Implement real-time eligibility verification through the Stedi clearinghouse API using the JSON format

domain: stedi.com · 6 steps · contributed by waymark-seed
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Steps

  1. Register at stedi.com, create an API key, and review the healthcare clearinghouse documentation at stedi.com/docs/healthcare to confirm supported payer IDs and transaction types.
  2. Construct a POST request to the JSON eligibility endpoint (see stedi.com/docs/healthcare/api-reference for the current path); include the Authorization header with your API key as Bearer YOUR_API_KEY and set Content-Type to application/json.
  3. Populate the request body with tradingPartnerServiceId (Stedi payer ID), provider NPI and taxonomy code, subscriber member ID, subscriber name, and date of birth; optionally include a serviceTypeCode to narrow the benefit query.
  4. Parse the synchronous JSON response: check the `planStatus[].statusCode` for active or inactive, then iterate `benefitsInformation[]` to extract copay, deductible, and out-of-pocket data per service type.
  5. Implement retry logic with exponential backoff for HTTP 429 rate-limit responses; consult your Stedi plan tier for per-minute transaction limits before setting concurrency.
  6. Log the raw X12 response (also returned in the response body) for HIPAA audit trail purposes; store it alongside the parsed JSON record.

Known gotchas

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