClaimStatusRawX12_example4: description: '' summary: Validation errors (999) value: controlNumber: '736013965' implementationTransactionSetSyntaxError: '5' status: ERROR transactionSetAcknowledgement: R x12: ISA*00* *00* *ZZ*STEDI *ZZ*SENDER *260403*0930*^*00501*736013965*0*P*`~GS*FA*STEDI*117151744*20260403*093042*736013965*X*005010X231A1~ST*999*0001*005010X231A1~AK1*HR*1*005010X212~AK2*276*0001*005010X212~IK3*SE*2**2~IK3*SE*2**3~IK5*R*5~AK9*R*1*1*0~SE*8*0001~GE*1*736013965~IEA*1*736013965~ schema: $ref: '#/components/schemas/ClaimStatusRawX12ResponseContent' description: ClaimStatusRawX12 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: - Real-time claim status /change/medicalnetwork/eligibility/v3: post: description: Submit a real-time 270/271 eligibility check in JSON format externalDocs: description: Developer guide url: https://www.stedi.com/docs/healthcare/send-eligibility-checks operationId: EligibilityCheck parameters: - in: header name: X-Forwarded-For schema: description: '**(CMS requests only):** Starting November 8, 2025, the Centers for Medicare & Medicaid Services (CMS) requires submitters to include network IP addresses from an eligibility request''s point of origin through receipt by the HETS system. To comply with this requirement, you may need to include this header in requests to CMS. When present, this header should contain a comma-separated list of upstream IP addresses, starting with the originating system and continuing through every intermediary. You can exclude your IP address from the list. Note that Stedi blocks eligibility requests to CMS when any IP address in the chain – the originating IP address or any in the X-Forwarded-For header – is located outside the United States. Visit [CMS traceability requirements](https://www.stedi.com/docs/healthcare/send-eligibility-checks#cms-traceability-requirements) for details and examples.' type: string requestBody: content: application/json: examples: EligibilityCheck_example1: description: '' summary: Eligibility check value: encounter: serviceTypeCodes: - MH externalPatientId: UAA111222333 provider: npi: '1999999984' organizationName: ACME Health Services subscriber: dateOfBirth: '19000101' firstName: Jane lastName: Doe memberId: '123456789' tradingPartnerServiceId: AHS EligibilityCheck_example2: description: '' summary: Invalid provider name value: provider: npi: '1447848577' organizationName: SIMPSON subscriber: dateOfBirth: '20240606' firstName: Abe lastName: Stedi tradingPartnerServiceId: BS001 schema: $ref: '#/components/schemas/EligibilityCheckRequestContent' required: true responses: '200': content: application/json: examples: EligibilityCheck_example1: description: '' summary: Eligibility check value: benefitsInformation: - additionalInformation: - description: Complete Care Management code: '1' name: Active Coverage planCoverage: Open Access Plus serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage - additionalInformation: - description: Includes services provided by Client Specific Network - description: Coinsurance does apply to member's out-of-pocket maximum - description: Copay does apply to member's out-of-pocket maximum - description: Deductible does apply to member's out-of-pocket maximum benefitAmount: '6000' code: G coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Out of Pocket (Stop Loss) serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Calendar Year timeQualifierCode: '23' - additionalInformation: - description: Includes services provided by Client Specific Network benefitAmount: '500' code: C coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Deductible serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Calendar Year timeQualifierCode: '23' - additionalInformation: - description: Includes services provided by Client Specific Network - description: Copay does apply to member's out-of-pocket maximum - description: Coinsurance does apply to member's out-of-pocket maximum - description: Deductible does apply to member's out-of-pocket maximum benefitAmount: '3000' code: G coverageLevel: Individual coverageLevelCode: IND inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Out of Pocket (Stop Loss) serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Calendar Year timeQualifierCode: '23' - additionalInformation: - description: Includes services provided by Client Specific Network benefitAmount: '250' code: C coverageLevel: Individual coverageLevelCode: IND inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Deductible serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Calendar Year timeQualifierCode: '23' - benefitAmount: '15000' code: C coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Deductible serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Calendar Year timeQualifierCode: '23' - additionalInformation: - description: Coinsurance does apply to member's out-of-pocket maximum - description: Deductible does apply to member's out-of-pocket maximum benefitAmount: '30000' code: G coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Out of Pocket (Stop Loss) serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Calendar Year timeQualifierCode: '23' - benefitPercent: '0.1' code: A coverageLevel: Individual coverageLevelCode: IND inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage - benefitAmount: '7500' code: C coverageLevel: Individual coverageLevelCode: IND inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Deductible serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Calendar Year timeQualifierCode: '23' - additionalInformation: - description: Deductible does apply to member's out-of-pocket maximum - description: Coinsurance does apply to member's out-of-pocket maximum benefitAmount: '15000' code: G coverageLevel: Individual coverageLevelCode: IND inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Out of Pocket (Stop Loss) serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Calendar Year timeQualifierCode: '23' - benefitPercent: '0.5' code: A coverageLevel: Individual coverageLevelCode: IND inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Co-Insurance serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage - code: '1' inPlanNetworkIndicator: Not Applicable inPlanNetworkIndicatorCode: W name: Active Coverage serviceTypeCodes: - A7 - BC - A8 - A4 - A5 - A6 - '7' - '4' - BB - '22' serviceTypes: - Psychiatric - Inpatient - Day Care (Psychiatric) - Psychiatric - Outpatient - Psychiatric - Psychiatric - Room and Board - Psychotherapy - Anesthesia - Diagnostic X-Ray - Partial Hospitalization (Psychiatric) - Social Work - additionalInformation: - description: Includes services provided by Client Specific Network authOrCertIndicator: N benefitAmount: '0' code: C coverageLevel: Individual coverageLevelCode: IND eligibilityAdditionalInformation: codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Outpatient Hospital industryCode: '22' eligibilityAdditionalInformationList: - codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Outpatient Hospital industryCode: '22' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Deductible serviceTypeCodes: - BC - A4 - A6 - '4' - '22' serviceTypes: - Day Care (Psychiatric) - Psychiatric - Psychotherapy - Diagnostic X-Ray - Social Work - additionalInformation: - description: Includes services provided by Client Specific Network authOrCertIndicator: N benefitAmount: '0' code: C coverageLevel: Individual coverageLevelCode: IND inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Deductible serviceTypeCodes: - A8 serviceTypes: - Psychiatric - Outpatient - additionalInformation: - description: Includes services provided by Client Specific Network authOrCertIndicator: N benefitAmount: '0' code: C coverageLevel: Individual coverageLevelCode: IND eligibilityAdditionalInformation: codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Office industryCode: '11' eligibilityAdditionalInformationList: - codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Office industryCode: '11' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Deductible serviceTypeCodes: - A4 - A6 - '4' - '22' serviceTypes: - Psychiatric - Psychotherapy - Diagnostic X-Ray - Social Work - additionalInformation: - description: Includes services provided by Client Specific Network authOrCertIndicator: N benefitAmount: '0' code: C coverageLevel: Individual coverageLevelCode: IND eligibilityAdditionalInformation: codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Telehealth Provided Other than in Patient’s Home industryCode: '02' eligibilityAdditionalInformationList: - codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Telehealth Provided Other than in Patient’s Home industryCode: '02' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Deductible serviceTypeCodes: - A4 - A6 - '22' serviceTypes: - Psychiatric - Psychotherapy - Social Work - authOrCertIndicator: N benefitAmount: '20' code: B coverageLevel: Individual coverageLevelCode: IND eligibilityAdditionalInformation: codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Office industryCode: '11' eligibilityAdditionalInformationList: - codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Office industryCode: '11' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Payment serviceTypeCodes: - A4 - A6 - '22' serviceTypes: - Psychiatric - Psychotherapy - Social Work timeQualifier: Visit timeQualifierCode: '27' - authOrCertIndicator: N benefitPercent: '0' code: A coverageLevel: Individual coverageLevelCode: IND eligibilityAdditionalInformation: codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Office industryCode: '11' eligibilityAdditionalInformationList: - codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Office industryCode: '11' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance serviceTypeCodes: - A4 - A6 - '4' - '22' serviceTypes: - Psychiatric - Psychotherapy - Diagnostic X-Ray - Social Work - additionalInformation: - description: Included For Specific Services authOrCertIndicator: N benefitAmount: '20' code: B coverageLevel: Individual coverageLevelCode: IND eligibilityAdditionalInformation: codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Telehealth Provided Other than in Patient’s Home industryCode: '02' eligibilityAdditionalInformationList: - codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Telehealth Provided Other than in Patient’s Home industryCode: '02' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Payment serviceTypeCodes: - A4 - A6 - '22' serviceTypes: - Psychiatric - Psychotherapy - Social Work timeQualifier: Visit timeQualifierCode: '27' - additionalInformation: - description: Included For Specific Services authOrCertIndicator: N benefitPercent: '0' code: A coverageLevel: Individual coverageLevelCode: IND eligibilityAdditionalInformation: codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Telehealth Provided Other than in Patient’s Home industryCode: '02' eligibilityAdditionalInformationList: - codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Telehealth Provided Other than in Patient’s Home industryCode: '02' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance serviceTypeCodes: - A4 - A6 - '22' serviceTypes: - Psychiatric - Psychotherapy - Social Work - additionalInformation: - description: Services rendered thru Client Specific Network authOrCertIndicator: N benefitPercent: '0' code: A coverageLevel: Individual coverageLevelCode: IND eligibilityAdditionalInformation: codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Telehealth Provided Other than in Patient’s Home industryCode: '02' eligibilityAdditionalInformationList: - codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Telehealth Provided Other than in Patient’s Home industryCode: '02' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance serviceTypeCodes: - A4 - A6 - '22' serviceTypes: - Psychiatric - Psychotherapy - Social Work - additionalInformation: - description: Services rendered thru Client Specific Network authOrCertIndicator: N benefitPercent: '0' code: A coverageLevel: Individual coverageLevelCode: IND eligibilityAdditionalInformation: codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Office industryCode: '11' eligibilityAdditionalInformationList: - codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Office industryCode: '11' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance serviceTypeCodes: - A4 - A6 - '4' - '22' serviceTypes: - Psychiatric - Psychotherapy - Diagnostic X-Ray - Social Work - additionalInformation: - description: Services rendered thru Client Specific Network authOrCertIndicator: N benefitAmount: '20' code: B coverageLevel: Individual coverageLevelCode: IND eligibilityAdditionalInformation: codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Telehealth Provided Other than in Patient’s Home industryCode: '02' eligibilityAdditionalInformationList: - codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Telehealth Provided Other than in Patient’s Home industryCode: '02' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Payment serviceTypeCodes: - A4 - A6 - '22' serviceTypes: - Psychiatric - Psychotherapy - Social Work timeQualifier: Visit timeQualifierCode: '27' - additionalInformation: - description: Services rendered thru Client Specific Network authOrCertIndicator: N benefitAmount: '20' code: B coverageLevel: Individual coverageLevelCode: IND eligibilityAdditionalInformation: codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Office industryCode: '11' eligibilityAdditionalInformationList: - codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Office industryCode: '11' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Payment serviceTypeCodes: - A4 - A6 - '22' serviceTypes: - Psychiatric - Psychotherapy - Social Work timeQualifier: Visit timeQualifierCode: '27' - additionalInformation: - description: Services rendered thru Client Specific Network authOrCertIndicator: Y benefitPercent: '0' code: A coverageLevel: Individual coverageLevelCode: IND eligibilityAdditionalInformation: codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Office industryCode: '11' eligibilityAdditionalInformationList: - codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Office industryCode: '11' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance serviceTypeCodes: - '7' serviceTypes: - Anesthesia - authOrCertIndicator: Y code: CB inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Coverage Basis serviceTypeCodes: - '7' - BB serviceTypes: - Anesthesia - Partial Hospitalization (Psychiatric) - additionalInformation: - description: Includes services provided by Client Specific Network authOrCertIndicator: Y benefitAmount: '0' code: C coverageLevel: Individual coverageLevelCode: IND eligibilityAdditionalInformation: codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Office industryCode: '11' eligibilityAdditionalInformationList: - codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Office industryCode: '11' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Deductible serviceTypeCodes: - '7' serviceTypes: - Anesthesia - authOrCertIndicator: Y benefitPercent: '0' code: A coverageLevel: Individual coverageLevelCode: IND eligibilityAdditionalInformation: codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Office industryCode: '11' eligibilityAdditionalInformationList: - codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Office industryCode: '11' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance serviceTypeCodes: - '7' serviceTypes: - Anesthesia - authOrCertIndicator: N benefitPercent: '0' code: A coverageLevel: Individual coverageLevelCode: IND eligibilityAdditionalInformation: codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Outpatient Hospital industryCode: '22' eligibilityAdditionalInformationList: - codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Outpatient Hospital industryCode: '22' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance serviceTypeCodes: - '4' serviceTypes: - Diagnostic X-Ray - additionalInformation: - description: Services rendered thru Client Specific Network authOrCertIndicator: N benefitPercent: '0' code: A coverageLevel: Individual coverageLevelCode: IND eligibilityAdditionalInformation: codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Outpatient Hospital industryCode: '22' eligibilityAdditionalInformationList: - codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Outpatient Hospital industryCode: '22' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance serviceTypeCodes: - '4' serviceTypes: - Diagnostic X-Ray - additionalInformation: - description: Includes services provided by Client Specific Network authOrCertIndicator: Y benefitAmount: '0' code: C coverageLevel: Individual coverageLevelCode: IND inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Deductible serviceTypeCodes: - BB serviceTypes: - Partial Hospitalization (Psychiatric) - additionalInformation: - description: ' Provider is out of network based on NPI ID provided in request.' code: '1' name: Active Coverage serviceTypeCodes: - MH serviceTypes: - Mental Health - additionalInformation: - description: Includes services provided by Client Specific Network - description: Coinsurance does apply to member's out-of-pocket maximum - description: Copay does apply to member's out-of-pocket maximum - description: Deductible does apply to member's out-of-pocket maximum benefitAmount: '5760' code: G coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Out of Pocket (Stop Loss) serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Remaining timeQualifierCode: '29' - additionalInformation: - description: Includes services provided by Client Specific Network benefitAmount: '500' code: C coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Deductible serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Remaining timeQualifierCode: '29' - additionalInformation: - description: Includes services provided by Client Specific Network - description: Copay does apply to member's out-of-pocket maximum - description: Coinsurance does apply to member's out-of-pocket maximum - description: Deductible does apply to member's out-of-pocket maximum benefitAmount: '2760' code: G coverageLevel: Individual coverageLevelCode: IND inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Out of Pocket (Stop Loss) serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Remaining timeQualifierCode: '29' - additionalInformation: - description: Includes services provided by Client Specific Network benefitAmount: '250' code: C coverageLevel: Individual coverageLevelCode: IND inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Deductible serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Remaining timeQualifierCode: '29' - benefitAmount: '15000' code: C coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Deductible serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Remaining timeQualifierCode: '29' - additionalInformation: - description: Coinsurance does apply to member's out-of-pocket maximum - description: Deductible does apply to member's out-of-pocket maximum benefitAmount: '30000' code: G coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Out of Pocket (Stop Loss) serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Remaining timeQualifierCode: '29' - benefitAmount: '7500' code: C coverageLevel: Individual coverageLevelCode: IND inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Deductible serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Remaining timeQualifierCode: '29' - additionalInformation: - description: Deductible does apply to member's out-of-pocket maximum - description: Coinsurance does apply to member's out-of-pocket maximum benefitAmount: '15000' code: G coverageLevel: Individual coverageLevelCode: IND inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Out of Pocket (Stop Loss) serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Remaining timeQualifierCode: '29' controlNumber: '214976898' eligibilitySearchId: 01922a35-a177-7171-b868-cd4974dd54df errors: [] id: ec_550e8400-e29b-41d4-a716-446655440000 meta: applicationMode: production outboundTraceId: 01J2VZA127GH93JT74HJU senderId: 030240928 submitterId: '117151744' traceId: 01J2VZA127GH93JT74HJU payer: contactInformation: contacts: - communicationMode: Telephone communicationNumber: '1234567890' - communicationMode: Uniform Resource Locator (URL) communicationNumber: website.company.com entityIdentifier: Payer entityType: Non-Person Entity federalTaxpayersIdNumber: '123412345' name: ABCDE planDateInformation: eligibilityBegin: '20220102' planBegin: '20240101' planEnd: '20241231' planInformation: groupDescription: ABCDE groupNumber: '12341234' priorIdNumber: '1234567890' planStatus: - planDetails: Open Access Plus serviceTypeCodes: - '30' status: Active Coverage statusCode: '1' - serviceTypeCodes: - A7 - BC - A8 - A4 - A5 - A6 - '7' - '4' - BB - '22' status: Active Coverage statusCode: '1' - serviceTypeCodes: - MH status: Active Coverage statusCode: '1' provider: entityIdentifier: Provider entityType: Non-Person Entity npi: '1999999984' providerName: ACME HEALTH SERVICES reassociationKey: '123456789' subscriber: address: address1: 1234 FIRST ST city: NEW YORK postalCode: '123451111' state: WV dateOfBirth: '19000101' entityIdentifier: Insured or Subscriber entityType: Person firstName: JANE gender: F groupNumber: '123456789' lastName: DOE memberId: '123456789' middleName: A tradingPartnerServiceId: '123456789' x12: ISA*00* *00* *ZZ*STEDI *01*117151744 *111111*1234*^*00501*123456782*0*P*>~GS*HB*STEDI*117151744*20240326*111000*1*X*005010X279A1~ST*271*1001*005010X279A1~BHT*0022*11*01J2VZA127GH93JT74HJU*20240326*1514~HL*1**20*1~NM1*PR*2*ABCDE*****FI*111000123~PER*IC**TE*123456789*UR*website.company.com~HL*2*1*21*1~NM1*1P*2*ACME HEALTH SERVICES*****XX*1999999984~HL*3*2*22*0~NM1*IL*1*DOE*JANE*A***MI*123456789~REF*6P*123456789*ABCDE~REF*Q4*123456789~N3*1234 FIRST ST~N4*NEW YORK*WV*123451111~DMG*D8*19000101*F~INS*Y*18*001*25~DTP*356*D8*20220102~DTP*346*D8*20240101~DTP*347*D8*20241231~EB*1**30**Open Access Plus~MSG*Complete Care Management~EB*G*FAM*30***23*6000.00*****Y~MSG*Includes services provided by Client Specific Network~MSG*Coinsurance does apply to member's out-of-pocket maximum~MSG*Copay does apply to member's out-of-pocket maximum~MSG*Deductible does apply to member's out-of-pocket maximum~EB*C*FAM*30***23*500.00*****Y~MSG*Includes services provided by Client Specific Network~EB*G*IND*30***23*3000.00*****Y~MSG*Includes services provided by Client Specific Network~MSG*Copay does apply to member's out-of-pocket maximum~MSG*Coinsurance does apply to member's out-of-pocket maximum~MSG*Deductible does apply to member's out-of-pocket maximum~EB*C*IND*30***23*250.00*****Y~MSG*Includes services provided by Client Specific Network~EB*C*FAM*30***23*15000.00*****N~EB*G*FAM*30***23*30000.00*****N~MSG*Coinsurance does apply to member's out-of-pocket maximum~MSG*Deductible does apply to member's out-of-pocket maximum~EB*A*IND*30*****.10****Y~EB*C*IND*30***23*7500.00*****N~EB*G*IND*30***23*15000.00*****N~MSG*Deductible does apply to member's out-of-pocket maximum~MSG*Coinsurance does apply to member's out-of-pocket maximum~EB*A*IND*30*****.50****N~EB*1**A7^BC^A8^A4^A5^A6^7^4^BB^22*********W~EB*C*IND*BC^A4^A6^4^22****0.00****N*Y~MSG*Includes services provided by Client Specific Network~III*ZZ*22~EB*C*IND*A8****0.00****N*Y~MSG*Includes services provided by Client Specific Network~EB*C*IND*A4^A6^4^22****0.00****N*Y~MSG*Includes services provided by Client Specific Network~III*ZZ*11~EB*C*IND*A4^A6^22****0.00****N*Y~MSG*Includes services provided by Client Specific Network~III*ZZ*02~EB*B*IND*A4^A6^22***27*20.00****N*Y~III*ZZ*11~EB*A*IND*A4^A6^4^22*****.00***N*Y~III*ZZ*11~EB*B*IND*A4^A6^22***27*20.00****N*Y~MSG*Included For Specific Services~III*ZZ*02~EB*A*IND*A4^A6^22*****.00***N*Y~MSG*Included For Specific Services~III*ZZ*02~EB*A*IND*A4^A6^22*****.00***N*Y~MSG*Services rendered thru Client Specific Network~III*ZZ*02~EB*A*IND*A4^A6^4^22*****.00***N*Y~MSG*Services rendered thru Client Specific Network~III*ZZ*11~EB*B*IND*A4^A6^22***27*20.00****N*Y~MSG*Services rendered thru Client Specific Network~III*ZZ*02~EB*B*IND*A4^A6^22***27*20.00****N*Y~MSG*Services rendered thru Client Specific Network~III*ZZ*11~EB*A*IND*7*****.00***Y*Y~MSG*Services rendered thru Client Specific Network~III*ZZ*11~EB*CB**7^BB********Y*Y~EB*C*IND*7****0.00****Y*Y~MSG*Includes services provided by Client Specific Network~III*ZZ*11~EB*A*IND*7*****.00***Y*Y~III*ZZ*11~EB*A*IND*4*****.00***N*Y~III*ZZ*22~EB*A*IND*4*****.00***N*Y~MSG*Services rendered thru Client Specific Network~III*ZZ*22~EB*C*IND*BB****0.00****Y*Y~MSG*Includes services provided by Client Specific Network~EB*1**MH~MSG* Provider is out of network based on NPI ID provided in request.~EB*G*FAM*30***29*5760.00*****Y~MSG*Includes services provided by Client Specific Network~MSG*Coinsurance does apply to member's out-of-pocket maximum~MSG*Copay does apply to member's out-of-pocket maximum~MSG*Deductible does apply to member's out-of-pocket maximum~EB*C*FAM*30***29*500.00*****Y~MSG*Includes services provided by Client Specific Network~EB*G*IND*30***29*2760.00*****Y~MSG*Includes services provided by Client Specific Network~MSG*Copay does apply to member's out-of-pocket maximum~MSG*Coinsurance does apply to member's out-of-pocket maximum~MSG*Deductible does apply to member's out-of-pocket maximum~EB*C*IND*30***29*250.00*****Y~MSG*Includes services provided by Client Specific Network~EB*C*FAM*30***29*15000.00*****N~EB*G*FAM*30***29*30000.00*****N~MSG*Coinsurance does apply to member's out-of-pocket maximum~MSG*Deductible does apply to member's out-of-pocket maximum~EB*C*IND*30***29*7500.00*****N~EB*G*IND*30***29*15000.00*****N~MSG*Deductible does apply to member's out-of-pocket maximum~MSG*Coinsurance does apply to member's out-of-pocket maximum~SE*119*1001~GE*1*1~IEA*1*123456782~ schema: $ref: '#/components/schemas/EligibilityCheckResponseContent' description: EligibilityCheck 200 response '400': content: application/json: examples: EligibilityCheck_example2: description: '' summary: Invalid provider name value: controlNumber: 000647813 eligibilitySearchId: 0198afa8-1610-7602-a436-911cb4bf2a9f errors: - code: '44' description: Invalid/Missing Provider Name field: AAA followupAction: Please Correct and Resubmit location: Loop 2100B possibleResolutions: Provider's NPI is registered with incorrect name at the payer. Contact the payer directly using the information in the `payer.contactInformation` object (if available) to resolve the issue. id: ec_650e8400-e29b-41d4-a716-446655440001 meta: applicationMode: test outboundTraceId: 01K2QTG5GGN7SSM34JMHS7QBDZ senderId: STEDI submitterId: '117151744' traceId: 01K2QTG5GGN7SSM34JMHS7QBDZ payer: entityIdentifier: Payer entityType: Non-Person Entity name: '100935' payorIdentification: '100935' planDateInformation: plan: '20240726' provider: aaaErrors: - code: '44' description: Invalid/Missing Provider Name field: AAA followupAction: Please Correct and Resubmit location: Loop 2100B possibleResolutions: Provider's NPI is registered with incorrect name at the payer. Contact the payer directly using the information in the `payer.contactInformation` object (if available) to resolve the issue. entityIdentifier: Provider entityType: Person npi: '1447848577' providerName: SIMPSON reassociationKey: 000647813 subscriber: dateOfBirth: '20240606' entityIdentifier: Insured or Subscriber entityType: Person firstName: ABE lastName: STEDI subscriberTraceNumbers: - originatingCompanyIdentifier: '3117151744' referenceIdentification: 01K2QTG5GJ8K030SK9QDWF5HD9 traceType: Current Transaction Trace Numbers traceTypeCode: '1' tradingPartnerServiceId: BS001 warnings: - code: response::271::invalid_subscriber_insured_id description: '[Subscriber/dependent] ID must use one of these formats: a three character alpha-numeric prefix (no zeros or ones) followed by a maximum of 14 alpha-numeric characters, an `R` followed by exactly 8 numbers, or an `H` followed by exactly 8 or 10 numbers.' x12: ISA*00* *00* *ZZ*STEDI *01*117151744 *250815*1734*^*00501*000647813*0*T*:~GS*HB*STEDI*117151744*20250815*173448*1*X*005010X279A1~ST*271*1001*005010X279A1~BHT*0022*11*01K2QTG5GGN7SSM34JMHS7QBDZ*20250815*1734~HL*1**20*1~NM1*PR*2*100935*****PI*100935~HL*2*1*21*1~NM1*1P*1*SIMPSON*****XX*1447848577~AAA*N**44*C~HL*3*2*22*0~TRN*1*01K2QTG5GJ8K030SK9QDWF5HD9*3117151744~NM1*IL*1*STEDI*ABE~DMG*D8*20240606~DTP*291*D8*20240726~SE*13*1001~GE*1*1~IEA*1*000647813~ schema: $ref: '#/components/schemas/EligibilityCheck400ErrorResponseContent' description: EligibilityCheck400Error 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: - Real-time eligibility check /change/medicalnetwork/eligibility/v3/raw-x12: post: description: Submit a real-time 270/271 eligibility check in raw X12 EDI format externalDocs: description: Developer guide url: https://www.stedi.com/docs/healthcare/send-eligibility-checks operationId: EligibilityRawX12Check parameters: - in: header name: X-Forwarded-For schema: description: '**(CMS requests only):** Starting November 8, 2025, the Centers for Medicare & Medicaid Services (CMS) requires submitters to include network IP addresses from an eligibility request''s point of origin through receipt by the HETS system. To comply with this requirement, you may need to include this header in requests to CMS. When present, this header should contain a comma-separated list of upstream IP addresses, starting with the originating system and continuing through every intermediary. You can exclude your IP address from the list. Note that Stedi blocks eligibility requests to CMS when any IP address in the chain – the originating IP address or any in the X-Forwarded-For header – is located outside the United States. Visit [CMS traceability requirements](https://www.stedi.com/docs/healthcare/send-eligibility-checks#cms-traceability-requirements) for details and examples.' type: string requestBody: content: application/json: examples: EligibilityRawX12Check_example1: description: '' summary: Eligibility check value: x12: ISA*00* *00* *ZZ*SENDER *ZZ*RECEIVER *231106*1406*^*00501*000000001*0*T*>~GS*HS*SENDERGS*RECEIVERGS*20231106*140631*000000001*X*005010X279A1~ST*270*1234*005010X279A1~BHT*0022*13*10001234*20240321*1319~HL*1**20*1~NM1*PR*2*ABCDE*****PI*11122~HL*2*1*21*1~NM1*1P*2*ACME HEALTH SERVICES*****SV*1999999984~HL*3*2*22*0~TRN*1*11122-12345*1234567890~NM1*IL*1*JANE*DOE****MI*123456789~DMG*D8*19000101~DTP*291*D8*20240108~EQ*MH~SE*13*1234~GE*1*000000001~IEA*1*000000001~ EligibilityRawX12Check_example2: description: '' summary: X12 EDI parse error value: x12: ISA*00* *00* *ZZ*SENDER *ZZ*RECEIVER *231106*1406*^*00501*000000001*0*T*>~GS*HS*SENDERGS*RECEIVERGS*20231106*140631*000000001*X*005010X279A1~ST*270*1234*005010X279A1~BHT*0022*13*10001234*20240321*1319~HL*1**20*1~NM1*PR*2*ABCDE*****PI*11122~HL*2*1*21*1~NM1*1P*2*ACME HEALTH SERVICES*****SV*1999999984~SE*8*1234~GE*1*000000001~IEA*1*000000001~ schema: $ref: '#/components/schemas/EligibilityRawX12CheckRequestContent' required: true responses: '200': content: application/json: examples: EligibilityRawX12Check_example1: description: '' summary: Eligibility check value: benefitsInformation: - additionalInformation: - description: Complete Care Management code: '1' name: Active Coverage planCoverage: Open Access Plus serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage - additionalInformation: - description: Includes services provided by Client Specific Network - description: Coinsurance does apply to member's out-of-pocket maximum - description: Copay does apply to member's out-of-pocket maximum - description: Deductible does apply to member's out-of-pocket maximum benefitAmount: '6000' code: G coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Out of Pocket (Stop Loss) serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Calendar Year timeQualifierCode: '23' - additionalInformation: - description: Includes services provided by Client Specific Network benefitAmount: '500' code: C coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Deductible serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Calendar Year timeQualifierCode: '23' - additionalInformation: - description: Includes services provided by Client Specific Network - description: Copay does apply to member's out-of-pocket maximum - description: Coinsurance does apply to member's out-of-pocket maximum - description: Deductible does apply to member's out-of-pocket maximum benefitAmount: '3000' code: G coverageLevel: Individual coverageLevelCode: IND inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Out of Pocket (Stop Loss) serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Calendar Year timeQualifierCode: '23' - additionalInformation: - description: Includes services provided by Client Specific Network benefitAmount: '250' code: C coverageLevel: Individual coverageLevelCode: IND inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Deductible serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Calendar Year timeQualifierCode: '23' - benefitAmount: '15000' code: C coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Deductible serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Calendar Year timeQualifierCode: '23' - additionalInformation: - description: Coinsurance does apply to member's out-of-pocket maximum - description: Deductible does apply to member's out-of-pocket maximum benefitAmount: '30000' code: G coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Out of Pocket (Stop Loss) serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Calendar Year timeQualifierCode: '23' - benefitPercent: '0.1' code: A coverageLevel: Individual coverageLevelCode: IND inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage - benefitAmount: '7500' code: C coverageLevel: Individual coverageLevelCode: IND inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Deductible serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Calendar Year timeQualifierCode: '23' - additionalInformation: - description: Deductible does apply to member's out-of-pocket maximum - description: Coinsurance does apply to member's out-of-pocket maximum benefitAmount: '15000' code: G coverageLevel: Individual coverageLevelCode: IND inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Out of Pocket (Stop Loss) serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Calendar Year timeQualifierCode: '23' - benefitPercent: '0.5' code: A coverageLevel: Individual coverageLevelCode: IND inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Co-Insurance serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage - code: '1' inPlanNetworkIndicator: Not Applicable inPlanNetworkIndicatorCode: W name: Active Coverage serviceTypeCodes: - A7 - BC - A8 - A4 - A5 - A6 - '7' - '4' - BB - '22' serviceTypes: - Psychiatric - Inpatient - Day Care (Psychiatric) - Psychiatric - Outpatient - Psychiatric - Psychiatric - Room and Board - Psychotherapy - Anesthesia - Diagnostic X-Ray - Partial Hospitalization (Psychiatric) - Social Work - additionalInformation: - description: Includes services provided by Client Specific Network authOrCertIndicator: N benefitAmount: '0' code: C coverageLevel: Individual coverageLevelCode: IND eligibilityAdditionalInformation: codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Outpatient Hospital industryCode: '22' eligibilityAdditionalInformationList: - codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Outpatient Hospital industryCode: '22' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Deductible serviceTypeCodes: - BC - A4 - A6 - '4' - '22' serviceTypes: - Day Care (Psychiatric) - Psychiatric - Psychotherapy - Diagnostic X-Ray - Social Work - additionalInformation: - description: Includes services provided by Client Specific Network authOrCertIndicator: N benefitAmount: '0' code: C coverageLevel: Individual coverageLevelCode: IND inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Deductible serviceTypeCodes: - A8 serviceTypes: - Psychiatric - Outpatient - additionalInformation: - description: Includes services provided by Client Specific Network authOrCertIndicator: N benefitAmount: '0' code: C coverageLevel: Individual coverageLevelCode: IND eligibilityAdditionalInformation: codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Office industryCode: '11' eligibilityAdditionalInformationList: - codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Office industryCode: '11' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Deductible serviceTypeCodes: - A4 - A6 - '4' - '22' serviceTypes: - Psychiatric - Psychotherapy - Diagnostic X-Ray - Social Work - additionalInformation: - description: Includes services provided by Client Specific Network authOrCertIndicator: N benefitAmount: '0' code: C coverageLevel: Individual coverageLevelCode: IND eligibilityAdditionalInformation: codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Telehealth Provided Other than in Patient’s Home industryCode: '02' eligibilityAdditionalInformationList: - codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Telehealth Provided Other than in Patient’s Home industryCode: '02' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Deductible serviceTypeCodes: - A4 - A6 - '22' serviceTypes: - Psychiatric - Psychotherapy - Social Work - authOrCertIndicator: N benefitAmount: '20' code: B coverageLevel: Individual coverageLevelCode: IND eligibilityAdditionalInformation: codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Office industryCode: '11' eligibilityAdditionalInformationList: - codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Office industryCode: '11' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Payment serviceTypeCodes: - A4 - A6 - '22' serviceTypes: - Psychiatric - Psychotherapy - Social Work timeQualifier: Visit timeQualifierCode: '27' - authOrCertIndicator: N benefitPercent: '0' code: A coverageLevel: Individual coverageLevelCode: IND eligibilityAdditionalInformation: codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Office industryCode: '11' eligibilityAdditionalInformationList: - codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Office industryCode: '11' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance serviceTypeCodes: - A4 - A6 - '4' - '22' serviceTypes: - Psychiatric - Psychotherapy - Diagnostic X-Ray - Social Work - additionalInformation: - description: Included For Specific Services authOrCertIndicator: N benefitAmount: '20' code: B coverageLevel: Individual coverageLevelCode: IND eligibilityAdditionalInformation: codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Telehealth Provided Other than in Patient’s Home industryCode: '02' eligibilityAdditionalInformationList: - codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Telehealth Provided Other than in Patient’s Home industryCode: '02' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Payment serviceTypeCodes: - A4 - A6 - '22' serviceTypes: - Psychiatric - Psychotherapy - Social Work timeQualifier: Visit timeQualifierCode: '27' - additionalInformation: - description: Included For Specific Services authOrCertIndicator: N benefitPercent: '0' code: A coverageLevel: Individual coverageLevelCode: IND eligibilityAdditionalInformation: codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Telehealth Provided Other than in Patient’s Home industryCode: '02' eligibilityAdditionalInformationList: - codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Telehealth Provided Other than in Patient’s Home industryCode: '02' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance serviceTypeCodes: - A4 - A6 - '22' serviceTypes: - Psychiatric - Psychotherapy - Social Work - additionalInformation: - description: Services rendered thru Client Specific Network authOrCertIndicator: N benefitPercent: '0' code: A coverageLevel: Individual coverageLevelCode: IND eligibilityAdditionalInformation: codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Telehealth Provided Other than in Patient’s Home industryCode: '02' eligibilityAdditionalInformationList: - codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Telehealth Provided Other than in Patient’s Home industryCode: '02' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance serviceTypeCodes: - A4 - A6 - '22' serviceTypes: - Psychiatric - Psychotherapy - Social Work - additionalInformation: - description: Services rendered thru Client Specific Network authOrCertIndicator: N benefitPercent: '0' code: A coverageLevel: Individual coverageLevelCode: IND eligibilityAdditionalInformation: codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Office industryCode: '11' eligibilityAdditionalInformationList: - codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Office industryCode: '11' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance serviceTypeCodes: - A4 - A6 - '4' - '22' serviceTypes: - Psychiatric - Psychotherapy - Diagnostic X-Ray - Social Work - additionalInformation: - description: Services rendered thru Client Specific Network authOrCertIndicator: N benefitAmount: '20' code: B coverageLevel: Individual coverageLevelCode: IND eligibilityAdditionalInformation: codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Telehealth Provided Other than in Patient’s Home industryCode: '02' eligibilityAdditionalInformationList: - codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Telehealth Provided Other than in Patient’s Home industryCode: '02' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Payment serviceTypeCodes: - A4 - A6 - '22' serviceTypes: - Psychiatric - Psychotherapy - Social Work timeQualifier: Visit timeQualifierCode: '27' - additionalInformation: - description: Services rendered thru Client Specific Network authOrCertIndicator: N benefitAmount: '20' code: B coverageLevel: Individual coverageLevelCode: IND eligibilityAdditionalInformation: codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Office industryCode: '11' eligibilityAdditionalInformationList: - codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Office industryCode: '11' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Payment serviceTypeCodes: - A4 - A6 - '22' serviceTypes: - Psychiatric - Psychotherapy - Social Work timeQualifier: Visit timeQualifierCode: '27' - additionalInformation: - description: Services rendered thru Client Specific Network authOrCertIndicator: Y benefitPercent: '0' code: A coverageLevel: Individual coverageLevelCode: IND eligibilityAdditionalInformation: codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Office industryCode: '11' eligibilityAdditionalInformationList: - codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Office industryCode: '11' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance serviceTypeCodes: - '7' serviceTypes: - Anesthesia - authOrCertIndicator: Y code: CB inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Coverage Basis serviceTypeCodes: - '7' - BB serviceTypes: - Anesthesia - Partial Hospitalization (Psychiatric) - additionalInformation: - description: Includes services provided by Client Specific Network authOrCertIndicator: Y benefitAmount: '0' code: C coverageLevel: Individual coverageLevelCode: IND eligibilityAdditionalInformation: codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Office industryCode: '11' eligibilityAdditionalInformationList: - codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Office industryCode: '11' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Deductible serviceTypeCodes: - '7' serviceTypes: - Anesthesia - authOrCertIndicator: Y benefitPercent: '0' code: A coverageLevel: Individual coverageLevelCode: IND eligibilityAdditionalInformation: codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Office industryCode: '11' eligibilityAdditionalInformationList: - codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Office industryCode: '11' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance serviceTypeCodes: - '7' serviceTypes: - Anesthesia - authOrCertIndicator: N benefitPercent: '0' code: A coverageLevel: Individual coverageLevelCode: IND eligibilityAdditionalInformation: codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Outpatient Hospital industryCode: '22' eligibilityAdditionalInformationList: - codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Outpatient Hospital industryCode: '22' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance serviceTypeCodes: - '4' serviceTypes: - Diagnostic X-Ray - additionalInformation: - description: Services rendered thru Client Specific Network authOrCertIndicator: N benefitPercent: '0' code: A coverageLevel: Individual coverageLevelCode: IND eligibilityAdditionalInformation: codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Outpatient Hospital industryCode: '22' eligibilityAdditionalInformationList: - codeListQualifier: Mutually Defined codeListQualifierCode: ZZ industry: Outpatient Hospital industryCode: '22' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance serviceTypeCodes: - '4' serviceTypes: - Diagnostic X-Ray - additionalInformation: - description: Includes services provided by Client Specific Network authOrCertIndicator: Y benefitAmount: '0' code: C coverageLevel: Individual coverageLevelCode: IND inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Deductible serviceTypeCodes: - BB serviceTypes: - Partial Hospitalization (Psychiatric) - additionalInformation: - description: ' Provider is out of network based on NPI ID provided in request.' code: '1' name: Active Coverage serviceTypeCodes: - MH serviceTypes: - Mental Health - additionalInformation: - description: Includes services provided by Client Specific Network - description: Coinsurance does apply to member's out-of-pocket maximum - description: Copay does apply to member's out-of-pocket maximum - description: Deductible does apply to member's out-of-pocket maximum benefitAmount: '5760' code: G coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Out of Pocket (Stop Loss) serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Remaining timeQualifierCode: '29' - additionalInformation: - description: Includes services provided by Client Specific Network benefitAmount: '500' code: C coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Deductible serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Remaining timeQualifierCode: '29' - additionalInformation: - description: Includes services provided by Client Specific Network - description: Copay does apply to member's out-of-pocket maximum - description: Coinsurance does apply to member's out-of-pocket maximum - description: Deductible does apply to member's out-of-pocket maximum benefitAmount: '2760' code: G coverageLevel: Individual coverageLevelCode: IND inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Out of Pocket (Stop Loss) serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Remaining timeQualifierCode: '29' - additionalInformation: - description: Includes services provided by Client Specific Network benefitAmount: '250' code: C coverageLevel: Individual coverageLevelCode: IND inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Deductible serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Remaining timeQualifierCode: '29' - benefitAmount: '15000' code: C coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Deductible serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Remaining timeQualifierCode: '29' - additionalInformation: - description: Coinsurance does apply to member's out-of-pocket maximum - description: Deductible does apply to member's out-of-pocket maximum benefitAmount: '30000' code: G coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Out of Pocket (Stop Loss) serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Remaining timeQualifierCode: '29' - benefitAmount: '7500' code: C coverageLevel: Individual coverageLevelCode: IND inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Deductible serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Remaining timeQualifierCode: '29' - additionalInformation: - description: Deductible does apply to member's out-of-pocket maximum - description: Coinsurance does apply to member's out-of-pocket maximum benefitAmount: '15000' code: G coverageLevel: Individual coverageLevelCode: IND inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Out of Pocket (Stop Loss) serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Remaining timeQualifierCode: '29' controlNumber: '1001' eligibilitySearchId: 01922a35-a177-7171-b868-cd4974dd54df errors: [] id: ec_650e8400-e29b-41d4-a716-446655440001 meta: applicationMode: production outboundTraceId: 01J2VZA127GH93JT74HJU senderId: STEDI submitterId: '117151744' traceId: 01J2VZA127GH93JT74HJU payer: contactInformation: contacts: - communicationMode: Telephone communicationNumber: '1234567890' - communicationMode: Uniform Resource Locator (URL) communicationNumber: website.company.com entityIdentifier: Payer entityType: Non-Person Entity federalTaxpayersIdNumber: '123412345' name: ABCDE planDateInformation: eligibilityBegin: '20240102' planBegin: '20240101' planEnd: '20241231' planInformation: groupDescription: ABCDE groupNumber: '12341234' priorIdNumber: '1234567890' planStatus: - planDetails: Open Access Plus serviceTypeCodes: - '30' status: Active Coverage statusCode: '1' - serviceTypeCodes: - A7 - BC - A8 - A4 - A5 - A6 - '7' - '4' - BB - '22' status: Active Coverage statusCode: '1' - serviceTypeCodes: - MH status: Active Coverage statusCode: '1' provider: entityIdentifier: Provider entityType: Non-Person Entity npi: '1999999984' providerName: ACME HEALTH SERVICES reassociationKey: '123456789' subscriber: address: address1: 1234 FIRST ST city: NEW YORK postalCode: '123451111' state: WV dateOfBirth: '19000101' entityIdentifier: Insured or Subscriber entityType: Person firstName: JANE gender: F groupNumber: '123456789' lastName: DOE memberId: '123456789' middleName: A tradingPartnerServiceId: '123456789' x12: ISA*00* *00* *ZZ*RECEIVER *ZZ*SENDER *111111*1234*^*00501*123456782*0*T*>~GS*HB*RECEIVERGS*SENDERGS*20240326*111000*1*X*005010X279A1~ST*271*1001*005010X279A1~BHT*0022*11*01J2VZA127GH93JT74HJU*20240326*1514~HL*1**20*1~NM1*PR*2*ABCDE*****FI*111000123~PER*IC**TE*123456789*UR*website.company.com~HL*2*1*21*1~NM1*1P*2*ACME HEALTH SERVICES*****XX*1999999984~HL*3*2*22*0~NM1*IL*1*DOE*JANE*A***MI*123456789~REF*6P*123456789*ABCDE~REF*Q4*123456789~N3*1234 FIRST ST~N4*NEW YORK*WV*123451111~DMG*D8*19000101*F~INS*Y*18*001*25~DTP*356*D8*20220102~DTP*346*D8*20240101~DTP*347*D8*20241231~EB*1**30**Open Access Plus~MSG*Complete Care Management~EB*G*FAM*30***23*6000.00*****Y~MSG*Includes services provided by Client Specific Network~MSG*Coinsurance does apply to member's out-of-pocket maximum~MSG*Copay does apply to member's out-of-pocket maximum~MSG*Deductible does apply to member's out-of-pocket maximum~EB*C*FAM*30***23*500.00*****Y~MSG*Includes services provided by Client Specific Network~EB*G*IND*30***23*3000.00*****Y~MSG*Includes services provided by Client Specific Network~MSG*Copay does apply to member's out-of-pocket maximum~MSG*Coinsurance does apply to member's out-of-pocket maximum~MSG*Deductible does apply to member's out-of-pocket maximum~EB*C*IND*30***23*250.00*****Y~MSG*Includes services provided by Client Specific Network~EB*C*FAM*30***23*15000.00*****N~EB*G*FAM*30***23*30000.00*****N~MSG*Coinsurance does apply to member's out-of-pocket maximum~MSG*Deductible does apply to member's out-of-pocket maximum~EB*A*IND*30*****.10****Y~EB*C*IND*30***23*7500.00*****N~EB*G*IND*30***23*15000.00*****N~MSG*Deductible does apply to member's out-of-pocket maximum~MSG*Coinsurance does apply to member's out-of-pocket maximum~EB*A*IND*30*****.50****N~EB*1**A7^BC^A8^A4^A5^A6^7^4^BB^22*********W~EB*C*IND*BC^A4^A6^4^22****0.00****N*Y~MSG*Includes services provided by Client Specific Network~III*ZZ*22~EB*C*IND*A8****0.00****N*Y~MSG*Includes services provided by Client Specific Network~EB*C*IND*A4^A6^4^22****0.00****N*Y~MSG*Includes services provided by Client Specific Network~III*ZZ*11~EB*C*IND*A4^A6^22****0.00****N*Y~MSG*Includes services provided by Client Specific Network~III*ZZ*02~EB*B*IND*A4^A6^22***27*20.00****N*Y~III*ZZ*11~EB*A*IND*A4^A6^4^22*****.00***N*Y~III*ZZ*11~EB*B*IND*A4^A6^22***27*20.00****N*Y~MSG*Included For Specific Services~III*ZZ*02~EB*A*IND*A4^A6^22*****.00***N*Y~MSG*Included For Specific Services~III*ZZ*02~EB*A*IND*A4^A6^22*****.00***N*Y~MSG*Services rendered thru Client Specific Network~III*ZZ*02~EB*A*IND*A4^A6^4^22*****.00***N*Y~MSG*Services rendered thru Client Specific Network~III*ZZ*11~EB*B*IND*A4^A6^22***27*20.00****N*Y~MSG*Services rendered thru Client Specific Network~III*ZZ*02~EB*B*IND*A4^A6^22***27*20.00****N*Y~MSG*Services rendered thru Client Specific Network~III*ZZ*11~EB*A*IND*7*****.00***Y*Y~MSG*Services rendered thru Client Specific Network~III*ZZ*11~EB*CB**7^BB********Y*Y~EB*C*IND*7****0.00****Y*Y~MSG*Includes services provided by Client Specific Network~III*ZZ*11~EB*A*IND*7*****.00***Y*Y~III*ZZ*11~EB*A*IND*4*****.00***N*Y~III*ZZ*22~EB*A*IND*4*****.00***N*Y~MSG*Services rendered thru Client Specific Network~III*ZZ*22~EB*C*IND*BB****0.00****Y*Y~MSG*Includes services provided by Client Specific Network~EB*1**MH~MSG* Provider is out of network based on NPI ID provided in request.~EB*G*FAM*30***29*5760.00*****Y~MSG*Includes services provided by Client Specific Network~MSG*Coinsurance does apply to member's out-of-pocket maximum~MSG*Copay does apply to member's out-of-pocket maximum~MSG*Deductible does apply to member's out-of-pocket maximum~EB*C*FAM*30***29*500.00*****Y~MSG*Includes services provided by Client Specific Network~EB*G*IND*30***29*2760.00*****Y~MSG*Includes services provided by Client Specific Network~MSG*Copay does apply to member's out-of-pocket maximum~MSG*Coinsurance does apply to member's out-of-pocket maximum~MSG*Deductible does apply to member's out-of-pocket maximum~EB*C*IND*30***29*250.00*****Y~MSG*Includes services provided by Client Specific Network~EB*C*FAM*30***29*15000.00*****N~EB*G*FAM*30***29*30000.00*****N~MSG*Coinsurance does apply to member's out-of-pocket maximum~MSG*Deductible does apply to member's out-of-pocket maximum~EB*C*IND*30***29*7500.00*****N~EB*G*IND*30***29*15000.00*****N~MSG*Deductible does apply to member's out-of-pocket maximum~MSG*Coinsurance does apply to member's out-of-pocket maximum~SE*119*1001~GE*1*1~IEA*1*123456782~ schema: $ref: '#/components/schemas/EligibilityRawX12CheckResponseContent' description: EligibilityRawX12Check 200 response '400': content: application/json: examples: EligibilityRawX12Check_example2: description: '' summary: X12 EDI parse error value: eligibilitySearchId: 0198afb0-0e35-7ed3-bc66-6c387c60f4bb errors: - code: '71' description: 'Parse errors: Loop has fewer than the minimum of 1 items' followupAction: Please Correct and Resubmit location: subscriber_level_HL_loop possibleResolutions: The X12 request could not be parsed. Verify the request is a valid 270 transaction. id: ec_650e8400-e29b-41d4-a716-446655440002 status: ERROR schema: $ref: '#/components/schemas/EligibilityRawX12Check400ErrorResponseContent' description: EligibilityRawX12Check400Error 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: - Real-time eligibility check /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: $ref: '#/components/schemas/GatewayTimeoutExceptionResponseContent' description: GatewayTimeoutException 504 response tags: - Claim submission /change/medicalnetwork/reports/v2/{transactionId}/277: get: description: Retrieve a 277CA claim acknowledgment in JSON format operationId: ConvertReport277 parameters: - description: A unique identifier for the processed 277 transaction within Stedi. This ID is included in the transaction processed event, which you can receive automatically through Stedi [webhooks](https://www.stedi.com/docs/healthcare/configure-webhooks). You can also retrieve it through the [Poll Transactions endpoint](https://www.stedi.com/docs/healthcare/api-reference/get-poll-transactions) or from the transaction's details page within the Stedi portal. examples: ConvertReport277_example1: description: '' summary: Accepted claim value: d567c2ae-f073-4725-8b8c-06c473b738a6 ConvertReport277_example2: description: '' summary: Denied claim value: 71716ec5-0e96-462f-bb77-869941bb27ab in: path name: transactionId required: true schema: description: A unique identifier for the processed 277 transaction within Stedi. This ID is included in the transaction processed event, which you can receive automatically through Stedi [webhooks](https://www.stedi.com/docs/healthcare/configure-webhooks). You can also retrieve it through the [Poll Transactions endpoint](https://www.stedi.com/docs/healthcare/api-reference/get-poll-transactions) or from the transaction's details page within the Stedi portal. maxLength: 36 minLength: 36 pattern: ^[0-9a-fA-F]{8}-[0-9a-fA-F]{4}-[0-9a-fA-F]{4}-[0-9a-fA-F]{4}-[0-9a-fA-F]{12}$ type: string responses: '200': content: application/json: examples: ConvertReport277_example1: description: '' summary: Accepted claim value: meta: transactionId: 71716ec5-0e96-462f-bb77-869941bb27ab transactions: - controlNumber: '1001' payers: - claimStatusTransactions: - claimStatusDetails: - patientClaimStatusDetails: - claims: - claimStatus: claimServiceBeginDate: '20240101' claimServiceEndDate: '20240101' clearinghouseTraceNumber: 01J1SNT1FQC8ABWD44MAMBDYKA informationClaimStatuses: - informationStatuses: - healthCareClaimStatusCategoryCode: A1 healthCareClaimStatusCategoryCodeValue: Acknowledgement/Receipt - The claim/encounter has been received. This does not mean that the claim has been accepted for adjudication. statusCode: '20' statusCodeValue: Accepted for processing. statusInformationEffectiveDate: '20240702' totalClaimChargeAmount: '109.20' patientAccountNumber: '11122233' referencedTransactionTraceNumber: '11122233' subscriber: firstName: JOHN lastName: ANON memberId: U7777788888 providerOFServiceInformationTraceIdentifier: '0' serviceProvider: npi: '1235600834' organizationName: THERAPY ASSOCIATES claimTransactionBatchNumber: 01J1SNRJ0FP4ZE6EFWM4G4XB3N provider: etin: '1235600834' organizationName: TEST DATA HEALTH SERVICES, INC. providerClaimStatuses: - providerStatuses: - healthCareClaimStatusCategoryCode: A1 healthCareClaimStatusCategoryCodeValue: Acknowledgement/Receipt - The claim/encounter has been received. This does not mean that the claim has been accepted for adjudication. statusCode: '20' statusCodeValue: Accepted for processing. statusInformationEffectiveDate: '20240702' organizationName: STEDI INC referenceIdentification: '1511096803' transactionSetCreationDate: '20240702' transactionSetCreationTime: 0815 ConvertReport277_example2: description: '' summary: Denied claim value: meta: transactionId: 71716ec5-0e96-462f-bb77-869941bb27ab transactions: - controlNumber: '1001' payers: - claimStatusTransactions: - claimStatusDetails: - patientClaimStatusDetails: - claims: - claimStatus: claimServiceBeginDate: '20250101' claimServiceEndDate: '20250109' clearinghouseTraceNumber: NA informationClaimStatuses: - informationStatuses: - healthCareClaimStatusCategoryCode: A3 healthCareClaimStatusCategoryCodeValue: Acknowledgement/Returned as unprocessable claim - The claim/encounter has been rejected and has not been entered into the adjudication system. statusCode: '21' statusCodeValue: Missing or invalid information. statusInformationEffectiveDate: '20250201' totalClaimChargeAmount: '3459.3' patientAccountNumber: AAA11111 referencedTransactionTraceNumber: AAA11111 serviceLines: - beginServiceLineDate: '20250101' lineItemControlNumber: ABCD1234 service: chargeAmount: '379.39' procedureCode: '97153' serviceIdQualifierCode: HC serviceIdQualifierCodeValue: Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes submittedUnits: '11' serviceClaimStatuses: - serviceStatuses: - entityIdentifierCode: IL entityIdentifierCodeValue: Insured or Subscriber healthCareClaimStatusCategoryCode: A3 healthCareClaimStatusCategoryCodeValue: Acknowledgement/Returned as unprocessable claim - The claim/encounter has been rejected and has not been entered into the adjudication system. statusCode: '164' statusCodeValue: Entity's contract/member number. - beginServiceLineDate: '20250101' lineItemControlNumber: DCBA4321 service: chargeAmount: '206.94' procedureCode: '97155' serviceIdQualifierCode: HC serviceIdQualifierCodeValue: Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes submittedUnits: '6' serviceClaimStatuses: - serviceStatuses: - entityIdentifierCode: IL entityIdentifierCodeValue: Insured or Subscriber healthCareClaimStatusCategoryCode: A3 healthCareClaimStatusCategoryCodeValue: Acknowledgement/Returned as unprocessable claim - The claim/encounter has been rejected and has not been entered into the adjudication system. statusCode: '164' statusCodeValue: Entity's contract/member number. - beginServiceLineDate: '20250101' lineItemControlNumber: WXYZ1234 service: chargeAmount: '413.92' procedureCode: '97154' serviceIdQualifierCode: HC serviceIdQualifierCodeValue: Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes submittedUnits: '16' serviceClaimStatuses: - serviceStatuses: - entityIdentifierCode: IL entityIdentifierCodeValue: Insured or Subscriber healthCareClaimStatusCategoryCode: A3 healthCareClaimStatusCategoryCodeValue: Acknowledgement/Returned as unprocessable claim - The claim/encounter has been rejected and has not been entered into the adjudication system. statusCode: '164' statusCodeValue: Entity's contract/member number. - beginServiceLineDate: '20250101' lineItemControlNumber: ZYXW4321 service: chargeAmount: '138.72' procedureCode: '97156' procedureModifiers: - GT - '59' serviceIdQualifierCode: HC serviceIdQualifierCodeValue: Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes submittedUnits: '4' serviceClaimStatuses: - serviceStatuses: - entityIdentifierCode: IL entityIdentifierCodeValue: Insured or Subscriber healthCareClaimStatusCategoryCode: A3 healthCareClaimStatusCategoryCodeValue: Acknowledgement/Returned as unprocessable claim - The claim/encounter has been rejected and has not been entered into the adjudication system. statusCode: '164' statusCodeValue: Entity's contract/member number. - beginServiceLineDate: '20250101' lineItemControlNumber: EFGH5678 service: chargeAmount: '413.92' procedureCode: '97154' serviceIdQualifierCode: HC serviceIdQualifierCodeValue: Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes submittedUnits: '16' serviceClaimStatuses: - serviceStatuses: - entityIdentifierCode: IL entityIdentifierCodeValue: Insured or Subscriber healthCareClaimStatusCategoryCode: A3 healthCareClaimStatusCategoryCodeValue: Acknowledgement/Returned as unprocessable claim - The claim/encounter has been rejected and has not been entered into the adjudication system. statusCode: '164' statusCodeValue: Entity's contract/member number. - beginServiceLineDate: '20250102' lineItemControlNumber: HGFE8765 service: chargeAmount: '413.92' procedureCode: '97154' serviceIdQualifierCode: HC serviceIdQualifierCodeValue: Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes submittedUnits: '16' serviceClaimStatuses: - serviceStatuses: - entityIdentifierCode: IL entityIdentifierCodeValue: Insured or Subscriber healthCareClaimStatusCategoryCode: A3 healthCareClaimStatusCategoryCodeValue: Acknowledgement/Returned as unprocessable claim - The claim/encounter has been rejected and has not been entered into the adjudication system. statusCode: '164' statusCodeValue: Entity's contract/member number. - beginServiceLineDate: '20250105' lineItemControlNumber: IJKL1234 service: chargeAmount: '137.96' procedureCode: '97155' serviceIdQualifierCode: HC serviceIdQualifierCodeValue: Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes submittedUnits: '4' serviceClaimStatuses: - serviceStatuses: - entityIdentifierCode: IL entityIdentifierCodeValue: Insured or Subscriber healthCareClaimStatusCategoryCode: A3 healthCareClaimStatusCategoryCodeValue: Acknowledgement/Returned as unprocessable claim - The claim/encounter has been rejected and has not been entered into the adjudication system. statusCode: '164' statusCodeValue: Entity's contract/member number. - beginServiceLineDate: '20250105' lineItemControlNumber: LKJI4321 service: chargeAmount: '388.05' procedureCode: '97154' serviceIdQualifierCode: HC serviceIdQualifierCodeValue: Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes submittedUnits: '15' serviceClaimStatuses: - serviceStatuses: - entityIdentifierCode: IL entityIdentifierCodeValue: Insured or Subscriber healthCareClaimStatusCategoryCode: A3 healthCareClaimStatusCategoryCodeValue: Acknowledgement/Returned as unprocessable claim - The claim/encounter has been rejected and has not been entered into the adjudication system. statusCode: '164' statusCodeValue: Entity's contract/member number. - beginServiceLineDate: '20250107' lineItemControlNumber: MNOP5678 service: chargeAmount: '138.72' procedureCode: '97156' procedureModifiers: - GT - '59' serviceIdQualifierCode: HC serviceIdQualifierCodeValue: Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes submittedUnits: '4' serviceClaimStatuses: - serviceStatuses: - entityIdentifierCode: IL entityIdentifierCodeValue: Insured or Subscriber healthCareClaimStatusCategoryCode: A3 healthCareClaimStatusCategoryCodeValue: Acknowledgement/Returned as unprocessable claim - The claim/encounter has been rejected and has not been entered into the adjudication system. statusCode: '164' statusCodeValue: Entity's contract/member number. - beginServiceLineDate: '20250107' lineItemControlNumber: PONM8765 service: chargeAmount: '413.88' procedureCode: '97153' serviceIdQualifierCode: HC serviceIdQualifierCodeValue: Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes submittedUnits: '12' serviceClaimStatuses: - serviceStatuses: - entityIdentifierCode: IL entityIdentifierCodeValue: Insured or Subscriber healthCareClaimStatusCategoryCode: A3 healthCareClaimStatusCategoryCodeValue: Acknowledgement/Returned as unprocessable claim - The claim/encounter has been rejected and has not been entered into the adjudication system. statusCode: '164' statusCodeValue: Entity's contract/member number. - beginServiceLineDate: '20250109' lineItemControlNumber: QRST6789 service: chargeAmount: '413.88' procedureCode: '97153' serviceIdQualifierCode: HC serviceIdQualifierCodeValue: Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes submittedUnits: '12' serviceClaimStatuses: - serviceStatuses: - entityIdentifierCode: IL entityIdentifierCodeValue: Insured or Subscriber healthCareClaimStatusCategoryCode: A3 healthCareClaimStatusCategoryCodeValue: Acknowledgement/Returned as unprocessable claim - The claim/encounter has been rejected and has not been entered into the adjudication system. statusCode: '164' statusCodeValue: Entity's contract/member number. subscriber: firstName: JOHN lastName: DOE memberId: XYZ1234567 providerOFServiceInformationTraceIdentifier: '0' serviceProvider: npi: '1234567890' organizationName: Provider Organization Name claimTransactionBatchNumber: 387DKEO986DMGN98733S provider: etin: '1234567890' organizationName: Provider Organization Name providerClaimStatuses: - providerStatuses: - healthCareClaimStatusCategoryCode: A1 healthCareClaimStatusCategoryCodeValue: Acknowledgement/Receipt - The claim/encounter has been received. This does not mean that the claim has been accepted for adjudication. statusCode: '20' statusCodeValue: Accepted for processing. statusInformationEffectiveDate: '20250201' organizationName: AZ BLUE payerIdentification: BCBSAZ referenceIdentification: '94846578362' transactionSetCreationDate: '20250201' transactionSetCreationTime: '1439' schema: $ref: '#/components/schemas/ConvertReport277ResponseContent' description: ConvertReport277 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: $ref: '#/components/schemas/GatewayTimeoutExceptionResponseContent' description: GatewayTimeoutException 504 response tags: - Claim acknowledgments /change/medicalnetwork/reports/v2/{transactionId}/835: get: description: Retrieve an 835 Electronic Remittance Advice (ERA) in JSON format operationId: ConvertReport835 parameters: - description: A unique identifier for the processed 835 transaction within Stedi. This ID is included in the transaction processed event, which you can receive automatically through Stedi [webhooks](https://www.stedi.com/docs/healthcare/configure-webhooks). You can also retrieve it through the [Poll Transactions endpoint](https://www.stedi.com/docs/healthcare/api-reference/get-poll-transactions) or from the transaction's details page within the Stedi portal. examples: ConvertReport835_example1: description: '' summary: Retrieve 835 ERA value: d567c2ae-f073-4725-8b8c-06c473b738a6 in: path name: transactionId required: true schema: description: A unique identifier for the processed 835 transaction within Stedi. This ID is included in the transaction processed event, which you can receive automatically through Stedi [webhooks](https://www.stedi.com/docs/healthcare/configure-webhooks). You can also retrieve it through the [Poll Transactions endpoint](https://www.stedi.com/docs/healthcare/api-reference/get-poll-transactions) or from the transaction's details page within the Stedi portal. maxLength: 36 minLength: 36 pattern: ^[0-9a-fA-F]{8}-[0-9a-fA-F]{4}-[0-9a-fA-F]{4}-[0-9a-fA-F]{4}-[0-9a-fA-F]{12}$ type: string responses: '200': content: application/json: examples: ConvertReport835_example1: description: '' summary: Retrieve 835 ERA value: meta: applicationMode: production senderId: BSW transactionId: 7647d644-9348-4596-a3b4-6830b8b48cc8 transactions: - controlNumber: '112233' detailInfo: - assignedNumber: '1' paymentInfo: - claimPaymentInfo: claimFilingIndicatorCode: '12' claimFrequencyCode: '1' claimPaymentAmount: '500' claimStatusCode: '1' facilityTypeCode: '11' patientControlNumber: '1112223333' patientResponsibilityAmount: '300' payerClaimControlNumber: '94060555410000' totalClaimChargeAmount: '800' claimSupplementalInformation: coverageAmount: '800' patientName: firstName: JOHN lastName: DOE memberId: '1234567891' serviceLines: - lineItemControlNumber: '111222333' serviceAdjustments: - adjustmentAmount1: '300' adjustmentReason1: Deductible Amount adjustmentReasonCode1: '1' claimAdjustmentGroupCode: PR claimAdjustmentGroupCodeValue: Patient Responsibility serviceDate: '20190301' servicePaymentInformation: adjudicatedProcedureCode: '99211' lineItemChargeAmount: '800' lineItemProviderPaymentAmount: '500' productOrServiceIDQualifier: HC productOrServiceIDQualifierValue: Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes serviceSupplementalAmounts: allowedActual: '800' - claimPaymentInfo: claimFilingIndicatorCode: '12' claimFrequencyCode: '1' claimPaymentAmount: '600' claimStatusCode: '1' facilityTypeCode: '11' patientControlNumber: '22255566677' patientResponsibilityAmount: '600' payerClaimControlNumber: '9407779923000' totalClaimChargeAmount: '1200' claimSupplementalInformation: coverageAmount: '1200' patientName: firstName: JANE lastName: DOE memberId: '1234567891' serviceLines: - serviceAdjustments: - adjustmentAmount1: '600' adjustmentReason1: Deductible Amount adjustmentReasonCode1: '1' claimAdjustmentGroupCode: PR claimAdjustmentGroupCodeValue: Patient Responsibility serviceDate: '20190310' servicePaymentInformation: adjudicatedProcedureCode: '93555' lineItemChargeAmount: '1200' lineItemProviderPaymentAmount: '600' productOrServiceIDQualifier: HC productOrServiceIDQualifierValue: Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes serviceSupplementalAmounts: allowedActual: '1200' financialInformation: checkIssueOrEFTEffectiveDate: '20190316' creditOrDebitFlagCode: C payerIdentifier: '000000000' paymentFormatCode: CCP paymentMethodCode: ACH receiverAccountDetails: receiverAccountNumber: '144444' receiverAccountNumberQualifier: DA receiverDfiIdNumberQualifier: '01' receiverDfiIdentificationNumber: '111333555' senderAccountDetails: senderAccountNumber: '11111111' senderAccountNumberQualifier: DA senderDFIIdentifier: '888999777' senderDfiIdNumberQualifier: '01' totalActualProviderPaymentAmount: '1100' transactionHandlingCode: I payee: federalTaxPayersIdentificationNumber: '777667755' name: ACME MEDICAL CENTER npi: '1999999984' payer: address: address1: 10 SOUTH AVENUET city: NEW YORK postalCode: '55111' state: SD name: RUSHMORE LIFE technicalContactInformation: - contactMethods: - phone: '8005550000' contactName: JOHN DOE paymentAndRemitReassociationDetails: checkOrEFTTraceNumber: '71700666555' originatingCompanyIdentifier: '1935665544' traceTypeCode: '1' productionDate: '20190314' schema: $ref: '#/components/schemas/ConvertReport835ResponseContent' description: ConvertReport835 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: - Remittances /coordination-of-benefits: post: description: Submit a coordination of benefits (COB) check in JSON format externalDocs: description: Developer guide url: https://www.stedi.com/docs/healthcare/coordination-of-benefits operationId: CoordinationOfBenefits requestBody: content: application/json: examples: CoordinationOfBenefits_example1: description: '' summary: COB check - dependent value: dependent: dateOfBirth: '2002-12-31' firstName: Jordan lastName: Doe encounter: dateOfService: '2024-08-02' serviceTypeCode: '30' provider: npi: '1999999984' organizationName: ACME Health Services subscriber: dateOfBirth: '1985-05-27' firstName: John lastName: Doe memberId: W000000000 tradingPartnerServiceId: SOMEID schema: $ref: '#/components/schemas/CoordinationOfBenefitsRequestContent' required: true responses: '200': content: application/json: examples: CoordinationOfBenefits_example1: description: '' summary: COB check - dependent value: benefitsInformation: - benefitsDateInformation: benefitBegin: '2023-03-01' code: '1' name: Active Coverage serviceTypeCodes: - '1' serviceTypes: - Medical Care subscriber: dateOfBirth: '2002-02-27' - benefitsDateInformation: benefitBegin: '2023-03-01' code: '1' name: Active Coverage serviceTypeCodes: - '88' serviceTypes: - Pharmacy subscriber: dateOfBirth: '2002-02-27' - benefitsDateInformation: benefitBegin: '2023-03-01' code: '1' name: Active Coverage serviceTypeCodes: - AL serviceTypes: - Vision (Optometry) subscriber: dateOfBirth: '2002-02-27' - benefitsDateInformation: coordinationOfBenefits: '2024-07-01' benefitsRelatedEntities: - entityIdentification: PI entityIdentificationValue: '1006' entityIdentifier: Primary Payer entityName: CIGNA - entityFirstname: JOHN entityIdentification: MI entityIdentificationValue: '00000000000' entityIdentifier: Insured or Subscriber entityLastname: DOE entityMiddlename: X code: R name: Other or Additional Payor serviceTypeCodes: - '1' serviceTypes: - Medical Care subscriber: dateOfBirth: '2002-12-31' coordinationOfBenefits: benefitOverlap: true classification: CobInstanceExistsPrimacyDetermined coverageOverlap: true instanceExists: true primacyDetermined: true dependent: address: address1: 1 MAIN ST. city: NEW YORK postalCode: '10000' state: NY dateOfBirth: '2002-12-31' firstName: JORDAN gender: M lastName: DOE relationToSubscriber: Child relationToSubscriberCode: '19' errors: [] meta: applicationMode: production outboundTraceId: 01JDQFT4W3KTWZNTADEZ55BFFX traceId: 01JDQFT4W3KTWZNTADEZ55BFFX payer: name: Aetna payerIdentification: AETNA-USH provider: npi: '1999999984' providerName: ACME Health Services subscriber: address: address1: 1 MAIN ST. city: NEW YORK postalCode: '10000' state: NY firstName: JOHN lastName: DOE memberId: W000000000 schema: $ref: '#/components/schemas/CoordinationOfBenefitsResponseContent' description: CoordinationOfBenefits 200 response '400': content: application/json: schema: $ref: '#/components/schemas/CoordinationOfBenefits400ErrorResponseContent' description: CoordinationOfBenefits400Error 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: - Coordination of benefits /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: $ref: '#/components/schemas/GatewayTimeoutExceptionResponseContent' description: GatewayTimeoutException 504 response tags: - Claim submission /electronic-remittance-advice/{transactionId}/pdf: get: description: Retrieve the generated PDF of an 835 Electronic Remittance Advice (ERA). operationId: GetElectronicRemittanceAdvicePdf parameters: - description: A unique identifier for the Electronic Remittance Advice (ERA) within Stedi. This ID is included in the transaction processed event for the ERA, which you can receive automatically through Stedi [webhooks](https://www.stedi.com/docs/healthcare/configure-webhooks). You can also retrieve this ID through the [Poll Transactions endpoint](https://www.stedi.com/docs/healthcare/api-reference/get-poll-transactions) or from the transaction's details page within Stedi. examples: GetElectronicRemittanceAdvicePdf_example1: description: '' summary: Retrieve PDF value: b12a1241-3312-a3dc-aed2-1a30ca50cd63 in: path name: transactionId required: true schema: description: A unique identifier for the Electronic Remittance Advice (ERA) within Stedi. This ID is included in the transaction processed event for the ERA, which you can receive automatically through Stedi [webhooks](https://www.stedi.com/docs/healthcare/configure-webhooks). You can also retrieve this ID through the [Poll Transactions endpoint](https://www.stedi.com/docs/healthcare/api-reference/get-poll-transactions) or from the transaction's details page within Stedi. maxLength: 36 minLength: 36 pattern: ^[0-9a-fA-F]{8}-[0-9a-fA-F]{4}-[0-9a-fA-F]{4}-[0-9a-fA-F]{4}-[0-9a-fA-F]{12}$ type: string - description: If false, the generated PDF will not include the Stedi logo in the footer. The default is true. in: query name: logo schema: description: If false, the generated PDF will not include the Stedi logo in the footer. The default is true. type: boolean responses: '200': content: application/pdf: examples: GetElectronicRemittanceAdvicePdf_example1: description: '' summary: Retrieve PDF value: '%PDF-1.3 1 0 obj<< ...' schema: $ref: '#/components/schemas/GetElectronicRemittanceAdvicePdfOutputPayload' description: GetElectronicRemittanceAdvicePdf 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: - Remittances /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 /insurance-discovery/check/v1: post: description: Submit an insurance discovery check in JSON format externalDocs: description: Developer guide url: https://www.stedi.com/docs/healthcare/insurance-discovery operationId: InsuranceDiscoveryCheck requestBody: content: application/json: examples: InsuranceDiscoveryCheck_example1: description: '' summary: Insurance discovery check value: encounter: beginningDateOfService: '20240326' endDateOfService: '20240326' provider: npi: '1999999984' subscriber: address: address1: 123 Main St city: Springfield postalCode: '62701' state: IL dateOfBirth: '19800101' firstName: John gender: M lastName: Smith middleName: Robert ssn: '123456789' schema: $ref: '#/components/schemas/InsuranceDiscoveryCheckRequestContent' required: true responses: '200': content: application/json: examples: InsuranceDiscoveryCheck_example1: description: '' summary: Insurance discovery check value: discoveryId: 12345678-abcd-4321-efgh-987654321abc items: - benefitsInformation: - additionalInformation: - description: To determine if a prior authorization is required, please check the health plan's website. benefitsRelatedEntities: - entityFirstname: Jane entityIdentification: XX entityIdentificationValue: '1234567890' entityIdentifier: Primary Care Provider entityName: Dough entityType: Person code: '1' inPlanNetworkIndicator: Not Applicable inPlanNetworkIndicatorCode: W name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage - code: '1' inPlanNetworkIndicator: Not Applicable inPlanNetworkIndicatorCode: W name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '1' serviceTypes: - Medical Care - additionalInformation: - description: Prior authorization may be required. Covered No Limit. code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '4' serviceTypes: - Diagnostic X-Ray - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - '4' serviceTypes: - Diagnostic X-Ray timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - '4' serviceTypes: - Diagnostic X-Ray - code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '5' serviceTypes: - Diagnostic Lab - additionalInformation: - description: per visit benefitAmount: '20' code: B coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Payment planCoverage: Gold Plan serviceTypeCodes: - '5' serviceTypes: - Diagnostic Lab timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - '5' serviceTypes: - Diagnostic Lab - additionalInformation: - description: Prior authorization may be required. Covered No Limit. code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '12' serviceTypes: - Durable Medical Equipment Purchase - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - '12' serviceTypes: - Durable Medical Equipment Purchase timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - '12' serviceTypes: - Durable Medical Equipment Purchase - code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '13' serviceTypes: - Ambulatory Service Center Facility - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - '13' serviceTypes: - Ambulatory Service Center Facility timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - '13' serviceTypes: - Ambulatory Service Center Facility - additionalInformation: - description: Prior authorization may be required. Covered No Limit. code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '18' serviceTypes: - Durable Medical Equipment Rental - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - '18' serviceTypes: - Durable Medical Equipment Rental timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - '18' serviceTypes: - Durable Medical Equipment Rental - additionalInformation: - description: Limited to 26 visits per year (visits in excess of 26 require prior authorization). code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '33' serviceTypes: - Chiropractic - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - '33' serviceTypes: - Chiropractic timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - '33' serviceTypes: - Chiropractic - additionalInformation: - description: Prior authorization may be required. Covered No Limit. code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '48' serviceTypes: - Hospital - Inpatient - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - '48' serviceTypes: - Hospital - Inpatient timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - '48' serviceTypes: - Hospital - Inpatient - additionalInformation: - description: Prior authorization may be required. Covered No Limit. code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '50' serviceTypes: - Hospital - Outpatient - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - '50' serviceTypes: - Hospital - Outpatient timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - '50' serviceTypes: - Hospital - Outpatient - additionalInformation: - description: Covered No Limit. code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '51' serviceTypes: - Hospital - Emergency Accident - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - '51' serviceTypes: - Hospital - Emergency Accident timeQualifier: Visit timeQualifierCode: '27' - additionalInformation: - description: Covered No Limit. code: '1' inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '51' serviceTypes: - Hospital - Emergency Accident - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - '51' serviceTypes: - Hospital - Emergency Accident timeQualifier: Visit timeQualifierCode: '27' - additionalInformation: - description: Covered No Limit. code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '52' serviceTypes: - Hospital - Emergency Medical - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - '52' serviceTypes: - Hospital - Emergency Medical timeQualifier: Visit timeQualifierCode: '27' - additionalInformation: - description: Covered No Limit. code: '1' inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '52' serviceTypes: - Hospital - Emergency Medical - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - '52' serviceTypes: - Hospital - Emergency Medical timeQualifier: Visit timeQualifierCode: '27' - code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '53' serviceTypes: - Hospital - Ambulatory Surgical - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - '53' serviceTypes: - Hospital - Ambulatory Surgical timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - '53' serviceTypes: - Hospital - Ambulatory Surgical - additionalInformation: - description: Prior authorization may be required. Covered No Limit. code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '62' serviceTypes: - MRI/CAT Scan - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - '62' serviceTypes: - MRI/CAT Scan timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - '62' serviceTypes: - MRI/CAT Scan - additionalInformation: - description: Prior authorization may be required. Covered No Limit. code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '65' serviceTypes: - Newborn Care - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - '65' serviceTypes: - Newborn Care timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - '65' serviceTypes: - Newborn Care - additionalInformation: - description: Covered in accordance with ACA guidelines. code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '68' serviceTypes: - Well Baby Care - benefitAmount: '0' code: B coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Payment planCoverage: Gold Plan serviceTypeCodes: - '68' serviceTypes: - Well Baby Care timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - '68' serviceTypes: - Well Baby Care - additionalInformation: - description: Prior authorization may be required. Covered No Limit. code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '69' serviceTypes: - Maternity - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - '69' serviceTypes: - Maternity timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - '69' serviceTypes: - Maternity - additionalInformation: - description: Covered No Limit. code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '86' serviceTypes: - Emergency Services - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - '86' serviceTypes: - Emergency Services timeQualifier: Visit timeQualifierCode: '27' - additionalInformation: - description: Covered No Limit. code: '1' inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '86' serviceTypes: - Emergency Services - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - '86' serviceTypes: - Emergency Services timeQualifier: Visit timeQualifierCode: '27' - code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '88' serviceTypes: - Pharmacy - additionalInformation: - description: per prescription benefitAmount: '10' code: B coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Payment planCoverage: Gold Plan serviceTypeCodes: - '88' serviceTypes: - Pharmacy timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - '88' serviceTypes: - Pharmacy - additionalInformation: - description: PCP code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '98' serviceTypes: - Professional (Physician) Visit - Office - additionalInformation: - description: per visit - description: PCP benefitAmount: '15' code: B coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Payment planCoverage: Gold Plan serviceTypeCodes: - '98' serviceTypes: - Professional (Physician) Visit - Office timeQualifier: Visit timeQualifierCode: '27' - additionalInformation: - description: PCP code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - '98' serviceTypes: - Professional (Physician) Visit - Office - additionalInformation: - description: Specialist - description: Covered No Limit. code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '98' serviceTypes: - Professional (Physician) Visit - Office - additionalInformation: - description: per visit - description: Specialist benefitAmount: '30' code: B coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Payment planCoverage: Gold Plan serviceTypeCodes: - '98' serviceTypes: - Professional (Physician) Visit - Office timeQualifier: Visit timeQualifierCode: '27' - additionalInformation: - description: Specialist code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - '98' serviceTypes: - Professional (Physician) Visit - Office - additionalInformation: - description: Prior authorization may be required. Covered No Limit. (Primary Care Provider (PCP) and other practitioner office visits do not require prior authorization.) Note| Services (excluding Emergency Room Care / Emergency Services) rendered by an out-of-network provider code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - A4 serviceTypes: - Psychiatric - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - A4 serviceTypes: - Psychiatric timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - A4 serviceTypes: - Psychiatric - code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - A6 serviceTypes: - Psychotherapy - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - A6 serviceTypes: - Psychotherapy timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - A6 serviceTypes: - Psychotherapy - code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - A7 serviceTypes: - Psychiatric - Inpatient - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - A7 serviceTypes: - Psychiatric - Inpatient timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - A7 serviceTypes: - Psychiatric - Inpatient - code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - A8 serviceTypes: - Psychiatric - Outpatient - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - A8 serviceTypes: - Psychiatric - Outpatient timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - A8 serviceTypes: - Psychiatric - Outpatient - code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - AD serviceTypes: - Occupational Therapy - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - AD serviceTypes: - Occupational Therapy timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - AD serviceTypes: - Occupational Therapy - code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - AF serviceTypes: - Speech Therapy - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - AF serviceTypes: - Speech Therapy timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - AF serviceTypes: - Speech Therapy - additionalInformation: - description: Prior authorization may be required. Limited to 150 days per year. code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - AG serviceTypes: - Skilled Nursing Care - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - AG serviceTypes: - Skilled Nursing Care timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - AG serviceTypes: - Skilled Nursing Care - additionalInformation: - description: Covered in accordance with ACA guidelines. code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - BZ serviceTypes: - 'Physician Visit - Office: Well' - benefitAmount: '0' code: B coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Payment planCoverage: Gold Plan serviceTypeCodes: - BZ serviceTypes: - 'Physician Visit - Office: Well' timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - BZ serviceTypes: - 'Physician Visit - Office: Well' - additionalInformation: - description: Prior authorization may be required. Covered No Limit. code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - MH serviceTypes: - Mental Health - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - MH serviceTypes: - Mental Health timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - MH serviceTypes: - Mental Health - code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - PT serviceTypes: - Physical Therapy - additionalInformation: - description: per visit benefitAmount: '15' code: B coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Payment planCoverage: Gold Plan serviceTypeCodes: - PT serviceTypes: - Physical Therapy timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - PT serviceTypes: - Physical Therapy - additionalInformation: - description: Covered No Limit. code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - UC serviceTypes: - Urgent Care - additionalInformation: - description: per visit benefitAmount: '10' code: B coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Payment planCoverage: Gold Plan serviceTypeCodes: - UC serviceTypes: - Urgent Care timeQualifier: Visit timeQualifierCode: '27' - additionalInformation: - description: Covered No Limit. code: '1' inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - UC serviceTypes: - Urgent Care - additionalInformation: - description: per visit benefitAmount: '10' code: B coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Co-Payment planCoverage: Gold Plan serviceTypeCodes: - UC serviceTypes: - Urgent Care timeQualifier: Visit timeQualifierCode: '27' - benefitAmount: '0' code: C coverageLevel: Individual coverageLevelCode: IND inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Deductible planCoverage: Gold Plan serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Calendar Year timeQualifierCode: '23' - benefitAmount: '0' code: C coverageLevel: Individual coverageLevelCode: IND inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Deductible planCoverage: Gold Plan serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Remaining timeQualifierCode: '29' - benefitAmount: '0' code: C coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Deductible planCoverage: Gold Plan serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Calendar Year timeQualifierCode: '23' - benefitAmount: '0' code: C coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Deductible planCoverage: Gold Plan serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Remaining timeQualifierCode: '29' - benefitAmount: '0' code: C coverageLevel: Individual coverageLevelCode: IND inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Deductible planCoverage: Gold Plan serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Calendar Year timeQualifierCode: '23' - benefitAmount: '0' code: C coverageLevel: Individual coverageLevelCode: IND inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Deductible planCoverage: Gold Plan serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Remaining timeQualifierCode: '29' - benefitAmount: '0' code: C coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Deductible planCoverage: Gold Plan serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Calendar Year timeQualifierCode: '23' - benefitAmount: '0' code: C coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Deductible planCoverage: Gold Plan serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Remaining timeQualifierCode: '29' - benefitAmount: '3000' code: G coverageLevel: Individual coverageLevelCode: IND inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Out of Pocket (Stop Loss) planCoverage: Gold Plan serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Calendar Year timeQualifierCode: '23' - benefitAmount: '2000' code: G coverageLevel: Individual coverageLevelCode: IND inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Out of Pocket (Stop Loss) planCoverage: Gold Plan serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Remaining timeQualifierCode: '29' - benefitAmount: '6000' code: G coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Out of Pocket (Stop Loss) planCoverage: Gold Plan serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Calendar Year timeQualifierCode: '23' - benefitAmount: '5000' code: G coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Out of Pocket (Stop Loss) planCoverage: Gold Plan serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Remaining timeQualifierCode: '29' - benefitAmount: '0' code: G coverageLevel: Individual coverageLevelCode: IND inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Out of Pocket (Stop Loss) planCoverage: Gold Plan serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Calendar Year timeQualifierCode: '23' - benefitAmount: '0' code: G coverageLevel: Individual coverageLevelCode: IND inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Out of Pocket (Stop Loss) planCoverage: Gold Plan serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Remaining timeQualifierCode: '29' - benefitAmount: '0' code: G coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Out of Pocket (Stop Loss) planCoverage: Gold Plan serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Calendar Year timeQualifierCode: '23' - benefitAmount: '0' code: G coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Out of Pocket (Stop Loss) planCoverage: Gold Plan serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Remaining timeQualifierCode: '29' confidence: level: REVIEW_NEEDED reason: This record was identified as a low confidence match due to a DOB partial match payer: name: EXAMPLE INSURANCE CO planDateInformation: eligibilityBegin: '20250101' planBegin: '20250101' service: '20250301' planInformation: groupDescription: Individual On-Exchange groupNumber: 123456-78 planNumber: 123456-EXMPL9876 provider: entityType: Non-Person Entity npi: '1999999984' providerName: provider subscriber: address: address1: 123 Main Street city: ANYTOWN postalCode: '12345' state: CA dateOfBirth: '19900115' firstName: John gender: M groupDescription: Individual On-Exchange groupNumber: 123456-78 lastName: Doe memberId: '987654321000' middleName: Smith planNumber: 123456-EXMPL9876 meta: applicationMode: production traceId: 1-abcdef12-123456789abcdef123456789 status: COMPLETE schema: $ref: '#/components/schemas/InsuranceDiscoveryCheckResponseContent' description: InsuranceDiscoveryCheck 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: - Insurance discovery /insurance-discovery/check/v1/{discoveryId}: get: description: Retrieve insurance discovery check results by `discoveryId` externalDocs: description: Developer guide url: https://www.stedi.com/docs/healthcare/insurance-discovery operationId: GetInsuranceDiscoveryCheck parameters: - description: The unique ID for the insurance discovery check. Stedi returns this value in the response from the [Insurance Discovery Check](https://www.stedi.com/docs/healthcare/api-reference/post-insurance-discovery) endpoint. examples: GetInsuranceDiscoveryCheck_example1: description: '' summary: Poll for results value: 12345678-abcd-4321-efgh-987654321abc in: path name: discoveryId required: true schema: description: The unique ID for the insurance discovery check. Stedi returns this value in the response from the [Insurance Discovery Check](https://www.stedi.com/docs/healthcare/api-reference/post-insurance-discovery) endpoint. type: string responses: '200': content: application/json: examples: GetInsuranceDiscoveryCheck_example1: description: '' summary: Poll for results value: discoveryId: 12345678-abcd-4321-efgh-987654321abc items: - benefitsInformation: - additionalInformation: - description: To determine if a prior authorization is required, please check the health plan's website. benefitsRelatedEntities: - entityFirstname: Jane entityIdentification: XX entityIdentificationValue: '1234567890' entityIdentifier: Primary Care Provider entityName: Dough entityType: Person code: '1' inPlanNetworkIndicator: Not Applicable inPlanNetworkIndicatorCode: W name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage - code: '1' inPlanNetworkIndicator: Not Applicable inPlanNetworkIndicatorCode: W name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '1' serviceTypes: - Medical Care - additionalInformation: - description: Prior authorization may be required. Covered No Limit. code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '4' serviceTypes: - Diagnostic X-Ray - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - '4' serviceTypes: - Diagnostic X-Ray timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - '4' serviceTypes: - Diagnostic X-Ray - code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '5' serviceTypes: - Diagnostic Lab - additionalInformation: - description: per visit benefitAmount: '20' code: B coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Payment planCoverage: Gold Plan serviceTypeCodes: - '5' serviceTypes: - Diagnostic Lab timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - '5' serviceTypes: - Diagnostic Lab - additionalInformation: - description: Prior authorization may be required. Covered No Limit. code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '12' serviceTypes: - Durable Medical Equipment Purchase - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - '12' serviceTypes: - Durable Medical Equipment Purchase timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - '12' serviceTypes: - Durable Medical Equipment Purchase - code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '13' serviceTypes: - Ambulatory Service Center Facility - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - '13' serviceTypes: - Ambulatory Service Center Facility timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - '13' serviceTypes: - Ambulatory Service Center Facility - additionalInformation: - description: Prior authorization may be required. Covered No Limit. code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '18' serviceTypes: - Durable Medical Equipment Rental - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - '18' serviceTypes: - Durable Medical Equipment Rental timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - '18' serviceTypes: - Durable Medical Equipment Rental - additionalInformation: - description: Limited to 26 visits per year (visits in excess of 26 require prior authorization). code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '33' serviceTypes: - Chiropractic - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - '33' serviceTypes: - Chiropractic timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - '33' serviceTypes: - Chiropractic - additionalInformation: - description: Prior authorization may be required. Covered No Limit. code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '48' serviceTypes: - Hospital - Inpatient - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - '48' serviceTypes: - Hospital - Inpatient timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - '48' serviceTypes: - Hospital - Inpatient - additionalInformation: - description: Prior authorization may be required. Covered No Limit. code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '50' serviceTypes: - Hospital - Outpatient - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - '50' serviceTypes: - Hospital - Outpatient timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - '50' serviceTypes: - Hospital - Outpatient - additionalInformation: - description: Covered No Limit. code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '51' serviceTypes: - Hospital - Emergency Accident - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - '51' serviceTypes: - Hospital - Emergency Accident timeQualifier: Visit timeQualifierCode: '27' - additionalInformation: - description: Covered No Limit. code: '1' inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '51' serviceTypes: - Hospital - Emergency Accident - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - '51' serviceTypes: - Hospital - Emergency Accident timeQualifier: Visit timeQualifierCode: '27' - additionalInformation: - description: Covered No Limit. code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '52' serviceTypes: - Hospital - Emergency Medical - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - '52' serviceTypes: - Hospital - Emergency Medical timeQualifier: Visit timeQualifierCode: '27' - additionalInformation: - description: Covered No Limit. code: '1' inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '52' serviceTypes: - Hospital - Emergency Medical - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - '52' serviceTypes: - Hospital - Emergency Medical timeQualifier: Visit timeQualifierCode: '27' - code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '53' serviceTypes: - Hospital - Ambulatory Surgical - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - '53' serviceTypes: - Hospital - Ambulatory Surgical timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - '53' serviceTypes: - Hospital - Ambulatory Surgical - additionalInformation: - description: Prior authorization may be required. Covered No Limit. code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '62' serviceTypes: - MRI/CAT Scan - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - '62' serviceTypes: - MRI/CAT Scan timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - '62' serviceTypes: - MRI/CAT Scan - additionalInformation: - description: Prior authorization may be required. Covered No Limit. code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '65' serviceTypes: - Newborn Care - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - '65' serviceTypes: - Newborn Care timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - '65' serviceTypes: - Newborn Care - additionalInformation: - description: Covered in accordance with ACA guidelines. code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '68' serviceTypes: - Well Baby Care - benefitAmount: '0' code: B coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Payment planCoverage: Gold Plan serviceTypeCodes: - '68' serviceTypes: - Well Baby Care timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - '68' serviceTypes: - Well Baby Care - additionalInformation: - description: Prior authorization may be required. Covered No Limit. code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '69' serviceTypes: - Maternity - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - '69' serviceTypes: - Maternity timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - '69' serviceTypes: - Maternity - additionalInformation: - description: Covered No Limit. code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '86' serviceTypes: - Emergency Services - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - '86' serviceTypes: - Emergency Services timeQualifier: Visit timeQualifierCode: '27' - additionalInformation: - description: Covered No Limit. code: '1' inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '86' serviceTypes: - Emergency Services - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - '86' serviceTypes: - Emergency Services timeQualifier: Visit timeQualifierCode: '27' - code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '88' serviceTypes: - Pharmacy - additionalInformation: - description: per prescription benefitAmount: '10' code: B coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Payment planCoverage: Gold Plan serviceTypeCodes: - '88' serviceTypes: - Pharmacy timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - '88' serviceTypes: - Pharmacy - additionalInformation: - description: PCP code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '98' serviceTypes: - Professional (Physician) Visit - Office - additionalInformation: - description: per visit - description: PCP benefitAmount: '15' code: B coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Payment planCoverage: Gold Plan serviceTypeCodes: - '98' serviceTypes: - Professional (Physician) Visit - Office timeQualifier: Visit timeQualifierCode: '27' - additionalInformation: - description: PCP code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - '98' serviceTypes: - Professional (Physician) Visit - Office - additionalInformation: - description: Specialist - description: Covered No Limit. code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - '98' serviceTypes: - Professional (Physician) Visit - Office - additionalInformation: - description: per visit - description: Specialist benefitAmount: '30' code: B coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Payment planCoverage: Gold Plan serviceTypeCodes: - '98' serviceTypes: - Professional (Physician) Visit - Office timeQualifier: Visit timeQualifierCode: '27' - additionalInformation: - description: Specialist code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - '98' serviceTypes: - Professional (Physician) Visit - Office - additionalInformation: - description: Prior authorization may be required. Covered No Limit. (Primary Care Provider (PCP) and other practitioner office visits do not require prior authorization.) Note| Services (excluding Emergency Room Care / Emergency Services) rendered by an out-of-network provider code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - A4 serviceTypes: - Psychiatric - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - A4 serviceTypes: - Psychiatric timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - A4 serviceTypes: - Psychiatric - code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - A6 serviceTypes: - Psychotherapy - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - A6 serviceTypes: - Psychotherapy timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - A6 serviceTypes: - Psychotherapy - code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - A7 serviceTypes: - Psychiatric - Inpatient - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - A7 serviceTypes: - Psychiatric - Inpatient timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - A7 serviceTypes: - Psychiatric - Inpatient - code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - A8 serviceTypes: - Psychiatric - Outpatient - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - A8 serviceTypes: - Psychiatric - Outpatient timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - A8 serviceTypes: - Psychiatric - Outpatient - code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - AD serviceTypes: - Occupational Therapy - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - AD serviceTypes: - Occupational Therapy timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - AD serviceTypes: - Occupational Therapy - code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - AF serviceTypes: - Speech Therapy - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - AF serviceTypes: - Speech Therapy timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - AF serviceTypes: - Speech Therapy - additionalInformation: - description: Prior authorization may be required. Limited to 150 days per year. code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - AG serviceTypes: - Skilled Nursing Care - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - AG serviceTypes: - Skilled Nursing Care timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - AG serviceTypes: - Skilled Nursing Care - additionalInformation: - description: Covered in accordance with ACA guidelines. code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - BZ serviceTypes: - 'Physician Visit - Office: Well' - benefitAmount: '0' code: B coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Payment planCoverage: Gold Plan serviceTypeCodes: - BZ serviceTypes: - 'Physician Visit - Office: Well' timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - BZ serviceTypes: - 'Physician Visit - Office: Well' - additionalInformation: - description: Prior authorization may be required. Covered No Limit. code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - MH serviceTypes: - Mental Health - benefitPercent: '0.5' code: A coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Insurance planCoverage: Gold Plan serviceTypeCodes: - MH serviceTypes: - Mental Health timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - MH serviceTypes: - Mental Health - code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - PT serviceTypes: - Physical Therapy - additionalInformation: - description: per visit benefitAmount: '15' code: B coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Payment planCoverage: Gold Plan serviceTypeCodes: - PT serviceTypes: - Physical Therapy timeQualifier: Visit timeQualifierCode: '27' - code: I inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Non-Covered planCoverage: Gold Plan serviceTypeCodes: - PT serviceTypes: - Physical Therapy - additionalInformation: - description: Covered No Limit. code: '1' inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - UC serviceTypes: - Urgent Care - additionalInformation: - description: per visit benefitAmount: '10' code: B coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Co-Payment planCoverage: Gold Plan serviceTypeCodes: - UC serviceTypes: - Urgent Care timeQualifier: Visit timeQualifierCode: '27' - additionalInformation: - description: Covered No Limit. code: '1' inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Active Coverage planCoverage: Gold Plan serviceTypeCodes: - UC serviceTypes: - Urgent Care - additionalInformation: - description: per visit benefitAmount: '10' code: B coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Co-Payment planCoverage: Gold Plan serviceTypeCodes: - UC serviceTypes: - Urgent Care timeQualifier: Visit timeQualifierCode: '27' - benefitAmount: '0' code: C coverageLevel: Individual coverageLevelCode: IND inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Deductible planCoverage: Gold Plan serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Calendar Year timeQualifierCode: '23' - benefitAmount: '0' code: C coverageLevel: Individual coverageLevelCode: IND inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Deductible planCoverage: Gold Plan serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Remaining timeQualifierCode: '29' - benefitAmount: '0' code: C coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Deductible planCoverage: Gold Plan serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Calendar Year timeQualifierCode: '23' - benefitAmount: '0' code: C coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Deductible planCoverage: Gold Plan serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Remaining timeQualifierCode: '29' - benefitAmount: '0' code: C coverageLevel: Individual coverageLevelCode: IND inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Deductible planCoverage: Gold Plan serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Calendar Year timeQualifierCode: '23' - benefitAmount: '0' code: C coverageLevel: Individual coverageLevelCode: IND inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Deductible planCoverage: Gold Plan serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Remaining timeQualifierCode: '29' - benefitAmount: '0' code: C coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Deductible planCoverage: Gold Plan serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Calendar Year timeQualifierCode: '23' - benefitAmount: '0' code: C coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Deductible planCoverage: Gold Plan serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Remaining timeQualifierCode: '29' - benefitAmount: '3000' code: G coverageLevel: Individual coverageLevelCode: IND inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Out of Pocket (Stop Loss) planCoverage: Gold Plan serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Calendar Year timeQualifierCode: '23' - benefitAmount: '2000' code: G coverageLevel: Individual coverageLevelCode: IND inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Out of Pocket (Stop Loss) planCoverage: Gold Plan serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Remaining timeQualifierCode: '29' - benefitAmount: '6000' code: G coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Out of Pocket (Stop Loss) planCoverage: Gold Plan serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Calendar Year timeQualifierCode: '23' - benefitAmount: '5000' code: G coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'Yes' inPlanNetworkIndicatorCode: Y name: Out of Pocket (Stop Loss) planCoverage: Gold Plan serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Remaining timeQualifierCode: '29' - benefitAmount: '0' code: G coverageLevel: Individual coverageLevelCode: IND inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Out of Pocket (Stop Loss) planCoverage: Gold Plan serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Calendar Year timeQualifierCode: '23' - benefitAmount: '0' code: G coverageLevel: Individual coverageLevelCode: IND inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Out of Pocket (Stop Loss) planCoverage: Gold Plan serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Remaining timeQualifierCode: '29' - benefitAmount: '0' code: G coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Out of Pocket (Stop Loss) planCoverage: Gold Plan serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Calendar Year timeQualifierCode: '23' - benefitAmount: '0' code: G coverageLevel: Family coverageLevelCode: FAM inPlanNetworkIndicator: 'No' inPlanNetworkIndicatorCode: N name: Out of Pocket (Stop Loss) planCoverage: Gold Plan serviceTypeCodes: - '30' serviceTypes: - Health Benefit Plan Coverage timeQualifier: Remaining timeQualifierCode: '29' confidence: level: REVIEW_NEEDED reason: This record was identified as a low confidence match due to a DOB partial match payer: name: EXAMPLE INSURANCE CO planDateInformation: eligibilityBegin: '20250101' planBegin: '20250101' service: '20250301' planInformation: groupDescription: Individual On-Exchange groupNumber: 123456-78 planNumber: 123456-EXMPL9876 provider: entityType: Non-Person Entity npi: '1999999984' providerName: provider subscriber: address: address1: 123 Main Street city: ANYTOWN postalCode: '12345' state: CA dateOfBirth: '19900115' firstName: John gender: M groupDescription: Individual On-Exchange groupNumber: 123456-78 lastName: Doe memberId: '987654321000' middleName: Smith planNumber: 123456-EXMPL9876 meta: applicationMode: production traceId: 1-abcdef12-123456789abcdef123456789 status: COMPLETE schema: $ref: '#/components/schemas/GetInsuranceDiscoveryCheckResponseContent' description: GetInsuranceDiscoveryCheck 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: $ref: '#/components/schemas/GatewayTimeoutExceptionResponseContent' description: GatewayTimeoutException 504 response tags: - Insurance discovery /payer/{stediId}: get: description: Retrieve a single payer record by its Stedi payer ID. operationId: GetPayerRecord parameters: - description: 'The Stedi payer ID, a unique identifier Stedi assigns to each payer that will never change. You can find the Stedi payer ID for any supported payer in the [Payer Network](https://www.stedi.com/healthcare/network). This must be the Stedi payer ID - querying with the primary payer ID or payer ID aliases isn''t supported.' examples: GetPayerRecord_example1: description: '' summary: Retrieve payer record value: QDTRP in: path name: stediId required: true schema: description: 'The Stedi payer ID, a unique identifier Stedi assigns to each payer that will never change. You can find the Stedi payer ID for any supported payer in the [Payer Network](https://www.stedi.com/healthcare/network). This must be the Stedi payer ID - querying with the primary payer ID or payer ID aliases isn''t supported.' pattern: ^[A-Z]{5}$ type: string responses: '200': content: application/json: examples: GetPayerRecord_example1: description: '' summary: Retrieve payer record value: payer: aliases: - '00420' - '13123' - '1584' - '4714' - '95655' - MEDGL - MEDGLD - MEDIGOLD avatarUrl: https://prod-payer-avatars.payers.us.stedi.com/YKHRB/avatar.png?v=1766600157693 coverageTypes: - dental - medical displayName: Trinity Health Plan enrollment: ptanRequired: false transactionEnrollmentProcesses: claimPayment: requestedEffectiveDate: NOT_SUPPORTED supportedAggregationPreferences: - NPI - TIN timeframe: DAYS type: ONE_CLICK names: - MediGold - Medigold Health Plans - Mount Carmel Health Plan - Mount Carmel MediGold - Trinity Health Plan of Michigan operatingStates: - ID - IA - MI - NY - OH parentPayerGroupId: GTRSH primaryPayerId: '95655' stediId: YKHRB transactionSupport: claimPayment: ENROLLMENT_REQUIRED claimStatus: SUPPORTED claimSubmission: SUPPORTED coordinationOfBenefits: NOT_SUPPORTED dentalClaimSubmission: NOT_SUPPORTED eligibilityCheck: SUPPORTED institutionalClaimSubmission: SUPPORTED professionalClaimSubmission: SUPPORTED unsolicitedClaimAttachment: NOT_SUPPORTED urls: website: https://www.thpmedicare.org schema: $ref: '#/components/schemas/GetPayerRecordResponseContent' description: GetPayerRecord 200 response '400': content: application/json: schema: $ref: '#/components/schemas/ValidationExceptionResponseContent' description: ValidationException 400 response '401': content: application/json: schema: $ref: '#/components/schemas/UnauthorizedExceptionResponseContent' description: UnauthorizedException 401 response '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: - Payers /payers: get: description: List Stedi's supported payers in JSON format operationId: ListPayerRecords parameters: - description: The maximum number of elements to return per page. If not set, Stedi returns all payers in a single response (no pagination). examples: ListPayerRecords_example1: description: '' summary: List payers with pagination value: 100 in: query name: pageSize schema: description: The maximum number of elements to return per page. If not set, Stedi returns all payers in a single response (no pagination). minimum: 10 type: integer - description: The `nextPageToken` value from a previous response. You can use this to get the next page of results. If not set, Stedi returns the first page of results. in: query name: pageToken schema: description: The `nextPageToken` value from a previous response. You can use this to get the next page of results. If not set, Stedi returns the first page of results. maxLength: 1024 minLength: 1 type: string responses: '200': content: application/json: examples: ListPayerRecords_example1: description: '' summary: List payers with pagination value: items: - aliases: - '00420' - '13123' - '1584' - '4714' - '95655' - MEDGL - MEDGLD - MEDIGOLD avatarUrl: https://prod-payer-avatars.payers.us.stedi.com/YKHRB/avatar.png?v=1766600157693 coverageTypes: - dental - medical displayName: Trinity Health Plan enrollment: ptanRequired: false transactionEnrollmentProcesses: claimPayment: requestedEffectiveDate: NOT_SUPPORTED supportedAggregationPreferences: - NPI - TIN timeframe: DAYS type: ONE_CLICK names: - MediGold - Medigold Health Plans - Mount Carmel Health Plan - Mount Carmel MediGold - Trinity Health Plan of Michigan operatingStates: - ID - IA - MI - NY - OH parentPayerGroupId: GTRSH primaryPayerId: '95655' stediId: YKHRB transactionSupport: claimPayment: ENROLLMENT_REQUIRED claimStatus: SUPPORTED claimSubmission: SUPPORTED coordinationOfBenefits: NOT_SUPPORTED dentalClaimSubmission: NOT_SUPPORTED eligibilityCheck: SUPPORTED institutionalClaimSubmission: SUPPORTED professionalClaimSubmission: SUPPORTED unsolicitedClaimAttachment: NOT_SUPPORTED urls: website: https://www.thpmedicare.org nextPageToken: yrZ3we9982etYlMgmw== schema: $ref: '#/components/schemas/ListPayerRecordsResponseContent' description: ListPayerRecords 200 response '400': content: application/json: schema: $ref: '#/components/schemas/ValidationExceptionResponseContent' description: ValidationException 400 response '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: - Payers /payers/csv: get: description: List Stedi's supported payers in CSV format operationId: ListPayerRecordsCsv responses: '200': content: text/plain: examples: ListPayerRecordsCsv_example1: description: '' summary: List payers value: '"StediId","PrimaryPayerId","DisplayName","Names","Aliases","EligibilityInquiry","EligibilityInquiryEnrollmentRequired","EligibilityInquiryEnrollmentType","EligibilityInquiryEnrollmentTimeframe","EligibilityInquiryEnrollmentRequestedEffectiveDate","ClaimStatusInquiry","ClaimStatusInquiryEnrollmentRequired","ClaimStatusInquiryEnrollmentType","ClaimStatusInquiryEnrollmentTimeframe","ClaimStatusInquiryEnrollmentRequestedEffectiveDate","ProfessionalClaim","ProfessionalClaimEnrollmentRequired","ProfessionalClaimEnrollmentType","ProfessionalClaimEnrollmentTimeframe","ProfessionalClaimEnrollmentRequestedEffectiveDate","InstitutionalClaim","InstitutionalClaimEnrollmentRequired","InstitutionalClaimEnrollmentType","InstitutionalClaimEnrollmentTimeframe","InstitutionalClaimEnrollmentRequestedEffectiveDate","DentalClaim","DentalClaimEnrollmentRequired","DentalClaimEnrollmentType","DentalClaimEnrollmentTimeframe","DentalClaimEnrollmentRequestedEffectiveDate","ClaimPaymentAdvice","ClaimPaymentAdviceEnrollmentRequired","ClaimPaymentEnrollmentType","ClaimPaymentEnrollmentTimeframe","ClaimPaymentEnrollmentSupportedAggregationPreferences","ClaimPaymentEnrollmentRequestedEffectiveDate","CoordinationOfBenefits","CoordinationOfBenefitsEnrollmentRequired","CoordinationOfBenefitsEnrollmentType","CoordinationOfBenefitsEnrollmentTimeframe","CoordinationOfBenefitsEnrollmentRequestedEffectiveDate","ClaimAttachmentsSupport","ClaimAttachmentsSupportEnrollmentRequired","ClaimAttachmentEnrollmentType","ClaimAttachmentEnrollmentTimeframe","ClaimAttachmentEnrollmentRequestedEffectiveDate","EmployerIdentificationNumbers","CoverageTypes","OperatingStates","PtanRequired","ParentPayerGroupId","WebsiteUrl" "YKHRB","95655","Trinity Health Plan","MediGold|Medigold Health Plans|Mount Carmel Health Plan|Mount Carmel MediGold|Trinity Health Plan of Michigan","00420|13123|1584|4714|95655|MEDGL|MEDGLD|MEDIGOLD","true","false","","","","true","false","","","","true","false","","","","true","false","","","","false","false","","","","true","true","ONE_CLICK","DAYS","NPI|TIN","NOT_SUPPORTED","false","false","","","","false","false","","","","","dental|medical","ID|IA|MI|NY|OH","false","GTRSH","https://www.thpmedicare.org"' schema: $ref: '#/components/schemas/ListPayerRecordsCsvOutputPayload' description: ListPayerRecordsCsv 200 response headers: Content-Type: description: Content type for CSV data schema: description: Content type for CSV data type: string '400': content: application/json: schema: $ref: '#/components/schemas/ValidationExceptionResponseContent' description: ValidationException 400 response '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: - Payers /payers/search: get: description: Search for payers by name, ID, or alias. operationId: SearchPayers parameters: - description: The maximum number of elements to return in a page. If not specified, the default is 20. in: query name: pageSize schema: description: The maximum number of elements to return in a page. If not specified, the default is 20. maximum: 100 minimum: 10 type: integer - description: An opaque token returned by a previous call to this endpoint in the `nextPageToken` property. You can use it to request the next page of results. If not specified, Stedi returns the first page of results. in: query name: pageToken schema: description: An opaque token returned by a previous call to this endpoint in the `nextPageToken` property. You can use it to request the next page of results. If not specified, Stedi returns the first page of results. maxLength: 1024 minLength: 1 type: string - description: The query Stedi will use to search the Payer Network database. You can supply a payer's name, ID, or alias. The query is case-insensitive, and fuzzy matching is supported. For example, `cig`, `62308`, and `SX071` all return Cigna in the results. If not provided, the other search options are used to conduct the search. examples: SearchPayers_example1: description: '' summary: Search for query string value: Blue Cross SearchPayers_example2: description: '' summary: Search with multiple filters value: Blue Cross in: query name: query schema: description: The query Stedi will use to search the Payer Network database. You can supply a payer's name, ID, or alias. The query is case-insensitive, and fuzzy matching is supported. For example, `cig`, `62308`, and `SX071` all return Cigna in the results. If not provided, the other search options are used to conduct the search. maxLength: 200 type: string - description: Filter for matching payers with the specified 270 eligibility checks support. When combined with other transaction filters, payers must satisfy **all** specified criteria to be included in results. examples: SearchPayers_example2: description: '' summary: Search with multiple filters value: SUPPORTED in: query name: eligibilityCheck schema: $ref: '#/components/schemas/TransactionFilterValue' - description: Filter for matching payers with the specified 276/277 real-time claim status checks support. When combined with other transaction filters, payers must satisfy **all** specified criteria to be included in results. examples: SearchPayers_example2: description: '' summary: Search with multiple filters value: SUPPORTED in: query name: claimStatus schema: $ref: '#/components/schemas/TransactionFilterValue' - description: Filter for matching payers with the specified 837 professional claims support. When combined with other transaction filters, payers must satisfy **all** specified criteria to be included in results. in: query name: professionalClaimSubmission schema: $ref: '#/components/schemas/TransactionFilterValue' - description: Filter for matching payers with the specified 837 dental claims support. When combined with other transaction filters, payers must satisfy **all** specified criteria to be included in results. in: query name: dentalClaimSubmission schema: $ref: '#/components/schemas/TransactionFilterValue' - description: Filter for matching payers with the specified 837 institutional claims support. When combined with other transaction filters, payers must satisfy **all** specified criteria to be included in results. in: query name: institutionalClaimSubmission schema: $ref: '#/components/schemas/TransactionFilterValue' - description: Filter for matching payers with the specified 835 Electronic Remittance Advice (ERA) support. When combined with other transaction filters, payers must satisfy **all** specified criteria to be included in results. in: query name: claimPayment schema: $ref: '#/components/schemas/TransactionFilterValue' - description: Filter for matching payers with the specified coordination of benefits (COB) checks support. When combined with other transaction filters, payers must satisfy **all** specified criteria to be included in results. in: query name: coordinationOfBenefits schema: $ref: '#/components/schemas/TransactionFilterValue' - description: Filter for matching payers with the specified unsolicited 275 claim attachments support. When combined with other transaction filters, payers must satisfy **all** specified criteria to be included in results. in: query name: unsolicitedClaimAttachment schema: $ref: '#/components/schemas/TransactionFilterValue' - description: 'Filter for matching payers that support transactions for **all** of the specified coverage types. For example, setting this array to `["medical", "dental"]` returns only payers who provide both medical and dental coverage. The results also exclude payers without coverage type classifications in Stedi''s database.' explode: true in: query name: coverageTypes schema: description: 'Filter for matching payers that support transactions for **all** of the specified coverage types. For example, setting this array to `["medical", "dental"]` returns only payers who provide both medical and dental coverage. The results also exclude payers without coverage type classifications in Stedi''s database.' items: $ref: '#/components/schemas/CoverageType' type: array style: form - description: 'Filter for matching payers that operate in **all** of the specified states. For example, setting this array to `["CA", "OR"]` returns only payers that operate in both California and Oregon, and setting it to `["NATIONAL"]` returns payers that operate throughout the entire United States. The results also exclude payers without operating state classifications in Stedi''s database.' explode: true in: query name: operatingStates schema: description: 'Filter for matching payers that operate in **all** of the specified states. For example, setting this array to `["CA", "OR"]` returns only payers that operate in both California and Oregon, and setting it to `["NATIONAL"]` returns payers that operate throughout the entire United States. The results also exclude payers without operating state classifications in Stedi''s database.' items: $ref: '#/components/schemas/OperatingStateCode' type: array style: form responses: '200': content: application/json: examples: SearchPayers_example1: description: '' summary: Search for query string value: items: - matches: names: - Highmark Blue Cross Blue Shield - Highmark Blue Cross Blue Shield Pennsylvania - Highmark Blue Cross Blue Shield Pennsylvania Professional - Highmark Blue Shield - Keystone Health Plan West - Community Blue HMO payer: aliases: - '10046' - '100900' - '10264' - '10524' - '2413' - '54771' - '95462' - PABCBS - PABLS - SB865 - SB865MA - SZXAY avatarUrl: https://prod-payer-avatars.payers.us.stedi.com/GUFCO/avatar.png?v=1763077235241 coverageTypes: - dental - medical - vision displayName: Highmark of Pennsylvania enrollment: ptanRequired: false transactionEnrollmentProcesses: claimPayment: requestedEffectiveDate: NOT_SUPPORTED supportedAggregationPreferences: - NPI - TIN timeframe: DAYS type: ONE_CLICK claimStatusInquiry: timeframe: DAYS type: ONE_CLICK names: - Highmark Blue Cross Blue Shield - Highmark Blue Cross Blue Shield Pennsylvania - Highmark Blue Cross Blue Shield Pennsylvania Professional - Highmark Blue Shield - Keystone Health Plan West - Community Blue HMO - First Priority Life Insurance Company (FPLIC) Out-of-Area Claims - Highmark of Pennsylvania - Medicare Advantage operatingStates: - PA parentPayerGroupId: QOSPQ primaryPayerId: '54771' stediId: GUFCO transactionSupport: claimPayment: ENROLLMENT_REQUIRED claimStatus: ENROLLMENT_REQUIRED coordinationOfBenefits: SUPPORTED dentalClaimSubmission: NOT_SUPPORTED eligibilityCheck: ENROLLMENT_REQUIRED institutionalClaimSubmission: NOT_SUPPORTED professionalClaimSubmission: SUPPORTED unsolicitedClaimAttachment: NOT_SUPPORTED score: 2314894167593451500 stats: total: 142 transactionSupport: claimPayment: enrollmentRequired: 113 notSupported: 29 supported: 0 claimStatus: enrollmentRequired: 3 notSupported: 55 supported: 84 coordinationOfBenefits: enrollmentRequired: 0 notSupported: 114 supported: 28 dentalClaimSubmission: enrollmentRequired: 2 notSupported: 95 supported: 45 eligibilityCheck: enrollmentRequired: 5 notSupported: 33 supported: 104 institutionalClaimSubmission: enrollmentRequired: 10 notSupported: 30 supported: 102 professionalClaimSubmission: enrollmentRequired: 9 notSupported: 16 supported: 117 unsolicitedClaimAttachment: enrollmentRequired: 0 notSupported: 109 supported: 33 transactionSupportCounts: claimPayment: notSupported: total: 29 supported: enrollmentNotRequired: 0 enrollmentRequired: 113 total: 113 claimStatus: notSupported: total: 55 supported: enrollmentNotRequired: 84 enrollmentRequired: 3 total: 87 coordinationOfBenefits: notSupported: total: 114 supported: enrollmentNotRequired: 28 enrollmentRequired: 0 total: 28 dentalClaimSubmission: notSupported: total: 95 supported: enrollmentNotRequired: 45 enrollmentRequired: 2 total: 47 eligibilityCheck: notSupported: total: 33 supported: enrollmentNotRequired: 104 enrollmentRequired: 5 total: 109 institutionalClaimSubmission: notSupported: total: 30 supported: enrollmentNotRequired: 102 enrollmentRequired: 10 total: 112 professionalClaimSubmission: notSupported: total: 16 supported: enrollmentNotRequired: 117 enrollmentRequired: 9 total: 126 unsolicitedClaimAttachment: notSupported: total: 109 supported: enrollmentNotRequired: 33 enrollmentRequired: 0 total: 33 SearchPayers_example2: description: '' summary: Search with multiple filters value: items: - matches: aliases: - BCSNC displayName: Blue Cross NC names: - Blue Cross Blue Shield North Carolina - Blue Cross Blue Shield of North Carolina - Blue Cross NC - Medicare Advantage - Blue Cross NC – Dental Blue primaryPayerId: BCSNC payer: aliases: - BCSNC - '10383' - 12B23 - '1411' - '560894904' - '61472' - '61473' - '7472' - '7514' - '7814' - NCBCBS - NCBLS - NCPNHP - SB810 - SB810MA avatarUrl: https://prod-payer-avatars.payers.us.stedi.com/UPICO/avatar.png?v=1765912707668 coverageTypes: - dental - medical - vision displayName: Blue Cross NC employerIdentificationNumbers: - 56-0894904 enrollment: ptanRequired: false transactionEnrollmentProcesses: claimPayment: requestedEffectiveDate: SUPPORTED supportedAggregationPreferences: - TIN timeframe: DAYS type: MULTI_STEP names: - Blue Cross Blue Shield North Carolina - Blue Cross Blue Shield of North Carolina - Blue Cross NC - Medicare Advantage - Blue Cross NC – Dental Blue - Partners National Health Plans of North Carolina Inc operatingStates: - NC parentPayerGroupId: OVWIG primaryPayerId: BCSNC stediId: UPICO transactionSupport: claimPayment: ENROLLMENT_REQUIRED claimStatus: SUPPORTED coordinationOfBenefits: SUPPORTED dentalClaimSubmission: SUPPORTED eligibilityCheck: SUPPORTED institutionalClaimSubmission: SUPPORTED professionalClaimSubmission: SUPPORTED unsolicitedClaimAttachment: NOT_SUPPORTED urls: website: https://www.bluecrossnc.com score: 2314894167592927000 stats: total: 83 transactionSupport: claimPayment: enrollmentRequired: 77 notSupported: 6 supported: 0 claimStatus: enrollmentRequired: 0 notSupported: 0 supported: 83 coordinationOfBenefits: enrollmentRequired: 0 notSupported: 57 supported: 26 dentalClaimSubmission: enrollmentRequired: 2 notSupported: 41 supported: 40 eligibilityCheck: enrollmentRequired: 0 notSupported: 0 supported: 83 institutionalClaimSubmission: enrollmentRequired: 5 notSupported: 3 supported: 75 professionalClaimSubmission: enrollmentRequired: 5 notSupported: 3 supported: 75 unsolicitedClaimAttachment: enrollmentRequired: 0 notSupported: 57 supported: 26 transactionSupportCounts: claimPayment: notSupported: total: 6 supported: enrollmentNotRequired: 0 enrollmentRequired: 77 total: 77 claimStatus: notSupported: total: 0 supported: enrollmentNotRequired: 83 enrollmentRequired: 0 total: 83 coordinationOfBenefits: notSupported: total: 57 supported: enrollmentNotRequired: 26 enrollmentRequired: 0 total: 26 dentalClaimSubmission: notSupported: total: 41 supported: enrollmentNotRequired: 40 enrollmentRequired: 2 total: 42 eligibilityCheck: notSupported: total: 0 supported: enrollmentNotRequired: 83 enrollmentRequired: 0 total: 83 institutionalClaimSubmission: notSupported: total: 3 supported: enrollmentNotRequired: 75 enrollmentRequired: 5 total: 80 professionalClaimSubmission: notSupported: total: 3 supported: enrollmentNotRequired: 75 enrollmentRequired: 5 total: 80 unsolicitedClaimAttachment: notSupported: total: 57 supported: enrollmentNotRequired: 26 enrollmentRequired: 0 total: 26 schema: $ref: '#/components/schemas/SearchPayersResponseContent' description: SearchPayers 200 response '400': content: application/json: schema: $ref: '#/components/schemas/ValidationExceptionResponseContent' description: ValidationException 400 response '401': content: application/json: schema: $ref: '#/components/schemas/UnauthorizedExceptionResponseContent' description: UnauthorizedException 401 response '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: - Payers security: - httpApiKeyAuth: [] servers: - description: Production url: https://healthcare.us.stedi.com/2024-04-01 x-amazon-apigateway-binary-media-types: - application/pdf - application/octet-stream x-stedi: lifecycle: general_availability product: healthcare public: true