Stedi · Example Payload
Stedi Healthcare Examples
EDIElectronic Data InterchangeHealthcareClearinghouseX12ClaimsEligibilityHIPAARevenue Cycle ManagementB2B Integration
Stedi Healthcare Examples is an example object payload from Stedi, with 36 top-level fields. It illustrates the shape of data this provider's APIs accept or return.
Top-level fields
ClaimStatus_requestClaimStatus_response_200ClaimStatusRawX12_requestClaimStatusRawX12_response_200EligibilityCheck_requestEligibilityCheck_response_200EligibilityCheck_response_400EligibilityRawX12Check_requestEligibilityRawX12Check_response_200EligibilityRawX12Check_response_400InstitutionalClaimsRawX12Submission_requestInstitutionalClaimsRawX12Submission_response_200InstitutionalClaimsSubmission_requestInstitutionalClaimsSubmission_response_200ClaimsRawX12Submission_requestClaimsRawX12Submission_response_200ClaimsSubmission_requestClaimsSubmission_response_200ConvertReport277_response_200ConvertReport835_response_200CoordinationOfBenefits_requestCoordinationOfBenefits_response_200DentalClaimsRawX12Submission_requestDentalClaimsRawX12Submission_response_200DentalClaimsSubmission_requestDentalClaimsSubmission_response_200GetElectronicRemittanceAdvicePdf_response_200ExportPDF_response_200GetPDF1500_response_200InsuranceDiscoveryCheck_requestInsuranceDiscoveryCheck_response_200GetInsuranceDiscoveryCheck_response_200GetPayerRecord_response_200ListPayerRecords_response_200ListPayerRecordsCsv_response_200SearchPayers_response_200
Example Payload
{
"ClaimStatus_request": {
"encounter": {
"beginningDateOfService": "20250630",
"endDateOfService": "20250702"
},
"providers": [
{
"npi": "1999999984",
"organizationName": "Provider Name",
"providerType": "BillingProvider"
}
],
"subscriber": {
"dateOfBirth": "19710101",
"firstName": "Jane",
"lastName": "Doe",
"memberId": "UHC123456"
},
"tradingPartnerServiceId": "87726"
},
"ClaimStatus_response_200": {
"claims": [
{
"claimStatus": {
"amountPaid": "108.77",
"checkIssueDate": "2025-07-17",
"checkNumber": "123456789",
"claimServiceDate": "20250701",
"effectiveDate": "2025-07-17",
"paidDate": "2025-07-15",
"patientAccountNumber": "12345678",
"statusCategoryCode": "F1",
"statusCategoryCodeValue": "Finalized/Payment - The claim/line has been paid.",
"statusCode": "65",
"statusCodeValue": "Claim/line has been paid.",
"submittedAmount": "267.54",
"trackingNumber": "0123456789",
"tradingPartnerClaimNumber": "0123456789"
},
"serviceDetails": [
{
"service": {
"amountPaid": "108.77",
"procedureId": "90837",
"serviceIdQualifier": "Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes",
"serviceIdQualifierCode": "HC",
"submittedAmount": "267.54",
"submittedUnits": "1"
},
"status": [
{
"effectiveDate": "2025-07-17",
"statusCategoryCode": "F1",
"statusCategoryCodeValue": "Finalized/Payment - The claim/line has been paid.",
"statusCode": "107",
"statusCodeValue": "Processed according to contract provisions (Contract refers to provisions that exist between the Health Plan and a Provider of Health Care Services)."
}
]
}
]
}
],
"controlNumber": "123456789",
"payer": {
"organizationName": "UNITEDHEALTHCARE",
"payerIdentification": "87726"
},
"providers": [
{
"npi": "1999999984",
"organizationName": "Provider Name",
"providerType": "BillingProvider"
}
],
"subscriber": {
"firstName": "Jane",
"lastName": "Doe",
"memberId": "UHC123456"
},
"tradingPartnerServiceId": "87726",
"x12": "ISA*00* *00* *ZZ*STEDI *01*117151744 *250912*1718*^*00501*123456789*0*P*:~GS*HN*STEDI*117151744*20250912*171842*1*X*005010X212~ST*277*1001*005010X212~BHT*0010*08*0123456789*20250912*171841*DG~HL*1**20*1~NM1*PR*2*UNITEDHEALTHCARE*****PI*87726~HL*2*1*21*1~NM1*41*2*PROVIDER NAME*****46*1234567890~HL*3*2*19*1~NM1*1P*2*PROVIDER NAME*****XX*1999999984~HL*4*3*22*0~NM1*IL*1*DOE*JANE****MI*UHC123456~TRN*2*0123456789~STC*F1:65*20250717**267.54*108.77*20250715**20250717*123456789~REF*1K*0123456789~REF*EJ*12345678~DTP*472*D8*20250701~SVC*HC:90837:GT*267.54*108.77****1~STC*F1:107*20250717~DTP*472*D8*20250701~SE*19*1001~GE*1*1~IEA*1*123456789~"
},
"ClaimStatusRawX12_request": {
"x12": "ISA*00* *00* *ZZ*SENDER *ZZ*RECEIVER *250916*2048*^*00501*000000001*0*T*>~GS*HR*SENDERGS*RECEIVERGS*20250916*204811*1*X*005010X212~ST*276*0001*005010X212~BHT*0010*13*ABC276XXX*20250915*1425~HL*1**20*1~NM1*PR*2*UNITEDHEALTHCARE*****PI*87726~HL*2*1*21*1~NM1*41*2*PROVIDER NAME*****46*123456789~HL*3*2*19*1~NM1*1P*2*PROVIDER NAME*****XX*1999999984~HL*4*3*22*0~DMG*D8*19710101~NM1*IL*1*DOE*JANE****MI*UHC123456~TRN*1*123456789~DTP*472*RD8*20250630-20250702~SE*14*0001~GE*1*1~IEA*1*000000001~"
},
"ClaimStatusRawX12_response_200": {
"claims": [
{
"claimStatus": {
"amountPaid": "108.77",
"checkIssueDate": "2025-07-17",
"checkNumber": "123456789",
"claimServiceDate": "20250701",
"effectiveDate": "2025-07-17",
"paidDate": "2025-07-15",
"patientAccountNumber": "12345678",
"statusCategoryCode": "F1",
"statusCategoryCodeValue": "Finalized/Payment - The claim/line has been paid.",
"statusCode": "65",
"statusCodeValue": "Claim/line has been paid.",
"submittedAmount": "267.54",
"trackingNumber": "0123456789",
"tradingPartnerClaimNumber": "0123456789"
},
"serviceDetails": [
{
"service": {
"amountPaid": "108.77",
"procedureId": "90837",
"serviceIdQualifier": "Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes",
"serviceIdQualifierCode": "HC",
"submittedAmount": "267.54",
"submittedUnits": "1"
},
"status": [
{
"effectiveDate": "2025-07-17",
"statusCategoryCode": "F1",
"statusCategoryCodeValue": "Finalized/Payment - The claim/line has been paid.",
"statusCode": "107",
"statusCodeValue": "Processed according to contract provisions (Contract refers to provisions that exist between the Health Plan and a Provider of Health Care Services)."
}
]
}
]
}
],
"controlNumber": "123456789",
"payer": {
"organizationName": "UNITEDHEALTHCARE",
"payerIdentification": "87726"
},
"providers": [
{
"npi": "1999999984",
"organizationName": "Provider Name",
"providerType": "BillingProvider"
}
],
"subscriber": {
"firstName": "Jane",
"lastName": "Doe",
"memberId": "UHC123456"
},
"tradingPartnerServiceId": "87726",
"x12": "ISA*00* *00* *ZZ*RECEIVER *ZZ*SENDER *250912*1718*^*00501*123456789*0*T*:~GS*HN*RECEIVERGS*SENDERGS*20250912*171842*1*X*005010X212~ST*277*1001*005010X212~BHT*0010*08*0123456789*20250912*171841*DG~HL*1**20*1~NM1*PR*2*UNITEDHEALTHCARE*****PI*87726~HL*2*1*21*1~NM1*41*2*PROVIDER NAME*****46*1234567890~HL*3*2*19*1~NM1*1P*2*PROVIDER NAME*****XX*1999999984~HL*4*3*22*0~NM1*IL*1*DOE*JANE****MI*UHC123456~TRN*2*0123456789~STC*F1:65*20250717**267.54*108.77*20250715**20250717*123456789~REF*1K*0123456789~REF*EJ*12345678~DTP*472*D8*20250701~SVC*HC:90837:GT*267.54*108.77****1~STC*F1:107*20250717~DTP*472*D8*20250701~SE*19*1001~GE*1*1~IEA*1*123456789~"
},
"EligibilityCheck_request": {
"encounter": {
"serviceTypeCodes": [
"MH"
]
},
"externalPatientId": "UAA111222333",
"provider": {
"npi": "1999999984",
"organizationName": "ACME Health Services"
},
"subscriber": {
"dateOfBirth": "19000101",
"firstName": "Jane",
"lastName": "Doe",
"memberId": "123456789"
},
"tradingPartnerServiceId": "AHS"
},
"EligibilityCheck_response_200": {
"benefitsInformation": [
{
"additionalInformation": [
{
"description": "Complete Care Management"
}
],
"code": "1",
"name": "Active Coverage",
"planCoverage": "Open Access Plus",
"serviceTypeCodes": [
"30"
],
"serviceTypes": [
"Health Benefit Plan Coverage"
]
},
{
"additionalInformation": [
{
"description": "Includes services provided by Client Specific Network"
},
{
"description": "Coinsurance does apply to member's out-of-pocket maximum"
},
{
"description": "Copay does apply to member's out-of-pocket maximum"
},
{
"description": "Deductible does apply to member's out-of-pocket maximum"
}
],
"benefitAmount": "6000",
"code": "G",
"coverageLevel": "Family",
"coverageLevelCode": "FAM",
"inPlanNetworkIndicator": "Yes",
"inPlanNetworkIndicatorCode": "Y",
"name": "Out of Pocket (Stop Loss)",
"serviceTypeCodes": [
"30"
],
"serviceTypes": [
"Health Benefit Plan Coverage"
],
"timeQualifier": "Calendar Year",
"timeQualifierCode": "23"
},
{
"additionalInformation": [
{
"description": "Includes services provided by Client Specific Network"
}
],
"benefitAmount": "500",
"code": "C",
"coverageLevel": "Family",
"coverageLevelCode": "FAM",
"inPlanNetworkIndicator": "Yes",
"inPlanNetworkIndicatorCode": "Y",
"name": "Deductible",
"serviceTypeCodes": [
"30"
],
"serviceTypes": [
"Health Benefit Plan Coverage"
],
"timeQualifier": "Calendar Year",
"timeQualifierCode": "23"
},
{
"additionalInformation": [
{
"description": "Includes services provided by Client Specific Network"
},
{
"description": "Copay does apply to member's out-of-pocket maximum"
},
{
"description": "Coinsurance does apply to member's out-of-pocket maximum"
},
{
"description": "Deductible does apply to member's out-of-pocket maximum"
}
],
"benefitAmount": "3000",
"code": "G",
"coverageLevel": "Individual",
"coverageLevelCode": "IND",
"inPlanNetworkIndicator": "Yes",
"inPlanNetworkIndicatorCode": "Y",
"name": "Out of Pocket (Stop Loss)",
"serviceTypeCodes": [
"30"
],
"serviceTypes": [
"Health Benefit Plan Coverage"
],
"timeQualifier": "Calendar Year",
"timeQualifierCode": "23"
},
{
"additionalInformation": [
{
"description": "Includes services provided by Client Specific Network"
}
],
"benefitAmount": "250",
"code": "C",
"coverageLevel": "Individual",
"coverageLevelCode": "IND",
"inPlanNetworkIndicator": "Yes",
"inPlanNetworkIndicatorCode": "Y",
"name": "Deductible",
"serviceTypeCodes": [
"30"
],
"serviceTypes": [
"Health Benefit Plan Coverage"
],
"timeQualifier": "Calendar Year",
"timeQualifierCode": "23"
},
{
"benefitAmount": "15000",
"code": "C",
"coverageLevel": "Family",
"coverageLevelCode": "FAM",
"inPlanNetworkIndicator": "No",
"inPlanNetworkIndicatorCode": "N",
"name": "Deductible",
"serviceTypeCodes": [
"30"
],
"serviceTypes": [
"Health Benefit Plan Coverage"
],
"timeQualifier": "Calendar Year",
"timeQualifierCode": "23"
},
{
"additionalInformation": [
{
"description": "Coinsurance does apply to member's out-of-pocket maximum"
},
{
"description": "Deductible does apply to member's out-of-pocket maximum"
}
],
"benefitAmount": "30000",
"code": "G",
"coverageLevel": "Family",
"coverageLevelCode": "FAM",
"inPlanNetworkIndicator": "No",
"inPlanNetworkIndicatorCode": "N",
"name": "Out of Pocket (Stop Loss)",
"serviceTypeCodes": [
"30"
],
"serviceTypes": [
"Health Benefit Plan Coverage"
],
"timeQualifier": "Calendar Year",
"timeQualifierCode": "23"
},
{
"benefitPercent": "0.1",
"code": "A",
"coverageLevel": "Individual",
"coverageLevelCode": "IND",
"inPlanNetworkIndicator": "Yes",
"inPlanNetworkIndicatorCode": "Y",
"name": "Co-Insurance",
"serviceTypeCodes": [
"30"
],
"serviceTypes": [
"Health Benefit Plan Coverage"
]
},
{
"benefitAmount": "7500",
"code": "C",
"coverageLevel": "Individual",
"coverageLevelCode": "IND",
"inPlanNetworkIndicator": "No",
"inPlanNetworkIndicatorCode": "N",
"name": "Deductible",
"serviceTypeCodes": [
"30"
],
"serviceTypes": [
"Health Benefit Plan Coverage"
],
"timeQualifier": "Calendar Year",
"timeQualifierCode": "23"
},
{
"additionalInformation": [
{
"description": "Deductible does apply to member's out-of-pocket maximum"
},
{
"description": "Coinsurance does apply to member's out-of-pocket maximum"
}
],
"benefitAmount": "15000",
"code": "G",
"coverageLevel": "Individual",
"coverageLevelCode": "IND",
"inPlanNetworkIndicator": "No",
"inPlanNetworkIndicatorCode": "N",
"name": "Out of Pocket (Stop Loss)",
"serviceTypeCodes": [
"30"
],
"serviceTypes": [
"Health Benefit Plan Coverage"
],
"timeQualifier": "Calendar Year",
"timeQualifierCode": "23"
},
{
"benefitPercent": "0.5",
"code": "A",
"coverageLevel": "Individual",
"coverageLevelCode": "IND",
"inPlanNetworkIndicator": "No",
"inPlanNetworkIndicatorCode": "N",
"name": "Co-Insurance",
"serviceTypeCodes": [
"30"
],
"serviceTypes": [
"Health Benefit Plan Coverage"
]
},
{
"code": "1",
"inPlanNetworkIndicator": "Not Applicable",
"inPlanNetworkIndicatorCode": "W",
"name": "Active Coverage",
"serviceTypeCodes": [
"A7",
"BC",
"A8",
"A4",
"A5",
"A6",
"7",
"4",
"BB",
"22"
],
"serviceTypes": [
"Psychiatric - Inpatient",
"Day Care (Psychiatric)",
"Psychiatric - Outpatient",
"Psychiatric",
"Psychiatric - Room and Board",
"Psychotherapy",
"Anesthesia",
"Diagnostic X-Ray",
"Partial Hospitalization (Psychiatric)",
"Social Work"
]
},
{
"additionalInformation": [
{
"description": "Includes services provided by Client Specific Network"
}
],
"authOrCertIndicator": "N",
"benefitAmount": "0",
"code": "C",
"coverageLevel": "Individual",
"coverageLevelCode": "IND",
"eligibilityAdditionalInformation": {
"codeListQualifier": "Mutually Defined",
"codeListQualifierCode": "ZZ",
"industry": "Outpatient Hospital",
"industryCode": "22"
},
"eligibilityAdditionalInformationList": [
{
"codeListQualifier": "Mutually Defined",
"codeListQualifierCode": "ZZ",
"industry": "Outpatient Hospital",
"industryCode": "22"
}
],
"inPlanNetworkIndicator": "Yes",
"inPlanNetworkIndicatorCode": "Y",
"name": "Deductible",
"serviceTypeCodes": [
"BC",
"A4",
"A6",
"4",
"22"
],
"serviceTypes": [
"Day Care (Psychiatric)",
"Psychiatric",
"Psychotherapy",
"Diagnostic X-Ray",
"Social Work"
]
},
{
"additionalInformation": [
{
"description": "Includes services provided by Client Specific Network"
}
],
"authOrCertIndicator": "N",
"benefitAmount": "0",
"code": "C",
"coverageLevel": "Individual",
"coverageLevelCode": "IND",
"inPlanNetworkIndicator": "Yes",
"inPlanNetworkIndicatorCode": "Y",
"name": "Deductible",
"serviceTypeCodes": [
"A8"
],
"serviceTypes": [
"Psychiatric - Outpatient"
]
},
{
"additionalInformation": [
{
"description": "Includes services provided by Client Specific Network"
}
],
"authOrCertIndicator": "N",
"benefitAmount": "0",
"code": "C",
"coverageLevel": "Individual",
"coverageLevelCode": "IND",
"eligibilityAdditionalInformation": {
"codeListQualifier": "Mutually Defined",
"codeListQualifierCode": "ZZ",
"industry": "Office",
"industryCode": "11"
},
"eligibilityAdditionalInformationList": [
{
"codeListQualifier": "Mutually Defined",
"codeListQualifierCode": "ZZ",
"industry": "Office",
"industryCode": "11"
}
],
"inPlanNetworkIndicator": "Yes",
"inPlanNetworkIndicatorCode": "Y",
"name": "Deductible",
"serviceTypeCodes": [
"A4",
"A6",
"4",
"22"
],
"serviceTypes": [
"Psychiatric",
"Psychotherapy",
"Diagnostic X-Ray",
"Social Work"
]
},
{
"additionalInformation": [
{
"description": "Includes services provided by Client Specific Network"
}
],
"authOrCertIndicator": "N",
"benefitAmount": "0",
"code": "C",
"coverageLevel": "Individual",
"coverageLevelCode": "IND",
"eligibilityAdditionalInformation": {
"codeListQualifier": "Mutually Defined",
"codeListQualifierCode": "ZZ",
"industry": "Telehealth Provided Other than in Patient\u2019s Home",
"industryCode": "02"
},
"eligibilityAdditionalInformationList": [
{
"codeListQualifier": "Mutually Defined",
"codeListQualifierCode": "ZZ",
"industry": "Telehealth Provided Other than in Patient\u2019s Home",
"industryCode": "02"
}
],
"inPlanNetworkIndicator": "Yes",
"inPlanNetworkIndicatorCode": "Y",
"name": "Deductible",
"serviceTypeCodes": [
"A4",
"A6",
"22"
],
"serviceTypes": [
"Psychiatric",
"Psychotherapy",
"Social Work"
]
},
{
"authOrCertIndicator": "N",
"benefitAmount": "20",
"code": "B",
"coverageLevel": "Individual",
"coverageLevelCode": "IND",
"eligibilityAdditionalInformation": {
"codeListQualifier": "Mutually Defined",
"codeListQualifierCode": "ZZ",
"industry": "Office",
"industryCode": "11"
},
"eligibilityAdditionalInformationList": [
{
"codeListQualifier": "Mutually Defined",
"codeListQualifierCode": "ZZ",
"industry": "Office",
"industryCode": "11"
}
],
"inPlanNetworkIndicator": "Yes",
"inPlanNetworkIndicatorCode": "Y",
"name": "Co-Payment",
"serviceTypeCodes": [
"A4",
"A6",
"22"
],
"serviceTypes": [
"Psychiatric",
"Psychotherapy",
"Social Work"
],
"timeQualifier": "Visit",
"timeQualifierCode": "27"
},
{
"authOrCertIndicator": "N",
"benefitPercent": "0",
"code": "A",
"coverageLevel": "Individual",
"coverageLevelCode": "IND",
"eligibilityAdditionalInformation": {
"codeListQualifier": "Mutually Defined",
"codeListQualifierCode": "ZZ",
"industry": "Office",
"industryCode": "11"
},
"eligibilityAdditionalInformationList": [
{
"codeListQualifier": "Mutually Defined",
"codeListQualifierCode": "ZZ",
"industry": "Office",
"industryCode": "11"
}
],
"inPlanNetworkIndicator": "Yes",
"inPlanNetworkIndicatorCode": "Y",
"name": "Co-Insurance",
"serviceTypeCodes": [
"A4",
"A6",
"4",
"22"
],
"serviceTypes": [
"Psychiatric",
"Psychotherapy",
"Diagnostic X-Ray",
"Social Work"
]
},
{
"additionalInformation": [
{
"description": "Included For Specific Services"
}
],
"authOrCertIndicator": "N",
"benefitAmount": "20",
"code": "B",
"coverageLevel": "Individual",
"coverageLevelCode": "IND",
"eligibilityAdditionalInformation": {
"codeListQualifier": "Mutually Defined",
"codeListQualifierCode": "ZZ",
"industry": "Telehealth Provided Other than in Patient\u2019s Home",
"industryCode": "02"
},
"eligibilityAdditionalInformationList": [
{
"codeListQualifier": "Mutually Defined",
"codeListQualifierCode": "ZZ",
"industry": "Telehealth Provided Other than in Patient\u2019s Home",
"industryCode": "02"
}
],
"inPlanNetworkIndicator": "Yes",
"inPlanNetworkIndicatorCode": "Y",
"name": "Co-Payment",
"serviceTypeCodes": [
"A4",
"A6",
"22"
],
"serviceTypes": [
"Psychiatric",
"Psychotherapy",
"Social Work"
],
"timeQualifier": "Visit",
"timeQualifierCode": "27"
},
{
"additionalInformation": [
{
"description": "Included For Specific Services"
}
],
"authOrCertIndicator": "N",
"benefitPercent": "0",
"code": "A",
"coverageLevel": "Individual",
"coverageLevelCode": "IND",
"eligibilityAdditionalInformation": {
"codeListQualifier": "Mutually Defined",
"codeListQualifierCode": "ZZ",
"industry": "Telehealth Provided Other than in Patient\u2019s Home",
"industryCode": "02"
},
"eligibilityAdditionalInformationList": [
{
"codeListQualifier": "Mutually Defined",
"codeListQualifierCode": "ZZ",
"industry": "Telehealth Provided Other than in Patient\u2019s Home",
"industryCode": "02"
}
],
"inPlanNetworkIndicator": "Yes",
"inPlanNetworkIndicatorCode": "Y",
"name": "Co-Insurance",
"serviceTypeCodes": [
"A4",
"A6",
"22"
],
"serviceTypes": [
"Psychiatric",
"Psychotherapy",
"Social Work"
]
},
{
"additionalInformation": [
{
"description": "Services rendered thru Client Specific Network"
}
],
"authOrCertIndicator": "N",
"benefitPercent": "0",
"code": "A",
"coverageLevel": "Individual",
"coverageLevelCode": "IND",
"eligibilityAdditionalInformation": {
"codeListQualifier": "Mutually Defined",
"codeListQualifierCode": "ZZ",
"industry": "Telehealth Provided Other than in Patient\u2019s Home",
"industryCode": "02"
},
"eligibilityAdditionalInformationList": [
{
"codeListQualifier": "Mutually Defined",
"codeListQualifierCode": "ZZ",
"industry": "Telehealth Provided Other than in Patient\u2019s Home",
"industryCode": "02"
}
],
"inPlanNetworkIndicator": "Yes",
"inPlanNetworkIndicatorCode": "Y",
"name": "Co-Insurance",
"serviceTypeCodes": [
"A4",
"A6",
"22"
],
"serviceTypes": [
"Psychiatric",
"Psychotherapy",
"Social Work"
]
},
{
"additionalInformation": [
{
"description": "Services rendered thru Client Specific Network"
}
],
"authOrCertIndicator": "N",
"benefitPercent": "0",
"code": "A",
"coverageLevel": "Individual",
"coverageLevelCode": "IND",
"eligibilityAdditionalInformation": {
"codeListQualifier": "Mutually Defined",
"codeListQualifierCode": "ZZ",
"industry": "Office",
"industryCode": "11"
},
"eligibilityAdditionalInformationList": [
{
"codeListQualifier": "Mutually Defined",
"codeListQualifierCode": "ZZ",
"industry": "Office",
"industryCode": "11"
}
],
"inPlanNetworkIndicator": "Yes",
"inPlanNetworkIndicatorCode": "Y",
"name": "Co-Insurance",
"serviceTypeCodes": [
"A4",
"A6",
"4",
"22"
],
"serviceTypes": [
"Psychiatric",
"Psychotherapy",
"Diagnostic X-Ray",
"Social Work"
]
},
{
"additionalInformation": [
{
"description": "Services rendered thru Client Specific Network"
}
],
"authOrCertIndicator": "N",
"benefitAmount": "20",
"code": "B",
"coverageLevel": "Individual",
"coverageLevelCode": "IND",
"eligibilityAdditionalInformation": {
"codeListQualifier": "Mutually Defined",
"codeListQualifierCode": "ZZ",
"industry": "Telehealth Provided Other than in Patient\u2019s Home",
"industryCode": "02"
},
"eligibilityAdditionalInformationList": [
{
"codeListQualifier": "Mutually Defined",
"codeListQualifierCode": "ZZ",
"industry": "Telehealth Provided Other than in Patient\u2019s Home",
"industryCode": "02"
}
],
"inPlanNetworkIndicator": "Yes",
"inPlanNetworkIndicatorCode": "Y",
"name": "Co-Payment",
"serviceTypeCodes": [
"A4",
"A6",
"22"
],
"serviceTypes": [
"Psychiatric",
"Psychotherapy",
"Social Work"
],
"timeQualifier": "Visit",
"timeQualifierCode": "27"
},
{
"additionalInformation": [
{
"description": "Services rendered thru Client Specific Network"
}
],
"authOrCertIndicator": "N",
"benefitAmount": "20",
"code": "B",
"coverageLevel": "Individual",
"coverageLevelCode": "IND",
"eligibilityAdditionalInformation": {
"codeListQualifier": "Mutually Defined",
"codeListQualifierCode": "ZZ",
"industry": "Office",
"industryCode": "11"
},
"eligibilityAdditionalInformationList": [
{
"codeListQualifier": "Mutually Defined",
"codeListQualifierCode": "ZZ",
"industry": "Office",
"industryCode": "11"
}
],
"inPlanNetworkIndicator": "Yes",
"inPlanNetworkIndicatorCode": "Y",
"name": "Co-Payment",
"serviceTypeCodes": [
"A4",
"A6",
"22"
],
"serviceTypes": [
"Psychiatric",
"Psychotherapy",
"Social Work"
],
"timeQualifier": "Visit",
"timeQualifierCode": "27"
},
{
"additionalInformation": [
{
"description": "Services rendered thru Client Specific Network"
}
],
"authOrCertIndicator": "Y",
"benefitPercent": "0",
"code": "A",
"coverageLevel": "Individual",
"coverageLevelCode": "IND",
"eligibilityAdditionalInformation": {
"codeListQualifier": "Mutually Defined",
"codeListQualifierCode": "ZZ",
"industry": "Office",
"industryCode": "11"
},
"eligibilityAdditionalInformationList": [
{
"codeListQualifier": "Mutually Defined",
"codeListQualifierCode": "ZZ",
"industry": "Office",
"industryCode": "11"
}
],
"inPlanNetworkIndicator": "Yes",
"inPlanNetworkIndicatorCode": "Y",
"name": "Co-Insurance",
"serviceTypeCodes": [
"7"
],
"serviceTypes": [
"Anesthesia"
]
},
{
"authOrCertIndicator": "Y",
"code": "CB",
"inPlanNetworkIndicator": "Yes",
"inPlanNetworkIndicatorCode": "Y",
"name": "Coverage Basis",
"serviceTypeCodes": [
"7",
"BB"
],
"serviceTypes": [
"Anesthesia",
"Partial Hospitalization (Psychiatric)"
]
},
{
"additionalInformation": [
{
"description": "Includes services provided by Client Specific Network"
}
],
"authOrCertIndicator": "Y",
"benefitAmount": "0",
"code": "C",
"coverageLevel": "Individual",
"coverageLevelCode": "IND",
"eligibilityAdditionalInformation": {
"codeListQualifier": "Mutually Defined",
"codeListQualifierCode": "ZZ",
"industry": "Office",
"industryCode": "11"
},
"eligibilityAdditionalInformationList": [
{
"codeListQualifier": "Mutually Defined",
"codeListQualifierCode": "ZZ",
"industry": "Office",
"industryCode": "11"
}
],
"inPlanNetworkIndicator": "Yes",
"inPlanNetworkIndicatorCode": "Y",
"name": "Deductible",
"serviceTypeCodes": [
"7"
],
"serviceTypes": [
"Anesthesia"
]
},
{
"authOrCertIndicator": "Y",
"benefitPercent": "0",
"code": "A",
"coverageLevel": "Individual",
"coverageLevelCode": "IND",
"eligibilityAdditionalInformation": {
"codeListQualifier": "Mutually Defined",
"codeListQualifierCode": "ZZ",
"industry": "Office",
"industryCode": "11"
},
"eligibilityAdditionalInformationList": [
{
"codeListQualifier": "Mutually Defined",
"codeListQualifierCode": "ZZ",
"industry": "Office",
"industryCode": "11"
}
],
"inPlanNetworkIndicator": "Yes",
"inPlanNetworkIndicatorCode": "Y",
"name": "Co-Insurance",
"serviceTypeCodes": [
"7"
],
"serviceTypes": [
"Anesthesia"
]
},
{
"authOrCertIndicator": "N",
"benefitPercent": "0",
"code": "A",
"coverageLevel": "Individual",
"coverageLevelCode": "IND",
"eligibilityAdditionalInformation": {
"codeListQualifier": "Mutually Defined",
"codeListQualifierCode": "ZZ",
"industry": "Outpatient Hospital",
"industryCode": "22"
},
"eligibilityAdditionalInformationList": [
{
"codeListQualifier": "Mutually Defined",
"codeListQualifierCode": "ZZ",
"industry": "Outpatient Hospital",
"industryCode": "22"
}
],
"inPlanNetworkIndicator": "Yes",
"inPlanNetworkIndicatorCode": "Y",
"name": "Co-Insurance",
"serviceTypeCodes": [
"4"
],
"serviceTypes": [
"Diagnostic X-Ray"
]
},
{
"additionalInformation": [
{
"description": "Services rendered thru Client Specific Network"
}
],
"authOrCertIndicator": "N",
"benefitPercent": "0",
"code": "A",
"coverageLevel": "Individual",
"coverageLevelCode": "IND",
"eligibilityAdditionalInformation": {
"codeListQualifier": "Mutually Defined",
"codeListQualifierCode": "ZZ",
"industry": "Outpatient Hospital",
"industryCode": "22"
},
"eligibilityAdditionalInformationList": [
# --- truncated at 32 KB (250 KB total) ---
# Full source: https://raw.githubusercontent.com/api-evangelist/stedi/refs/heads/main/examples/stedi-healthcare-examples.json