The Payer API from Stedi — 1 operation(s) for payer.
components:
schemas:
ClaimPaymentEnrollmentProcess:
description: Details about the enrollment process for Electronic Remittance Advice (ERAs).
properties:
requestedEffectiveDate:
$ref: '#/components/schemas/RequestedEffectiveDate'
description: "Whether this payer supports specifying a requested effective date for transaction enrollments.\n\
\ - If set to `SUPPORTED`, Stedi will process [transaction enrollment requests](https://www.stedi.com/docs/healthcare/api-reference/post-enrollment-create-enrollment)\
\ for this payer according to their specified `requestedEffectiveDate`.\n - This property is only returned\
\ when Stedi can determine whether the payer supports requested effective dates."
supportedAggregationPreferences:
description: "Aggregation types this payer supports for 835 Electronic Remittance Advice (ERA) transactions.\
\ Payers can aggregate by the provider's NPI, tax ID (TIN), or both.\n - You can use this information\
\ to specify an `aggregationPreference` when submitting ERA enrollment requests.\n - This property\
\ is only returned when Stedi can determine the payer's supported aggregation types."
items:
$ref: '#/components/schemas/SupportedAggregationType'
type: array
timeframe:
$ref: '#/components/schemas/EnrollmentProcessTimeframe'
type:
$ref: '#/components/schemas/EnrollmentProcessType'
type: object
ClaimStatusInquiryEnrollmentProcess:
description: Details about the enrollment process for real-time claim status requests.
properties:
requestedEffectiveDate:
$ref: '#/components/schemas/RequestedEffectiveDate'
description: "Whether this payer supports specifying a requested effective date for transaction enrollments.\n\
\ - If set to `SUPPORTED`, Stedi will process [transaction enrollment requests](https://www.stedi.com/docs/healthcare/api-reference/post-enrollment-create-enrollment)\
\ for this payer according to their specified `requestedEffectiveDate`.\n - This property is only returned\
\ when Stedi can determine whether the payer supports requested effective dates."
timeframe:
$ref: '#/components/schemas/EnrollmentProcessTimeframe'
type:
$ref: '#/components/schemas/EnrollmentProcessType'
type: object
CoordinationOfBenefitsEnrollmentProcess:
description: Details about the enrollment process for coordination of benefits (COB) checks.
properties:
requestedEffectiveDate:
$ref: '#/components/schemas/RequestedEffectiveDate'
description: "Whether this payer supports specifying a requested effective date for transaction enrollments.\n\
\ - If set to `SUPPORTED`, Stedi will process [transaction enrollment requests](https://www.stedi.com/docs/healthcare/api-reference/post-enrollment-create-enrollment)\
\ for this payer according to their specified `requestedEffectiveDate`.\n - This property is only returned\
\ when Stedi can determine whether the payer supports requested effective dates."
timeframe:
$ref: '#/components/schemas/EnrollmentProcessTimeframe'
type:
$ref: '#/components/schemas/EnrollmentProcessType'
type: object
CoverageType:
description: The types of insurance coverage that a payer can provide. Used to indicate whether a payer supports
transactions for medical coverage, dental coverage, vision coverage, or a combination of these.
enum:
- medical
- dental
- vision
type: string
DentalClaimEnrollmentProcess:
description: Details about the enrollment process for dental claim submission.
properties:
requestedEffectiveDate:
$ref: '#/components/schemas/RequestedEffectiveDate'
description: "Whether this payer supports specifying a requested effective date for transaction enrollments.\n\
\ - If set to `SUPPORTED`, Stedi will process [transaction enrollment requests](https://www.stedi.com/docs/healthcare/api-reference/post-enrollment-create-enrollment)\
\ for this payer according to their specified `requestedEffectiveDate`.\n - This property is only returned\
\ when Stedi can determine whether the payer supports requested effective dates."
timeframe:
$ref: '#/components/schemas/EnrollmentProcessTimeframe'
type:
$ref: '#/components/schemas/EnrollmentProcessType'
type: object
EligibilityInquiryEnrollmentProcess:
description: Details about the enrollment process for eligibility checks.
properties:
requestedEffectiveDate:
$ref: '#/components/schemas/RequestedEffectiveDate'
description: "Whether this payer supports specifying a requested effective date for transaction enrollments.\n\
\ - If set to `SUPPORTED`, Stedi will process [transaction enrollment requests](https://www.stedi.com/docs/healthcare/api-reference/post-enrollment-create-enrollment)\
\ for this payer according to their specified `requestedEffectiveDate`.\n - This property is only returned\
\ when Stedi can determine whether the payer supports requested effective dates."
timeframe:
$ref: '#/components/schemas/EnrollmentProcessTimeframe'
type:
$ref: '#/components/schemas/EnrollmentProcessType'
type: object
EnrollmentInfo:
description: Information about enrollment requirements for the payer
properties:
ptanRequired:
description: 'Whether a PTAN (Provider Transaction Access Number) is required for transaction enrollment.
The Provider Transaction Access Number (PTAN) is a Medicare-issued number given to providers upon enrollment
with Medicare. This number is usually six digits and is assigned based on the type of service and the
location of the provider. Upon enrollment, Medicare Administrating Contracting (MAC) providers should
receive their assigned PTAN number in their approval letter.'
type: boolean
transactionEnrollmentProcesses:
$ref: '#/components/schemas/TransactionEnrollmentProcesses'
description: 'Enrollment details for specific transaction types.
Stedi only returns this object when information about the enrollment process is available for one or
more transaction types. When this object isn''t included in the response, it **doesn''t** mean no transaction
types require enrollment. Refer to the `transactionSupport` object for details about which transaction
types require enrollment.'
type: object
EnrollmentProcessTimeframe:
description: Stedi's expected timeframe for completing the transaction enrollment process. `INSTANT` indicates
that the enrollment will be in `LIVE` status within minutes of submitting the request.
enum:
- INSTANT
- HOURS
- DAYS
- WEEKS
- OVER_4_WEEKS
type: string
EnrollmentProcessType:
description: "Whether transaction enrollment is single or multi-step.\n - `ONE_CLICK` indicates that once\
\ you submit the transaction enrollment request, Stedi can complete the rest of the enrollment process without\
\ any further action from you.\n - `MULTI_STEP` indicates that you must complete additional steps to finish\
\ the enrollment process. Customer support will reach out with clear instructions explaining how to complete\
\ any remaining steps."
enum:
- ONE_CLICK
- MULTI_STEP
type: string
GetPayerRecordResponseContent:
properties:
payer:
$ref: '#/components/schemas/PayerRecord'
description: The payer record matching the provided Stedi payer ID. The record includes the payer's display
name and aliases as well as supported transaction types and details about the payer's [transaction enrollment](https://www.stedi.com/docs/healthcare/transaction-enrollment)
process.
required:
- payer
type: object
InstitutionalClaimEnrollmentProcess:
description: Details about the enrollment process for institutional claim submission.
properties:
requestedEffectiveDate:
$ref: '#/components/schemas/RequestedEffectiveDate'
description: "Whether this payer supports specifying a requested effective date for transaction enrollments.\n\
\ - If set to `SUPPORTED`, Stedi will process [transaction enrollment requests](https://www.stedi.com/docs/healthcare/api-reference/post-enrollment-create-enrollment)\
\ for this payer according to their specified `requestedEffectiveDate`.\n - This property is only returned\
\ when Stedi can determine whether the payer supports requested effective dates."
timeframe:
$ref: '#/components/schemas/EnrollmentProcessTimeframe'
type:
$ref: '#/components/schemas/EnrollmentProcessType'
type: object
InternalFailureExceptionResponseContent:
description: The server response when an unexpected error occurred while processing request.
properties:
code:
description: Error classification code
type: string
message:
description: Human-readable error message
type: string
required:
- message
type: object
OperatingStateCode:
description: US state codes, territories, or `NATIONAL` indicating the geographic regions where a payer operates.
When set to `NATIONAL`, the payer operates throughout the entire United States.
enum:
- AL
- AK
- AZ
- AR
- CA
- CO
- CT
- DE
- FL
- GA
- HI
- ID
- IL
- IN
- IA
- KS
- KY
- LA
- ME
- MD
- MA
- MI
- MN
- MS
- MO
- MT
- NE
- NV
- NH
- NJ
- NM
- NY
- NC
- ND
- OH
- OK
- OR
- PA
- RI
- SC
- SD
- TN
- TX
- UT
- VT
- VA
- WA
- WV
- WI
- WY
- DC
- PR
- VI
- GU
- AS
- MP
- NATIONAL
type: string
PayerRecord:
properties:
aliases:
description: Alternative IDs associated with a payer. If a payer changes their `primaryPayerId`, aliases
allow you to continue sending transactions to the payer using the old ID uninterrupted.
items:
type: string
type: array
avatarUrl:
description: 'A URL pointing to an image file (`.png`, `.jpeg`, or `.jpg`) with the payer''s logo. This
is the same logo Stedi displays in the [Payer Network](https://www.stedi.com/healthcare/network). You
can use this property to display payer logos in your system or application.
This property is only returned when a payer logo is available.'
type: string
conciseName:
description: A shorter version of the payer's display name for use in dense UI views. This property is
only returned when a concise name is available for the payer.
type: string
coverageTypes:
description: 'A list of insurance coverage types that indicates whether this payer supports transactions
for medical coverage, dental coverage, vision coverage, or a combination of these. For example: `["medical"]`
or `["medical", "dental", "vision"]`.
When this array isn''t in the response, it means Stedi hasn''t classified the payer''s coverage types
yet, **not** that the payer doesn''t support any coverage types.'
items:
$ref: '#/components/schemas/CoverageType'
type: array
displayName:
description: The payer's business name, such as Cigna or Aetna. This is the name most commonly used to
identify the payer.
type: string
employerIdentificationNumbers:
description: Employer Identification Numbers (EINs) associated with this payer.
items:
description: A valid Employer Identification Number (EIN) in the format XX-XXXXXXX
pattern: ^[0-9]{2}-[0-9]{7}$
type: string
type: array
enrollment:
$ref: '#/components/schemas/EnrollmentInfo'
description: Details about the [transaction enrollment process](https://www.stedi.com/docs/healthcare/transaction-enrollment)
for this payer, if available. This object may not be returned for some payers.
names:
description: Alternative names associated with a payer. These additional names help you search for and
identify payers using the name most familiar to your organization.
items:
type: string
type: array
operatingStates:
description: 'A list of US state codes, territories, or `NATIONAL` that indicates the geographic regions
where this payer operates. For example: `["CA", "OR"]` for a regional payer, or `["NATIONAL"]` for a
payer that operates throughout the entire United States.
When this array isn''t in the response, it means Stedi hasn''t classified the payer''s operating states
yet.'
items:
$ref: '#/components/schemas/OperatingStateCode'
type: array
parentPayerGroupId:
description: The payer's parent payer group entity. This is metadata Stedi uses internally. It doesn't
necessarily relate to the payer's enrollment process or other capabilities.
type: string
primaryPayerId:
description: The most commonly used ID for a payer. This value often corresponds to the name the payer
uses internally and provides to patients on member ID cards.
type: string
stediId:
description: A unique ID that Stedi assigned to this payer and uses internally for routing requests. This
ID will not change even if the `primaryPayerId` is updated.
type: string
transactionSupport:
$ref: '#/components/schemas/TransactionSupport'
urls:
$ref: '#/components/schemas/PayerUrls'
description: URLs associated with this payer, such as their website. This object is only returned when
URL information is available for the payer.
required:
- aliases
- displayName
- names
- primaryPayerId
- stediId
- transactionSupport
type: object
PayerUrls:
description: URLs associated with a payer.
properties:
website:
description: The payer's website URL.
type: string
type: object
ProfessionalClaimEnrollmentProcess:
description: Details about the enrollment process for professional claim submission.
properties:
requestedEffectiveDate:
$ref: '#/components/schemas/RequestedEffectiveDate'
description: "Whether this payer supports specifying a requested effective date for transaction enrollments.\n\
\ - If set to `SUPPORTED`, Stedi will process [transaction enrollment requests](https://www.stedi.com/docs/healthcare/api-reference/post-enrollment-create-enrollment)\
\ for this payer according to their specified `requestedEffectiveDate`.\n - This property is only returned\
\ when Stedi can determine whether the payer supports requested effective dates."
timeframe:
$ref: '#/components/schemas/EnrollmentProcessTimeframe'
type:
$ref: '#/components/schemas/EnrollmentProcessType'
type: object
RequestedEffectiveDate:
description: Whether a payer supports specifying a requested effective date for transaction enrollments.
enum:
- SUPPORTED
- NOT_SUPPORTED
type: string
ResourceNotFoundExceptionResponseContent:
description: The server response when the specified resource cannot be found after an API request passes authentication
and authorization.
properties:
code:
description: Error classification code
type: string
message:
description: Human-readable error message
type: string
required:
- message
type: object
SupportedAggregationType:
description: 'Aggregation types a payer supports for 835 Electronic Remittance Advice (ERA) transactions.
Payers can aggregate by the provider''s NPI, tax ID (TIN), or both.
You can use this information to specify an `aggregationPreference` when submitting ERA enrollment requests.'
enum:
- NPI
- TIN
type: string
TransactionEnrollmentProcesses:
description: Information about the transaction enrollment requirements and expected timeframes for each transaction
type.
properties:
claimPayment:
$ref: '#/components/schemas/ClaimPaymentEnrollmentProcess'
description: Details about the enrollment process for Electronic Remittance Advice (ERAs) with this payer.
claimStatusInquiry:
$ref: '#/components/schemas/ClaimStatusInquiryEnrollmentProcess'
description: Details about the enrollment process for real-time claim status requests with this payer.
coordinationOfBenefits:
$ref: '#/components/schemas/CoordinationOfBenefitsEnrollmentProcess'
description: Details about the enrollment process for coordination of benefits (COB) checks with this
payer.
dentalClaim:
$ref: '#/components/schemas/DentalClaimEnrollmentProcess'
description: Details about the enrollment process for dental claim submission with this payer.
eligibilityInquiry:
$ref: '#/components/schemas/EligibilityInquiryEnrollmentProcess'
description: Details about the enrollment process for eligibility checks with this payer.
institutionalClaim:
$ref: '#/components/schemas/InstitutionalClaimEnrollmentProcess'
description: Details about the enrollment process for institutional claim submission with this payer.
professionalClaim:
$ref: '#/components/schemas/ProfessionalClaimEnrollmentProcess'
description: Details about the enrollment process for professional claim submission with this payer.
unsolicitedClaimAttachment:
$ref: '#/components/schemas/UnsolicitedClaimAttachmentEnrollmentProcess'
description: Details about the enrollment process for unsolicited claim attachments with this payer.
type: object
TransactionSupport:
description: 'Whether the following transaction types are supported: 270 eligibility checks, 276 claim status
requests, 837 professional claims, and 835 ERAs (claim payments). If the value is `ENROLLMENT_REQUIRED`,
Stedi supports the transaction type, but you must [enroll with the payer](https://www.stedi.com/docs/healthcare/supported-payers#enrollment)
first.'
properties:
claimPayment:
$ref: '#/components/schemas/TransactionSupportValue'
description: Whether you can receive 835 Electronic Remittance Advice (ERA) transactions from this payer.
claimStatus:
$ref: '#/components/schemas/TransactionSupportValue'
description: Whether you can send 276 claim status requests to this payer.
claimSubmission:
$ref: '#/components/schemas/TransactionSupportValue'
deprecated: true
description: 'Whether you can send 837 professional claims to this payer.
This shape is deprecated since 2024-11-13: This `claimSubmission` property is deprecated and will be
removed in a future release. Instead, use the `professionalClaimSubmission` property.'
coordinationOfBenefits:
$ref: '#/components/schemas/TransactionSupportValue'
description: Coordination of Benefits (COB) support.
dentalClaimSubmission:
$ref: '#/components/schemas/TransactionSupportValue'
description: Whether you can send 837D dental claims to this payer.
eligibilityCheck:
$ref: '#/components/schemas/TransactionSupportValue'
description: Whether you can send 270 eligibility checks to this payer.
institutionalClaimSubmission:
$ref: '#/components/schemas/TransactionSupportValue'
description: Whether you can send 837I institutional claims to this payer.
professionalClaimSubmission:
$ref: '#/components/schemas/TransactionSupportValue'
description: Whether you can send 837P professional claims to this payer.
unsolicitedClaimAttachment:
$ref: '#/components/schemas/TransactionSupportValue'
description: Whether you can send unsolicited claim attachments to this payer.
required:
- claimPayment
- claimStatus
- claimSubmission
- coordinationOfBenefits
- dentalClaimSubmission
- eligibilityCheck
- institutionalClaimSubmission
- professionalClaimSubmission
- unsolicitedClaimAttachment
type: object
TransactionSupportValue:
enum:
- SUPPORTED
- NOT_SUPPORTED
- ENROLLMENT_REQUIRED
type: string
UnauthorizedExceptionResponseContent:
description: The server response when the authorizer failed to authenticate the caller.
properties:
code:
description: Error classification code
type: string
message:
description: Human-readable error message
type: string
required:
- message
type: object
UnsolicitedClaimAttachmentEnrollmentProcess:
description: Details about the enrollment process for unsolicited claim attachments.
properties:
requestedEffectiveDate:
$ref: '#/components/schemas/RequestedEffectiveDate'
description: "Whether this payer supports specifying a requested effective date for transaction enrollments.\n\
\ - If set to `SUPPORTED`, Stedi will process [transaction enrollment requests](https://www.stedi.com/docs/healthcare/api-reference/post-enrollment-create-enrollment)\
\ for this payer according to their specified `requestedEffectiveDate`.\n - This property is only returned\
\ when Stedi can determine whether the payer supports requested effective dates."
timeframe:
$ref: '#/components/schemas/EnrollmentProcessTimeframe'
type:
$ref: '#/components/schemas/EnrollmentProcessType'
type: object
ValidationExceptionField:
description: Describes one specific validation failure for an input member.
properties:
message:
description: A detailed description of the validation failure.
type: string
path:
description: A JSONPointer expression to the structure member whose value failed to satisfy the modeled
constraints.
type: string
required:
- message
- path
type: object
ValidationExceptionResponseContent:
description: 'A standard error for input validation failures.
This should be thrown by services when a member of the input structure
falls outside of the modeled or documented constraints.'
properties:
fieldList:
description: 'A list of specific failures encountered while validating the input.
A member can appear in this list more than once if it failed to satisfy multiple constraints.'
items:
$ref: '#/components/schemas/ValidationExceptionField'
type: array
message:
description: A summary of the validation failure.
type: string
required:
- message
type: object
securitySchemes:
httpApiKeyAuth:
description: A [Stedi API Key](https://www.stedi.com/app/settings/api-keys) for authentication.
in: header
name: Authorization
type: apiKey
info:
contact:
email: healthcare@stedi.com
license:
name: Proprietary
url: https://stedi.com
title: Stedi Healthcare Claims Claim acknowledgments Payer API
version: '2025-03-07'
openapi: 3.0.3
paths:
/payer/{stediId}:
get:
description: Retrieve a single payer record by its Stedi payer ID.
operationId: GetPayerRecord
parameters:
- description: 'The Stedi payer ID, a unique identifier Stedi assigns to each payer that will never change.
You can find the Stedi payer ID for any supported payer in the [Payer Network](https://www.stedi.com/healthcare/network).
This must be the Stedi payer ID - querying with the primary payer ID or payer ID aliases isn''t supported.'
examples:
GetPayerRecord_example1:
description: ''
summary: Retrieve payer record
value: QDTRP
in: path
name: stediId
required: true
schema:
description: 'The Stedi payer ID, a unique identifier Stedi assigns to each payer that will never change.
You can find the Stedi payer ID for any supported payer in the [Payer Network](https://www.stedi.com/healthcare/network).
This must be the Stedi payer ID - querying with the primary payer ID or payer ID aliases isn''t supported.'
pattern: ^[A-Z]{5}$
type: string
responses:
'200':
content:
application/json:
examples:
GetPayerRecord_example1:
description: ''
summary: Retrieve payer record
value:
payer:
aliases:
- '00420'
- '13123'
- '1584'
- '4714'
- '95655'
- MEDGL
- MEDGLD
- MEDIGOLD
avatarUrl: https://prod-payer-avatars.payers.us.stedi.com/YKHRB/avatar.png?v=1766600157693
coverageTypes:
- dental
- medical
displayName: Trinity Health Plan
enrollment:
ptanRequired: false
transactionEnrollmentProcesses:
claimPayment:
requestedEffectiveDate: NOT_SUPPORTED
supportedAggregationPreferences:
- NPI
- TIN
timeframe: DAYS
type: ONE_CLICK
names:
- MediGold
- Medigold Health Plans
- Mount Carmel Health Plan
- Mount Carmel MediGold
- Trinity Health Plan of Michigan
operatingStates:
- ID
- IA
- MI
- NY
- OH
parentPayerGroupId: GTRSH
primaryPayerId: '95655'
stediId: YKHRB
transactionSupport:
claimPayment: ENROLLMENT_REQUIRED
claimStatus: SUPPORTED
claimSubmission: SUPPORTED
coordinationOfBenefits: NOT_SUPPORTED
dentalClaimSubmission: NOT_SUPPORTED
eligibilityCheck: SUPPORTED
institutionalClaimSubmission: SUPPORTED
professionalClaimSubmission: SUPPORTED
unsolicitedClaimAttachment: NOT_SUPPORTED
urls:
website: https://www.thpmedicare.org
schema:
$ref: '#/components/schemas/GetPayerRecordResponseContent'
description: GetPayerRecord 200 response
'400':
content:
application/json:
schema:
$ref: '#/components/schemas/ValidationExceptionResponseContent'
description: ValidationException 400 response
'401':
content:
application/json:
schema:
$ref: '#/components/schemas/UnauthorizedExceptionResponseContent'
description: UnauthorizedException 401 response
'404':
content:
application/json:
schema:
$ref: '#/components/schemas/ResourceNotFoundExceptionResponseContent'
description: ResourceNotFoundException 404 response
'500':
content:
application/json:
schema:
$ref: '#/components/schemas/InternalFailureExceptionResponseContent'
description: InternalFailureException 500 response
tags:
- Payer
security:
- httpApiKeyAuth: []
servers:
- description: Production
url: https://healthcare.us.stedi.com/2024-04-01
- description: Production
url: https://payers.us.stedi.com/2024-04-01
tags:
- name: Payer
x-stedi:
lifecycle: general_availability
product: claims
public: true