Stedi

https://www.stedi.com/docs
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Stedi is a healthcare clearinghouse platform that automates eligibility checks, claims processing,...
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### Example Get Enrollment Response (JSON)

Source: https://www.stedi.com/docs/healthcare/api-reference/get-enrollment

Example response body for a successful Get Enrollment request. Shows enrollment details including documents, history, payer, provider, tasks, and transactions. The primaryContact is set to the oldest account member with the Admin role for automatic enrollment requests.

```json
{
  "createdAt": "2023-11-07T05:31:56Z",
  "documents": [
    {
      "createdAt": "2026-11-08T12:00:00Z",
      "enrollmentId": "db6675c5-7bg7-4af9-8c68-a54a336d2911",
      "id": "dc6665a5-7b97-4agh-8c74-a00a336c2989",
      "name": "pdf-agreement.pdf",
      "status": "UPLOADED",
      "updatedAt": "2026-11-08T12:05:00Z"
    }
  ],
  "history": [
    {
      "changedAt": "2026-11-07T05:31:56Z",
      "changedBy": "user@example.com",
      "newStatus": "DRAFT",
      "type": "STATUS_CHANGE"
    },
    {
      "changedAt": "2026-11-07T05:31:56Z",
      "changedBy": "user@example.com",
      "newStatus": "STEDI_ACTION_REQUIRED",
      "previousStatus": "DRAFT",
      "type": "STATUS_CHANGE"
    },
    {
      "changedAt": "2026-11-07T06:15:22Z",
      "changedBy": "system",
      "newStatus": "PROVIDER_ACTION_REQUIRED",
      "previousStatus": "STEDI_ACTION_REQUIRED",
      "type": "STATUS_CHANGE"
    },
    {
      "changedAt": "2026-11-08T06:15:22Z",
      "changedBy": "system",
      "newStatus": "STEDI_ACTION_REQUIRED",
      "previousStatus": "PROVIDER_ACTION_REQUIRED",
      "type": "STATUS_CHANGE"
    },
    {
      "changedAt": "2026-11-10T06:15:22Z",
      "changedBy": "system",
      "newStatus": "PROVIDER_ACTION_REQUIRED",
      "previousStatus": "STEDI_ACTION_REQUIRED",
      "type": "STATUS_CHANGE"
    }
  ],
  "id": "db6675c5-7bg7-4af9-8c68-a54a336d2911",
  "payer": {
    "name": "UnitedHealthcare",
    "stediPayerId": "KMQTZ",
    "submittedPayerIdOrAlias": "87726"
  },
  "primaryContact": {
    "city": "A City",
    "country": "US",
    "email": "test@example.com",
    "firstName": "John",
    "lastName": "Doe",
    "phone": "5551234567",
    "state": "MD",
    "streetAddress1": "123 Some Str.",
    "zipCode": "20814"
  },
  "provider": {
    "id": "db6665c5-7b97-4af9-8c68-a00a336c2998",
    "name": "Test Medical Provider",
    "npi": "1234567890",
    "taxId": "123456789",
    "taxIdType": "EIN"
  },
  "requestedEffectiveDate": "20231107",
  "source": "API",
  "status": "PROVIDER_ACTION_REQUIRED",
  "statusLastUpdatedAt": "2023-11-07T06:15:22Z",
  "submittedAt": "2023-11-07T05:31:56Z",
  "tasks": [
    {
      "definition": {
        "manualTask": {
          "fields": [],
          "instructions": "Log in to your Authority's portal and request clearinghouse access for Stedi."
        }
      },
      "id": "ac6665a5-7b97-4agh-8c74-a00a336c2989",
      "isComplete": false,
      "rank": 1,
      "responsibleParty": "PROVIDER"
    },
    {
      "completedAt": "2026-06-01T12:00:00Z",
      "definition": {
        "manualTask": {
          "fields": [
            {
              "description": "Your filled-in and signed enrollment form, as a PDF",
              "fieldType": "DOCUMENT",
              "key": "ENROLLMENT_FORM",
              "label": "Signed PDF"
            }
          ],
          "instructions": "Download the enrollment form, sign it, and upload the completed PDF.",
          "links": [
            {
              "label": "Enrollment Form",
              "url": "https://enrollments.us.stedi.com/2024-09-01/documents/019375d0-9876-7890-abcd-567890fedcba/download"
            }
          ]
        }
      },
      "id": "019ce833-b234-75f1-9599-0f14ba643709",
      "isComplete": true,
      "rank": 0,
      "responseData": {
        "manualTask": {
          "values": [
            {
              "key": "ENROLLMENT_FORM",
              "value": {
                "document": {
                  "documentId": "dc6665a5-7b97-4af9-8c74-a00a336c2989"
                }
              }
            }
          ]
        }
      },
      "responsibleParty": "PROVIDER"
    }
  ],
  "transactions": {
    "professionalClaimSubmission": {
      "enroll": true
    }
  },
  "updatedAt": "2023-11-07T05:31:56Z",
  "userEmail": "test@example.com"
}
```

--------------------------------

### Get Enrollment List Response Example

Source: https://www.stedi.com/docs/healthcare/api-reference/get-enrollment-list-enrollments

A JSON representation of a successful response from the Get Enrollment List endpoint, showing the structure of items, documents, and history.

```json
{
  "items": [
    {
      "aggregationPreference": {
        "taxId": "123456789"
      },
      "createdAt": "2025-04-01T12:00:00Z",
      "documents": [
        {
          "createdAt": "2025-04-01T12:00:00Z",
          "enrollmentId": "db6675c5-7bg7-4af9-8c68-a54a336d2911",
          "id": "dc6665a5-7b97-4agh-8c74-a00a336c2989",
          "name": "pdf-agreement.pdf",
          "status": "UPLOADED",
          "updatedAt": "2025-04-02T12:00:00Z"
        }
      ],
      "history": [
        {
          "changedAt": "2025-04-15T09:00:00Z",
          "changedBy": "user@example.com",
          "newStatus": "DRAFT",
          "type": "STATUS_CHANGE"
        },
        {
          "changedAt": "2025-04-15T09:05:00Z",
          "changedBy": "user@example.com"
```

--------------------------------

### Create Enrollment Response Example

Source: https://www.stedi.com/docs/healthcare/api-reference/post-enrollment-create-enrollment

Example JSON response for a successful enrollment creation request. Shows the enrollment object with fields such as aggregationPreference, history, payer, primaryContact, provider, and transactions. The status is STEDI_ACTION_REQUIRED.

```json
{
  "aggregationPreference": {
    "taxId": "123456789"
  },
  "createdAt": "2023-11-07T05:31:56Z",
  "history": [
    {
      "changedAt": "2023-11-07T05:31:56Z",
      "changedBy": "test@example.com",
      "newStatus": "DRAFT",
      "type": "STATUS_CHANGE"
    },
    {
      "changedAt": "2023-11-07T05:31:56Z",
      "changedBy": "test@example.com",
      "newStatus": "STEDI_ACTION_REQUIRED",
      "previousStatus": "DRAFT",
      "type": "STATUS_CHANGE"
    }
  ],
  "id": "db6675c5-7bg7-4af9-8c68-a54a336d2911",
  "payer": {
    "name": "UnitedHealthcare",
    "stediPayerId": "KMQTZ",
    "submittedPayerIdOrAlias": "87726"
  },
  "primaryContact": {
    "city": "A City",
    "country": "US",
    "email": "test@example.com",
    "firstName": "John",
    "lastName": "Doe",
    "phone": "5551234567",
    "state": "MD",
    "streetAddress1": "123 Some Str.",
    "zipCode": "20814"
  },
  "provider": {
    "id": "db6665c5-7b97-4af9-8c68-a00a336c2998",
    "name": "Test Medical Provider",
    "npi": "1234567890",
    "taxId": "123456789",
    "taxIdType": "EIN"
  },
  "requestedEffectiveDate": "20240301",
  "source": "API",
  "status": "STEDI_ACTION_REQUIRED",
  "statusLastUpdatedAt": "2023-11-07T05:31:56Z",
  "submittedAt": "2023-11-07T05:31:56Z",
  "transactions": {
    "claimPayment": {
      "enroll": true
    }
  },
  "updatedAt": "2023-11-07T05:31:56Z",
  "userEmail": "test@example.com"
}
```

--------------------------------

### Example response for Download Enrollment Document

Source: https://www.stedi.com/docs/healthcare/api-reference/get-enrollment-document-download

Example JSON response for a successful (200) request to the Download Enrollment Document endpoint. It includes the documentId and the pre-signed downloadUrl.

```json
{
  "documentId": "doc-123e4567-e89b-12d3-a456-426614174000",
  "downloadUrl": "https://s3.amazonaws.com/enrollment-documents/doc-123e4567-e89b-12d3-a456-426614174000/provider-license.pdf?X-Amz-Algorithm=AWS4-HMAC-SHA256&X-Amz-Credential=..."
}
```

--------------------------------

### plans array response example

Source: https://www.stedi.com/docs/llms-full.txt

Example JSON response showing the plans array structure for a real-time eligibility check, including benefits grouped by plan with statuses and co-payment details.

```APIDOC
## plans array

### Description
The `plans` array groups benefits under their associated health plan. A response can contain multiple plans. Each plan contains a `benefits` object with a `statuses` array and named benefit arrays such as `coPayment` or `deductible`.

### Applies to
Real-Time Eligibility Check JSON

### Response Example
```json
{
  "id": "ec_550e8400-e29b-41d4-a716-446655440000",
  "payerId": "87726",
  "payer": {
    "type": "PAYER",
    "name": { "organization": "HUMANA" }
  },
  "x12": "...",
  "subscriber": {
    "memberId": "123456789",
    "dates": {
      "plan": { "start": "2024-01-01" },
      "service": { "start": "2024-09-17" }
    }
  },
  "plans": [
    {
      "benefits": {
        "statuses": [
          {
            "status": "ACTIVE_COVERAGE",
            "coverageLevel": "EMPLOYEE_ONLY",
            "insuranceType": "PREFERRED_PROVIDER_ORGANIZATION_PPO",
            "network": { "indicator": "IN_AND_OUT_OF_NETWORK" },
            "planCoverageDescription": "Humana Gold Plan",
            "service": {
              "system": "STC",
              "value": "30",
              "definition": "Health Benefit Plan Coverage"
            },
            "messages": ["Medicare PPO"]
          }
        ],
        "coPayment": [
          {
            "amount": "2000",
            "coverageLevel": "INDIVIDUAL",
            "insuranceType": "PREFERRED_PROVIDER_ORGANIZATION_PPO",
            "network": { "indicator": "IN_NETWORK" },
            "service": {
              "system": "STC",
              "value": "49",
              "definition": "Hospital - Room and Board"
            },
            "timePeriod": "ADMISSION",
            "messages": ["INPATIENT HOSPITAL ROOM AND BOARD"]
          }
        ]
      }
    }
  ]
}
```
```

--------------------------------

### Retrieve polling results with cURL

Source: https://www.stedi.com/docs/healthcare/batch-refresh-eligibility-checks

An example of using the cURL command to retrieve batch eligibility check results filtered by a start date and time.

```bash
curl --request GET \
  --url https://manager.us.stedi.com/2024-04-01/eligibility-manager/polling/batch-eligibility?startDateTime=2025-12-31T00:00:00Z \
  --header 'Authorization: <api-key>'
```

--------------------------------

### GET /2024-04-01/eligibility-manager/polling/batch-eligibility

Source: https://www.stedi.com/docs/llms-full.txt

Retrieve results from batch eligibility checks submitted through the API or CSV upload. Use query parameters to filter results by batch ID or start date/time.

```APIDOC
## GET /2024-04-01/eligibility-manager/polling/batch-eligibility

### Description
Retrieves the results from batch eligibility checks submitted through both the API and CSV upload. Use this endpoint to poll for results after submitting a batch.

### Method
GET

### Endpoint
https://manager.us.stedi.com/2024-04-01/eligibility-manager/polling/batch-eligibility

### Parameters
#### Query Parameters
- **batchId** (string) - Optional - Retrieve results for a specific batch of eligibility checks. You can find this value in the synchronous response from the Batch Eligibility Check endpoint.
- **startDateTime** (string) - Optional - Retrieve results for checks submitted after a specific date and time (in ISO 8601 format).

### Request Example
curl --request GET \
  --url https://manager.us.stedi.com/2024-04-01/eligibility-manager/polling/batch-eligibility?startDateTime=2025-12-31T00:00:00Z \
  --header 'Authorization: <api-key>'

### Response
#### Success Response (200)
- **successCount** (integer) - Number of checks that Stedi has finished processing successfully.
- **errorCount** (integer) - Number of checks that Stedi has finished processing with errors.
- **inProgressCount** (integer) - Number of checks still in progress.
- **status** (string) - Batch status, e.g., COMPLETED or COMPLETED_WITH_ERRORS.

#### Response Example
{
  "successCount": 10,
  "errorCount": 2,
  "inProgressCount": 0,
  "status": "COMPLETED"
}
```

--------------------------------

### Example task with mixed fields (JSON)

Source: https://www.stedi.com/docs/healthcare/transaction-enrollment-tasks-documents

Shows a manual task definition with a TEXT field (MEDICAID_ID) and a DOCUMENT field (AGREEMENT_PDF). The task requires the provider to supply a Medicaid ID and upload a signed enrollment PDF.

```json
{
  "responsibleParty": "PROVIDER",
  "definition": {
    "manualTask": {
      "instructions": "Please provide your Medicaid ID and upload signed enrollment PDF.",
      "links": [
        {
          "label": "Enrollment Form",
          "url": "https://enrollments.us.stedi.com/2024-09-01/documents/019375d0-9876-7890-abcd-567890fedcba/download"
        }
      ],
      "fields": [
        {
          "key": "MEDICAID_ID",
          "label": "Medicaid ID",
          "description": "Please provide your Medicaid ID.",
          "fieldType": "TEXT"
        },
        {
          "key": "AGREEMENT_PDF",
          "label": "Enrollment PDF",
          "description": "Please sign PDF.",
          "fieldType": "DOCUMENT"
        }
      ]
    }
  },
  "rank": 0,
  "isComplete": false,
  "id": "019eb887-82dc-7613-a279-8a4a2ba794fe"
}
```

--------------------------------

### 276 X12 EDI Request Body Example

Source: https://www.stedi.com/docs/healthcare/api-reference/post-healthcare-claim-status-raw-x12

Example JSON payload for the ClaimStatusRawX12RequestContent schema. The x12 field must contain a 276 X12 EDI string for a production claim that has entered the payer's processing system. Providing too much information can negatively affect results; start with the recommended base request.

```json
{
  "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~"
}
```
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