For: RCM Specialist · Time: 1–5 min per claim (less in batch) · Frequency: Daily
Electronic submission through Stedi is in pilot. It is built and tested against Stedi’s published specification, and stays labelled UNVERIFIED, with production sending switched off, until its first live test run. Today, send claims from your EHR, practice-management system or clearinghouse (path B below) and track them in Credentik; 837 and 835 files can be imported.
Two ways to send a claim
A. Send it from Credentik through Stedi (when your agency has it turned on). Credentik checks the claim, builds the 837P, sends it to the Stedi clearinghouse, and shows every response on the claim: Stedi's acceptance or rejection, the payer's acknowledgment (277CA), status checks (276/277) and the ERA (835).
B. Send it from your EHR / PM system or clearinghouse (always available). Credentik tracks the claim: you import it (claims CSV, 837 file) or enter it, mark it submitted, and post the ERA when it comes back.
Look at Settings → Integrations → Stedi to see which applies:
| Card says | Meaning |
|---|---|
| Not configured | Path B only. Electronic submission isn't set up (no key, or not turned on for the agency). |
| Test mode | You can practice: claims go to Stedi in test mode with made-up patient data, nothing reaches a payer, and the claim's own status never changes. |
| Production | Claims go to the payer. |
| UNVERIFIED label | The connection hasn't passed its first real test run yet. Production stays off until it has. |
Trigger
A practice had a visit and the claim is ready to bill.
Outcome
The claim is in Credentik with the right patient, provider, payer, DOS and CPT lines, it passed Check claim (or the credentialing gate was knowingly overridden), and it reached the payer. From there acknowledgments, status checks and ERA posting carry it to paid, partial_paid or denied.
Where
- RCM → Claims: claim list, Check, Submit ready claims, filters by submission and check status
- Claim detail → Electronic submission panel: Check claim, Submit, timeline, rejection reasons, corrected claim / void
- Settings → Integrations: the Stedi connection card (agency admins change it)
- Tools → RCM Import: claims CSV, charges CSV, 837 file import, ERA files
Path A: send through Stedi
1. Fill in the submission details (once per claim)
An electronic claim needs a few facts the claim screen doesn't ask for: the patient's sex and address, the patient's relationship to the policyholder (and the policyholder's name, date of birth and sex when it isn't the patient), the group number, the plan type (claim filing code), and, if there is one, the referring provider's NPI. For a secondary claim, add the primary payer, its payer ID, the member ID there, and what it paid and when.
Open the claim → Electronic submission → Submission details.
2. Check claim
Click Check claim (or select claims in the list → Check). Credentik runs its claim edits:
- billing and rendering NPIs present, valid and verified against NPPES; taxonomy codes valid; billing address with ZIP+4 and a 9-digit Tax ID
- patient / policyholder name, date of birth, sex, address and member ID
- payer matched, and a Stedi payer ID set for claims
- date and place of service, CPT / HCPCS format, ICD-10-CM format (ICD-9 is refused), at most 4 diagnoses per line and 12 per claim, modifiers, units and charges above zero
- possible duplicates, the timely-filing window, the credentialing gate and the rendering provider's enrollment
Results are grouped. Errors block sending; warnings don't. Each item says where to fix it.
3. Submit
Click Submit on the claim, or select claims → Submit ready claims (claims with errors are skipped and listed). Credentik always re-checks the claim before sending. The button is disabled, with the reason next to it, when the claim has errors, was already sent, or Stedi isn't configured.
Sending twice is safe: if nothing changed, the second click returns the first submission.
4. Watch the timeline
| Timeline entry | Meaning |
|---|---|
| Queued / Sent to Stedi | Credentik handed the claim to Stedi |
| Accepted by the clearinghouse | It passed Stedi's claim edits |
| Rejected by the clearinghouse | Stedi refused it. Fix what it lists and resubmit. |
| Accepted by the payer | The payer took it into processing (the claim becomes acknowledged) |
| Rejected by the payer | The payer refused it before processing. Fix and resubmit. |
| Status check | A 276/277 answer from the payer |
| ERA received | The payer's 835; payments and denials post as in Post an ERA file |
Responses arrive automatically (Credentik checks Stedi every 15 minutes). A claim still waiting 21 days after submission with no ERA gets an automatic status check, and you can run Check status any time (production only; Stedi's test mode doesn't support it).
5. Fix a rejection, correct or void
- Rejected (clearinghouse or payer): read the reasons. Each one says what's wrong, how to fix it, and which part of the claim to change. Fix it, run Check claim, then Resubmit. A claim the payer never accepted goes again as an original with the same patient control number.
- Corrected claim: once the payer has accepted the claim (it has a payer claim number), use Corrected claim to send a replacement (frequency 7). Give a reason.
- Void: Void claim cancels a claim the payer has accepted (frequency 8).
- Medicare: Medicare doesn't take replacement or void claims electronically. Correct the claim and resend it as an original, or contact the MAC.
Path B: send from the EHR / clearinghouse
- Send the claim from the EHR / PM system or clearinghouse as usual, and fix clearinghouse rejections there. Credentik doesn't see those acknowledgments on this path.
- Get it into Credentik: Tools → RCM Import → Import Claims (CSV) or Import 837 EDI (a copy of the 837 the EHR produced; this imports it, nothing is sent), or enter it by hand.
- Check it: the credentialing gate and the Pre-submission Check (payer denial history, fee schedule) still apply. Check claim works too, as a quality check.
- Mark it submitted: RCM → Claims → select claims → Submit selected. This only records that the claim went out; it doesn't send anything.
- Track it: ERA posting and A/R aging (automatic claim status checks are coming soon).
Statuses
| Status | Meaning in Credentik |
|---|---|
draft / pending | Not yet sent. Can be submitted. |
submitted | Sent through Stedi, or recorded as sent (Submit selected, 837 import, claims CSV). |
acknowledged | The payer accepted it into processing (Stedi path). |
rejected | Refused before processing. Fix and resubmit. |
paid / partial_paid / denied | Set by ERA posting, payment posting or a finalized status response. |
voided | A void the payer accepted. |
written_off | Balance written off through the write-off flow. |
Test-mode submissions show TEST on the claim and never change these statuses.
Watch-outs
- Marking a claim submitted (path B) doesn't send it. If the EHR never sent it, A/R shows a
submittedclaim the payer has never seen. - Payer enrollment. Some payers require the billing provider to be enrolled with the clearinghouse for electronic claims, and separately for ERAs. Once ERA enrollment moves to Stedi, the previous clearinghouse stops receiving those ERAs.
- POS and telehealth modifiers. Use POS 02 / 10 for telehealth; most payers want -95 instead of -GT.
- Secondary claims through Stedi send the primary payer's paid amount and date, not its line adjustments; some secondary payers need those. Check claim warns on every secondary claim.
- Duplicates. Check claim flags a claim with the same patient, provider, date and procedures that was already sent. Run Tools → Duplicate Check after mixing CSV, 837 and manual entry.
Related jobs
- Verify patient eligibility: check before billing
- Post an ERA file: what happens 14–45 days after submission
- Work the Denial Inbox: when submitted claims are denied
- Recover an underpayment: when the payer allowed less than the contract
- Enroll for ERA delivery
Something on this page doesn’t match what you see in the app? Email support@credentik.com and we’ll fix the guide.