Setup stedi ability - Z360 Help Center

This document covers the two main Stedi MCP tools: 1. Search for Payer 2. Eligibility Check

Tool 1: Search for Payer

What It Does

Searches Stedi’s payer database to find the correct Payer ID for an insurance company. Use this before running an eligibility check when you have the insurance company name but need the Payer ID.

When to Use

Patient provides insurance company name but you need the Payer ID
Patient gives insurance name with typos or partial name
You need to verify a payer supports eligibility checks
You need to find related payer IDs (e.g., Cigna vs Cigna Medicare)

Input Parameters

Parameter	Required	Description	Example
`query`	Yes	Insurance company name or partial name	`"cigna"`
`pageSize`	No	Number of results to return (recommended: 5-10)	`5`

Recommended Page Size

pageSize	Use Case
`5`	Quick lookup, show top matches only
`10`	Standard search, good balance
`20`	Broader search when unsure of payer name

_💡 Tip: Always set pageSizeto _ 5 by default to avoid returning too many results. If no good match is found, ask the user for more details and search again.

Example Request

{
  "query": "blue cross texas",
  "pageSize": 5
}

Example Response

{
  "payers": [
    {
      "payerId": "BCBSTX",
      "payerName": "Blue Cross Blue Shield of Texas",
      "availableTransaction: ["eligibility", "claims"]
    },
    {
      "payerId": "BCBSTX_MC",
      "payerName": "Blue Cross Blue Shield of Texas - Medicare",
      "availableTransaction: ["eligibility"]
    }
  ]
}

Response Fields

Field	Description
`payerId`	Unique Stedi Payer ID - use this for eligibility check
`payerName`	Full insurance company name
`availableTransactions`	What transactions this payer supports

Tips for Best Results

Use partial names: "cigna" finds all Cigna plans
Works with typos: "aetna" or "etna" both work
Be specific if needed: "cigna medicare" vs just "cigna"
If multiple results, ask user to clarify which plan

Common Issues

Issue	Fix
No results found	Try shorter search term or different spelling
Too many results	Ask user for more details (Medicare? Medicaid? Commercial?)
Wrong payer selected	Confirm with user before proceeding

Tool 2: Eligibility Check

What It Does

Runs a real-time eligibility verification with an insurance payer. Returns coverage status, benefits information, copays, deductibles, and more.

When to Use

Patient wants to book appointment with insurance
Need to verify active coverage before scheduling
Need to get copay/deductible information
Need to check if provider is in-network

Input Parameters

Required Parameters

Parameter	Description	Example
`tradingPartnerServiceId`	Payer ID from search_for_payer	`"CIGNA"`
`provider.npi`	Provider’s 10-digit NPI number	`"1234567890"`
`provider.organizationName`	Practice/Provider name	`"Your Practice Name"`
`subscriber.firstName`	Patient’s legal first name	`"Jane"`
`subscriber.lastName`	Patient’s legal last name	`"Doe"`
`subscriber.dateOfBirth`	DOB in YYYYMMDD format	`"19850215"`
`subscriber.memberId`	Insurance member ID	`"XYZ123456789"`
`encounter.serviceTypeCodes`	Array of service type codes	`["30"]`

Optional Parameters

Parameter	Description	Example
`subscriber.gender`	M, F, or U	`"F"`
`subscriber.ssn`	Social Security Number (for Medicare MBI lookup)	`"123456789"`
`encounter.dateOfService`	Service date YYYYMMDD	`"20260127"`
`encounter.procedureCode`	CPT code	`"99214"`
`encounter.productOrServiceIDQualifier`	REQUIRED if procedureCode is set	`"HC"`
`dependents`	Array for dependent patients	See example below

Service Type Codes

Code	Description	Use For
`30`	Health Benefit Plan Coverage	General benefits check
`MH`	Mental Health	Therapy, counseling
`A4`	Psychiatric	Psychiatric services
`A6`	Psychotherapy	Psychotherapy sessions
`A8`	Psychiatric - Outpatient	Outpatient psych
`35`	Dental Care	Dental services
`88`	Prescription Drug	Pharmacy benefits
`98`	Physical Therapy	PT services
`UC`	Urgent Care	Urgent care visits
`AL`	Vision	Vision services
`BZ`	Home Health	Home health services

Product or Service ID Qualifiers

Code	Description	Use For
`HC`	HCPCS (includes CPT)	CPT codes like 99214, 90837
`ID`	ICD-10	Diagnosis codes
`AD`	American Dental Association	Dental procedure codes

_⚠️ IMPORTANT: If you include procedureCode, you MUST include _productOrServiceIDQualifier

Example Requests

Basic Request

{
  "tradingPartnerServiceId": "CIGNA",
  "provider": {
    "organization: "Your Practice Name",
    "npi": "1234567890"
  },
  "subscriber": {
    "firstName": "Jane",
    "lastName": "Doe",
    "dateOfBirth": "19850215",
    "memberId": "XYZ123456789"
  },
  "encounter": {
    "serviceTypeCodes": ["30"]
  }
}

With CPT Code

{
  "tradingPartnerServiceId": "CIGNA",
  "provider": {
    "organization: "Your Practice Name",
    "npi": "1234567890"
  },
  "subscriber": {
    "firstName": "Jane",
    "lastName": "Doe",
    "dateOfBirth": "19850215",
    "memberId": "XYZ123456789"
  },
  "encounter": {
    "serviceTypeCodes": ["30"],
    "procedureCode": "99214",
    "productOrServiceIDQualifier": "HC"
  }
}

With Dependent

{
  "tradingPartnerServiceId": "CIGNA",
  "provider": {
    "organization: "Your Practice Name",
    "npi": "1234567890"
  },
  "subscriber": {
    "firstName": "John",
    "lastName": "Doe",
    "dateOfBirth": "19800101",
    "memberId": "XYZ123456789"
  },
  "dependents": [
    {
      "firstName": "Jane",
      "lastName": "Doe",
      "dateOfBirth": "20100515",
      "relation: "19"
    }
  ],
  "encounter": {
    "serviceTypeCodes": ["30"]
  }
}

Response Fields

Key Fields

Field Path	Description
`id`	Stedi Check ID (ec_xxxxx)
`meta.traceId`	Trace ID for support inquiries
`subscriber.firstName`	Patient first name
`subscriber.lastName`	Patient last name
`subscriber.memberId`	Member ID
`subscriber.dateOfBirth`	Date of birth
`payer.name`	Insurance company name
`planStatus[0].status`	Coverage status (Active Coverage/Inactive)
`planStatus[0].statusCode`	Status code (1=Active, 6=Inactive)
`planStatus[0].planDetails`	Plan name
`planInformation.groupNumber`	Group number
`planInformation.groupDescription`	Group name
`planDateInformation.planBegin`	Coverage start date (YYYYMMDD)
`planDateInformation.planEnd`	Coverage end date (YYYYMMDD)

Benefits Information Fields

Field Path	Description
`benefitsInformation[].code`	Benefit type code
`benefitsInformation[].name`	Benefit type name
`benefitsInformation[].coverageLevelCode`	IND (Individual) or FAM (Family)
`benefitsInformation[].benefitAmount`	Dollar amount
`benefitsInformation[].benefitPercent`	Percentage (for coinsurance)
`benefitsInformation[].inPlanNetworkIndicatorCode`	Y=In-Network, N=Out-of-Network
`benefitsInformation[].timeQualifierCode`	23=Calendar Year, 29=Remaining, 27=Per Visit
`benefitsInformation[].authOrCertIndicator`	Y=Auth Required, N=Not Required

Benefit Type Codes

Code	Name	What It Is
`1`	Active Coverage	Confirms coverage is active
`A`	Co-Insurance	Percentage patient pays after deductible
`B`	Co-Payment	Fixed copay amount per visit
`C`	Deductible	Deductible amount
`G`	Out of Pocket (Stop Loss)	Out-of-pocket maximum
`F`	Limitations	Visit limits or restrictions
`CB`	Coverage Basis	Prior authorization requirement

Coverage Level Codes

Code	Meaning
`IND`	Individual
`FAM`	Family
`CHD`	Children Only
`DEP`	Dependents
`EMP`	Employee Only
`ESP`	Employee and Spouse

Time Qualifier Codes

Code	Meaning
`23`	Calendar Year
`24`	Year to Date
`29`	Remaining
`27`	Per Visit
`7`	Per Day

Network Indicator Codes

Code	Meaning
`Y`	In-Network
`N`	Out-of-Network
`W`	Not Applicable
`U`	Unknown

Error Codes

Connectivity Errors (Retry Automatically)

Code	Description	What to Do
`42`	Unable to Respond at Current Time	Wait 15 seconds, retry up to 2 minutes
`79`	Invalid Request	Retry with same data
`80`	Unable to Respond	Retry, then offer manual verification

Patient Not Found (Troubleshoot)

Code	Description	What to Do
`72`	Invalid/Missing Subscriber ID	Verify member ID spelling, remove dashes
`75`	Subscriber/Insured Not Found	Try legal name, verify DOB, try without member ID

Provider Errors (Escalate to Billing Team)

Code	Description	What to Do
`41`	Authorization Restrictions	Billing team to follow up
`70`	Certification Info Not Found	Manual verification needed
`73`	Invalid/Missing Provider	Check NPI, billing team to verify

Data Errors (Fix and Retry)

Code	Description	What to Do
`15`	Required Data Missing	Ask for group number or additional info
`35`	Out of Date Information	Confirm current insurance card
`43`	Invalid/Missing Provider ID	Verify NPI number

Common Issues and Fixes

Issue	Fix
`"Missing conditional field: productOrServiceIDQualifier is required"`	Add `"productOrServiceIDQualifier": "HC"` when using `procedureCode`
`"Subscriber Not Found"` (Code 75)	Verify name matches card exactly, try legal name instead of nickname, try without member ID
`"Invalid Member ID"` (Code 72)	Double-check for typos, remove dashes or spaces, try with leading zeros
Response missing copay/deductible	Try different service type code, some payers return limited data
Timeout or no response	Retry automatically, if persists offer manual verification
Multiple plan statuses returned	Check `planStatus[0]` for primary status, review all for complete picture

Workflow Summary

Step	Action	Details
1	Get Insurance Name	Ask patient for insurance company name
2	Search for Payer	Use `search_for_payer` tool, get `payerId` from response
3	Collect Patient Info	First name (legal), last name, DOB, member ID
4	Run Eligibility Check	Use `eligibility_check` with payer ID, provider info, patient info
5	Interpret Results	Check `planStatus[0].status`, extract benefits from `benefitsInformation`
6	Communicate to Patient	Share coverage status, copay amount, include disclaimer
7	Log Results	Save all verification details for billing team follow-up

Best Practices

Data Collection

Always use patient’s legal name as shown on insurance card
Format DOB as YYYYMMDD (no dashes)
Confirm member ID spelling with patient
Ask clarifying questions if insurance name is ambiguous

Running Checks

Use one service type code per request for clearest results
Always include productOrServiceIDQualifier: "HC" when using CPT codes
Retry connectivity errors automatically before alerting user

Communicating Results

Always state this is a preliminary eligibility check
Explain that billing team will confirm details
Provide clear next steps for inactive or out-of-network results

Logging

Save Stedi Check ID and Trace ID for all verifications
Log complete benefits information for billing team
Note any errors or missing data for follow-up

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Settings

​Tool 1: Search for Payer

​What It Does

​When to Use

​Input Parameters

​Recommended Page Size

​Example Request

​Example Response

​Response Fields

​Tips for Best Results

​Common Issues

​Tool 2: Eligibility Check

​What It Does

​When to Use

​Input Parameters

​Required Parameters

​Optional Parameters

​Service Type Codes

​Product or Service ID Qualifiers

​Example Requests

​Basic Request

​With CPT Code

​With Dependent

​Response Fields

​Key Fields

​Benefits Information Fields

​Benefit Type Codes

​Coverage Level Codes

​Time Qualifier Codes

​Network Indicator Codes

​Error Codes

​Connectivity Errors (Retry Automatically)

​Patient Not Found (Troubleshoot)

​Provider Errors (Escalate to Billing Team)

​Data Errors (Fix and Retry)

​Common Issues and Fixes

​Workflow Summary

​Best Practices

​Data Collection

​Running Checks

​Communicating Results

​Logging

Tool 1: Search for Payer

What It Does

When to Use

Input Parameters

Recommended Page Size

Example Request

Example Response

Response Fields

Tips for Best Results

Common Issues

Tool 2: Eligibility Check

What It Does

When to Use

Input Parameters

Required Parameters

Optional Parameters

Service Type Codes

Product or Service ID Qualifiers

Example Requests

Basic Request

With CPT Code

With Dependent

Response Fields

Key Fields

Benefits Information Fields

Benefit Type Codes

Coverage Level Codes

Time Qualifier Codes

Network Indicator Codes

Error Codes

Connectivity Errors (Retry Automatically)

Patient Not Found (Troubleshoot)

Provider Errors (Escalate to Billing Team)

Data Errors (Fix and Retry)

Common Issues and Fixes

Workflow Summary

Best Practices

Data Collection

Running Checks

Communicating Results

Logging