How claims transactions fit together

To track a claim and figure out its current status, you need to follow a chain of transactions. Each one tells you something new about where the claim stands. But they work together in ways that aren’t obvious.

This guide is your map. It walks you through each step of the claim lifecycle and the transactions that go with it.

Step 1. Claim submission

After treating a patient, a provider sends a claim to the payer through a clearinghouse, like Stedi.

To submit and track the claim, most providers use software – like a Stedi Platform Partner – that connects to Stedi behind the scenes.

HIPAA and X12
As a clearinghouse, Stedi has two main jobs:

1. Connect providers to payers.

2. Ensure transactions sent to payers are well-formed and compliant.

HIPAA is a federal law that, among other things, requires certain electronic healthcare transactions be exchanged in the standardized X12 EDI format.

Stedi ensures transactions sent to payers are in HIPAA-compliant X12. For example, claims must be sent as one of the following X12 transactions:

• 837P – Professional claims, used for services like doctor visits, outpatient care, and therapy

• 837D – Dental claims, used for services like oral examinations, dental implants, and dental X-rays

• 837I – Institutional claims, used for services like hospital stays and skilled nursing

Translation and validation
You can submit claims to Stedi as X12 using SFTP or our X12 API. But most Stedi customers use our JSON API or the Stedi portal. In that case, we translate the claim into an 837 X12 transaction for you.

We then validate the claim’s X12 against HIPAA’s X12 standards. If it passes, we forward the claim to the payer.

Patient control number
When you submit a claim, you must include a patient control number. It acts as the tracking ID for the claim. The payer sends the ID back in follow-up transactions. For more information, check out How to track claims.

Step 2. Claim acknowledgment

A 277CA claim acknowledgment is an X12 transaction sent from a clearinghouse or payer back to the provider. It shows whether the claim will move forward or not. Providers often get several 277CAs for the same claim.

If you submit a claim through Stedi, you also get the 277CAs through Stedi. You can use a webhook to listen for incoming 277CAs or monitor them manually in the Stedi portal.

277CAs from Stedi
When Stedi validates a claim, we send a 277CA within about 30 minutes. We either acknowledge the claim – meaning the claim will be forwarded to the payer – or reject it for corrections and resubmission.

Payer 277CAs
These are usually the acknowledgments that providers care about. After Stedi submits the claim, the payer validates its format and data. That process takes 2–7 days. The payer may send several 277CAs during that time.

These 277CAs contain the claim's status: acknowledged (still validating), rejected, or accepted for processing. Accepted means the payer will adjudicate (rule on) the claim. It’s not a guarantee that the claim will be reimbursed.

Rejections
Claims can be rejected for several reasons, including syntax errors, payer-specific requirements, or duplicates. If that happens, the provider can fix and resubmit the claim until it’s accepted.

Step 3. Payment

Once your claim is accepted, the payer begins adjudication, deciding whether and how much to pay.

If the payer owes the provider money, they send it by electronic funds transfer (EFT) to the provider’s bank.

Paper checks
If the payer doesn’t support EFT or the provider isn’t enrolled with the payer for EFT, the payer typically mails a check to the address listed in the claim. Some payers may also use virtual credit cards.

Stedi isn’t involved in payment.

Note: EFT enrollment is often separate from transaction enrollment.

Step 4. Remittance

After the payer adjudicates the claim, they send the provider an 835 Electronic Remittance Advice (ERA) through the provider’s enrolled clearinghouse.

Providers use ERAs to see if a claim was paid in full, partly paid, or denied. A related ERA typically arrives 7–20 business days after claim submission.

An ERA is tied to a payment, not a single claim. One ERA can cover multiple claims, and a single claim’s payment might be spread across multiple ERAs.

Payers can also send ERAs that aren't tied to any claim, such as for bonus payments or value-based care arrangements. 

You can use a webhook to listen for incoming ERAs or monitor them manually in the Stedi portal.

Transaction enrollment
Transaction enrollment is the process of registering a provider to exchange specific healthcare transactions with a payer. Providers must enroll with a payer through Stedi to receive ERAs from Stedi.

Stedi’s transaction enrollment features also let you onboard providers at scale with less paperwork. In many cases, you just need to submit a request using our API or the Stedi portal.

A provider can only receive ERAs from one clearinghouse per payer.

Explanation of Benefits / Payments
Explanations of Benefits (EOBs) and Explanations of Payments (EOPs) are documents – typically paper or PDF – that contain the same information as ERAs. Many payers mail EOBs or EOPs when no ERA enrollment is on file, or when the payer doesn’t support ERAs.

You can use Anatomy to convert EOBs into ERAs that you can retrieve through Stedi.

Real-time claim status checks

If you’ve sent a claim but haven’t seen a 277CA or ERA – or just want to know the claim’s current status –  you can run a real-time claim status check using our API or the Stedi portal.

To run a real-time status check, you submit a 276 claim status check request. The payer returns a 277 claim status response. Unlike 277CAs and ERAs, claim status checks return immediate results. You can run status checks multiple times.

You can make a claim status check 7 days after claim submission. Most Stedi customers wait until day 21 – most ERAs will have arrived by then. Then they monitor the claim using real-time claim status checks until they receive a final status or an ERA.

277CAs vs. 277 claim status responses
Technically, both 277CAs and 277 claim status responses use the same X12 transaction – the 277 – but each applies the standard a little differently.

For simplicity, think of them as two separate transaction types that serve different purposes. The 277CA tells the provider if the payer (or Stedi) got the claim. The 277 tells the provider the claim’s status.

Putting it all together

Stedi helps you process and track claims through every part of the lifecycle – from submission and validation to payment and remittance.

Get started for free. Stedi’s Basic plan includes 100 monthly claim submissions, ERAs, and claim status checks to help you get rolling.