openapi: 3.0.3 info: contact: email: healthcare@stedi.com license: name: Proprietary url: https://stedi.com title: Stedi Healthcare Claims Claim acknowledgments Remittances API version: '2025-03-07' servers: - description: Production url: https://claims.us.stedi.com/2025-03-07 security: - httpApiKeyAuth: [] tags: - name: Remittances paths: /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: $ref: '#/components/schemas/GatewayTimeoutExceptionResponseContent' description: GatewayTimeoutException 504 response tags: - Remittances /electronic-remittance-advice/{transactionId}/pdf: get: description: Retrieve the generated PDF of an 835 Electronic Remittance Advice (ERA). operationId: GetElectronicRemittanceAdvicePdf parameters: - description: A unique identifier for the Electronic Remittance Advice (ERA) within Stedi. This ID is included in the transaction processed event for the ERA, which you can receive automatically through Stedi [webhooks](https://www.stedi.com/docs/healthcare/configure-webhooks). You can also retrieve this ID through the [Poll Transactions endpoint](https://www.stedi.com/docs/healthcare/api-reference/get-poll-transactions) or from the transaction's details page within Stedi. examples: GetElectronicRemittanceAdvicePdf_example1: description: '' summary: Retrieve PDF value: b12a1241-3312-a3dc-aed2-1a30ca50cd63 in: path name: transactionId required: true schema: description: A unique identifier for the Electronic Remittance Advice (ERA) within Stedi. This ID is included in the transaction processed event for the ERA, which you can receive automatically through Stedi [webhooks](https://www.stedi.com/docs/healthcare/configure-webhooks). You can also retrieve this ID through the [Poll Transactions endpoint](https://www.stedi.com/docs/healthcare/api-reference/get-poll-transactions) or from the transaction's details page within Stedi. maxLength: 36 minLength: 36 pattern: ^[0-9a-fA-F]{8}-[0-9a-fA-F]{4}-[0-9a-fA-F]{4}-[0-9a-fA-F]{4}-[0-9a-fA-F]{12}$ 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 components: schemas: 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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: $ref: '#/components/schemas/ProviderAdjustments' type: array receiverIdentifier: description: The business identification information for the entity initially receiving the transaction. This is typically included when the receiver of the transaction is not the payee, such as a clearinghouse or billing service. type: string versionIdentification: description: The version number of the adjudication system that generated the claim payments. type: string type: object ProviderSummaryInformation: description: Summary information about the provider, including the provider's identifier, where the services were performed, and total claim charge amounts. properties: facilityTypeCode: description: A code identifying the type of facility where services were performed. This is the [Place of Service Codes](https://www.cms.gov/medicare/coding-billing/place-of-service-codes/code-sets) for Professional or Dental Services. type: string fiscalPeriodDate: description: The last day of the provider's fiscal year. pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ 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 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 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 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 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: $ref: '#/components/schemas/ClaimPaymentAdviceResponse' type: array required: - meta type: object PaymentInfoPatientName: description: Information about the individual who received medical services. properties: firstName: description: The patient's first name. type: string healthInsuranceClaimNumber: description: The patient's Health Insurance Claim (HIC) Number. type: string lastName: description: The patient's last name. type: string medicaidRecipientIdentificationNumber: description: The patient's Medicaid Recipient Identification Number. type: string memberId: description: The patient's member ID number for their health plan. type: string middleName: description: The patient's middle name or initial. type: string ssn: description: The patient's Social Security Number (SSN). pattern: ^\d{9}$ type: string standardUniqueHealthIdentifierForEachIndividualInTheUnitedStates: description: Deprecated. type: string suffix: description: The patient's name suffix, such as Jr or III. type: string type: object 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: $ref: '#/components/schemas/DfiIdNumberQualifier' description: The code identifying the type of identification number of the Depository Financial Institution (DFI). Can be either `01` - ABA Transit Routing Number Including Check Digits (9 digits) or `04` - Canadian Bank Branch Institution Number. type: object PaymentInfoOtherClaimRelatedIdentification: description: Additional reference numbers to identify the specific claim. properties: adjustedRePricedClaimReferenceNumber: description: The adjusted repriced claim reference number. type: string authorizationNumber: description: An authorization number assigned by the adjudication process that was not provided prior to the services. type: string classOfContractCode: description: The class of contract code. type: string classOfContractCodes: description: A list of class of contract codes when multiple codes are applicable. items: type: string type: array employeeIdentificationNumber: description: The employee identification number. type: string groupNumber: description: The other insured group number. type: string groupOrPolicyNumber: description: The group or policy number for the health plan. type: string insurancePolicyNumber: description: The insurance policy number. type: string medicalRecordIdentificationNumber: description: The medical record identification number. type: string memberIdentificationNumber: description: The health plan member identification number. type: string originalReferenceNumber: description: The reference number for the original claim. This is included for correction claims. type: string predeterminationOfBenefitsIdentificationNumber: description: The predetermination of benefits identification number. type: string priorAuthorizationNumber: description: The prior authorization number. type: string rePricedClaimReferenceNumber: description: The repriced claim reference number. type: string ssn: description: The social security number (SSN). pattern: ^\d{9}$ type: string type: object 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 TechnicalContactInformation: description: Technical contact information for the payer. properties: contactMethods: description: Available contact methods for technical support. items: $ref: '#/components/schemas/TechnicalContactMethod' type: array contactName: description: The name of the contact person or entity. type: string type: object PaymentInfoRenderingProvider: description: Information about the provider who rendered the services. properties: blueCrossProviderNumber: description: The rendering provider's Blue Cross Provider Number. type: string blueShieldProviderNumber: description: The rendering provider's Blue Shield Provider Number. type: string firstName: description: The rendering provider's first name. type: string lastName: description: The rendering provider's last name. type: string medicaidProviderNumber: description: The rendering provider's Medicare Provider Number. type: string middleName: description: The rendering provider's middle name or initial. type: string npi: description: The rendering provider's National Provider Identifier (NPI). pattern: ^\d{10}$ 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 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 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 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 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 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 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 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 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 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 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 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 ReportsContactInformation: properties: contactMethods: items: $ref: '#/components/schemas/ContactMethod' type: array contactName: description: The name of the contact person or entity. type: string 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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: $ref: '#/components/schemas/PaymentInfoSubscriber' description: Subscriber information for the insurance policy. type: object CrossoverCarrier: description: Information about the crossover carrier. The crossover carrier is defined as any payer to which the claim is transferred for further payment after the current payer has finalized it. properties: blueCrossBlueShieldAssociationPlanCode: description: The provider's Blue Cross Blue Shield Association Plan Code. type: string centersForMedicareAndMedicaidServicesPlanId: description: Used to report the provider's Health Plan ID (HPID) or Other Entity Identifier (OEID). type: string nationalAssociationOfInsuranceCommissionersIdentification: description: The provider's National Association of Insurance Commissioners (NAIC) number. type: string organizationName: description: The provider's business name (when the provider is not an individual) or the provider's last name (when the provider is an individual). type: string payorId: description: The provider's Payer Identification number. type: string pharmacyProcessorNumber: description: The provider's Pharmacy Processor Number. type: string taxId: description: The provider's Federal Tax Identification Number. pattern: ^\d{9}$ type: string type: object 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 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 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 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 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 securitySchemes: httpApiKeyAuth: description: A [Stedi API Key](https://www.stedi.com/app/settings/api-keys) for authentication. in: header name: Authorization type: apiKey x-stedi: lifecycle: general_availability product: claims public: true