--- title: "POST /change/medicalnetwork/institutionalclaims/v1/submission" method: POST path: "/change/medicalnetwork/institutionalclaims/v1/submission" tags: ["Claim submission"] --- # POST /change/medicalnetwork/institutionalclaims/v1/submission `POST /change/medicalnetwork/institutionalclaims/v1/submission` Submit an 837I institutional claim in JSON format ## Headers - `Idempotency-Key` string — A unique string to identify this request to the server. The key can be up to 255 characters. You can safely retry requests with the same idempotency key within 24 hours of making the first request. This prevents you from sending duplicate claims due to network errors or other intermittent failures. [Learn more](https://www.stedi.com/docs/api-reference/index#idempotency-keys). ## Request body - InstitutionalClaimsSubmissionRequestContent - `attending` Attending — Information about the individual who has overall responsibility for the patient's medical care and treatment reported in the claim. This information is required when the claim contains any services other than non-scheduled transportation claims. This provider should be an individual, not an organization, and you should supply at least the provider's `lastName` and an identifier, which is typically the `npi`. - `address` InstitutionalAddress - `address1` string, required — The first line of the street address. This typically contains the building number and street name. - `address2` string — The second line of the street address. This typically contains the apartment or suite number. - `city` string, required — The city name. - `countryCode` string — Use the alpha-2 country codes from Part 1 of ISO 3166. - `countrySubDivisionCode` string — Use the country subdivision codes from Part 2 of ISO 3166. - `postalCode` string — The postal zone or zip code. For United States addresses, you must include the full nine-digit zip code with no separators, such as `100031502`. If you don't know the full zip code, you can find it using the [USPS ZIP Code Lookup](https://tools.usps.com/zip-code-lookup.htm) tool. Exclude punctuation and spaces. - `state` string — The state or province code. Only required when the city is in the United States and Canada. - `contactInformation` InstitutionalContactInformation - `email` string — The email address. - `faxNumber` string — The fax number. - `name` string, required — The full name of the person or office. - `phoneNumber` string — The phone number, formatted as AAABBBCCCC, where AAA represents the area code, BBB is the telephone number prefix, and CCCC is the telephone number. The phone number should only include the digits 0 to 9. Don't include separators, such as dashes, and don't include long distance access numbers, such as 1. For example, you would format the phone number 123-456-7890 as 1234567890. - `validContact` boolean - `employerId` string - `firstName` string — The provider's first name. - `lastName` string — The provider's last name. This is **required**. - `middleName` string — The provider's middle name or initial. - `npi` string — The individual [National Provider Identifier (NPI)](https://www.stedi.com/docs/healthcare/national-provider-identifier) assigned to the provider. - `organizationName` string — The provider's business name. - `providerType` string — This field is now automatically populated and it only remains for backwards compatibility. - `secondaryIdentificationQualifierCode` '0B' | '1G' | 'G2' | 'LU' — The type of identifier used in `secondaryIdentifier`. Can be set to `0B` - State License Number, `1G` - Provider UPIN Number, `G2` - Provider Commercial Number, or `LU` - Location Number. Note that UPIN is deprecated and should not be used. - `secondaryIdentifier` string — The identifier referenced by `secondaryIdentificationQualifierCode`. For example, if `secondaryIdentificationQualifierCode` is set to `0B`, this property should be the provider's state license number. You can only include one secondary identifier for the provider. - `suffix` string — The provider's name suffix, such as Jr. or III. - `taxonomyCode` string — The provider's [taxnonomy code](https://www.cms.gov/medicare/enrollment-renewal/providers-suppliers/health-care-taxonomy), a unique 10-character code that designates their classification and specialization. Only applies to the attending provider. - `billing` InstitutionalBilling — Information about the billing provider. The following information is required: - An `address` that is a physical location such as the office where care is delivered or an administrative facility. - The provider's Employer Identification Number (EIN) in `employerId`. - The provider's business name in `organizationName`. - The provider's [National Provider Identifier (NPI)](https://www.stedi.com/docs/healthcare/national-provider-identifier) in `npi`, if one is assigned. When the billing provider is not assigned an NPI, supply `secondaryIdentifier` with `secondaryIdentificationQualifierCode` set to `G2` (commercial number). - `address` InstitutionalAddress, required - `address1` string, required — The first line of the street address. This typically contains the building number and street name. - `address2` string — The second line of the street address. This typically contains the apartment or suite number. - `city` string, required — The city name. - `countryCode` string — Use the alpha-2 country codes from Part 1 of ISO 3166. - `countrySubDivisionCode` string — Use the country subdivision codes from Part 2 of ISO 3166. - `postalCode` string — The postal zone or zip code. For United States addresses, you must include the full nine-digit zip code with no separators, such as `100031502`. If you don't know the full zip code, you can find it using the [USPS ZIP Code Lookup](https://tools.usps.com/zip-code-lookup.htm) tool. Exclude punctuation and spaces. - `state` string — The state or province code. Only required when the city is in the United States and Canada. - `commercialNumber` string - `contactInformation` InstitutionalContactInformation - `email` string — The email address. - `faxNumber` string — The fax number. - `name` string, required — The full name of the person or office. - `phoneNumber` string — The phone number, formatted as AAABBBCCCC, where AAA represents the area code, BBB is the telephone number prefix, and CCCC is the telephone number. The phone number should only include the digits 0 to 9. Don't include separators, such as dashes, and don't include long distance access numbers, such as 1. For example, you would format the phone number 123-456-7890 as 1234567890. - `validContact` boolean - `employerId` string, required — The provider's employer ID, also known as an EIN or TIN. Must be a string of exactly nine numbers with no separators. - `firstName` string — The provider's first name. - `lastName` string — The provider's last name. - `locationNumber` string - `middleName` string — The provider's middle name or initial. - `npi` string — The organization [National Provider Identifier (NPI)](https://www.stedi.com/docs/healthcare/national-provider-identifier). Optional. When the billing provider is not assigned an NPI, supply `secondaryIdentifier` with `secondaryIdentificationQualifierCode` set to `G2` instead. - `organizationName` string — The provider's business name. - `providerType` 'BillingProvider' — Defines the billing provider type. - `providerUpinNumber` string - `secondaryIdentificationQualifierCode` '0B' | '1G' | 'G2' | 'LU' — The type of identifier used in `secondaryIdentifier`. Can be set to `0B` - State License Number, `1G` - Provider UPIN Number, `G2` - Provider Commercial Number, or `LU` - Location Number. Note that UPIN is deprecated and should not be used. - `secondaryIdentifier` string — The identifier specified in `secondaryIdentifierQualifierCode`. You can only include one secondary identifier for the provider. - `stateLicenseNumber` string - `suffix` string — The provider's suffix, such as Jr. or Sr. - `taxonomyCode` string — The provider's [taxnonomy code](https://www.cms.gov/medicare/enrollment-renewal/providers-suppliers/health-care-taxonomy), a unique 10-character code that designates their classification and specialization. - `billingPayToAddressName` PayToAddressName — Use to specify an address for payment that is different from the billing provider's physical address. This is relevant when the provider expects to receive paper checks at a different location, such as a PO Box, lockbox, or other mailing address. - `address` InstitutionalAddress, required - `address1` string, required — The first line of the street address. This typically contains the building number and street name. - `address2` string — The second line of the street address. This typically contains the apartment or suite number. - `city` string, required — The city name. - `countryCode` string — Use the alpha-2 country codes from Part 1 of ISO 3166. - `countrySubDivisionCode` string — Use the country subdivision codes from Part 2 of ISO 3166. - `postalCode` string — The postal zone or zip code. For United States addresses, you must include the full nine-digit zip code with no separators, such as `100031502`. If you don't know the full zip code, you can find it using the [USPS ZIP Code Lookup](https://tools.usps.com/zip-code-lookup.htm) tool. Exclude punctuation and spaces. - `state` string — The state or province code. Only required when the city is in the United States and Canada. - `entityTypeQualifier` '2', required — Code identifying the type of entity. Can be set to `2` - Non-Person Entity. - `billingPayToPlanName` PayToPlanName — 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. - `address` InstitutionalAddress - `address1` string, required — The first line of the street address. This typically contains the building number and street name. - `address2` string — The second line of the street address. This typically contains the apartment or suite number. - `city` string, required — The city name. - `countryCode` string — Use the alpha-2 country codes from Part 1 of ISO 3166. - `countrySubDivisionCode` string — Use the country subdivision codes from Part 2 of ISO 3166. - `postalCode` string — The postal zone or zip code. For United States addresses, you must include the full nine-digit zip code with no separators, such as `100031502`. If you don't know the full zip code, you can find it using the [USPS ZIP Code Lookup](https://tools.usps.com/zip-code-lookup.htm) tool. Exclude punctuation and spaces. - `state` string — The state or province code. Only required when the city is in the United States and Canada. - `claimOfficeNumber` string — The Claim Office Number. - `identificationCode` string, required — The identification code specified by the `identificationCodeQualifier`. - `identificationCodeQualifier` 'PI' | 'XV', required — The type of identification code used to identify the organization. Can be set to `PI` - Payer Identification or `XV` - Centers for Medicare and Medicaid Services PlanID. Use `XV` when reporting the Health Plan ID (HPID) or Other Entity Identifier (OEID). - `naic` string — The National Association of Insurance Commisioners (NAIC) code. This is the five-digit identifier assigned to each insurance company. - `organizationName` string, required — The business name of the organization to which the payment should be made. - `payerIdentificationNumber` string — The payer identification number. Only include this information when the `identificationCodeQualifier` is set to `XV` - Centers for Medicare and Medicaid Services PlanID. - `taxId` string, required — The payer tax identification number (TIN). This is a unique number assigned to the payer by the IRS. - `claimIdentifier` '31' | 'CH' | 'RP' — A code specifying the type of transaction. Defaults to `CH` if not provided. - `31`: Only for use by state Medicaid agencies performing post payment recovery. - `CH`: Use when the transaction contains only fee for service claims or claims with at least one chargeable line item. Also use when it's not clear whether a transaction contains claims or capitated encounters, or if the transaction contains a mix of claims and capitated encounters. - `RP`: Use for capitated encounters. Also use when the transaction is being sent to an entity for purposes other than adjudication of a claim. For example, when you're sending the claim to a state health agency that is using the claim for health data reporting purposes. - `claimInformation` InstitutionalClaimInformation, required — Information about the healthcare claim. Note that the objects and properties marked as required are required for all claims, while others are conditionally required, depending on type of claim and claim circumstances. For example, you must always provide the `claimChargeAmount`, but you only need to provide the `otherSubscriberInformation` object in coordination of benefits scenarios. When you include a conditionally required object, you must provide all of its required properties. - `admittingDiagnosis` AdmittingDiagnosis - `admittingDiagnosisCode` string, required — The admitting diagnosis code for the patient. - You must submit a valid, billable code at the highest level of specificity. Include the 4th - 7th characters as applicable. - **Don't** submit the decimal point for ICD codes. The decimal point is implied. - **Don't** submit ICD-10 header codes. Header codes exist to group related codes and aren't valid for billing. These header codes can change with each new version of ICD-10, so we recommend reviewing your diagnosis codes every year to ensure that they aren't classified as header codes in the most recent version. To determine whether a code is a header code, you can also search the [Value Set Authority Center](https://vsac.nlm.nih.gov/context/cs). If the 'Header' property is set, the code is a header code and you shouldn't use it in claim submissions. - `qualifierCode` 'ABJ' | 'BJ', required — Code identifying the type of admitting diagnosis code used. Can be set to `ABJ` - International Classification of Diseases Clinical Modification (ICD-10-CM) Admitting Diagnosis or `BJ` - International Classification of Diseases Clinical Modification (ICD-9-CM) Admitting Diagnosis. Note that ICD-9 is deprecated and cannot be used in new claims. - `benefitsAssignmentCertificationIndicator` 'N' | 'W' | 'Y', required - `billingNote` string — To communicate special instructions regarding claim billing. Required when the provider judges the information is needed to substantiate the medical treatment and cannot be provided elsewhere in the request. - `claimChargeAmount` string, required — The total dollar amount charged for the services on this claim, expressed as a decimal. For example, `100.50`. This is the total amount before any adjustments or payments. The amount must balance to the sum of the service line charges. - `claimCodeInformation` ClaimCodeInformation, required — Supply information specific to hospital claims, such as the priority of the admission. - `admissionSourceCode` string — Code indicating the source of the admission, such as the emergency room (ER), a doctor’s referral, or another facility. This code is **required** for all institutional claims except when the `claimInformation.placeOfServiceCode` is set to `14` (Non-Patient Laboratory). Stedi rejects claims that don't meet this requirement [Full code list](https://med.noridianmedicare.com/web/jea/topics/claim-submission/point-of-origin-codes). - `admissionTypeCode` string, required — The code indicating the priority of the admission. - `patientStatusCode` string, required — Code indicating patient status as of the end of the claim's billed period. It tells the payer whether the patient was discharged, transferred, or still admitted. This code must be compatible with the `claimInformation.claimFrequencyCode`. For example, claim frequency code `1` (Admit thru Discharge Claim) means the patient's stay is finished. In this case, the patient status code shouldn't be `30` (Still a Patient), which indicates the patient is still in the facility. [Full code list](https://med.noridianmedicare.com/web/jea/topics/claim-submission/patient-discharge-status-codes) - `claimContractInformation` ClaimContractInformation — Required when the submitter is contractually obligated to supply this information on post-adjudicated claims. - `contractAmount` string — The total dollar amount of the contract, expressed as a decimal. For example, `100.50`. - `contractCode` string — The contract code. This is a unique identifier for the contract. - `contractPercentage` string — The allowance or charge percent, expressed as a decimal. For example, `0.80`. - `contractTypeCode` '01' | '02' | '03' | '04' | '05' | '06' | '09', required — A code identifying the type of contract. Can be set to `01` - Diagnosis Related Group (DRG), `02` - Per Diem, `03` - Variable Per Diem, `04` - Flat, `05` - Capitated, `06` - Percent, or `09` - Other. - `contractVersionIdentifier` string — An additional identifer for the contract. Identifies the revision level of a particular format, program, technique or algorithm. - `termsDiscountPercentage` string — Terms discount percentage, expressed as a percent, available to the purchaser if an invoice is paid on or before the Terms Discount Due Date. - `claimDateInformation` InstitutionalClaimDateInformation, required — Dates and times related to the claim. For example, when the patient was discharged from the hospital. - `admissionDateAndHour` string — When the patient was admitted to the hospital or facility. This property is **required** on inpatient claims. Can be expressed as a date and time (YYYYMMDDHHMM) or a single date (YYYYMMDD). - `dischargeHour` string — The time the patient was discharged from the hospital or facility. This property is **required** on final inpatient claims. Can be expressed as a time in format HHMM. - `repricerReceivedDate` string — The date the repricer received the claim. Required when a repricer is passing the claim onto the payer. - `statementBeginDate` string, required — The beginning date of the statement. - `statementEndDate` string, required — The ending date of the statement. - `claimFilingCode` '11' | '12' | '13' | '14' | '15' | '16' | '17' | 'AM' | 'BL' | 'CH' | 'CI' | 'DS' | 'FI' | 'HM' | 'LM' | 'MA' | 'MB' | 'MC' | 'OF' | 'TV' | 'VA' | 'WC' | 'ZZ', required — A code identifying the type of claim. For example `DS` - Disability. - Use `OF` when submitting Medicare Part D claims. - Use `ZZ` when you don't know the type of insurance. - Some payers reject claims with invalid codes. If you're not sure which code to use, we recommend running a [real-time eligibility check](https://www.stedi.com/docs/healthcare/api-reference/post-healthcare-eligibility) and using the value returned in the most relevant `benefitsInformation.insuranceTypeCode` property. Note that the eligibility response uses a different code list than claims, so you may need to map that code value to the appropriate claim filing code. Visit [Claims code lists](https://www.stedi.com/docs/healthcare/claims-code-lists#claim-filing-indicator-codes) for a complete list. - `claimFrequencyCode` string, required — Code specifying the frequency of the claim. Not all payers allow all codes. Can be set to `1` - Admit thru Discharge Claim, `2` - Interim – First Claim, `3` - Interim – Continuing Claim, `4` - Interim – Last Claim, `7` - Replacement, `8` - Void, and `9` - Final Claim for a Home Health PPS Episode. - The claim frequency code and patient status code (`claimInformation.claimCodeInformation.patientStatusCode`) must be compatible. For example, claim frequency code `1` (Admit thru Discharge Claim) means the patient’s stay is finished. In this case, the patient status code shouldn't be `30` (Still a Patient), which indicates the patient is still in the facility. - Set this to `7` when you need to resubmit a corrected claim that the payer has already processed. These are claims that the payer has already adjudicated or claims that the payer has rejected with a 277CA containing the Payer Claim Control Number (PCCN), indicating it has entered the payer's system. Note that Original Medicare doesn't accept code `7` for resubmissions, so you'll need to resubmit with the same code as the original claim. - When resubmitting with code `7` or voiding with code `8`, you must also include the Payer Claim Control Number (sometimes called the ICN) in the `claimInformation.claimSupplementalInformation.claimControlNumber` property. An exception is Original Medicare, which requires that you omit the Payer Claim Control Number from resubmissions. - For resubmissions and cancellations, we strongly recommend including a unique Patient Control Number in the `claimInformation.patientControlNumber` for tracking purposes. Visit [Resubmit or cancel claims](https://www.stedi.com/docs/healthcare/resubmit-cancel-claims) for complete details. - `claimNotes` ClaimNotes — Free-form information to substantiate the medical treatment that isn't provided elsewhere in the claim submission. Also used to provide narrative information from the forms Home Health Certification and Plan of Treatment or Medical Update and Patient Information, as needed to substantiate home health services. You can provide up to 10 strings in this array. - `additionalInformation` string[] - `allergies` string[] — Allergies - `diagnosisDescription` string[] — Diagnosis Description - `dme` string[] — Durable Medical Equipment (DME) and Supplies - `functionalLimitsOrReasonHomebound` string[] — Functional Limitations, Reason Homebound, or Both - `goalRehabOrDischargePlans` string[] — Goals, Rehabilitation Potential, or Discharge Plans - `medications` string[] — Medications - `nutritionalRequirments` string[] — Nutritional Requirements - `ordersForDiscipLinesAndTreatments` string[] — Orders for Disciplines and Treatments - `reasonsPatientLeavesHome` string[] — Reasons Patient Leaves Home - `safetyMeasures` string[] — Safety Measures - `supplementalPlanOfTreatment` string[] — Supplementary Plan of Treatment - `timesAndReasonsPatientNotAtHome` string[] — Times and Reasons Patient Not at Home - `unusualHomeOrSocialEnv` string[] — Unusual Home, Social Environment, or Both - `updatedInformation` string[] — Updated Information - `claimPricingInformation` ClaimPricingInformation - `exceptionCode` '1' | '2' | '3' | '4' | '5' | '6' — Code specifying the exception reason for consideration of out-of-network health care services. Can be set to `1` - Non-Network Professional Provider in Network Hospital, `2` - Emergency Care, `3` - Services or Specialist not in Network, `4` - Out-of-Service Area, `5` - State Mandates, or `6` - Other. - `policyComplianceCode` '1' | '2' | '3' | '4' | '5' - `pricingMethodologyCode` '00' | '01' | '02' | '03' | '04' | '05' | '06' | '07' | '08' | '09' | '10' | '11' | '12' | '13' | '14', required — Code indicating the pricing or repricing methodology. Visit [Claims code lists](https://www.stedi.com/docs/healthcare/claims-code-lists#pricing-methodology-codes-2) for a complete list. - `productOrServiceIDQualifier` 'ER' | 'HC' | 'HP' | 'IV' | 'WK' — Code identifying the type of product or service ID used. Can be set to `ER` - Jurisdiction Specific Procedure and Supply Codes, `HC` - Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes, `HP` - Health Insurance Prospective Payment System (HIPPS) Skilled Nursing Facility Rate Code, `IV` - Home Infusion EDI Coalition (HIEC) Product/Service Code, or `WK` - Advanced Billing Concepts (ABC) Codes. Note that ABC codes are deprecated and should not be used in new claims. If you provide this property, you must also provide `repricedApprovedHCPCSCode` Visit [Claims code lists](https://www.stedi.com/docs/healthcare/claims-code-lists#product-or-service-id-qualifier-codes) for a complete list and additional usage notes. - `rejectReasonCode` 'T1' | 'T2' | 'T3' | 'T4' | 'T5' | 'T6' - `repricedAllowedAmount` string, required — The allowed amount, expressed as a decimal. - `repricedApprovedAmount` string — The approved DRG amount, expressed as a decimal. - `repricedApprovedDRGCode` string — The approved DRG code. - `repricedApprovedHCPCSCode` string — The approved procedure code. If you provide this property, you must also include `productOrServiceIDQualifier`. - `repricedApprovedRevenueCode` string — The approved revenue code. - `repricedApprovedServiceUnitCode` 'DA' | 'UN' — The approved service units or inpatient days. Can be set to `DA` - Days or `UN` - Unit. - `repricedApprovedServiceUnitCount` string — The approved service units or inpatient days. The maximum length for this field is 8 digits excluding the decimal. When a decimal is used, the maximum number of digits allowed to the right of the decimal is three. - `repricedOrgIdentifier` string — The organization identification number. - `repricedPerDiem` string — The pricing rate associated with per diem or flat rate pricing, expressed as a decimal. - `repricedSavingAmount` string — The savings amount, expressed as a decimal. - `claimSupplementalInformation` InstitutionalClaimSupplementalInformation — Additional information or documentation required for the claim. This is where you can include information about [attachments](https://www.stedi.com/docs/healthcare/submit-claim-attachments), if applicable. - `adjustedRepricedClaimRefNumber` string — The adjusted repriced claim reference number. Required when the repricer believes this information is necessary. Providers should not complete this property. - `autoAccidentState` string — Required when the services reported on this claim are related to an auto accident and the accident occurred in a country or location that has a state, province, or sub-country code. - `claimControlNumber` string — This is the Payer Claim Control Number (PCCN) for an existing claim that this claim is meant to replace or cancel. This property is generally **required** when the `claimInformation.claimFrequencyCode` is set to `7` or `8`. One exception to this guidance is Original Medicare, which specifies that you omit the PCCN from resubmissions. Visit [Resubmit or cancel claims](https://www.stedi.com/docs/healthcare/resubmit-cancel-claims) for complete details and information about where to find the PCCN for an existing claim. - `claimNumber` string — The identifier assigned by clearinghouse, van, etc. when they need to assign their own unique claim number. Stedi overwrites this value when it sends the claim to the payer, so you shouldn't include this property in your request. We strongly recommend using the `claimInformation.patientControlNumber` property as your claim tracking ID. - `demoProjectIdentifier` string — Required when it is necessary to identify claims that are atypical in ways such as content, purpose, and/or payment. For example, claims made as the result of a demonstration or a clinical trial. - `investigationalDeviceExemptionNumber` string — Required when claim involves a Food and Drug Administration (FDA) assigned investigational device exemption (IDE) number. When more than one IDE applies, you must split into separate claims. - `medicalRecordNumber` string — Required when the provider needs to identify the actual medical record of the patient for this episode of care. - `peerReviewAuthorizationNumber` string — Required when an external Peer Review Organization assigns an Approval Number to services deemed medically necessary by that organization. - `priorAuthorizationNumber` string — Required when an authorization number is assigned by the payer or UMO _and_ the services on this claim were preauthorized. The UMO (Utilization Management Organization) is generally the entity empowered to decide the outcome of a health services review or the owner of the information. You can only send one prior authorization (preauthorization) number per claim. If different numbers apply to specific service lines, you must split those service lines into separate claims. - `referralNumber` string — Required when a referral number is assigned by the payer or Utilization Management Organization (UMO) and a referral is involved. This value applies to the entire claim unless overridden within a specific service line. - `reportInformation` InstitutionalReportInformation - `attachmentControlNumber` string — A control number assigned to the attachment. The payer uses this identifier to match the attachment to the claim. - You must include either this property or `attachmentId` in the request, but not both. Including both properties will result in an error. - We recommend using a ULID or UUID of up to 50 characters. - Stedi autogenerates a control number if you don't provide one. - `attachmentId` string — The unique identifier for the attachment file you previously uploaded to Stedi. This value is returned in the `attachmentId` property of the [Create Claim Attachment (275) JSON](https://www.stedi.com/docs/healthcare/api-reference/post-healthcare-submit-claim-attachment) response. Stedi uses it to generate and submit the 275 claim attachment transaction to the payer. - This property is **required** when you're submitting attachment files through Stedi. - You must include either this property or `attachmentControlNumber` in the request, but not both. Including both properties will result in an error. - `attachmentReportTypeCode` '03' | '04' | '05' | '06' | '07' | '08' | '09' | '10' | '11' | '13' | '15' | '21' | 'A3' | 'A4' | 'AM' | 'AS' | 'B2' | 'B3' | 'B4' | 'BR' | 'BS' | 'BT' | 'CB' | 'CK' | 'CT' | 'D2' | 'DA' | 'DB' | 'DG' | 'DJ' | 'DS' | 'EB' | 'HC' | 'HR' | 'I5' | 'IR' | 'LA' | 'M1' | 'MT' | 'NN' | 'OB' | 'OC' | 'OD' | 'OE' | 'OX' | 'OZ' | 'P4' | 'P5' | 'PE' | 'PN' | 'PO' | 'PQ' | 'PY' | 'PZ' | 'RB' | 'RR' | 'RT' | 'RX' | 'SG' | 'V5' | 'XP', required — Code indicating the title or contents of a document, report or supporting item. For example, `08` - Plan of Treatment or `CT` - Certification. Visit [Claims code lists](https://www.stedi.com/docs/healthcare/claims-code-lists#attachment-report-type-codes) for a complete list. - `attachmentTransmissionCode` 'AA' | 'BM' | 'EL' | 'EM' | 'FT' | 'FX', required — Code identifying the method by which the provider's report is attached. Can be set to `AA` - Available on Request at Provider Site, `BM` - By Mail, `EL` - Electronically Only, `EM` - E-Mail, `FT` - File Transfer, or `FX` - By Fax. - `reportInformations` InstitutionalReportInformation[] — An array of report information for the claim. Use this when you need to submit multiple report information records. You can submit up to 10 objects in this array. Required when you plan to submit [attachments](https://www.stedi.com/docs/healthcare/submit-claim-attachments) for the claim electronically through Stedi APIs or SFTP, when there is a paper attachment following this claim, or when the provider deems it necessary to identify that they have additional information at their office that is available upon request. - `attachmentControlNumber` string — A control number assigned to the attachment. The payer uses this identifier to match the attachment to the claim. - You must include either this property or `attachmentId` in the request, but not both. Including both properties will result in an error. - We recommend using a ULID or UUID of up to 50 characters. - Stedi autogenerates a control number if you don't provide one. - `attachmentId` string — The unique identifier for the attachment file you previously uploaded to Stedi. This value is returned in the `attachmentId` property of the [Create Claim Attachment (275) JSON](https://www.stedi.com/docs/healthcare/api-reference/post-healthcare-submit-claim-attachment) response. Stedi uses it to generate and submit the 275 claim attachment transaction to the payer. - This property is **required** when you're submitting attachment files through Stedi. - You must include either this property or `attachmentControlNumber` in the request, but not both. Including both properties will result in an error. - `attachmentReportTypeCode` '03' | '04' | '05' | '06' | '07' | '08' | '09' | '10' | '11' | '13' | '15' | '21' | 'A3' | 'A4' | 'AM' | 'AS' | 'B2' | 'B3' | 'B4' | 'BR' | 'BS' | 'BT' | 'CB' | 'CK' | 'CT' | 'D2' | 'DA' | 'DB' | 'DG' | 'DJ' | 'DS' | 'EB' | 'HC' | 'HR' | 'I5' | 'IR' | 'LA' | 'M1' | 'MT' | 'NN' | 'OB' | 'OC' | 'OD' | 'OE' | 'OX' | 'OZ' | 'P4' | 'P5' | 'PE' | 'PN' | 'PO' | 'PQ' | 'PY' | 'PZ' | 'RB' | 'RR' | 'RT' | 'RX' | 'SG' | 'V5' | 'XP', required — Code indicating the title or contents of a document, report or supporting item. For example, `08` - Plan of Treatment or `CT` - Certification. Visit [Claims code lists](https://www.stedi.com/docs/healthcare/claims-code-lists#attachment-report-type-codes) for a complete list. - `attachmentTransmissionCode` 'AA' | 'BM' | 'EL' | 'EM' | 'FT' | 'FX', required — Code identifying the method by which the provider's report is attached. Can be set to `AA` - Available on Request at Provider Site, `BM` - By Mail, `EL` - Electronically Only, `EM` - E-Mail, `FT` - File Transfer, or `FX` - By Fax. - `repricedClaimNumber` string — Required when the repricer believes this information is necessary. Providers should not complete this property. - `serviceAuthorizationExceptionCode` '1' | '2' | '3' | '4' | '5' | '6' | '7' — Code indicating the type of service authorization exception. Visit [Claims code lists](https://www.stedi.com/docs/healthcare/claims-code-lists#service-authorization-exception-codes) for a complete list. - `conditionCodes` ClaimInformationConditionCodesItem[] — Indicates the condition of the patient for EPSDT referral situations. Can be set to `AV` - Available-Not Used, `NU` - Not Used, `S2` - Under Treatment, `ST` - New Services Requested. - Use `AV` when the patient refused a referral. - Use `S2` when the patient is currently under treatment for the referred diagnostic or corrective health problem. - Use `ST` when the patient is referred to another provider for diagnostic or corrective treatment for at least one health problem identified during an initial or periodic screening service (not including dental referrals) OR the patient is scheduled for another appointment with the screening provider for diagnostic or corrective treatment for at least one health problem identified during an initial or periodic screening service (not including dental referrals). - `conditionCodesList` array[] — Required when there is a Condition Code that applies to this claim. This is an array of arrays of objects. You can provide up to two object arrays, and each array can contain up to 12 objects. - InstitutionalConditionInformation[] - `conditionCode` string, required — The condition code. - `delayReasonCode` '1' | '2' | '3' | '4' | '5' | '6' | '7' | '8' | '9' | '10' | '11' | '15' — Code indicating the reason for the delay in claim submission. Visit [Claims code lists](https://www.stedi.com/docs/healthcare/claims-code-lists#delay-reason-codes) for a complete list. - `diagnosisRelatedGroupInformation` DiagnosisRelatedGroupInformation - `drugRelatedGroupCode` string, required — The diagnosis related group code. - `epsdtReferral` EpsdtReferral — Required on Early & Periodic Screening, Diagnosis, and Treatment (EPSDT) claims when the screening service is being billed in this claim. - `certificationConditionCodeAppliesIndicator` 'N' | 'Y', required — Code indicating whether an EPSDT referral was given to the patient. Can be set to `N` - No or `Y` - Yes. - `conditionCodes` EpsdtReferralConditionCodesItem[], required — Code indicating the patient's status. Set to `AV` when the patient refused the referral. Set to `NU` when you set `certificationConditionCodeAppliesIndicator` to `N`. Set to `S2` when the patient is currently under treatment for the referred diagnostic or corrective health problem. Set to `ST` when _either_ the patient is referred to another provider for diagnostic or corrective treatment for at least one health problem identified during an initial or periodic screening service (not including dental referrals) _or_ the patient is scheduled for another appointment with the screening provider for diagnostic or corrective treatment for at least one health problem identified during an initial or periodic screening service (not including dental referrals). - `externalCauseOfInjuries` ExternalCauseOfInjury[] — Diagnosis codes to describe the patient's condition. Required when an external Cause of Injury is needed to describe an injury, poisoning, or adverse effect. Note that to fully describe an injury using ICD-10-CM, it will be necessary to report a series of 3 external cause of injury codes. Refer to the [ICD-10-CM Official Guidelines for Coding and Reporting](https://stacks.cdc.gov/view/cdc/158747). You can provide up to 12 objects in this array. - `externalCauseOfInjury` string, required — The external cause of injury code(s) for the patient. - You must submit a valid, billable code at the highest level of specificity. Include the 4th - 7th characters as applicable. - **Don't** submit the decimal point for ICD codes. The decimal point is implied. - **Don't** submit ICD-10 header codes. Header codes exist to group related codes and aren't valid for billing. These header codes can change with each new version of ICD-10, so we recommend reviewing your diagnosis codes every year to ensure that they aren't classified as header codes in the most recent version. To determine whether a code is a header code, you can also search the [Value Set Authority Center](https://vsac.nlm.nih.gov/context/cs). If the 'Header' property is set, the code is a header code and you shouldn't use it in claim submissions. - `presentOnAdmissionIndicator` 'N' | 'U' | 'Y' | 'W' — Indicates whether the external cause of injury was present on admission. Can be set to `N` - No (onset did NOT occur prior to admission to the hospital), `Y` - Yes (onset occurred prior to admission to the hospital), `U` - Unknown, or `W` - Not Applicable. - `qualifierCode` 'ABN' | 'BN', required — Code identifying the type of external cause of injury code used. Can be set to `ABN` - International Classification of Diseases Clinical Modification External Cause of Injury Code or `BN` - International Classification of Diseases Clinical Modification External Cause of Injury Code. Note that ICD-9 is deprecated and cannot be used in new claims. - `fileInformation` string[] — Used to send additional data specifically requested by the payer. Not commonly used. - `occurrenceInformationList` array[] — Required when there is a Occurrence Code that applies to this claim. This is an array of arrays of objects. You can provide up to two object arrays, and each array can contain up to 12 objects. - OccurrenceInformation[] - `occurrenceSpanCode` string, required — The occurrence span code. - `occurrenceSpanCodeDate` string, required — The date or date range for the occurrence span. - `occurrenceSpanInformations` array[] — Required when there is an Occurrence Span Code that applies to this claim. This is an array or arrays of objects. You can provide up to two object arrays and each array can contain up to 12 objects. - OccurrenceSpanInformation[] - `occurrenceSpanCode` string, required — The occurrence span code. - `occurrenceSpanCodeEndDate` string, required — The end date for the occurrence span. - `occurrenceSpanCodeStartDate` string, required — The start date for the occurrence span. - `otherDiagnosisInformationList` array[] — Additional diagnosis codes relevant to the claim. Required when other condition(s) coexist or develop(s) subsequently during the patient's treatment. This is an array of arrays of objects. You can provide up to two object arrays, and each object array can contain up to 12 objects. - OtherDiagnosisInformation[] - `otherDiagnosisCode` string, required — A diagnosis code for the patient. - You must submit a valid, billable code at the highest level of specificity. Include the 4th - 7th characters as applicable. - **Don't** submit the decimal point for ICD codes. The decimal point is implied. - **Don't** submit ICD-10 header codes. Header codes exist to group related codes and aren't valid for billing. These header codes can change with each new version of ICD-10, so we recommend reviewing your diagnosis codes every year to ensure that they aren't classified as header codes in the most recent version. To determine whether a code is a header code, you can also search the [Value Set Authority Center](https://vsac.nlm.nih.gov/context/cs). If the 'Header' property is set, the code is a header code and you shouldn't use it in claim submissions. - `presentOnAdmissionIndicator` 'N' | 'Y' | 'U' | 'W' - `qualifierCode` 'ABF' | 'BF', required — Code identifying the type of diagnosis code used. Can be set to `ABF` - International Classification of Diseases Clinical Modification (ICD-10-CM) or `BF` - International Classification of Diseases Clinical Modification (ICD-9-CM). Note that ICD-9 is deprecated and cannot be used in new claims. - `otherProcedureInformationList` array[] — Required on inpatient claims when additional procedures must be reported. This is an array of arrays of objects. You can provide up to two object arrays, and each array can contain up to 12 objects. - OtherProcedureInformation[] - `otherProcedureCode` string, required — The code from the code set specified in `qualifierCode`. Don't submit the decimal for ICD codes; the decimal is implied. - `otherProcedureDate` string — The date when the procedure was performed. - `qualifierCode` 'BBQ' | 'BQ', required - `otherSubscriberInformation` InstitutionalOtherSubscriberInformation — Required when other payers are known to potentially be involved in paying on this claim. This object contains information about other health plans under which the patient has coverage. It's used for coordination of benefits scenarios. - `benefitsAssignmentCertificationIndicator` 'N' | 'Y' | 'W', required - `claimFilingIndicatorCode` '11' | '12' | '13' | '14' | '15' | '16' | '17' | 'AM' | 'BL' | 'CH' | 'DS' | 'FI' | 'HM' | 'LM' | 'MA' | 'MB' | 'MC' | 'OF' | 'TV' | 'VA' | 'WC' | 'ZZ', required - `claimLevelAdjustments` InstitutionalClaimAdjustment[] — Supply adjustment reason codes and amounts as needed. Required when the claim has been adjudicated by the payer identified in this loop, and the claim has claim level adjustment information. Submitters must use this object to report prior payers' claim level adjustments that cause the amount paid to differ from the amount originally charged. Codes and associated amounts must come from either paper remittance advice or 835s (Electronic Remittance Advice) received on the claim. When the information originates from a paper remittance advice that does not use the standard Claim Adjustment Reason Codes, the paper values must be converted to standard Claim Adjustment Reason Codes. You can include up to five `claimLevelAdjustments` objects in this array. - `adjustmentGroupCode` 'CO' | 'CR' | 'OA' | 'PI' | 'PR', required — Code identifying the general category of payment adjustment. Can be set to `CO` - Contractual Obligations, `CR` - Correction and Reversals, `OA` - Other adjustments, `PI` - Payor Initiated Reductions, or `PR` - Patient Responsibility. - `claimAdjustmentDetails` InstitutionalClaimAdjustmentDetails[] — The adjustment reason, amount, and quantity. You can include up to six of these objects to describe a single `adjustmentGroupCode`. - `adjustmentAmount` string, required — The dollar amount of the adjustment, expressed as a decimal. - `adjustmentQuantity` string — The units of service being adjusted, expressed as a decimal. - `adjustmentReasonCode` string, required — Code identifying the detailed reason the adjustment was made. Visit the X12 [Claim Adjustment Reason Codes](https://x12.org/codes/claim-adjustment-reason-codes) for a complete list. - `groupNumber` string — The group number for the subscriber's health plan. Provide this property OR the `otherInsuredGroupName`, not both. If this property is set, Stedi ignores the `otherInsuredGroupName` property. - `individualRelationshipCode` '01' | '18' | '19' | '20' | '21' | '39' | '40' | '53' | 'G8', required - `medicareInpatientAdjudication` MedicareInpatientAdjudication - `capitalExceptionAmount` string — The capital exception amount, expressed as a decimal. - `capitalHSPDRGAmount` string — The Prospective Payment System (PPS) capital, hospital specific portion, Diagnosis Related Group (DRG) amount. Expressed as a decimal. - `claimDRGAmount` string — The Diagnosis Related Group (DRG) amount, expressed as a decimal. - `claimDisproportionateShareAmount` string — The disproportionate share amount, expressed as a decimal. - `claimIndirectTeachingAmount` string — The indirect teaching amount, expressed as a decimal. - `claimMspPassThroughAmount` string — The Medicare Secondary Payer (MSP) pass-through amount, expressed as a decimal. - `claimPaymentRemarkCode` string[] — The claim payment remark code. Refer to the X12 [Remittance Advice Remark Codes](https://x12.org/codes/remittance-advice-remark-codes) for a complete list. You can include up to four codes in this array. - `claimPpsCapitalAmount` string — The Prospective Payment System (PPS) capital amount, expressed as a decimal. - `claimPpsCapitalOutlierAmmount` string — The Prospective Payment System (PPS) capital outlier amount, expressed as a decimal. - `costReportDayCount` string — The number of cost report days, expressed as a decimal. - `coveredDaysOrVisitsCount` string, required — The number of covered days, expressed as a decimal. - `lifetimePsychiatricDaysCount` string — The number of lifetime psychiatric days, expressed as a decimal. - `nonPayableProfessionalComponentBilledAmount` string — The professional component amount billed but not payable, expressed as a decimal. - `oldCapitalAmount` string — The old capital amount, expressed as a decimal. - `ppsCapitalDshDrgAmount` string — The prospective Payment System (PPS) capital, disproportionate share, hospital Diagnosis Related Group (DRG) amount. Expressed as a decimal. - `ppsCapitalHspDrgAmount` string — The Prospective Payment System (PPS) capital, disproportionate share, hospital Diagnosis Related Group (DRG) amount. Expressed as a decimal. - `ppsCapitalImeAmount` string — The Prospective Payment System (PPS) capital Indirect Medical Education (IME) claim amount, expressed as a decimal. - `ppsOperatingFederalSpecificDrgAmount` string — The federal specific Diagnosis Related Group (DRG) amount, expressed as a decimal. - `ppsOperatingHospitalSpecificDrgAmount` string — The hospital specific Diagnosis Related Group (DRG) amount, expressed as a decimal. - `medicareOutpatientAdjudication` MedicareOutpatientAdjudication — Claim-level data related to the adjudication of Medicare claims not related to an inpatient setting. Required when outpatient adjudication information is reported in the remittance advice _or_ when you need to report remark codes. - `claimPaymentRemarkCode` string[] — The remark code. Visit the X12 [Remittance Advice Remark Codes](https://x12.org/codes/remittance-advice-remark-codes) for a complete list. You can include up to five codes in this array. - `endStageRenalDiseasePaymentAmount` string — The End-Stage Renal Disease (ESRD) payment amount, expressed as a decimal. - `hcpcsPayableAmount` string — The claim Health Care Financing Administration Common Procedural Coding System (HCPCS) payable amount, expressed as a decimal. - `nonPayableProfessionalComponentBilledAmount` string — The professional component amount billed but not payable, expressed as a decimal. - `reimbursementRate` string — The reimbursement percentage, expressed as a decimal. - `nonCoveredChargeAmount` string — Required when the destination payer's cost avoidance policy allows providers to bypass claim submission to the otherwise prior payer identified in `otherPayerName`. The amount must equal the total claim charge amount you reported in `claimInformation.claimChargeAmount`. - `otherInsuredGroupName` string — The name of the subscriber's health plan. Provide either this property OR the `groupNumber`, not both. If `groupNumber` is set, Stedi ignores this value and uses the value in `groupNumber`. - `otherPayerAttendingProvider` OtherPayerAttendingProvider — Information regarding the other payer's attending provider. The attending provider is the provider who is primarily responsible for the care of the patient. - `otherPayerAttendingProviderIdentifier` InstitutionalReferenceIdentification[], required — The provider's identifier. The `qualifier` can be set to `OB` - State License Number, `1G` - Provider UPIN Number, `G2` - Provider Commercial Number, or `LU` - Location Number. Note that UPIN numbers are deprecated and should not be used in new claims. - `identifier` string, required — The identifier specified in `qualifier`. - `qualifier` string, required — The code qualifying the type of `identifier`. - `otherPayerBillingProvider` InstitutionalOtherPayerBillingProvider — Information regarding the other payer's billing provider. - `otherPayerBillingProviderIdentifier` InstitutionalReferenceIdentification[], required — The provider's identifier. The `qualifier` can be set to `G2` - Provider Commercial Number or `LU` - Location Number. Note that UPIN numbers are deprecated and should not be used in new claims. - `identifier` string, required — The identifier specified in `qualifier`. - `qualifier` string, required — The code qualifying the type of `identifier`. - `otherPayerName` InstitutionalOtherPayerName, required - `otherInsuredAdditionalIdentifier` string - `otherPayerAddress` InstitutionalAddress - `address1` string, required — The first line of the street address. This typically contains the building number and street name. - `address2` string — The second line of the street address. This typically contains the apartment or suite number. - `city` string, required — The city name. - `countryCode` string — Use the alpha-2 country codes from Part 1 of ISO 3166. - `countrySubDivisionCode` string — Use the country subdivision codes from Part 2 of ISO 3166. - `postalCode` string — The postal zone or zip code. For United States addresses, you must include the full nine-digit zip code with no separators, such as `100031502`. If you don't know the full zip code, you can find it using the [USPS ZIP Code Lookup](https://tools.usps.com/zip-code-lookup.htm) tool. Exclude punctuation and spaces. - `state` string — The state or province code. Only required when the city is in the United States and Canada. - `otherPayerAdjudicationOrPaymentDate` string - `otherPayerClaimAdjustmentIndicator` boolean — Required when the claim is being sent in the payer-to-payer COB model, AND the destination payer is secondary to the payer identified in this object, AND the payer identified in this object re-adjudicated the claim. Can be set to `Y` - Yes. - `otherPayerClaimControlNumber` string — The other payer's claim control number for this claim. - `otherPayerIdentifier` string, required — The identifier specified in `otherPayerIdentifierTypeCode`. - `otherPayerIdentifierTypeCode` 'PI' | 'XV', required — Code specifying the type of identifier used for the other payer. Can be set to `PI` - Payor Identification or `XV` - Centers for Medicare and Medicaid Services PlanID. Use `XV` when reporting Health Plan ID (HPID) or Other Entity Identifier (OEID). - `otherPayerOrganizationName` string, required — The business name of the other payer. - `otherPayerPriorAuthorizationNumber` string — The other payer's prior authorization number. Required when this payer has assigned a prior authorization number to this claim. - `otherPayerPriorAuthorizationOrReferralNumber` string — The other payer's referral number. Required when this payer has assigned a referral number to this claim. - `otherPayerSecondaryIdentifier` InstitutionalReferenceIdentification[] — Additional identification number for the other payer. The `qualifier` property can be set to `2U` - Payer Identification Number, `EI` - Employer's Identification Number, `FY` - Claim Office Number, or `NF` - National Association of Insurance Commissioners (NAIC) Code. - `identifier` string, required — The identifier specified in `qualifier`. - `qualifier` string, required — The code qualifying the type of `identifier`. - `otherPayerOperatingPhysician` OtherPayerOperatingPhysician — Information regarding the other payer's operating physician. The operating physician is the provider who performed the procedure. - `otherPayerOperatingPhysicianIdentifier` InstitutionalReferenceIdentification[], required — The `qualifier` can be set to `OB` - State License Number, `1G` - Provider UPIN Number, `G2` - Provider Commercial Number, or `LU` - Location Number. Note that UPIN numbers are deprecated and should not be used in new claims. - `identifier` string, required — The identifier specified in `qualifier`. - `qualifier` string, required — The code qualifying the type of `identifier`. - `otherPayerOtherOperatingPhysician` OtherPayerOtherOperatingPhysician — Information regarding the other payer's other operating physician. The other operating physician is the provider who performed a secondary surgical procedure or assisted the `otherPayerOperatingPhysician`. - `otherPayerOtherOperatingPhysicianIdentifier` InstitutionalReferenceIdentification[], required — The physician's identifier. The `qualifier` can be set to `OB` - State License Number, `1G` - Provider UPIN Number, `G2` - Provider Commercial Number, or `LU` - Location Number. Note that UPIN numbers are deprecated and should not be used in new claims. - `identifier` string, required — The identifier specified in `qualifier`. - `qualifier` string, required — The code qualifying the type of `identifier`. - `otherPayerReferringProvider` InstitutionalOtherPayerReferringProvider — Information regarding the other payer's referring provider. This is the provider who sent the patient to another provider for services. - `otherPayerReferringProviderIdentifier` InstitutionalReferenceIdentification[], required — The provider's identifier. The `qualifier` can be set to `OB` - State License Number, `1G` - Provider UPIN Number, or `G2` - Provider Commercial Number. Note that UPIN numbers are deprecated and should not be used in new claims. - `identifier` string, required — The identifier specified in `qualifier`. - `qualifier` string, required — The code qualifying the type of `identifier`. - `otherPayerRenderingProvider` InstitutionalOtherPayerRenderingProvider — Information regarding the other payer's rendering provider. The rendering provider is the provider who performed the service or non-surgical procedure. - `otherPayerRenderingProviderIdentifier` InstitutionalReferenceIdentification[], required — The provider's identifier. The `qualifier` can be set to `OB` - State License Number, `1G` - Provider UPIN Number, `G2` - Provider Commercial Number, or `LU` - Location Number. Note that UPIN numbers are deprecated and should not be used in new claims. - `identifier` string, required — The identifier specified in `qualifier`. - `qualifier` string, required — The code qualifying the type of `identifier`. - `otherPayerServiceFacilityLocation` InstitutionalOtherPayerServiceFacilityLocation — Information regarding the other payer's service facility location. This is where the service was performed. - `otherPayerServiceFacilityLocationIdentifier` InstitutionalReferenceIdentification[], required — The facility's identifier. The `qualifier` can be set to `OB` - State License Number, `G2` - Provider Commercial Number, or `LU` - Location Number. - `identifier` string, required — The identifier specified in `qualifier`. - `qualifier` string, required — The code qualifying the type of `identifier`. - `otherSubscriberName` InstitutionalOtherSubscriberName, required - `address` InstitutionalAddress - `address1` string, required — The first line of the street address. This typically contains the building number and street name. - `address2` string — The second line of the street address. This typically contains the apartment or suite number. - `city` string, required — The city name. - `countryCode` string — Use the alpha-2 country codes from Part 1 of ISO 3166. - `countrySubDivisionCode` string — Use the country subdivision codes from Part 2 of ISO 3166. - `postalCode` string — The postal zone or zip code. For United States addresses, you must include the full nine-digit zip code with no separators, such as `100031502`. If you don't know the full zip code, you can find it using the [USPS ZIP Code Lookup](https://tools.usps.com/zip-code-lookup.htm) tool. Exclude punctuation and spaces. - `state` string — The state or province code. Only required when the city is in the United States and Canada. - `firstName` string - `otherInsuredAdditionalIdentifier` string[] — The subscriber's social security number (SSN). This must be a string of exactly nine numbers with no separators. - `otherInsuredFirstName` string — The subscriber's first name. - `otherInsuredIdentifier` string, required — The identifier specified in `otherInsuredIdentifierTypeCode`. - `otherInsuredIdentifierTypeCode` 'II' | 'MI', required — Code identifying the type of identifier used for the other insured. Can be set to `II` - Standard Unique Health Identifier for each Individual in the United States or `MI` - Member Identification Number. Note that `II` is deprecated and should not be used in new claims. - `otherInsuredLastName` string, required — The last name (when the subscriber is an individual) or the name of the organization (when the subscriber is an organization). **Don't** include the subscriber's name suffix, such as Jr. or III. Use the designated `otherInsuredSuffix` property instead. - `otherInsuredMiddleName` string — The subscriber's middle name or initial. - `otherInsuredQualifier` '1' | '2', required — Code identifying the type of entity. Can be set to `1` - Person or `2` - Non-Person Entity. - `otherInsuredSuffix` string — The subscriber's name suffix, such as Jr or III. Only include the subscriber's personal name suffix - **don't** include professional or academic titles, such as M.D. or MBA. - `payerPaidAmount` string — The total amount in dollars the payer has paid on this claim. It is acceptable to set this to `0` (Zero). This is required when you include the `payToPlan` object, and you should set it to the amount the Medicaid agency actually paid. - `paymentResponsibilityLevelCode` 'A' | 'B' | 'C' | 'D' | 'E' | 'F' | 'G' | 'H' | 'P' | 'S' | 'T' | 'U', required - `policyNumber` string — The policy number for the subscriber's health plan. - `releaseOfInformationCode` 'I' | 'Y', required — Code indicating whether the provider has on file a signed statement by the patient authorizing the release of medical data to other organizations. Can be set to `I` - Informed Consent to Release Medical Information or `Y` - Yes. Code `I` is required when the provider has not collected a signature AND state or federal laws do not require a signature be collected. Code `Y` is required when the provider has collected a signature OR when state or federal laws require a signature be collected. - `remainingPatientLiability` string — This is the remaining amount (as determined by the provider) to be paid after the other payer identified in the `otherPayerName` object has adjudicated the claim. Required when the other payer adjudicated the claim and provided claim level information only _or_ when the other payer adjudicated the claim, and the provider received a paper remittance advice, and the provider does not have the ability to report line item information. Don't include this property if you're specifying remaining patient liability at the service line level. - `patientAmountPaid` string - `patientControlNumber` string, required — An identifier you assign to the claim. We **strongly recommend** submitting a unique value for this property so that you can use it to correlate this claim with responses, such as the [277CA claim acknowledgment](https://www.stedi.com/docs/healthcare/receive-claim-responses#correlate-277ca) and the [835 ERA](https://www.stedi.com/docs/healthcare/receive-claim-responses#correlate-835-era). - Use random strings. The identifier should be more complex than a simple sequential number and should be hard to guess. Formats with patient initials or the date of service in them can create duplicates. We recommend using [nanoid](https://www.npmjs.com/package/nanoid) or a similar library configured with the characters from the [basic character set](https://www.stedi.com/docs/healthcare/submit-institutional-claims#character-restrictions) to generate unique IDs. - Keep it to 17 characters max. Some payers cut off values longer than 17 characters in 277CAs and ERAs, which makes it hard to match them with the original claim. - Use only characters available in the [basic character set](https://www.stedi.com/docs/healthcare/submit-institutional-claims#character-restrictions), and avoid special characters that are only available in the extended character set. Using other characters may result in data loss or mismatches when correlating claims with responses. - `patientEstimatedAmountDue` string — The total estimated amount the patient must pay for the services listed in this claim. Expressed as a decimal, such as `20.50`. This includes any co-payments, co-insurance, or other costs. - `patientReasonForVisits` PatientReasonForVisit[] — The diagnosis for which the patient visited an outpatient provider. Required when the claim involves outpatient visits. This may be different from the principal diagnosis. This is an array of objects and you can provide up to three objects. - `patientReasonForVisitCode` string, required — The patient's reason for visit code. - You must submit a valid, billable code at the highest level of specificity. Include the 4th - 7th characters as applicable. - **Don't** submit the decimal point for ICD codes. The decimal point is implied. - **Don't** submit ICD-10 header codes. Header codes exist to group related codes and aren't valid for billing. These header codes can change with each new version of ICD-10, so we recommend reviewing your diagnosis codes every year to ensure that they aren't classified as header codes in the most recent version. To determine whether a code is a header code, you can also search the [Value Set Authority Center](https://vsac.nlm.nih.gov/context/cs). If the 'Header' property is set, the code is a header code and you shouldn't use it in claim submissions. - `qualifierCode` 'APR' | 'PR', required — Code identifying the type of reason for visit code used. Can be set to `APR` - International Classification of Diseases Clinical Modification Patient's Reason for Visit or `PR` - International Classification of Diseases Clinical Modification Patient's Reason for Visit. Note that ICD-9 is deprecated and cannot be used in new claims. - `patientWeight` string - `placeOfServiceCode` string, required — Code identifying the type of facility where the services were or may be performed. This must be the two-digit facility type code from the National Uniform Billing Committee [Official UB-04 Data File](https://www.nubc.org/license) (FL 04 - Type of Bill Facility Codes). - `planParticipationCode` 'A' | 'B' | 'C', required — Code indicating whether the provider accepts assignment. This refers to whether the provider accepts assignment and/or has a participation agreement with the destination payer. It does not indicate whether the patient has assigned benefits to the provider. Can be set to `A` - Assigned, `B` - Assignment Accepted on Clinical Lab Services Only, or `C` - Not Assigned. Choose `A` when the provider accepts assignment and/or has a participation agreement with the destination payer, OR the provider does not accept assignment and/or have a participation agreement, but is advising the payer to adjudicate this specific claim under the participating provider benefits allowed under certain plans. - `principalDiagnosis` PrincipalDiagnosis, required - `presentOnAdmissionIndicator` 'N' | 'Y' | 'U' | 'W' — Indicates whether the principal diagnosis was present on admission. Can be set to `N` - No (onset did NOT occur prior to admission to the hospital), `Y` - Yes (onset occurred prior to admission to the hospital), `U` - Unknown, or `W` - Not Applicable. - `principalDiagnosisCode` string, required — The principal diagnosis code for the patient. - You must submit a valid, billable code at the highest level of specificity. Include the 4th - 7th characters as applicable. - **Don't** submit the decimal point for ICD codes. The decimal point is implied. - **Don't** submit ICD-10 header codes. Header codes exist to group related codes and aren't valid for billing. These header codes can change with each new version of ICD-10, so we recommend reviewing your diagnosis codes every year to ensure that they aren't classified as header codes in the most recent version. To determine whether a code is a header code, you can also search the [Value Set Authority Center](https://vsac.nlm.nih.gov/context/cs). If the 'Header' property is set, the code is a header code and you shouldn't use it in claim submissions. - `qualifierCode` 'ABK' | 'BK', required — Code identifying the type of diagnosis code used. Can be set to `ABK` - International Classification of Diseases Clinical Modification Principal Diagnosis or `BK` - International Classification of Diseases Clinical Modification (ICD-9-CM) Principal Diagnosis. Note that ICD-9 is deprecated and cannot be used in new claims. - `principalProcedureInformation` PrincipalProcedureInformation - `principalProcedureCode` string, required — The principal procedure code for the patient. It must be a valid code from the appropriate coding system. **Don't** submit the decimal for ICD codes; the decimal is implied. - `principalProcedureDate` string — The date when the procedure was performed. - `qualifierCode` 'BBR' | 'BR' | 'CAH', required — Code identifying the type of procedure code used. Can be set to `BBR` - International Classification of Diseases Clinical Modification (ICD-10-PCS) Principal Procedure Codes, `BR` - International Classification of Diseases Clinical Modification (ICD-9-CM) Principal Procedure Codes, or `CAH` - Advanced Billing Concepts (ABC) Codes. Note that ICD-9 and ABC codes are deprecated and cannot be used in new claims. - `propertyCasualtyClaimNumber` string — The agency claim number for this transaction. Used when services included in this claim are part of a property and casualty claim. This property is typically not used by Stedi customers. - `releaseInformationCode` 'I' | 'Y', required — Indicates whether the provider has on file a signed statement by the patient authorizing the release of medical data to other organizations. Can be set to `Y` - Yes, or `I` - Informed Consent to Release Medical Information for Conditions or Diagnoses Regulated by Federal Statues. Use `I` when the provider has not collected a signature AND state or federal laws do not require a signature be collected. - `serviceFacilityLocation` InstitutionalServiceFacilityLocation — The service facility location. Required when the location of healthcare services is different from the billing provider's address. - When an organization's healthcare provider's [NPI](https://www.stedi.com/docs/healthcare/national-provider-identifier) is provided to identify the service location, the organization healthcare provider must be external to the entity identified as the billing provider (for example, a reference lab). - The service location can't be a component or subpart of the billing provider entity. Only include this object when the service location is **different** from the billing provider's address. If you include this object when the address is the same, Stedi omits all of the service facility location information from the claim submission, including the name and any identifiers. - Sometimes the billing provider is an actual physician group that is located at the same address as a hospital, but is in fact a separate entity. In this case, you can differentiate the service facility location by including the specific suite or building number of the physician group. This ensures that the service facility location is different from the billing provider's address and is reported accurately. - `address` InstitutionalAddress, required - `address1` string, required — The first line of the street address. This typically contains the building number and street name. - `address2` string — The second line of the street address. This typically contains the apartment or suite number. - `city` string, required — The city name. - `countryCode` string — Use the alpha-2 country codes from Part 1 of ISO 3166. - `countrySubDivisionCode` string — Use the country subdivision codes from Part 2 of ISO 3166. - `postalCode` string — The postal zone or zip code. For United States addresses, you must include the full nine-digit zip code with no separators, such as `100031502`. If you don't know the full zip code, you can find it using the [USPS ZIP Code Lookup](https://tools.usps.com/zip-code-lookup.htm) tool. Exclude punctuation and spaces. - `state` string — The state or province code. Only required when the city is in the United States and Canada. - `identificationCode` string — The organization [National Provider Identifier (NPI)](https://www.stedi.com/docs/healthcare/national-provider-identifier) assigned to the service facility location. Required when the service location to be identified has an NPI and is not a component or subpart of the billing provider. - `organizationName` string, required — The business name of the laboratory or facility. - `secondaryIdentificationQualifierCode` '0B' | 'G2' | 'LU' — Code identifying the type of secondary identification. Can be set to `0B` - State License Number, `G2` - Provider Commercial Number, or `LU` - Location Number. - `secondaryIdentifier` string — The identifier specified in `secondaryIdentifierQualifierCode`. You can only include one secondary identifier for the service facility. - `serviceLines` InstitutionalServiceLine[], required — Information about one or more services rendered to the patient. - Each service line must be a unique service event as defined by the payer's billing policies. This means that you can use the same procedure code on multiple service lines as long as they are distinct events. - Some procedure codes are date-specific. In these cases, you may need to create a separate service line with that code for each applicable date of service, even if the episode of care extended over multiple days. - Service lines can share the same dates of service if the patient received multiple services on the same day. - `adjustedRepricedLineItemReferenceNumber` string — Required when a repricing (pricing) organization needs to have an identifying number on an adjusted service line in their submission to their payer organization. Providers shouldn't complete this property. - `assignedNumber` string — Stedi assigns this value automatically. It's a unique number identifying the service line within the claim. - `description` string — A free-form description to clarify information about the service line. You can use this to further describe the service/product/supply reported in the service line or for non-specific procedure codes. Non-specific procedure codes may include descriptors such as 'Not Otherwise Classified (NOC)', 'Unlisted', 'Unspecified', 'Other', 'Prescription Drug: Generic', 'Prescription Drug, Brand Name', or 'Miscellaneous'. - `drugIdentification` InstitutionalDrugIdentification - `linkSequenceNumber` string — The sequence number assigned to the drug or biologic. Required when the provided medication involves the compounding of two or more drugs being reported and there is no prescription number. The link sequence number is a provider-assigned number unique to this claim. Its purpose is to enable the receiver to piece together the components of the compound. Note that you can set either this property _or_ `pharmacyPrescriptionNumber`, but not both. - `measurementUnitCode` 'F2' | 'GR' | 'ME' | 'ML' | 'UN', required — Code identifying the unit of measure for the drug or biologic. Can be set to `F2` - International Unit, `GR` - Gram, `ME` - Milligram, `ML` - Milliliter, or `UN` - Unit. - `nationalDrugCode` string, required — The National Drug Code (NDC) number for the drug or biologic. This is a unique number that identifies the drug or biologic, including the labeler code, product code, and package code. The NDC number must be formatted as 5-4-2, with hyphens separating the three parts. For example, 12345-6789-01. - `nationalDrugUnitCount` string, required — The number of units of the drug or biologic, formtted as a decimal. - `pharmacyPrescriptionNumber` string — The prescription number assigned by the pharmacy. Required when dispensing of the drug has been done with an assigned prescription number. In cases where a compound drug is being billed, the components of the compound will all have the same prescription number. Payers receiving the claim can relate all the components by matching the prescription number. Note that you can set either this property _or_ `linkSequenceNumber`, but not both. - `facilityTaxAmount` string — The amount of the facility tax or surcharge, formatted as a decimal. Required when a facility tax applies to the service being reported. The `claimInformation.serviceLines[].institutionalService.lineItemChargeAmount` must include the amount you report here. - `institutionalService` InstitutionalService, required - `description` string — The description of the procedure identified in `procedureCode`. - `lineItemChargeAmount` string, required — The amount charged for the service line, expressed as a decimal. This should include the provider's base charge and any applicable tax amounts reported within the service line. - `measurementUnit` 'DA' | 'UN', required — The unit of measurement for the service. Can be set to `DA` - Days or `UN` - Unit. - `nonCoveredChargeAmount` string — The non-covered service amount, expressed as a decimal. This property isn't intended for sending claims to secondary insurance after receiving a remittance from the original payer. It's used when a provider wants to report that they performed an uncovered service for a patient, but they aren't asking for payment. For example, a cosmetic procedure that isn't covered by the patient's health plan. - `procedureCode` string — The procedure code. If you set this property, you must also set the `procedureIdentifier`. - `procedureIdentifier` 'ER' | 'HC' | 'HP' | 'IV' | 'WK' — Code identifying the type of `procedureCode`. If you set this property, you must also set `procedureCode`. Can be set to `ER` - Jurisdiction Specific Procedure and Supply Codes, `HC` - Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes, `HP` - Health Insurance Prospective Payment System (HIPPS) Skilled Nursing Facility Rate Code, `IV` - Home Infusion EDI Coalition (HIEC) Product/Service Code, or `WK` - Advanced Billing Concepts (ABC) Codes. Note that ABC codes are deprecated and shouldn't be used in new claims. Visit [Claims code lists](https://www.stedi.com/docs/healthcare/claims-code-lists#product-or-service-id-qualifier-codes) for more information and usage instructions. - `procedureModifiers` string[] — A modifier that conveys special circumstances related to the performance of the service. - `serviceLineRevenueCode` string, required — The identifying number for the product or service. Visit the [National Uniform Billing Committee (NUBC) Codes](https://www.nubc.org/license) documentation for a complete list. - `serviceUnitCount` string, required — The number of units of service provided. The maximum length for this property is 8 digits, excluding the decimal. When a decimal is used, the maximum number of digits allowed to the right of the decimal is 3. The units depend on the procedure code being billed and the nature of the service. For example, they may correspond to days (1 unit = 1 inpatient day), individual treatments or encounters (3 units = 3 dialysis sessions), or medication doses (2 units = 2 doses or vials). - `lineAdjudicationInformation` InstitutionalLineAdjudicationInformation[] — Includes service line adjudication information for coordination of benefits between the initial payers of a health care claim and all subsequent payers. - `adjudicationOrPaymentDate` string, required — The date the claim was paid. - `bundledLineNumber` string — The LX assigned number of the service line into which this service line is bundled. It's only used to bundle service lines. - `lineAdjustment` InstitutionalClaimAdjustment[] — Adjustment reason codes and amounts as needed for the service line. You can include up to five of these objects within `claimInformation.serviceLines[].lineAdjudicationInformation[].claimAdjustmentInformation`. - `adjustmentGroupCode` 'CO' | 'CR' | 'OA' | 'PI' | 'PR', required — Code identifying the general category of payment adjustment. Can be set to `CO` - Contractual Obligations, `CR` - Correction and Reversals, `OA` - Other adjustments, `PI` - Payor Initiated Reductions, or `PR` - Patient Responsibility. - `claimAdjustmentDetails` InstitutionalClaimAdjustmentDetails[] — The adjustment reason, amount, and quantity. You can include up to six of these objects to describe a single `adjustmentGroupCode`. - `adjustmentAmount` string, required — The dollar amount of the adjustment, expressed as a decimal. - `adjustmentQuantity` string — The units of service being adjusted, expressed as a decimal. - `adjustmentReasonCode` string, required — Code identifying the detailed reason the adjustment was made. Visit the X12 [Claim Adjustment Reason Codes](https://x12.org/codes/claim-adjustment-reason-codes) for a complete list. - `otherPayerPrimaryIdentifier` string, required — The payer ID for the payer responsible for reimbursement. - `paidServiceUnitCount` string, required — The number of paid units from the remittance advice. When paid units are not present on the remittance advice, use the original billed units. The maximum length for this property is 8 digits excluding the decimal. When a decimal is used, the maximum number of digits allowed to the right of the decimal is three. - `procedureCode` string — The procedure code. - `procedureCodeDescription` string — A description of the procedure identified in `procedureCode`. - `procedureModifier` string[] — A modifier that conveys special circumstances related to the performance of the service. - `productOrServiceIDQualifier` 'ER' | 'HC' | 'HP' | 'IV' | 'WK' — Code identifying the type of `procedureCode`. Can be set to `ER` - Jurisdiction Specific Procedure and Supply Codes, `HC` - Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes, `HP` - Health Insurance Prospective Payment System (HIPPS) Skilled Nursing Facility Rate Code, `IV` - Home Infusion EDI Coalition (HIEC) Product/Service Code, or `WK` - Advanced Billing Concepts (ABC) Codes. Note that ABC codes are deprecated and shouldn't be used in new claims. Visit [Claims code lists](https://www.stedi.com/docs/healthcare/claims-code-lists#product-or-service-id-qualifier-codes) for a complete list and usage guidelines. - `remainingPatientLiability` string — The remaining amount (as determined by the provider) to be paid after the other payer identified in the `otherPayerPrimaryIdentifier` property has adjudicated the claim. Expressed as a decimal. Only used in claims submitted by providers - not in payer-to-payer coordination of benefits (COB). Don't include this if you already provided `claimInformation.otherSubscriberInformation.remainingPatientLiability` for the claim. - `serviceLinePaidAmount` string, required — The amount paid for this service line, expressed as a decimal. Zero (0) is an acceptable value. - `serviceLineRevenueCode` string, required — The revenue code for the service line. - `lineAdjustmentInformation` LineAdjustmentInformation - `bundledOrUnbundledLineNumber` string - `claimAdjustment` InstitutionalClaimAdjustment - `adjustmentGroupCode` 'CO' | 'CR' | 'OA' | 'PI' | 'PR', required — Code identifying the general category of payment adjustment. Can be set to `CO` - Contractual Obligations, `CR` - Correction and Reversals, `OA` - Other adjustments, `PI` - Payor Initiated Reductions, or `PR` - Patient Responsibility. - `claimAdjustmentDetails` InstitutionalClaimAdjustmentDetails[] — The adjustment reason, amount, and quantity. You can include up to six of these objects to describe a single `adjustmentGroupCode`. - `adjustmentAmount` string, required — The dollar amount of the adjustment, expressed as a decimal. - `adjustmentQuantity` string — The units of service being adjusted, expressed as a decimal. - `adjustmentReasonCode` string, required — Code identifying the detailed reason the adjustment was made. Visit the X12 [Claim Adjustment Reason Codes](https://x12.org/codes/claim-adjustment-reason-codes) for a complete list. - `claimPaidDate` string, required - `otherPayerPrimaryIdentifier` string, required - `paidServiceUnitCount` string, required - `procedureCode` string, required - `procedureCodeDescription` string - `procedureModifiers` string[] - `remainingPatientLiability` string, required - `serviceIdQualifier` 'ER' | 'HC' | 'HP' | 'IV' | 'WK', required — Code identifying the type of `procedureCode`. Can be set to `ER` - Jurisdiction Specific Procedure and Supply Codes, `HC` - Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes, `HP` - Health Insurance Prospective Payment System (HIPPS) Skilled Nursing Facility Rate Code, `IV` - Home Infusion EDI Coalition (HIEC) Product/Service Code, or `WK` - Advanced Billing Concepts (ABC) Codes. Note that ABC codes are deprecated and shouldn't be used in new claims. Visit [Claims code lists](https://www.stedi.com/docs/healthcare/claims-code-lists#product-or-service-id-qualifier-codes) for a complete list and usage guidelines. - `serviceLinePaidAmount` string, required - `lineItemControlNumber` string — A unique identifier for this service line within the claim. It appears in the 835 (ERA) response as `lineItemControlNumber`, allowing you to correlate ERAs to the specific service lines from the original claim. If you don't set this property, Stedi uses a random ULID. Stedi returns service line identifiers in the `claimReference.serviceLines[].lineItemControlNumber` object of the synchronous API response. - `lineNoteText` string — Another way to provide additional information for comment or special instruction - same as `thirdPartyOrganizationNotes`. Required when the TPO/repricer needs to forward additional information to the payer. - `linePricingInformation` LinePricingInformation - `apgAmount` string - `apgCode` string - `exceptionCode` '1' | '2' | '3' | '4' | '5' | '6' — Code specifying the exception reason for consideration of out-of-network health care services. Can be set to `1` - Non-Network Professional Provider in Network Hospital, `2` - Emergency Care, `3` - Services or Specialist not in Network, `4` - Out-of-Service Area, `5` - State Mandates, or `6` - Other. - `flatRateAmount` string - `measurementUnitCode` 'DA' | 'UN' — The unit of measurement for the service. Can be set to `DA` - Days or `UN` - Unit. - `policyComplianceCode` '1' | '2' | '3' | '4' | '5' - `pricingMethodologyCode` '00' | '01' | '02' | '03' | '04' | '05' | '06' | '07' | '08' | '09' | '10' | '11' | '12' | '13' | '14', required — Code indicating the pricing or repricing methodology. Visit [Claims code lists](https://www.stedi.com/docs/healthcare/claims-code-lists#pricing-methodology-codes-2) for a complete list. - `rejectReasonCode` 'T1' | 'T2' | 'T3' | 'T4' | 'T5' | 'T6' - `repricedAllowedAmount` string, required - `repricedApprovedHCPCSCode` string - `repricedApprovedServiceUnitCount` string - `repricedOrganizationIdentifier` string - `repricedSavingAmount` string - `serviceIdQualifier` 'ER' | 'HC' | 'HP' | 'IV' | 'WK' — Code identifying the type of `procedureCode`. If you set this property, you must also set `procedureCode`. Can be set to `ER` - Jurisdiction Specific Procedure and Supply Codes, `HC` - Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes, `HP` - Health Insurance Prospective Payment System (HIPPS) Skilled Nursing Facility Rate Code, `IV` - Home Infusion EDI Coalition (HIEC) Product/Service Code, or `WK` - Advanced Billing Concepts (ABC) Codes. Note that ABC codes are deprecated and shouldn't be used in new claims. Visit [Claims code lists](https://www.stedi.com/docs/healthcare/claims-code-lists#product-or-service-id-qualifier-codes) for more information and usage instructions. - `lineRepricingInformation` ClaimPricingInformation - `exceptionCode` '1' | '2' | '3' | '4' | '5' | '6' — Code specifying the exception reason for consideration of out-of-network health care services. Can be set to `1` - Non-Network Professional Provider in Network Hospital, `2` - Emergency Care, `3` - Services or Specialist not in Network, `4` - Out-of-Service Area, `5` - State Mandates, or `6` - Other. - `policyComplianceCode` '1' | '2' | '3' | '4' | '5' - `pricingMethodologyCode` '00' | '01' | '02' | '03' | '04' | '05' | '06' | '07' | '08' | '09' | '10' | '11' | '12' | '13' | '14', required — Code indicating the pricing or repricing methodology. Visit [Claims code lists](https://www.stedi.com/docs/healthcare/claims-code-lists#pricing-methodology-codes-2) for a complete list. - `productOrServiceIDQualifier` 'ER' | 'HC' | 'HP' | 'IV' | 'WK' — Code identifying the type of product or service ID used. Can be set to `ER` - Jurisdiction Specific Procedure and Supply Codes, `HC` - Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes, `HP` - Health Insurance Prospective Payment System (HIPPS) Skilled Nursing Facility Rate Code, `IV` - Home Infusion EDI Coalition (HIEC) Product/Service Code, or `WK` - Advanced Billing Concepts (ABC) Codes. Note that ABC codes are deprecated and should not be used in new claims. If you provide this property, you must also provide `repricedApprovedHCPCSCode` Visit [Claims code lists](https://www.stedi.com/docs/healthcare/claims-code-lists#product-or-service-id-qualifier-codes) for a complete list and additional usage notes. - `rejectReasonCode` 'T1' | 'T2' | 'T3' | 'T4' | 'T5' | 'T6' - `repricedAllowedAmount` string, required — The allowed amount, expressed as a decimal. - `repricedApprovedAmount` string — The approved DRG amount, expressed as a decimal. - `repricedApprovedDRGCode` string — The approved DRG code. - `repricedApprovedHCPCSCode` string — The approved procedure code. If you provide this property, you must also include `productOrServiceIDQualifier`. - `repricedApprovedRevenueCode` string — The approved revenue code. - `repricedApprovedServiceUnitCode` 'DA' | 'UN' — The approved service units or inpatient days. Can be set to `DA` - Days or `UN` - Unit. - `repricedApprovedServiceUnitCount` string — The approved service units or inpatient days. The maximum length for this field is 8 digits excluding the decimal. When a decimal is used, the maximum number of digits allowed to the right of the decimal is three. - `repricedOrgIdentifier` string — The organization identification number. - `repricedPerDiem` string — The pricing rate associated with per diem or flat rate pricing, expressed as a decimal. - `repricedSavingAmount` string — The savings amount, expressed as a decimal. - `lineSupplementInformation` InstitutionalClaimSupplementalInformationServiceLine — Additional information or documentation required for the claim. This is where you can include information about [attachments](https://www.stedi.com/docs/healthcare/submit-claim-attachments), if applicable. - `adjustedRepricedClaimRefNumber` string - `autoAccidentState` string - `claimControlNumber` string - `claimNumber` string - `demoProjectIdentifier` string - `investigationalDeviceExemptionNumber` string - `medicalRecordNumber` string - `peerReviewAuthorizationNumber` string - `priorAuthorizationNumber` string - `referralNumber` string - `reportInformation` InstitutionalReportInformation - `attachmentControlNumber` string — A control number assigned to the attachment. The payer uses this identifier to match the attachment to the claim. - You must include either this property or `attachmentId` in the request, but not both. Including both properties will result in an error. - We recommend using a ULID or UUID of up to 50 characters. - Stedi autogenerates a control number if you don't provide one. - `attachmentId` string — The unique identifier for the attachment file you previously uploaded to Stedi. This value is returned in the `attachmentId` property of the [Create Claim Attachment (275) JSON](https://www.stedi.com/docs/healthcare/api-reference/post-healthcare-submit-claim-attachment) response. Stedi uses it to generate and submit the 275 claim attachment transaction to the payer. - This property is **required** when you're submitting attachment files through Stedi. - You must include either this property or `attachmentControlNumber` in the request, but not both. Including both properties will result in an error. - `attachmentReportTypeCode` '03' | '04' | '05' | '06' | '07' | '08' | '09' | '10' | '11' | '13' | '15' | '21' | 'A3' | 'A4' | 'AM' | 'AS' | 'B2' | 'B3' | 'B4' | 'BR' | 'BS' | 'BT' | 'CB' | 'CK' | 'CT' | 'D2' | 'DA' | 'DB' | 'DG' | 'DJ' | 'DS' | 'EB' | 'HC' | 'HR' | 'I5' | 'IR' | 'LA' | 'M1' | 'MT' | 'NN' | 'OB' | 'OC' | 'OD' | 'OE' | 'OX' | 'OZ' | 'P4' | 'P5' | 'PE' | 'PN' | 'PO' | 'PQ' | 'PY' | 'PZ' | 'RB' | 'RR' | 'RT' | 'RX' | 'SG' | 'V5' | 'XP', required — Code indicating the title or contents of a document, report or supporting item. For example, `08` - Plan of Treatment or `CT` - Certification. Visit [Claims code lists](https://www.stedi.com/docs/healthcare/claims-code-lists#attachment-report-type-codes) for a complete list. - `attachmentTransmissionCode` 'AA' | 'BM' | 'EL' | 'EM' | 'FT' | 'FX', required — Code identifying the method by which the provider's report is attached. Can be set to `AA` - Available on Request at Provider Site, `BM` - By Mail, `EL` - Electronically Only, `EM` - E-Mail, `FT` - File Transfer, or `FX` - By Fax. - `reportInformations` InstitutionalReportInformation[] — An array of report information for the claim. Use this when you need to submit multiple report information records. You can submit up to 10 objects in this array. Required when you plan to submit [attachments](https://www.stedi.com/docs/healthcare/submit-claim-attachments) for the claim electronically through Stedi APIs or SFTP, when there is a paper attachment following this claim, or when the provider deems it necessary to identify that they have additional information at their office that is available upon request. - `attachmentControlNumber` string — A control number assigned to the attachment. The payer uses this identifier to match the attachment to the claim. - You must include either this property or `attachmentId` in the request, but not both. Including both properties will result in an error. - We recommend using a ULID or UUID of up to 50 characters. - Stedi autogenerates a control number if you don't provide one. - `attachmentId` string — The unique identifier for the attachment file you previously uploaded to Stedi. This value is returned in the `attachmentId` property of the [Create Claim Attachment (275) JSON](https://www.stedi.com/docs/healthcare/api-reference/post-healthcare-submit-claim-attachment) response. Stedi uses it to generate and submit the 275 claim attachment transaction to the payer. - This property is **required** when you're submitting attachment files through Stedi. - You must include either this property or `attachmentControlNumber` in the request, but not both. Including both properties will result in an error. - `attachmentReportTypeCode` '03' | '04' | '05' | '06' | '07' | '08' | '09' | '10' | '11' | '13' | '15' | '21' | 'A3' | 'A4' | 'AM' | 'AS' | 'B2' | 'B3' | 'B4' | 'BR' | 'BS' | 'BT' | 'CB' | 'CK' | 'CT' | 'D2' | 'DA' | 'DB' | 'DG' | 'DJ' | 'DS' | 'EB' | 'HC' | 'HR' | 'I5' | 'IR' | 'LA' | 'M1' | 'MT' | 'NN' | 'OB' | 'OC' | 'OD' | 'OE' | 'OX' | 'OZ' | 'P4' | 'P5' | 'PE' | 'PN' | 'PO' | 'PQ' | 'PY' | 'PZ' | 'RB' | 'RR' | 'RT' | 'RX' | 'SG' | 'V5' | 'XP', required — Code indicating the title or contents of a document, report or supporting item. For example, `08` - Plan of Treatment or `CT` - Certification. Visit [Claims code lists](https://www.stedi.com/docs/healthcare/claims-code-lists#attachment-report-type-codes) for a complete list. - `attachmentTransmissionCode` 'AA' | 'BM' | 'EL' | 'EM' | 'FT' | 'FX', required — Code identifying the method by which the provider's report is attached. Can be set to `AA` - Available on Request at Provider Site, `BM` - By Mail, `EL` - Electronically Only, `EM` - E-Mail, `FT` - File Transfer, or `FX` - By Fax. - `repricedClaimNumber` string - `serviceAuthorizationExceptionCode` '1' | '2' | '3' | '4' | '5' | '6' | '7' — Code indicating the type of service authorization exception. Visit [Claims code lists](https://www.stedi.com/docs/healthcare/claims-code-lists#service-authorization-exception-codes) for a complete list. - `operatingPhysician` OperatingPhysician - `firstName` string — The physician's first name. - `identificationQualifierCode` '0B' | '1G' | 'G2' | 'LU' — The type of identifier used in `secondaryIdentifier`. Can be set to `0B` - State License Number, `1G` - Provider UPIN Number, `G2` - Provider Commercial Number, or `LU` - Location Number. Note that UPIN is deprecated and should not be used. - `lastName` string, required — The physician's last name. - `middleName` string — The physician's middle name or initial. - `npi` string — The individual [National Provider Identifier (NPI)](https://www.stedi.com/docs/healthcare/national-provider-identifier) assigned to the physician. - `organizationName` string — The physician's business name. - `secondaryIdentifier` string — The identifier specified in `identificationQualifierCode`. You can only include one secondary identifier for the provider. - `suffix` string — The physician's name suffix, such as Jr. or III. - `otherOperatingPhysician` OperatingPhysician - `firstName` string — The physician's first name. - `identificationQualifierCode` '0B' | '1G' | 'G2' | 'LU' — The type of identifier used in `secondaryIdentifier`. Can be set to `0B` - State License Number, `1G` - Provider UPIN Number, `G2` - Provider Commercial Number, or `LU` - Location Number. Note that UPIN is deprecated and should not be used. - `lastName` string, required — The physician's last name. - `middleName` string — The physician's middle name or initial. - `npi` string — The individual [National Provider Identifier (NPI)](https://www.stedi.com/docs/healthcare/national-provider-identifier) assigned to the physician. - `organizationName` string — The physician's business name. - `secondaryIdentifier` string — The identifier specified in `identificationQualifierCode`. You can only include one secondary identifier for the provider. - `suffix` string — The physician's name suffix, such as Jr. or III. - `referringProvider` InstitutionalServiceLineReferringProvider — Information about the provider who referred the patient for care. - Include this object only when the referring provider is different than the provider listed in the `attending` object. - This should be an individual, not an organization, and you should supply at least the provider's `lastName` and an identifier, which is typically the `npi`. - `address` InstitutionalAddress - `address1` string, required — The first line of the street address. This typically contains the building number and street name. - `address2` string — The second line of the street address. This typically contains the apartment or suite number. - `city` string, required — The city name. - `countryCode` string — Use the alpha-2 country codes from Part 1 of ISO 3166. - `countrySubDivisionCode` string — Use the country subdivision codes from Part 2 of ISO 3166. - `postalCode` string — The postal zone or zip code. For United States addresses, you must include the full nine-digit zip code with no separators, such as `100031502`. If you don't know the full zip code, you can find it using the [USPS ZIP Code Lookup](https://tools.usps.com/zip-code-lookup.htm) tool. Exclude punctuation and spaces. - `state` string — The state or province code. Only required when the city is in the United States and Canada. - `commercialNumber` string - `contactInformation` InstitutionalContactInformation - `email` string — The email address. - `faxNumber` string — The fax number. - `name` string, required — The full name of the person or office. - `phoneNumber` string — The phone number, formatted as AAABBBCCCC, where AAA represents the area code, BBB is the telephone number prefix, and CCCC is the telephone number. The phone number should only include the digits 0 to 9. Don't include separators, such as dashes, and don't include long distance access numbers, such as 1. For example, you would format the phone number 123-456-7890 as 1234567890. - `validContact` boolean - `employerId` string - `firstName` string — The provider's first name. - `lastName` string — The provider's last name. - `locationNumber` string - `middleName` string — The provider's middle name or initial. - `npi` string — The individual [National Provider Identifier (NPI)](https://www.stedi.com/docs/healthcare/national-provider-identifier) assigned to the provider. - `organizationName` string — The provider's business name. - `providerType` 'ReferringProvider' — Defines the referring provider type. - `providerUpinNumber` string - `referenceIdentification` InstitutionalReferenceIdentification[] — Additional identifiers for the provider. You can set `qualifier` to `2U` - Payer Identification Number. - `identifier` string, required — The identifier specified in `qualifier`. - `qualifier` string, required — The code qualifying the type of `identifier`. - `secondaryIdentificationQualifierCode` '0B' | '1G' | 'G2' — The type of identifier used in `secondaryIdentifier`. Can be set to `0B` - State License Number, `1G` - Provider UPIN Number, or `G2` - Provider Commercial Number. Note that UPIN is deprecated and should not be used. - `secondaryIdentifier` string — The identifier specified in `secondaryIdentifierQualifierCode`. You can only include one secondary identifier for the provider. - `stateLicenseNumber` string - `suffix` string — The provider's suffix, such as Jr. or Sr. - `taxonomyCode` string - `renderingProvider` InstitutionalServiceLineRenderingProvider — Information about the provider who delivered the medical services or non-surgical procedures in this service line. This must be an individual, not an organization, and you must include the provider's `lastName` and an identifier, which is typically the `npi`. The provider's `firstName` is also required, if applicable. Include this object when the following are both true: - The rendering provider for this service line is different than the provider listed in the `attending` and `rendering` objects for the entire claim. - State or federal regulatory requirements call for a combined claim. A combined claim includes both facility and professional components, such as a Medicaid clinic bill or a critical access hospital claim. - `address` InstitutionalAddress - `address1` string, required — The first line of the street address. This typically contains the building number and street name. - `address2` string — The second line of the street address. This typically contains the apartment or suite number. - `city` string, required — The city name. - `countryCode` string — Use the alpha-2 country codes from Part 1 of ISO 3166. - `countrySubDivisionCode` string — Use the country subdivision codes from Part 2 of ISO 3166. - `postalCode` string — The postal zone or zip code. For United States addresses, you must include the full nine-digit zip code with no separators, such as `100031502`. If you don't know the full zip code, you can find it using the [USPS ZIP Code Lookup](https://tools.usps.com/zip-code-lookup.htm) tool. Exclude punctuation and spaces. - `state` string — The state or province code. Only required when the city is in the United States and Canada. - `commercialNumber` string - `contactInformation` InstitutionalContactInformation - `email` string — The email address. - `faxNumber` string — The fax number. - `name` string, required — The full name of the person or office. - `phoneNumber` string — The phone number, formatted as AAABBBCCCC, where AAA represents the area code, BBB is the telephone number prefix, and CCCC is the telephone number. The phone number should only include the digits 0 to 9. Don't include separators, such as dashes, and don't include long distance access numbers, such as 1. For example, you would format the phone number 123-456-7890 as 1234567890. - `validContact` boolean - `employerId` string - `firstName` string — The provider's first name. - `lastName` string — The provider's last name. - `locationNumber` string - `middleName` string — The provider's middle name or initial. - `npi` string — The individual [National Provider Identifier (NPI)](https://www.stedi.com/docs/healthcare/national-provider-identifier) assigned to the provider. - `organizationName` string — The provider's business name. - `providerType` 'RenderingProvider' — Defines the rendering provider type. - `providerUpinNumber` string - `referenceIdentification` InstitutionalReferenceIdentification[] — Additional identifiers for the provider. You can set `qualifier` to `2U` - Payer Identification Number. - `identifier` string, required — The identifier specified in `qualifier`. - `qualifier` string, required — The code qualifying the type of `identifier`. - `secondaryIdentificationQualifierCode` '0B' | '1G' | 'G2' | 'LU' — The type of identifier used in `secondaryIdentifier`. Can be set to `0B` - State License Number, `1G` - Provider UPIN Number, `G2` - Provider Commercial Number, or `LU` - Location Number. Note that UPIN is deprecated and should not be used. - `secondaryIdentifier` string — The identifier specified in `secondaryIdentifierQualifierCode`. You can only include one secondary identifier for the provider. - `stateLicenseNumber` string - `suffix` string — The provider's suffix, such as Jr. or Sr. - `taxonomyCode` string - `repricedLineItemReferenceNumber` string — Required when a repricing (pricing) organization needs to have an identifying number on the service line in their submission to their payer organization. - `serviceDate` string — Either a single date of service or the beginning of a range of service dates. If a range is provided, the end date should be provided in `serviceDateEnd`. This property is required on outpatient service lines where a drug is not being billed and the Statement Covers Period is greater than one day. It's also required when a drug is being billed and the payer's adjudication is known to be impacted by the drug duration or the date the prescription was written. In cases where a drug is being billed on a service line, this property may be used to indicate the date the prescription was written (or otherwise communicated by the prescriber if not written). This property may also be used to indicate the beginning of the duration for which the drug supply will be used by the patient. The difference in dates, including both the begin and end dates, are the days supply of the drug. Example: 20000101-20000107 (1/1/00 to 1/7/00) is used for a 7 day supply where the first day of the drug used by the patient is 1/1/00. In the event a drug is administered on less than a daily basis (for example, every other day) the date range would include the entire period during which the drug was supplied, including the last day the drug was used. Example: 20000101-20000108 (1/1/00 to 1/8/00) is used for an 8 days supply where the prescription is written for Q48 (every 48 hours), four doses of the drug are dispensed and the first dose is used on 1/1/00. - `serviceDateEnd` string — The end of a range of service dates. If you include this property, you must also include `serviceDate` to indicate the beginning of the range. - `serviceLineDateInformation` InstitutionalServiceLineDateInformation - `beginServiceDate` string - `endServiceDate` string - `serviceDate` string - `validDateInformation` boolean - `serviceLineReferenceInformation` union — Additional identifiers for the service line. We **strongly recommend** setting the `providerControlNumber` property for each service line within the claim. - object - `providerControlNumber` string, required — A unique identifier for this service line within the claim. It appears in the 835 (ERA) response as `lineItemControlNumber`, allowing you to correlate ERAs to the specific service lines from the original claim. We **strongly recommend** setting this property for every service line within the claim. We also recommend using a [ULID](https://github.com/ulid/spec) instead of a UUID because payers are only required to store up to 30 characters for this value. - object - `repricedLineItemRefNumber` string, required — Required when a repricing (pricing) organization needs to have an identifying number on the service line in their submission to their payer organization. Providers shouldn't complete this property. - object - `adjustedRepricedLineItemRefNumber` string, required — Required when a repricing (pricing) organization needs to have an identifying number on an adjusted service line in their submission to their payer organization. Providers shouldn't complete this property. - `serviceLineSupplementalInformation` InstitutionalServiceLineSupplementalInformation - `attachmentControlNumber` string — A control number assigned to the attachment. The payer uses this identifier to match the attachment to the claim. - You must include either this property or `attachmentId` in the request, but not both. Including both properties will result in an error. - We recommend using a ULID or UUID of up to 50 characters. - Stedi autogenerates a control number if you don't provide one. - `attachmentId` string — The unique identifier for the attachment file you previously uploaded to Stedi. This value is returned in the `attachmentId` property of the [Create Claim Attachment (275) JSON](https://www.stedi.com/docs/healthcare/api-reference/post-healthcare-submit-claim-attachment) response. Stedi uses it to generate and submit the 275 claim attachment transaction to the payer. - This property is **required** when you're submitting attachment files through Stedi. - You must include either this property or `attachmentControlNumber` in the request, but not both. Including both properties will result in an error. - `attachmentReportTypeCode` '03' | '04' | '05' | '06' | '07' | '08' | '09' | '10' | '11' | '13' | '15' | '21' | 'A3' | 'A4' | 'AM' | 'AS' | 'B2' | 'B3' | 'B4' | 'BR' | 'BS' | 'BT' | 'CB' | 'CK' | 'CT' | 'D2' | 'DA' | 'DB' | 'DG' | 'DJ' | 'DS' | 'EB' | 'HC' | 'HR' | 'I5' | 'IR' | 'LA' | 'M1' | 'MT' | 'NN' | 'OB' | 'OC' | 'OD' | 'OE' | 'OX' | 'OZ' | 'P4' | 'P5' | 'PE' | 'PN' | 'PO' | 'PQ' | 'PY' | 'PZ' | 'RB' | 'RR' | 'RT' | 'RX' | 'SG' | 'V5' | 'XP', required — Code indicating the title or contents of a document, report or supporting item. For example, `08` - Plan of Treatment or `CT` - Certification. Visit [Claims code lists](https://www.stedi.com/docs/healthcare/claims-code-lists#attachment-report-type-codes) for a complete list. - `attachmentTransmissionCode` 'AA' | 'BM' | 'EL' | 'EM' | 'FT' | 'FX', required — Code indicating the method by which the attachment was transmitted. Can be set to `AA` - Available on Request at Provider Site, `BM` - By Mail, `EL` - Electronically Only, `EM` - E-Mail, `FT` - File Transfer, or `FX` - By Fax. - `serviceLineSupplementalInformations` InstitutionalServiceLineSupplementalInformation[] — An array of supplemental information for the service line. This is the array version of the `serviceLineSupplementalInformation` property. This array is required when you plan to submit multiple [attachments](https://www.stedi.com/docs/healthcare/submit-claim-attachments) for the service line electronically through Stedi APIs or SFTP, when there is a paper attachment following this claim, or when the provider deems it necessary to identify additional information that is being held at the provider's office and is available upon request. You can submit up to 10 objects in this array. - `attachmentControlNumber` string — A control number assigned to the attachment. The payer uses this identifier to match the attachment to the claim. - You must include either this property or `attachmentId` in the request, but not both. Including both properties will result in an error. - We recommend using a ULID or UUID of up to 50 characters. - Stedi autogenerates a control number if you don't provide one. - `attachmentId` string — The unique identifier for the attachment file you previously uploaded to Stedi. This value is returned in the `attachmentId` property of the [Create Claim Attachment (275) JSON](https://www.stedi.com/docs/healthcare/api-reference/post-healthcare-submit-claim-attachment) response. Stedi uses it to generate and submit the 275 claim attachment transaction to the payer. - This property is **required** when you're submitting attachment files through Stedi. - You must include either this property or `attachmentControlNumber` in the request, but not both. Including both properties will result in an error. - `attachmentReportTypeCode` '03' | '04' | '05' | '06' | '07' | '08' | '09' | '10' | '11' | '13' | '15' | '21' | 'A3' | 'A4' | 'AM' | 'AS' | 'B2' | 'B3' | 'B4' | 'BR' | 'BS' | 'BT' | 'CB' | 'CK' | 'CT' | 'D2' | 'DA' | 'DB' | 'DG' | 'DJ' | 'DS' | 'EB' | 'HC' | 'HR' | 'I5' | 'IR' | 'LA' | 'M1' | 'MT' | 'NN' | 'OB' | 'OC' | 'OD' | 'OE' | 'OX' | 'OZ' | 'P4' | 'P5' | 'PE' | 'PN' | 'PO' | 'PQ' | 'PY' | 'PZ' | 'RB' | 'RR' | 'RT' | 'RX' | 'SG' | 'V5' | 'XP', required — Code indicating the title or contents of a document, report or supporting item. For example, `08` - Plan of Treatment or `CT` - Certification. Visit [Claims code lists](https://www.stedi.com/docs/healthcare/claims-code-lists#attachment-report-type-codes) for a complete list. - `attachmentTransmissionCode` 'AA' | 'BM' | 'EL' | 'EM' | 'FT' | 'FX', required — Code indicating the method by which the attachment was transmitted. Can be set to `AA` - Available on Request at Provider Site, `BM` - By Mail, `EL` - Electronically Only, `EM` - E-Mail, `FT` - File Transfer, or `FX` - By Fax. - `serviceTaxAmount` string — The amount of the service tax or surcharge, formatted as a decimal. Required when a service tax or surcharge applies to the service being reported. The `claimInformation.serviceLines[].institutionalService.lineItemChargeAmount` must include the amount you report here. - `thirdPartyOrganizationNotes` string — To provide additional information for comment or special instruction. Required when the TPO/repricer needs to forward additional information to the payer. - `signatureIndicator` string - `treatmentCodeInformationList` array[] — Required when Home Health Agencies need to report Plan of Treatment information under various payer contracts. This is an array of arrays of strings. You can provide up to two string arrays, and each array can contain up to 12 strings. Each string represents one treatment code. - string[] - `valueInformationList` array[] — Required when there is a Value Code that applies to this claim. This is an array of arrays of objects. You can provide up to two object arrays, and each array can contain up to 12 objects. - ValueInformation[] - `valueCode` string, required — The value code. - `valueCodeAmount` string, required — The monetary amount associated with the value code, expressed as a decimal. - `controlNumber` string — Not currently used. - `dependent` InstitutionalDependent - `address` InstitutionalAddress - `address1` string, required — The first line of the street address. This typically contains the building number and street name. - `address2` string — The second line of the street address. This typically contains the apartment or suite number. - `city` string, required — The city name. - `countryCode` string — Use the alpha-2 country codes from Part 1 of ISO 3166. - `countrySubDivisionCode` string — Use the country subdivision codes from Part 2 of ISO 3166. - `postalCode` string — The postal zone or zip code. For United States addresses, you must include the full nine-digit zip code with no separators, such as `100031502`. If you don't know the full zip code, you can find it using the [USPS ZIP Code Lookup](https://tools.usps.com/zip-code-lookup.htm) tool. Exclude punctuation and spaces. - `state` string — The state or province code. Only required when the city is in the United States and Canada. - `dateOfBirth` string, required — The patient's date of birth. - `firstName` string, required — The patient's first name. - `gender` 'M' | 'F' | 'U', required - `lastName` string, required — The patient's last name. **Don't** include the patient's name suffix, such as Jr. or III. Use the designated `suffix` property instead. - `middleName` string — The patient's middle name or initial. - `relationshipToSubscriberCode` '01' | '19' | '20' | '21' | '39' | '40' | '53' | 'G8', required — Identifies the relationship of the patient to the subscriber. Can be set to `01` - Spouse, `19` - Child, `20` - Employee, `21` - Unknown, `39` - Organ Donor, `40` - Cadaver Donor, `53` - Life Partner, or `G8` - Other Relationship. - `ssn` string — The patient's Social Security Number. Only used for Property and Casualty claims. - `suffix` string — The patient's name suffix, such as Jr. or III. Only include the patient's personal name suffix - **don't** include professional or academic titles, such as M.D. or MBA. - `operatingPhysician` OperatingPhysician - `firstName` string — The physician's first name. - `identificationQualifierCode` '0B' | '1G' | 'G2' | 'LU' — The type of identifier used in `secondaryIdentifier`. Can be set to `0B` - State License Number, `1G` - Provider UPIN Number, `G2` - Provider Commercial Number, or `LU` - Location Number. Note that UPIN is deprecated and should not be used. - `lastName` string, required — The physician's last name. - `middleName` string — The physician's middle name or initial. - `npi` string — The individual [National Provider Identifier (NPI)](https://www.stedi.com/docs/healthcare/national-provider-identifier) assigned to the physician. - `organizationName` string — The physician's business name. - `secondaryIdentifier` string — The identifier specified in `identificationQualifierCode`. You can only include one secondary identifier for the provider. - `suffix` string — The physician's name suffix, such as Jr. or III. - `otherOperatingPhysician` OperatingPhysician - `firstName` string — The physician's first name. - `identificationQualifierCode` '0B' | '1G' | 'G2' | 'LU' — The type of identifier used in `secondaryIdentifier`. Can be set to `0B` - State License Number, `1G` - Provider UPIN Number, `G2` - Provider Commercial Number, or `LU` - Location Number. Note that UPIN is deprecated and should not be used. - `lastName` string, required — The physician's last name. - `middleName` string — The physician's middle name or initial. - `npi` string — The individual [National Provider Identifier (NPI)](https://www.stedi.com/docs/healthcare/national-provider-identifier) assigned to the physician. - `organizationName` string — The physician's business name. - `secondaryIdentifier` string — The identifier specified in `identificationQualifierCode`. You can only include one secondary identifier for the provider. - `suffix` string — The physician's name suffix, such as Jr. or III. - `payerAddress` InstitutionalAddress - `address1` string, required — The first line of the street address. This typically contains the building number and street name. - `address2` string — The second line of the street address. This typically contains the apartment or suite number. - `city` string, required — The city name. - `countryCode` string — Use the alpha-2 country codes from Part 1 of ISO 3166. - `countrySubDivisionCode` string — Use the country subdivision codes from Part 2 of ISO 3166. - `postalCode` string — The postal zone or zip code. For United States addresses, you must include the full nine-digit zip code with no separators, such as `100031502`. If you don't know the full zip code, you can find it using the [USPS ZIP Code Lookup](https://tools.usps.com/zip-code-lookup.htm) tool. Exclude punctuation and spaces. - `state` string — The state or province code. Only required when the city is in the United States and Canada. - `providers` InstitutionalProvidersObject[] — Another way to send information for each provider relevant to the claim. This object overwrites the information you send in the `billing`, `referring`, `rendering`, and `attending` objects. Note that your request **must** include information about the billing provider either here or within the `billing` object. - `address` InstitutionalAddress - `address1` string, required — The first line of the street address. This typically contains the building number and street name. - `address2` string — The second line of the street address. This typically contains the apartment or suite number. - `city` string, required — The city name. - `countryCode` string — Use the alpha-2 country codes from Part 1 of ISO 3166. - `countrySubDivisionCode` string — Use the country subdivision codes from Part 2 of ISO 3166. - `postalCode` string — The postal zone or zip code. For United States addresses, you must include the full nine-digit zip code with no separators, such as `100031502`. If you don't know the full zip code, you can find it using the [USPS ZIP Code Lookup](https://tools.usps.com/zip-code-lookup.htm) tool. Exclude punctuation and spaces. - `state` string — The state or province code. Only required when the city is in the United States and Canada. - `contactInformation` InstitutionalContactInformation - `email` string — The email address. - `faxNumber` string — The fax number. - `name` string, required — The full name of the person or office. - `phoneNumber` string — The phone number, formatted as AAABBBCCCC, where AAA represents the area code, BBB is the telephone number prefix, and CCCC is the telephone number. The phone number should only include the digits 0 to 9. Don't include separators, such as dashes, and don't include long distance access numbers, such as 1. For example, you would format the phone number 123-456-7890 as 1234567890. - `validContact` boolean - `employerId` string — The provider's employer ID, also known as an EIN or TIN. Must be a string of exactly nine numbers with no separators. This is **required** for the billing provider, and doesn’t apply to other provider types. - `firstName` string — The provider's first name. - `lastName` string — The provider's last name. - `middleName` string — The provider's middle name or initial. - `npi` string — The [National Provider Identifier (NPI)](https://www.stedi.com/docs/healthcare/national-provider-identifier) of the provider. Note that this is **required** for billing providers that have an NPI assigned. - `organizationName` string — The provider's business name, when the provider is not an individual. - `providerType` 'BillingProvider' | 'AttendingProvider' | 'ReferringProvider' | 'RenderingProvider', required - `secondaryIdentificationQualifierCode` '0B' | '1G' | 'G2' | 'LU' — The type of identifier used in `secondaryIdentifier`. Can be set to `0B` - State License Number, `1G` - Provider UPIN Number, `G2` - Provider Commercial Number, or `LU` - Location Number. Note that UPIN is deprecated and should not be used. - `secondaryIdentifier` string — The identifier referenced by `secondaryIdentificationQualifierCode`. For example, if `secondaryIdentificationQualifierCode` is set to `0B`, this property should be the provider's state license number. You can only include one secondary identifier for the provider. - `suffix` string — The provider's name suffix, such as Jr. or III. - `taxonomyCode` string — The provider's [taxnonomy code](https://www.cms.gov/medicare/enrollment-renewal/providers-suppliers/health-care-taxonomy), a unique 10-character code that designates their classification and specialization. Only applies to the attending provider. - `receiver` InstitutionalReceiver, required — The entity responsible for the payment of the claim, such as an insurance company or government agency. - `organizationName` string, required — The business name of the payer receiving the claim, such as Aetna or Cigna. - `receiverId` string — Set to `PAPER` when you want Stedi to print this claim and mail it to the payer. Omit otherwise. Visit [Submit paper claims](https://www.stedi.com/docs/healthcare/submit-paper-claims) for details. - `taxId` string — The receiver's Electronic Transmitter Identification Number (ETIN), as assigned by the payer. This may be the same as the payer's TIN, but it can also be another unique identifier. We **strongly recommend** including this property in your request. - `referring` InstitutionalReferring — Information about the provider who referred the patient for care. - Include this object only when the referring provider is different than the provider listed in the `attending` object. - Use this object for providers that apply to the entire claim. - This should be an individual, not an organization, and you should supply at least the provider's `lastName` and an identifier, which is typically the `npi`. - `address` InstitutionalAddress - `address1` string, required — The first line of the street address. This typically contains the building number and street name. - `address2` string — The second line of the street address. This typically contains the apartment or suite number. - `city` string, required — The city name. - `countryCode` string — Use the alpha-2 country codes from Part 1 of ISO 3166. - `countrySubDivisionCode` string — Use the country subdivision codes from Part 2 of ISO 3166. - `postalCode` string — The postal zone or zip code. For United States addresses, you must include the full nine-digit zip code with no separators, such as `100031502`. If you don't know the full zip code, you can find it using the [USPS ZIP Code Lookup](https://tools.usps.com/zip-code-lookup.htm) tool. Exclude punctuation and spaces. - `state` string — The state or province code. Only required when the city is in the United States and Canada. - `commercialNumber` string - `contactInformation` InstitutionalContactInformation - `email` string — The email address. - `faxNumber` string — The fax number. - `name` string, required — The full name of the person or office. - `phoneNumber` string — The phone number, formatted as AAABBBCCCC, where AAA represents the area code, BBB is the telephone number prefix, and CCCC is the telephone number. The phone number should only include the digits 0 to 9. Don't include separators, such as dashes, and don't include long distance access numbers, such as 1. For example, you would format the phone number 123-456-7890 as 1234567890. - `validContact` boolean - `employerId` string - `firstName` string — The provider's first name. - `lastName` string, required — The provider's last name. - `locationNumber` string - `middleName` string — The provider's middle name or initial. - `npi` string — The individual [National Provider Identifier (NPI)](https://www.stedi.com/docs/healthcare/national-provider-identifier) assigned to the provider. - `organizationName` string — The provider's business name. - `providerType` 'ReferringProvider' — Defines the referring provider type. - `providerUpinNumber` string - `secondaryIdentificationQualifierCode` '0B' | '1G' | 'G2' — The type of identifier used in `secondaryIdentifier`. Can be set to `0B` - State License Number, `1G` - Provider UPIN Number, or `G2` - Provider Commercial Number. Note that UPIN is deprecated and should not be used. - `secondaryIdentifier` string — The identifier specified in `secondaryIdentifierQualifierCode`. You can only include one secondary identifier for the provider. - `stateLicenseNumber` string - `suffix` string — The provider's name suffix, such as Jr. or III. - `taxonomyCode` string - `rendering` InstitutionalRendering — Information about the provider who delivered the medical services or non-surgical procedures listed in the claim. This must be an individual, not an organization, and you must supply at least the provider's `lastName` and an identifier, which is typically the `npi`. The provider's `firstName` is also required, if applicable. Include this object when all of the following are true: - The rendering provider is different than the provider listed in the `attending` object. - The provider applies to the entire claim or to at least one service line. For example, if a claim had two service lines with two different rendering providers, you would include the provider for the first service line here and leave the `claimInformation.serviceLines[].renderingProvider` object for that service line blank. Then, you would specify the second provider in the appropriate service line's `claimInformation.serviceLines[].renderingProvider` object. - State or federal regulatory requirements call for a combined claim. A combined claim includes both facility and professional components, such as a Medicaid clinic bill or a critical access hospital claim. - `address` InstitutionalAddress - `address1` string, required — The first line of the street address. This typically contains the building number and street name. - `address2` string — The second line of the street address. This typically contains the apartment or suite number. - `city` string, required — The city name. - `countryCode` string — Use the alpha-2 country codes from Part 1 of ISO 3166. - `countrySubDivisionCode` string — Use the country subdivision codes from Part 2 of ISO 3166. - `postalCode` string — The postal zone or zip code. For United States addresses, you must include the full nine-digit zip code with no separators, such as `100031502`. If you don't know the full zip code, you can find it using the [USPS ZIP Code Lookup](https://tools.usps.com/zip-code-lookup.htm) tool. Exclude punctuation and spaces. - `state` string — The state or province code. Only required when the city is in the United States and Canada. - `commercialNumber` string — The provider's commercial number. - `contactInformation` InstitutionalContactInformation - `email` string — The email address. - `faxNumber` string — The fax number. - `name` string, required — The full name of the person or office. - `phoneNumber` string — The phone number, formatted as AAABBBCCCC, where AAA represents the area code, BBB is the telephone number prefix, and CCCC is the telephone number. The phone number should only include the digits 0 to 9. Don't include separators, such as dashes, and don't include long distance access numbers, such as 1. For example, you would format the phone number 123-456-7890 as 1234567890. - `validContact` boolean - `employerId` string - `firstName` string — The provider's first name. - `lastName` string, required — The provider's last name. - `locationNumber` string — The provider's location number. - `middleName` string — The provider's middle name or initial. - `npi` string — The individual [National Provider Identifier (NPI)](https://www.stedi.com/docs/healthcare/national-provider-identifier) assigned to the provider. - `organizationName` string — The provider's business name. - `providerType` string — This field is now automatically populated and it only remains for backwards compatibility. - `providerUpinNumber` string - `secondaryIdentificationQualifierCode` '0B' | '1G' | 'G2' | 'LU' — The type of identifier used in `secondaryIdentifier`. Can be set to `0B` - State License Number, `1G` - Provider UPIN Number, `G2` - Provider Commercial Number, or `LU` - Location Number. Note that UPIN is deprecated and should not be used. - `secondaryIdentifier` string — The identifier specified in the `secondaryIdentificationQualifierCode`. You can only include one secondary identifier for the provider. - `stateLicenseNumber` string — The provider's state license number. This is assigned directly by a payer in order to identify the provider in their system. This is not commonly used. - `suffix` string — The provider's name suffix, such as Jr. or III. - `taxonomyCode` string - `submitter` InstitutionalSubmitter, required — The entity submitting the healthcare claim. This is an organization, such as a hospital or other treatment center. - `contactInformation` InstitutionalSubmitterContactInformation, required - `email` string — The email address. - `faxNumber` string — The fax number. - `name` string — The full name of the person or office. - `phoneNumber` string — The phone number, formatted as AAABBBCCCC, where AAA represents the area code, BBB is the telephone number prefix, and CCCC is the telephone number. The phone number should only include the digits 0 to 9. Don't include separators, such as dashes, and don't include long distance access numbers, such as 1. For example, you would format the phone number 123-456-7890 as 1234567890. - `validContact` boolean - `organizationName` string, required — The business name of the institution submitting the claim. - `taxId` string, required — The submitter's Electronic Transmitter Identification Number (ETIN), **as assigned by the payer**. For some payers, this may be the same as the submitter's NPI, EIN/TIN, but it can also be another unique identifier. Payers can refer to this identifier as the Provider Number, Submitter ID, Submitter Identifier, Submitter Primary Number, Sender Code, Certified Contracted Provider ID, and other names. - `subscriber` InstitutionalSubscriber, required — The person or entity who is the primary policyholder for the health plan _or_ a dependent with their own member ID. - When a dependent has a unique, payer-assigned member ID, treat them as the subscriber for the claim submission - include their information here and omit the `dependent` object from the request. - You must set the `dateOfBirth` and `gender` properties when the subscriber is the patient. Stedi determines that the subscriber is the patient when the `dependent` object is not included in the request. - If either `dateOfBirth` or `gender` is set, you must include both properties. You can either include both properties or neither within a single request. - You must include `address` in this object when the patient is the subscriber. If the patient is a dependent, include address information in the `dependent` object instead. - `address` InstitutionalAddress - `address1` string, required — The first line of the street address. This typically contains the building number and street name. - `address2` string — The second line of the street address. This typically contains the apartment or suite number. - `city` string, required — The city name. - `countryCode` string — Use the alpha-2 country codes from Part 1 of ISO 3166. - `countrySubDivisionCode` string — Use the country subdivision codes from Part 2 of ISO 3166. - `postalCode` string — The postal zone or zip code. For United States addresses, you must include the full nine-digit zip code with no separators, such as `100031502`. If you don't know the full zip code, you can find it using the [USPS ZIP Code Lookup](https://tools.usps.com/zip-code-lookup.htm) tool. Exclude punctuation and spaces. - `state` string — The state or province code. Only required when the city is in the United States and Canada. - `dateOfBirth` string — The subscriber's date of birth, formatted as `YYYYMMDD`. - `firstName` string, required — The subscriber's first name. - `gender` 'M' | 'F' | 'U' - `groupNumber` string — The subscriber's health plan group number. - `lastName` string, required — The subscriber's last name. **Don't** include the subscriber's name suffix, such as Jr. or III. Use the designated `suffix` property instead. - `memberId` string — The member ID for the subscriber's insurance policy. - `middleName` string — The subscriber's middle name or initial. - `paymentResponsibilityLevelCode` 'A' | 'B' | 'C' | 'D' | 'E' | 'F' | 'G' | 'H' | 'P' | 'S' | 'T' | 'U', required — The payer's level of responsibility for paying this claim. Can be set to `A` - Payer Responsibility Four, `B` - Payer Responsibility Five, `C` - Payer Responsibility Six, `D` - Payer Responsibility Seven, `E` - Payer Responsibility Eight, `F` - Payer Responsibility Nine, `G` - Payer Responsibility Ten, `H` - Payer Responsibility Eleven, `P` - Primary, `S` - Secondary, `T` Tertiary, or `U` - Unknown (only use in payer-to-payer COB claims). - `policyNumber` string — Deprecated. - `ssn` string — The subscriber's Social Security Number. This must be a string of exactly nine numbers with no separators. For example, `123456789`. - `standardHealthId` string — Deprecated. Use the `memberId` property instead. - `suffix` string — The subscriber's name suffix, such as Jr. or III. Only include the subscriber's personal name suffix - **don't** include professional or academic titles, such as M.D. or MBA. - `tradingPartnerName` string — This is the payer's business name, like Cigna or Aetna. - `tradingPartnerSecondaryIdentifiers` TradingPartnerSecondaryIdentifiers — Secondary identifiers for the payer. You can include up to three properties in this object. - `claimOfficeNumber` string — Claim Office Number. - `employerIdentificationNumber` string — Employer Identification Number. This must be a string of exactly nine numbers with no separators. - `naic` string — National Association of Insurance Commissioners (NAIC) Code. - `payerIdentificationNumber` string — Payer Identification Number. This shape is deprecated since 1/9/25. - `tradingPartnerServiceId` string, required — The payer ID. Visit the [Payer Network](https://www.stedi.com/healthcare/network) for a complete list. - You can send requests using the primary payer ID, the Stedi payer ID, or any alias listed in the payer record. - You must include leading `0` characters - payer IDs are alphanumeric strings and must be treated as complete strings, not integers. For example, use `00540` for SISCO, not `540`. - `usageIndicator` string — Whether you want to send a test or production claim. This property also allows you to filter claims in the Stedi portal by production or test data. By default, this property is set to `P` for production data. Use `T` to designate a claim as test data. ## Response `200` InstitutionalClaimsSubmission 200 response - InstitutionalClaimsSubmissionResponseContent - `claimReference` InstitutionalClaimReference — Information about the claim. - `claimType` string — The type of claim, always `INST`. - `correlationId` string — An identifier Stedi assigns to the claim. - `customerClaimNumber` string — A tracking number that Stedi assigns to the claim. - `formatVersion` string — The X12 EDI version Stedi used to generate the claim for the payer. This is always `5010`. - `patientControlNumber` string — The `patientControlNumber` from the original request, if supplied. This is a unique identifier that you assign to the claim so you can track the claim and correlate it with responses from the payer. - `payerId` string — The payer's ID. This is the same as the `tradingPartnerServiceId`. - `rhClaimNumber` string — A tracking number Stedi assigns to the claim. This is the same as the `correlationId`. - `serviceLines` ServiceLineResponseIdentifier[] — Contains a unique identifier for each service line, listed in the order the service lines were included in the claim. You can use these identifiers to correlate payer responses to specific service lines. - `lineItemControlNumber` string — A unique identifier for the service line, matching the value provided for the `claimInformation.serviceLines[].providerControlNumber` property in the claim submission. If you didn't provide a value for `providerControlNumber`, this property contains a randomly generated a ULID for the service line. - `submitterId` string — Stedi's ID for the entity that submitted the claim. - `timeOfResponse` string — A timestamp for Stedi's response to the claim submission. - `controlNumber` string — An identifier for the transaction. - `editResponses` EditResponse[] — Currently not used. - `allowOverride` string - `badData` string - `claimCorePath` string - `editActivity` string - `editName` string - `element` string - `errorDescription` string - `fieldIndex` string - `loop` string - `phaseID` string - `qualifierCode` string - `referenceID` string - `segment` string - `editStatus` string — This shape is deprecated: Currently not used. - `errors` InstitutionalError[] — Errors resulting from claim edits. You must review and fix these errors before resubmitting. - `code` string — The error code. - `description` string — The description of the error code. - `followupAction` string — Recommended followup actions to correct the error. - `location` string — Where the error is located in the original request. - `value` string — The value for the data causing the error. - `failure` Failure — Currently not used. - `code` string - `description` string - `httpStatusCode` '200 OK' | '400 BAD_REQUEST' | '403 FORBIDDEN' — Stedi can return the following status codes: - `200`: Stedi successfully generated the X12 EDI claim format required by the payer. It does not indicate whether the payer has accepted the claim - the payer will respond later with a 277CA containing this information. [Learn more about 277CAs](https://www.stedi.com/docs/healthcare/receive-claim-responses#response-types). - `400`: The request contains one or more problems with the claim data. Examples include missing required fields, invalid values, or incorrect data types. The response includes a message describing the problem. - `403`: The request is not permitted, such as using a test API key to submit a production transaction. - `meta` InstitutionalResponseMeta — Metadata from Stedi about the request. - `applicationMode` string — Indicates where this request can be found for support. - `billerId` string — The biller ID assigned to this request. - `senderId` string — The sender ID assigned to this request. - `submitterId` string — The submitter ID assigned to this request. - `traceId` string — The file execution ID, a unique identifier assigned to the processed file within the Stedi platform. - `payer` InstitutionalPayer — Information about the payer for the submitted claim. - `payerID` string — The payer's ID. This is the same as the `tradingPartnerServiceId`. - `payerName` string — The payer's business name, such as Aetna or Cigna. - `status` string — The status of the claim submission. - `tradingPartnerServiceId` string — An ID for the payer you identified in the original claim. This value may differ from the `tradingPartnerServiceId` you submitted in the original request because it reflects the payer's internal concept of their ID, not necessarily the ID Stedi uses to route requests to this payer. - `warnings` ClaimsWarning[] — A list of warnings. Currently not used. - `code` string — A machine-readable code indicating the type of problem. - `description` string — A human-readable description of the problem. - `x12` string — A [277CA claim acknowledgment](https://www.stedi.com/docs/healthcare/claim-responses-overview#277ca-claim-acknowledgment) acceptance or rejection from Stedi in X12 EDI format. It indicates whether the claim has passed Stedi's claim edits. When the claim fails one or more edits, the 277CA contains `STC` segments with information about each error. These are the same error codes that appear in the `errors` array. Note that this 277CA only indicates whether Stedi has accepted or rejected the claim submission. You may receive additional 277CA acceptances or rejections as the claim is routed to the payer. ## Other responses - `400` — ValidationException 400 response - `403` — AccessDeniedException 403 response - `404` — ResourceNotFoundException 404 response - `409` — ConflictException 409 response - `422` — RequestChangedException 422 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/c156a60615bb/schema)