Signature and assignment-of-benefits indicators for the claim.

Billing details for the claim, including the billing provider, service facility, tax identification, and charges.

Clinical details about the encounter, including diagnoses, related providers, relevant dates, and supporting information.

The person or entity that carries the insurance policy being billed, also called the subscriber or primary policyholder. May be different from the patient.

[CMS-1500 Box 9, 9a, 9d] Coverage the patient holds under another insurance policy, relevant to coordination of benefits. Include this when the patient has coverage from another payer in addition to the one you're billing.

The person who received care, when they are someone other than the insured.

The payer being billed for the claim.

[CMS-1500 Box 17, 17a, 17b, 20, 24a-24j] The individual services, procedures, or supplies being billed. Each service line corresponds to one row in Box 24 of the CMS-1500 form.

The entity submitting the claim to Stedi.