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Submit a claim

Walk through the New Claim form to create and submit a CMS-1500-based claim to the payer via the Stedi clearinghouse (837P JSON).

Before you start

• The patient visit has been completed and signed by the rendering provider.
• You have the patient's insurance information (payer, member ID, group number).
• Diagnosis (ICD-10) and procedure (CPT/HCPCS) codes are confirmed.
• You have the biller role, or admin.

CMS-1500 sections in the New Claim form

The New Claim form maps directly to the CMS-1500 paper claim form sections. The table below lists every section represented in Medipyxis and the corresponding fields.

CMS-1500 Section	Fields in Medipyxis
§1 Insurance Type	Insurance type selector (Medicare · Medicaid · Tricare · Champva · Group Health Plan · FECA Blk Lung · Other)
§2 Patient Name	patient_last_name, patient_first_name, patient_middle_initial, patient_suffix
§4 Insured Name	insured_last_name, insured_first_name, insured_middle_initial
§5 Patient Address	patient_address, patient_city, patient_state, patient_zip, patient_phone
§6 Patient Relationship to Insured	Relationship selector (Self · Spouse · Child · Other)
§7 Insured Address	insured_address, insured_city, insured_state, insured_zip, insured_phone
§8 Reserved	Reserved field (read-only; populated per payer requirements)
§10 Condition Related To	Checkboxes: Employment (current or previous) · Auto Accident (with state) · Other Accident
§17 Referring Provider	referring_provider_name, referring_provider_npi — auto-filled from the patient's referring physician on record
§21 Diagnosis Codes	ICD-10 codes A through L (up to 12 diagnosis pointers)
§24A Date of Service	date_of_service_from, date_of_service_to
§24B Place of Service (POS)	POS code selector (e.g., 11 Office · 12 Home · 31 SNF)
§24D Procedure Code + Modifiers	cpt_hcpcs_code, modifier_1, modifier_2, modifier_3, modifier_4
§24E Diagnosis Pointer	Pointer(s) linking procedure to §21 diagnosis codes (A–L)
§24F Charges	charge_amount per line
§24G Units	units per line
§24H EPSDT / Family Plan	EPSDT indicator checkbox
§24I ID Qualifier	Qualifier code for the rendering provider ID type
§24J Rendering Provider NPI	rendering_provider_npi
§25 Federal Tax ID	federal_tax_id (EIN or SSN toggle)
§26 Patient Account Number	patient_account_number (auto-populated from the patient record)
§27 Accept Assignment	Accept Assignment toggle (Yes / No)
§28 Total Charge	Calculated automatically from §24F line totals
§29 Amount Paid	amount_paid (patient or other payer payment received prior to submission)
§30 Balance Due	Calculated automatically (§28 minus §29)
§31 Provider Signature	Digital provider signature captured during visit attestation
§32 Service Facility	service_facility_name, service_facility_address, service_facility_npi
§33 Billing Provider	billing_provider_name, billing_provider_address, billing_provider_npi, billing_provider_phone

Steps

1. Open the claim form. Navigate to /facility/{facility_uuid}/billing/new — the New Claim form opens as a full page. (Billers also reach it by clicking Edit on a claim in the Work Queue.)

The top of the New Claim form. §1 Insurance Type and §2 Patient Name are the first fields.

2. Complete §1 — Insurance Type. Select the appropriate insurance type from the dropdown. This drives payer-specific validation rules downstream.

3. Complete §2 — Patient Name. Search for the patient by last name or date of birth. Selecting an existing patient auto-fills §4 Insured Name, §5 Patient Address, §17 Referring Provider, §26 Patient Account Number, and §29 Amount Paid from the patient record.

4. Verify §4 through §8. Confirm the insured name and address match the insurance card. Correct any discrepancies before proceeding — payer rejections for demographic mismatches are common.

§6, §10, and §21 appear in the middle of the form. Diagnosis codes A–L are entered in the §21 grid.

5. Set §6 — Patient Relationship. If the patient is the subscriber, select Self. For dependents, select Spouse, Child, or Other and enter the insured's name in §4.

6. Confirm §17 — Referring Provider. The referring provider name and NPI auto-fill from the patient's referring physician on record. Correct them if the referral is different for this claim.

7. Complete §10 — Condition Related To. Check the applicable box if the condition is related to employment, an auto accident (include the state), or another accident. Leave all boxes unchecked for standard illness/injury.

8. Enter §21 — Diagnosis Codes. Add up to 12 ICD-10 codes using the code search. The first code entered becomes pointer A and is required. Additional codes (B–L) are optional.

9. Add service lines — §24A through §24J. Click + Add Line for each procedure: - §24A: Enter the date of service range (date_of_service_from and date_of_service_to). - §24B: The POS code is auto-derived from the visit's service location; override it if needed. - §24D: Enter the CPT/HCPCS code and up to four modifiers. - §24E: Select the diagnosis pointer(s) from the codes entered in §21. - §24F: Enter the charge amount. - §24G: Enter units. - §24H: Check EPSDT if applicable. - §24I / §24J: Confirm the ID qualifier and rendering provider NPI (auto-populated from the visit record).

Service lines can be dragged to reorder; the CMS-1500 Box 24 line numbering re-asserts automatically after a move.

The lower portion of the New Claim form covering §24 service lines through §33 Billing Provider.

Expanded §24 line showing the modifier fields and charge/unit entry.

10. Complete §25 through §33. These fields are generally auto-populated from your facility and provider configuration:

    • §25 Federal Tax ID — verify the EIN is correct for the billing entity.
    • §27 Accept Assignment — confirm the toggle matches your payer contract.
    • §28 Total Charge and §30 Balance Due are read-only calculated fields.
    • §32 Service Facility and §33 Billing Provider — confirm addresses and NPIs match your payer enrollment.

11. Save or submit the claim. Click Save Draft to save without submitting, or Submit Claim to send it to the payer through Stedi. (A confirmation prompt appears before either action completes.)

The rendering provider NPI in §24J must match the NPI on file with the payer. Submitting with a group NPI in §24J instead of the individual NPI is a common rejection cause for Medicare claims.

Result

A Save Draft keeps the claim as a draft; Submit Claim sends it to Stedi and advances it toward Submitted. The claim appears in the Work Queue tied to its encounter, where you can track and set its Claim Status.

Claims are generated automatically from a completed visit and appear in the Work Queue — you do not need to create them manually. Use the claim form for claims that need to be entered or corrected outside the normal visit workflow (e.g., corrected claims, late charges), reached via Edit in the Work Queue or /billing/new.

Troubleshooting

Symptom	Likely cause	What to do
Submit Claim disabled or errors	One or more required fields missing or invalid	Scroll through the form — required fields are outlined in red
Payer rejects claim for NPI mismatch	Group NPI used in §24J instead of individual NPI	Update the rendering provider's NPI in HR & Compliance, then resubmit
§28 Total Charge calculates as zero	No service lines added, or charge amounts left blank	Add at least one §24 line with a non-zero charge
Claim stuck at Exported	Stedi credentials missing, webhook not wired, or payer not enrolled	Have your administrator verify the Stedi setup in Billing Setup and confirm payer enrollment is Active

Related

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