--- title: "GET /change/medicalnetwork/reports/v2/{transactionId}/835" method: GET path: "/change/medicalnetwork/reports/v2/{transactionId}/835" tags: ["Remittances"] --- # GET /change/medicalnetwork/reports/v2/{transactionId}/835 `GET /change/medicalnetwork/reports/v2/{transactionId}/835` Retrieve an 835 Electronic Remittance Advice (ERA) in JSON format ## Path parameters - `transactionId` string, required — 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). ## Response `200` ConvertReport835 200 response - ConvertReport835ResponseContent — Transaction response structure for claim payment advice. - `meta` Meta, required — Metadata that helps Stedi track and debug the response. - `applicationMode` string — Whether this is a test or production ERA. - `senderId` string — 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`. - `traceId` string — Not currently used. - `transactionId` string — The Stedi transaction identifier. - `transactions` ClaimPaymentAdviceResponse[] — The payer's 835 response. - `controlNumber` string — The control number the payer provided in the claim payment response. This is used to identify the transaction. - `detailInfo` DetailInfo[] — Detailed information about claims in this payment advice. - `assignedNumber` string — A unique ID assigned to identify this set of claim information within the response. - `paymentInfo` PaymentInfo[] — 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. - `claimAdjustments` ClaimAdjustments[] — Adjustments applied to this claim. - `adjustmentAmount1` string — The amount of the adjustment. A negative amount increases the claim payment and a positive amount decreases the claim payment. - `adjustmentAmount2` string — The amount of the adjustment. A negative amount increases the claim payment and a positive amount decreases the claim payment. - `adjustmentAmount3` string — The amount of the adjustment. A negative amount increases the claim payment and a positive amount decreases the claim payment. - `adjustmentAmount4` string — The amount of the adjustment. A negative amount increases the claim payment and a positive amount decreases the claim payment. - `adjustmentAmount5` string — The amount of the adjustment. A negative amount increases the claim payment and a positive amount decreases the claim payment. - `adjustmentAmount6` string — The amount of the adjustment. A negative amount increases the claim payment and a positive amount decreases the claim payment. - `adjustmentQuantity1` string — The units of service being adjusted. A positive value decreases the covered days and a negative number increases the covered days. - `adjustmentQuantity2` string — The units of service being adjusted. A positive value decreases the covered days and a negative number increases the covered days. - `adjustmentQuantity3` string — The units of service being adjusted. A positive value decreases the covered days and a negative number increases the covered days. - `adjustmentQuantity4` string — The units of service being adjusted. A positive value decreases the covered days and a negative number increases the covered days. - `adjustmentQuantity5` string — The units of service being adjusted. A positive value decreases the covered days and a negative number increases the covered days. - `adjustmentQuantity6` string — The units of service being adjusted. A positive value decreases the covered days and a negative number increases the covered days. - `adjustmentReason1` string — A description identifying the detailed reason the adjustment was made. - `adjustmentReason2` string — A description identifying the detailed reason the adjustment was made. - `adjustmentReason3` string — A description identifying the detailed reason the adjustment was made. - `adjustmentReason4` string — A description identifying the detailed reason the adjustment was made. - `adjustmentReason5` string — A description identifying the detailed reason the adjustment was made. - `adjustmentReason6` string — A description identifying the detailed reason the adjustment was made. - `adjustmentReasonCode1` string — 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. - `adjustmentReasonCode2` string — 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. - `adjustmentReasonCode3` string — 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. - `adjustmentReasonCode4` string — 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. - `adjustmentReasonCode5` string — 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. - `adjustmentReasonCode6` string — 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. - `claimAdjustmentGroupCode` 'CO' | 'OA' | 'PI' | 'PR' — 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. - `claimAdjustmentGroupCodeValue` string — The description of the `claimAdjustmentGroupCode`. - `claimContactInformation` ReportsContactInformation[] — Contact information for claim-related communications. - `contactMethods` ContactMethod[] - `email` string — The email address. - `fax` string — The fax number. - `phone` string — 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`. - `phoneExtension` string — The telephone extension, if applicable. - `contactName` string — The name of the contact person or entity. - `claimPaymentInfo` PaymentInfoClaimPaymentInfo — Claim payment information for the payment info structure. - `claimFilingIndicatorCode` '12' | '13' | '14' | '15' | '16' | '17' | 'AM' | 'CH' | 'DS' | 'HM' | 'LI' | 'LM' | 'MA' | 'MB' | 'MC' | 'OF' | 'TV' | 'VA' | 'WC' | 'ZZ' — 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. - `claimFrequencyCode` string — 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. - `claimPaymentAmount` string — The total amount of the claim payment, expressed as a decimal. This value can be positive, zero, or negative. - `claimStatusCode` '1' | '2' | '3' | '4' | '19' | '20' | '21' | '22' | '23' | '25' — 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. - `diagnosisRelatedGroupDRGCode` string — Code indicating a patient's diagnosis group based on their medical symptoms. - `diagnosisRelatedGroupDRGWeight` string — The adjudicated diagnosis-related group (DRG) weight. - `dischargeFraction` string — The adjudicated discharge fraction. - `facilityTypeCode` string — 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. - `patientControlNumber` string — The patient control number provided in the original claim. You can use this value to correlate the payer's response with the original claim. - `patientResponsibilityAmount` string — 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. - `payerClaimControlNumber` string — The payer's internal control number for the claim. - `totalClaimChargeAmount` string — 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. - `claimReceivedDate` string — The date the claim was received by the payer. - `claimStatementPeriodEnd` string — 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. - `claimStatementPeriodStart` string — 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. - `claimSupplementalInformation` PaymentInfoClaimSupplementalInformation — Additional information about the claim payment. All values are expressed as decimals. - `coverageAmount` string — 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. - `discountAmount` string — This is the Prompt Pay Discount Amount. - `federalMedicareOrMedicaidPaymentMandateCategory1` string — Federal Medicare or Medicaid Payment Mandate - Category 1. - `federalMedicareOrMedicaidPaymentMandateCategory2` string — Federal Medicare or Medicaid Payment Mandate - Category 2. - `federalMedicareOrMedicaidPaymentMandateCategory3` string — Federal Medicare or Medicaid Payment Mandate - Category 3. - `federalMedicareOrMedicaidPaymentMandateCategory4` string — Federal Medicare or Medicaid Payment Mandate - Category 4. - `federalMedicareOrMedicaidPaymentMandateCategory5` string — Federal Medicare or Medicaid Payment Mandate - Category 5. - `interest` string — The interest amount. - `negativeLedgerBalance` string — The negative ledger balance. Only used by Medicare Part A and Medicare Part B. - `patientAmountPaid` string — The amount the patient has already paid. - `perDayLimit` string — The per day limit. - `tax` string — The total taxes. - `totalClaimBeforeTaxes` string — The total claim amount before taxes. - `claimSupplementalInformationQuantities` PaymentInfoClaimSupplementalInformationQuantities — Additional quantity information about the claim payment. All values are expressed as decimals. - `coInsuredActual` string — The actual amount of co-insurance designated by the health plan. - `coveredActual` string — The number of days covered. - `federalMedicareOrMedicaidPaymentMandateCategory1` string — Federal Medicare or Medicaid Payment Mandate - Category 1. - `federalMedicareOrMedicaidPaymentMandateCategory2` string — Federal Medicare or Medicaid Payment Mandate - Category 2. - `federalMedicareOrMedicaidPaymentMandateCategory3` string — Federal Medicare or Medicaid Payment Mandate - Category 3. - `federalMedicareOrMedicaidPaymentMandateCategory4` string — Federal Medicare or Medicaid Payment Mandate - Category 4. - `federalMedicareOrMedicaidPaymentMandateCategory5` string — Federal Medicare or Medicaid Payment Mandate - Category 5. - `lifeTimeReserveActual` string — The actual lifetime reserve days. - `lifeTimeReserveEstimated` string — The estimated lifetime reserve days. - `nonCoveredEstimated` string — The non-covered estimated amount. - `notReplacedBloodUnits` string — The number of non-replaced blood units. - `outlierDays` string — The number of outlier days. - `prescription` string — The prescription. - `visits` string — The number of visits. - `correctedPatientOrInsuredName` PaymentInfoCorrectedPatientOrInsuredName — Used to provide corrected information about the insured. - `firstName` string — The insured's first name. - `insuredsChangedUniqueIdentificationNumber` string — The insured's changed unique identification number. - `lastName` string — The insured's last name. - `middleName` string — The insured's middle name or initial of the insured. - `organizationName` string — The business name of the insured when they are not an individual. - `suffix` string — The insured's name suffix, such as Jr. or III. - `correctedPriorityPayer` CorrectedPriorityPayer — 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. - `blueCrossBlueShieldAssociationPlanCode` string — The provider's Blue Cross Blue Shield Association Plan Code. - `centersForMedicareAndMedicaidServicesPlanId` string — Used to report the provider's Health Plan ID (HPID) or Other Entity Identifier (OEID). - `nationalAssociationOfInsuranceCommissionersIdentification` string — The provider's National Association of Insurance Commissioners (NAIC) number. - `organizationName` string — The provider's business name (when the provider is not an individual) or the provider's last name (when the provider is an individual). - `payorId` string — The provider's Payer Identification number. - `pharmacyProcessorNumber` string — The provider's Pharmacy Processor Number. - `taxId` string — The provider's Federal Tax Identification Number. - `coverageExpirationDate` string — The expiration date of the patient's coverage. - `crossoverCarrier` CrossoverCarrier — 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. - `blueCrossBlueShieldAssociationPlanCode` string — The provider's Blue Cross Blue Shield Association Plan Code. - `centersForMedicareAndMedicaidServicesPlanId` string — Used to report the provider's Health Plan ID (HPID) or Other Entity Identifier (OEID). - `nationalAssociationOfInsuranceCommissionersIdentification` string — The provider's National Association of Insurance Commissioners (NAIC) number. - `organizationName` string — The provider's business name (when the provider is not an individual) or the provider's last name (when the provider is an individual). - `payorId` string — The provider's Payer Identification number. - `pharmacyProcessorNumber` string — The provider's Pharmacy Processor Number. - `taxId` string — The provider's Federal Tax Identification Number. - `inpatientAdjudication` PaymentInfoInpatientAdjudication — Information about the adjudication of inpatient claims. - `claimDRGAmount` string — The Diagnosis Related Group (DRG) amount. - `claimDisproportionateShareAmount` string — The Disproportionate Share amount. - `claimIndirectTeachingAmount` string — The indirect teaching amount. - `claimMSPPassThroughAmount` string — The Medicare Secondary Payer (MSP) pass-through amount. - `claimPPSCapitalAmount` string — The total Prospective Payment System (PPS) capital amount. - `claimPPSCapitalOutlierAmount` string — The Prospective Payment System (PPS) Capital Outlier amount. - `claimPaymentRemarkCode1` string — The [Claim Payment Remark Code](https://x12.org/codes/remittance-advice-remark-codes). - `claimPaymentRemarkCode2` string — A [Claim Payment Remark Code](https://x12.org/codes/remittance-advice-remark-codes). - `claimPaymentRemarkCode3` string — A [Claim Payment Remark Code](https://x12.org/codes/remittance-advice-remark-codes). - `claimPaymentRemarkCode4` string — A [Claim Payment Remark Code](https://x12.org/codes/remittance-advice-remark-codes). - `claimPaymentRemarkCode5` string — A [Claim Payment Remark Code](https://x12.org/codes/remittance-advice-remark-codes). - `costReportDayCount` string — The number of cost report days. - `coveredDaysOrVisitsCount` string — The number of days or visits covered by the health plan. - `lifetimePsychiatricDaysCount` string — The number of psychiatric days for the patient's lifetime. - `nonPayableProfessionalComponentAmount` string — The professional component amount billed but not payable. - `oldCapitalAmount` string — The old capital amount. - `ppsCapitalDSHDRGAmount` string — The Prospective Payment System (PPS) capital, disproportionate share, hospital Diagnosis Related Group (DRG) amount. - `ppsCapitalExceptionAmount` string — The capital exception amount. - `ppsCapitalFSPDRGAmount` string — The Prospective Payment System (PPS) capital, federal specific portion, Diagnosis Related Group (DRG) amount. - `ppsCapitalHSPDRGAmount` string — The Prospective Payment System (PPS) capital, hospital specific portion, Diagnosis Related Group (DRG), amount. - `ppsCapitalIMEAmount` string — The Prospective Payment System (PPS) capital indirect medical education claim amount. - `ppsOperatingFederalSpecificDRGAmount` string — The federal specific Diagnosis Related Group (DRG) amount. - `ppsOperatingHospitalSpecificDRGAmount` string — The hospital specific Diagnosis Related Group (DRG) Amount. - `ppsOperatingOutlierAmount` string — The Prospective Payment System (PPS) Operating Outlier amount, expressed as a decimal. - `otherClaimRelatedIdentification` PaymentInfoOtherClaimRelatedIdentification — Additional reference numbers to identify the specific claim. - `adjustedRePricedClaimReferenceNumber` string — The adjusted repriced claim reference number. - `authorizationNumber` string — An authorization number assigned by the adjudication process that was not provided prior to the services. - `classOfContractCode` string — The class of contract code. - `classOfContractCodes` string[] — A list of class of contract codes when multiple codes are applicable. - `employeeIdentificationNumber` string — The employee identification number. - `groupNumber` string — The other insured group number. - `groupOrPolicyNumber` string — The group or policy number for the health plan. - `insurancePolicyNumber` string — The insurance policy number. - `medicalRecordIdentificationNumber` string — The medical record identification number. - `memberIdentificationNumber` string — The health plan member identification number. - `originalReferenceNumber` string — The reference number for the original claim. This is included for correction claims. - `predeterminationOfBenefitsIdentificationNumber` string — The predetermination of benefits identification number. - `priorAuthorizationNumber` string — The prior authorization number. - `rePricedClaimReferenceNumber` string — The repriced claim reference number. - `ssn` string — The social security number (SSN). - `otherSubscriber` OtherSubscriber — Information about the other subscriber, when a corrected priority payer has been identified. - `firstName` string — The subscriber's first name. - `lastName` string — The subscriber's last name. - `memberId` string — The subscriber's member ID for their health plan. - `middleName` string — The subscriber's middle name or initial. - `organizationName` string — The subscriber's business name, if the subscriber is not an individual. - `standardUniqueHealthIdentifierForEachIndividualInTheUnitedStates` string — Deprecated - `suffix` string — The subscriber's name suffix, such as Jr. or III. - `taxId` string — The subscriber's Federal Taxpayer's Identification Number. Only used when the subscriber is a business entity and not an individual. - `outpatientAdjudication` PaymentInfoOutpatientAdjudication — Information about the adjudication of claims not related to an inpatient setting. - `claimESRDPaymentAmount` string — The End Stage Renal Disease (ESRD) payment amount. - `claimHCPCSPayableAmount` string — The claim Health Care Financing Administration Common Procedural Coding System (HCPCS) payable amount, expressed as a decimal. - `claimPaymentRemarkCode1` string — A [Claim Payment Remark Code](https://x12.org/codes/remittance-advice-remark-codes). - `claimPaymentRemarkCode2` string — A [Claim Payment Remark Code](https://x12.org/codes/remittance-advice-remark-codes). - `claimPaymentRemarkCode3` string — A [Claim Payment Remark Code](https://x12.org/codes/remittance-advice-remark-codes). - `claimPaymentRemarkCode4` string — A [Claim Payment Remark Code](https://x12.org/codes/remittance-advice-remark-codes). - `claimPaymentRemarkCode5` string — A [Claim Payment Remark Code](https://x12.org/codes/remittance-advice-remark-codes). - `nonPayableProfessionalComponentAmount` string — The professional component amount billed but not payable. - `reimbursementRate` string — The reimbursement rate, expressed as a decimal. - `patientName` PaymentInfoPatientName — Information about the individual who received medical services. - `firstName` string — The patient's first name. - `healthInsuranceClaimNumber` string — The patient's Health Insurance Claim (HIC) Number. - `lastName` string — The patient's last name. - `medicaidRecipientIdentificationNumber` string — The patient's Medicaid Recipient Identification Number. - `memberId` string — The patient's member ID number for their health plan. - `middleName` string — The patient's middle name or initial. - `ssn` string — The patient's Social Security Number (SSN). - `standardUniqueHealthIdentifierForEachIndividualInTheUnitedStates` string — Deprecated. - `suffix` string — The patient's name suffix, such as Jr or III. - `renderingProvider` PaymentInfoRenderingProvider — Information about the provider who rendered the services. - `blueCrossProviderNumber` string — The rendering provider's Blue Cross Provider Number. - `blueShieldProviderNumber` string — The rendering provider's Blue Shield Provider Number. - `firstName` string — The rendering provider's first name. - `lastName` string — The rendering provider's last name. - `medicaidProviderNumber` string — The rendering provider's Medicare Provider Number. - `middleName` string — The rendering provider's middle name or initial. - `npi` string — The rendering provider's National Provider Identifier (NPI). - `organizationName` string — The rendering provider's business name. - `providerCommercialNumber` string — The rendering provider's Provider Commercial Number. - `stateLicenseNumber` string — The rendering provider's State License Number. - `suffix` string — The rendering provider's name suffix, such as Jr. or III. - `taxId` string — The rendering provider's Federal Taxpayer Identification Number. - `uniquePhysicianIdentificationNumber` string — Deprecated; replaced by NPI in 2007. - `renderingProviderIdentification` PaymentInfoRenderingProviderIdentification — Additional identifiers for the rendering provider. - `blueCrossProviderNumber` string — The rendering provider's Blue Cross Provider Number. - `blueShieldProviderNumber` string — The rendering provider's Blue Shield Provider Number. - `champusIdentificationNumber` string — The rendering provider's CHAMPUS Identification Number. - `facilityIdNumber` string — The rendering provider's Facility ID Number. - `locationNumber` string — The rendering provider's Location Number. - `medicaidProviderNumber` string — The rendering provider's Medicaid Provider Number. - `medicareProviderNumber` string — The rendering provider's Medicare Provider Number. - `nationalCouncilForPrescriptionDrugProgramPharmacyNumber` string — The rendering provider's National Council for Prescription Drug Program Pharmacy Number. - `providerCommercialNumber` string — The rendering provider's Provider Commercial Number. - `providerUPINNumber` string — Deprecated; replaced by NPI in 2007. - `stateLicenseNumber` string — The rendering provider's State License Number. - `serviceLines` ClaimPaymentAdviceServiceLines[] — Service lines included in this claim. - `healthCareCheckRemarkCodes` HealthCareCheckRemarkCodes[] — Healthcare check remark codes for this service. - `codeListQualifierCode` string — 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. - `codeListQualifierCodeValue` string — The description of the `codeListQualifierCode`. Can be `Claim Payment Remark Codes` or `National Council for Prescription Drug Programs Reject/Payment Codes`. - `remark` string — The human readable description of the remark code. - `remarkCode` string — 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`). - `healthCarePolicyIdentification` HealthCarePolicyIdentification[] — Healthcare policy identification for this service. - `policyFormIdentifyingNumber` string — The identifying number for the policy form. - `lineItemControlNumber` string — The `providerControlNumber` submitted in the original claim to identify the service line. - `renderingProviderInformation` ClaimPaymentAdviceServiceLinesRenderingProviderInformation — Identifiers for the provider who rendered this service. - `blueCrossProviderNumber` string — The rendering provider's Blue Cross Provider Number. - `blueShieldProviderNumber` string — The rendering provider's Blue Shield Provider Number. - `champusIdentificationNumber` string — The rendering provider's CHAMPUS Identification Number. - `facilityIdNumber` string — The rendering provider's Facility ID Number. - `federalTaxpayerIdentificationNumber` string — The rendering provider's Federal Taxpayer Identification Number. - `medicaidProviderNumber` string — The rendering provider's Medicaid Provider Number. - `medicareProviderNumber` string — The rendering provider's Medicare Provider Number. - `nationalCouncilForPrescriptionDrugProgramPharmacyNumber` string — The rendering provider's National Council for Prescription Drug Programs Pharmacy Number. - `npi` string — The rendering provider's National Provider Identifier (NPI). - `providerCommercialNumber` string — The Provider Commercial Number. - `providerUPINNumber` string — Deprecated; replaced by NPI in 2007. - `ssn` string — The rendering provider's Social Security Number (SSN). - `stateLicenseNumber` string — The rendering provider's State License Number. - `serviceAdjustments` ClaimAdjustments[] — Adjustments applied to this service line. - `adjustmentAmount1` string — The amount of the adjustment. A negative amount increases the claim payment and a positive amount decreases the claim payment. - `adjustmentAmount2` string — The amount of the adjustment. A negative amount increases the claim payment and a positive amount decreases the claim payment. - `adjustmentAmount3` string — The amount of the adjustment. A negative amount increases the claim payment and a positive amount decreases the claim payment. - `adjustmentAmount4` string — The amount of the adjustment. A negative amount increases the claim payment and a positive amount decreases the claim payment. - `adjustmentAmount5` string — The amount of the adjustment. A negative amount increases the claim payment and a positive amount decreases the claim payment. - `adjustmentAmount6` string — The amount of the adjustment. A negative amount increases the claim payment and a positive amount decreases the claim payment. - `adjustmentQuantity1` string — The units of service being adjusted. A positive value decreases the covered days and a negative number increases the covered days. - `adjustmentQuantity2` string — The units of service being adjusted. A positive value decreases the covered days and a negative number increases the covered days. - `adjustmentQuantity3` string — The units of service being adjusted. A positive value decreases the covered days and a negative number increases the covered days. - `adjustmentQuantity4` string — The units of service being adjusted. A positive value decreases the covered days and a negative number increases the covered days. - `adjustmentQuantity5` string — The units of service being adjusted. A positive value decreases the covered days and a negative number increases the covered days. - `adjustmentQuantity6` string — The units of service being adjusted. A positive value decreases the covered days and a negative number increases the covered days. - `adjustmentReason1` string — A description identifying the detailed reason the adjustment was made. - `adjustmentReason2` string — A description identifying the detailed reason the adjustment was made. - `adjustmentReason3` string — A description identifying the detailed reason the adjustment was made. - `adjustmentReason4` string — A description identifying the detailed reason the adjustment was made. - `adjustmentReason5` string — A description identifying the detailed reason the adjustment was made. - `adjustmentReason6` string — A description identifying the detailed reason the adjustment was made. - `adjustmentReasonCode1` string — 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. - `adjustmentReasonCode2` string — 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. - `adjustmentReasonCode3` string — 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. - `adjustmentReasonCode4` string — 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. - `adjustmentReasonCode5` string — 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. - `adjustmentReasonCode6` string — 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. - `claimAdjustmentGroupCode` 'CO' | 'OA' | 'PI' | 'PR' — 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. - `claimAdjustmentGroupCodeValue` string — The description of the `claimAdjustmentGroupCode`. - `serviceDate` string — The date the service was rendered. Used for single-day services. - `serviceEndDate` string — The date the service ended. Used for multi-day services. - `serviceIdentification` ClaimPaymentAdviceServiceLinesServiceIdentification — Additional identifiers related to the service line. - `ambulatoryPatientGroupNumber` string — The service line's Ambulatory Patient Group (APG) Number. - `ambulatoryPaymentClassification` string — The service line's Ambulatory Payment Classification Number. - `attachmentCode` string — The service line's Attachment Code. - `authorizationNumber` string — The service line's Authorization Number. - `locationNumber` string — The payer's identification for the provider location. - `preDeterminationOfBenefitsIdentificationNumber` string — The service line's Predetermination of Benefits Identification Number. - `priorAuthorizationNumber` string — The service line's Prior Authorization Number. - `rateCodeNumber` string — 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. - `servicePaymentInformation` ClaimPaymentAdviceServiceLinesServicePaymentInformation — Payment and control information about a provider for a particular service. - `adjudicatedProcedureCode` string — The adjudicated procedure code - an identifying number for a product or service. - `adjudicatedProcedureModifierCodes` string[] — A list of up to four modifiers that identify special circumstances related to the product or service. - `lineItemChargeAmount` string — The submitted service charge, expressed as a decimal. - `lineItemProviderPaymentAmount` string — The amount paid for the service, expressed as a decimal. This amount is calculated as follows: `servicePaymentInformation.lineItemProviderPaymentAmount = servicePaymentInformation.lineItemChargeAmount - (sum(serviceAdjustments[].adjustmentAmount1) + sum(serviceAdjustments[].adjustmentAmount2) + sum(serviceAdjustments[].adjustmentAmount3) + sum(serviceAdjustments[].adjustmentAmount4) + sum(serviceAdjustments[].adjustmentAmount5) + sum(serviceAdjustments[].adjustmentAmount6))` All 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. Adjustments 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`. - `nationalUniformBillingCommitteeRevenueCode` string — The National Uniform Billing Committee Revenue Code. - `originalUnitsOfServiceCount` string — The original number of units of service submitted, expressed as a decimal. - `productOrServiceIDQualifier` 'HC' | 'AD' | 'ER' | 'IV' | 'N4' | 'NU' | 'WK' — 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. - `productOrServiceIDQualifierValue` string — The description of the `productOrServiceIDQualifier`. - `submittedAdjudicatedProcedureCode` string — The submitted adjudicated procedure code - an identifying number for a product or service. - `submittedAdjudicatedProcedureModifierCodes` string[] — A list of up to four modifiers that identify special circumstances related to the product or service. - `submittedProcedureCodeDescription` string — A free-form description to further clarify the procedure code and any modifiers. - `submittedProductOrServiceIDQualifier` 'HC' | 'AD' | 'ER' | 'IV' | 'N4' | 'NU' | 'WK' — 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. - `submittedProductOrServiceIDQualifierValue` string — The description of the `submittedProductOrServiceIDQualifier`. - `unitsOfServicePaidCount` string — The number of units of service that were paid, expressed as a decimal. If not present, the value is assumed to be one. - `serviceStartDate` string — The date the service began. Used for multi-day services. - `serviceSupplementalAmounts` ClaimPaymentAdviceServiceLinesServiceSupplementalAmounts — Information about the service supplemental amount. All values are expressed as decimals. - `allowedActual` string — The payer payment plus any assigned patient responsibility. - `deductionAmount` string — This is the late filing reduction amount. - `federalMedicareOrMedicaidPaymentMandateCategory1` string — Federal Medicare or Medicaid Payment Mandate - Category 1. - `federalMedicareOrMedicaidPaymentMandateCategory2` string — Federal Medicare or Medicaid Payment Mandate - Category 2. - `federalMedicareOrMedicaidPaymentMandateCategory3` string — Federal Medicare or Medicaid Payment Mandate - Category 3. - `federalMedicareOrMedicaidPaymentMandateCategory4` string — Federal Medicare or Medicaid Payment Mandate - Category 4. - `federalMedicareOrMedicaidPaymentMandateCategory5` string — Federal Medicare or Medicaid Payment Mandate - Category 5. - `tax` string — The tax amount. - `totalClaimBeforeTaxes` string — The total amount for the service charge before taxes. - `serviceSupplementalQuantities` ClaimPaymentAdviceServiceLinesServiceSupplementalQuantities — Additional quantity information about the service. All values are expressed as decimals. - `federalMedicareOrMedicaidPaymentMandateCategory1` string — Federal Medicare or Medicaid Payment Mandate - Category 1. - `federalMedicareOrMedicaidPaymentMandateCategory2` string — Federal Medicare or Medicaid Payment Mandate - Category 2. - `federalMedicareOrMedicaidPaymentMandateCategory3` string — Federal Medicare or Medicaid Payment Mandate - Category 3. - `federalMedicareOrMedicaidPaymentMandateCategory4` string — Federal Medicare or Medicaid Payment Mandate - Category 4. - `federalMedicareOrMedicaidPaymentMandateCategory5` string — Federal Medicare or Medicaid Payment Mandate - Category 5. - `subscriber` PaymentInfoSubscriber — Information about the primary policyholder for the health plan. This may or may not be the patient. - `firstName` string — The subscriber's first name. - `lastName` string — The subscriber's last name. - `memberId` string — The subscriber's member ID for their health plan. - `middleName` string — The subscriber's middle name or initial. - `organizationName` string — The subscriber's business name, if the subscriber is not an individual. - `standardUniqueHealthIdentifierForEachIndividualInTheUnitedStates` string — Deprecated - `suffix` string — The subscriber's name suffix, such as Jr. or III. - `taxId` string — The subscriber's Federal Taxpayer's Identification Number. Only used when the subscriber is a business entity and not an individual. - `providerSummaryInformation` ProviderSummaryInformation — Summary information about the provider, including the provider's identifier, where the services were performed, and total claim charge amounts. - `facilityTypeCode` string — 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. - `fiscalPeriodDate` string — The last day of the provider's fiscal year. - `providerIdentifier` string — The provider number. - `totalClaimChargeAmount` string — The total of the charges reported for all claims, expressed as a decimal. - `totalClaimCount` string — The total number of claims. - `totalHCPCSPayableAmount` string — The total of the charges reported for all HCPCS codes that are payable, expressed as a decimal. - `totalHCPCSReportedChargeAmount` string — The total of the charges reported for all Health Care Financing Administration Common Procedural Coding System (HCPCS) codes, expressed as a decimal. - `totalMSPPatientLiabilityMetAmount` string — The total Medicare Secondary Payer (MSP) patient liability met, expressed as a decimal. - `totalMSPPayerAmount` string — The total Medicare Secondary Payer (MSP) primary payer amount, expressed as a decimal. - `totalNonLabChargeAmount` string — The total of non-laboratory charges, expressed as a decimal. - `totalPIPAdjustmentAmount` string — The total periodic interim payment (PIP) adjustment amount, expressed as a decimal. - `totalPIPClaimCount` string — The total periodic interim payment (PIP) number of claims, expressed as a decimal. - `totalPatientReimbursementAmount` string — The total patient reimbursement amount, expressed as a decimal. - `totalProfessionalComponentAmount` string — The total of the professional component charges, expressed as a decimal. - `providerSupplementalSummaryInformation` ProviderSupplementalSummaryInformation — Additional summary information about the provider and the charges in the claim. All values are expressed as decimals. - `averageDRGLengthOfStay` string — The average length of stay for diagnosis related group (DRG) claims. - `averageDRGWeight` string — The average diagnosis-related group (DRG) weight. - `totalCapitalAmount` string — 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. - `totalCostOutlierAmount` string — The total cost outlier amount. - `totalCostReportDayCount` string — The total number of cost report days. - `totalCoveredDayCount` string — The total number of covered days. - `totalDRGAmount` string — The total of the charges reported for all diagnosis-related group (DRG) codes. - `totalDayOutlierAmount` string — The total day outlier amount. - `totalDischargeCount` string — The total number of discharges. - `totalDisproportionateShareAmount` string — The total disproportionate share amount. - `totalFederalSpecificAmount` string — The total federal specific amount. - `totalHospitalSpecificAmount` string — The total hospital specific amount. - `totalIndirectMedicalEducationAmount` string — The total indirect medical education amount. - `totalMSPPassThroughAmount` string — The total Medicare Secondary Payer (MSP) pass-through amount, calculated for a non-Medicare payer. - `totalNonCoveredDayCount` string — The total number of non-covered days. - `totalOutlierDayCount` string — The total number of outlier days. - `totalPPSCapitalFSPDRGAmount` string — The total prospective payment system (PPS) capital, federal-specific portion, diagnosis-related group (DRG) amount. - `totalPPSCapitalHSPDRGAmount` string — The total prospective payment system (PPS) capital, hospital-specific portion, diagnosis-related group (DRG) amount. - `totalPPSDSHDRGAmount` string — The total prospective payment system (PPS) disproportionate share, hospital diagnosis-related group (DRG) amount. - `financialInformation` ClaimPaymentAdviceResponseFinancialInformation — Information about a payment, including the payment method, payment amount, and account details for both the sender and receiver. - `checkIssueOrEFTEffectiveDate` string — 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. - `creditOrDebitFlagCode` 'C' | 'D' — 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. - `originatingCompanySupplementalCode` string — A code that further identifies the payer by division or region. - `payerIdentifier` string — A unique identifier for the payer, mutually established between the financial institution and the payer. - `paymentFormatCode` 'CCP' | 'CTX' — Identifies the specific electronic payment format used for ACH transactions. These formats determine the structure and content of the electronic payment message. - `paymentMethodCode` 'ACH' | 'BOP' | 'CHK' | 'FWT' | 'NON' — 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. - `receiverAccountDetails` ReceiverAccountDetails — Financial institution account details for the payment receiver. - `receiverAccountNumber` string — The provider's account number. - `receiverAccountNumberQualifier` 'DA' | 'SA' — 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. - `receiverDfiIdNumberQualifier` '01' | '04' — Identifies the type of Depository Financial Institution (DFI) identification number being used. This specifies the format and country of the bank routing information. - `receiverDfiIdentificationNumber` string — The identification number specified in `receiverDfiIdNumberQualifier`. - `senderAccountDetails` SenderAccountDetails — Financial institution account details for the payment sender. - `senderAccountNumber` string — The account number for the company originating the payment. - `senderAccountNumberQualifier` 'DA' | 'SA' — 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. - `senderDFIIdentifier` string — The identifier specified by the `senderDfiIdNumberQualifier`. - `senderDfiIdNumberQualifier` '01' | '04' — Identifies the type of Depository Financial Institution (DFI) identification number being used. This specifies the format and country of the bank routing information. - `totalActualProviderPaymentAmount` string — The total amount of the payment to the provider, expressed as a decimal. - `transactionHandlingCode` 'C' | 'D' | 'H' | 'I' | 'P' | 'U' | 'X' — 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. - `foreignCurrency` string — The standard ISO code for the country whose currency is being used for payments. If this is not present, the currency is US dollars. - `payee` Payee — Information about the provider receiving the payment. - `address` PayeeAddress — Address information for the payee. - `address1` string — The first line of the address. - `address2` string — The second line of the address. - `city` string — The city where the address is located. - `countryCode` string — The standard code for the country from Part 1 of ISO 3166. - `countrySubCode` string — The standard code for the country subdivision from Part 2 of ISO 3166. - `postalCode` string — The postal code for the address, excluding punctuation and blanks. - `state` string — The standard code for the state or province. For example `PA` for Pennsylvania. - `centersForMedicareAndMedicaidServicesPlanId` string — 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. - `federalTaxPayersIdentificationNumber` string — 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). - `name` string — The payee's name. This can be the name of an individual or an organization. - `nationalCouncilForPrescriptionDrugProgramsPharmacyNumber` string — The payee's National Council for Prescription Drugs Pharmacy Number. - `npi` string — The payee's National Provider Identifier (NPI). - `payeeIdentification` string — Other information necessary to identify the payee. - `remittanceDeliveryMethod` PayeeRemittanceDeliveryMethod — The method by which the remittance advice is delivered. This is used when the remittance is separate from the payment. - `email` string — The email address. - `ftp` string — Information for file transfer deliveries, such as SFTP, FTP, or FTPS. - `name` string — The name of the third party processor, if required, that would be the first recipient of the remittance. - `onLine` string — 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`. - `stateLicenseNumber` string — The payee's State License Number. - `taxId` string — The payee's Federal Tax Identification Number (TIN). - `payer` ClaimPaymentAdvicePayer — Information about the payer. - `address` ClaimPaymentAdvicePayerAddress — Address information for the payer. - `address1` string — The first line of the address. - `address2` string — The second line of the address. - `city` string — The city where the address is located. - `countryCode` string — The standard code for the country from Part 1 of ISO 3166. - `countrySubCode` string — The standard code for the country subdivision from Part 2 of ISO 3166. - `postalCode` string — The postal code for the address, excluding punctuation and blanks. - `state` string — The standard code for the state or province. For example `PA` for Pennsylvania. - `businessContactInformation` BusinessContactInformation — A person or office to whom administrative communications should be directed. - `contactMethods` ContactMethod[] - `email` string — The email address. - `fax` string — The fax number. - `phone` string — 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`. - `phoneExtension` string — The telephone extension, if applicable. - `contactName` string — The name of the contact person or entity. - `centersForMedicareAndMedicaidServicesPlanId` string — 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. - `healthIndustryNumber` string — The payer's health industry number. - `name` string — The payer's business name, such as Cigna or Aetna. - `nationalAssociationOfInsuranceCommissioners` string — The payer's National Association of Insurance Commissioners (NAIC) code. - `payerIdentificationNumber` string — 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. - `payerWebSiteUrl` string — The payer's web address. The URL is typically provided without the scheme and separator. For example, `stedi.com`. - `submitterIdentificationNumber` string — 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. - `technicalContactInformation` TechnicalContactInformation[] — A person or office. - `contactMethods` TechnicalContactMethod[] — Available contact methods for technical support. - `email` string — The contact email address. - `fax` string — The contact fax number. - `phone` string — 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`. - `phoneExtension` string — The contact telephone extension, if applicable. - `url` string — A web address to contact the person or entity. The URL is typically provided without the scheme and separator. For example, `stedi.com`. - `contactName` string — The name of the contact person or entity. - `paymentAndRemitReassociationDetails` ClaimPaymentAdviceResponsePaymentAndRemitReassociationDetails — Information to uniquely identify the transaction and help with reassociating payments and remittances that have been separated. - `checkOrEFTTraceNumber` string — 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). - `originatingCompanyIdentifier` string — A unique identifier for the payer. This is a 1 followed by the payer's Employer Identification Number (EIN) or Taxpayer Identification Number (TIN). - `originatingCompanySupplementalCode` string — A value that identifies a further subdivision within the payer's organization. - `traceTypeCode` '1' — Identifies the type of trace number used to uniquely identify and track payment transactions. This helps reassociate payments with their corresponding remittance advice. - `productionDate` string — The end date for the adjudication production cycle for claims included in this ERA. - `providerAdjustments` ProviderAdjustments[] — 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). - `adjustments` Adjustments[] — List of adjustments applied to the provider. - `adjustmentReasonCode` string — 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. - `adjustmentReasonCodeValue` string — The description of the `adjustmentReasonCode`. - `providerAdjustmentAmount` string — 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. - `providerAdjustmentIdentifier` string — An identifier used to assist the receiver in identifying, tracking, or reconciling the adjustment. - `fiscalPeriodDate` string — The last day of the provider's fiscal year. - `providerIdentifier` string — This is the provider's NPI. - `receiverIdentifier` string — 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. - `versionIdentification` string — The version number of the adjudication system that generated the claim payments. ## Other responses - `400` — ValidationException 400 response - `403` — AccessDeniedException 403 response - `404` — ResourceNotFoundException 404 response - `429` — ThrottlingException 429 response - `500` — InternalFailureException 500 response - `503` — ServiceUnavailableException 503 response - `504` — GatewayTimeoutException 504 response --- [API](https://skmtc.net/stedi/apis/stedi-healthcare.md) · [All operations](https://skmtc.net/stedi/apis/stedi-healthcare/llms.txt) · [OpenAPI document](https://skmtc-service-staging.skmtc.workers.dev/v1/apis/stedi/stedi-healthcare/revisions/4ba02a47bfc5/schema)