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.

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 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.

Dependent who received the medical care associated with the claim.

• 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 to the payer. The payer returns the dependent's member ID in the dependents.memberId property in the response, if present.
• You must include address in this object when the patient is a dependent.

Deprecated; please use claimInformation.serviceLines[].orderingProvider instead.

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.

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.

The entity responsible for the payment of the claim, such as an insurance company or government agency.

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.

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.

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.

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.

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.

Secondary identifiers for the payer. You can include up to three properties in this object.

Information about the claim.

Currently not used.

Errors resulting from claim edits. You must review and fix these errors before resubmitting.

Currently not used.

Metadata from Stedi about the request.

Information about the payer for the submitted claim.

A list of warnings. Currently not used.