Ambulatory Payment Classification v1

Summary API Attachments FAQ CHANGE LOG     

Overview

APCs or Ambulatory Payment Classifications are the United States government's method of paying for facility outpatient services for the Medicare (United States) program. A part of the Federal Balanced Budget Act of 1997 made the Centers for Medicare and Medicaid Services create a new Medicare "Outpatient Prospective Payment System" (OPPS) for hospital outpatient services. - analogous to the Medicare prospective payment system for hospital inpatients known as Diagnosis-related group or DRGs.

This OPPS, was implemented on August 1, 2000. APCs are an outpatient prospective payment system applicable only to hospitals. Physicians are reimbursed via other methodologies for payment in the United States, such as Current Procedural Terminology or CPTs.

APC payments are made to hospitals when the Medicare outpatient is discharged from the Emergency Department or clinic or is transferred to another hospital (or other facility) which is not affiliated with the initial hospital where the patient received outpatient services.

Although APCs began through the federal system of Medicare, they have also been considered for adoption by state programs, such as Medicaid, and other third-party private health insurers. If the patient is admitted from a hospital clinic or Emergency Department, then there is no APC payment, and Medicare will pay the hospital under inpatient Diagnosis-related group DRG methodology.

API Onboarding

See the Security and Authorization section in this portal to learn more about using our APIs. Most of our APIs are private and require credentials to gain access.

After receiving your client_id and client_secret for our sandbox environment, you can test the API from within our interactive documentation, using an application such as Postman, or from your own stack.

Try our Postman Collection Run in Postman

Documentation

For details on the request model, see the FAQ tab. This documents the field names and examples of the request.

In depth mapping of the JSON field to the X12 EDI can be found in the Attachments tab.

Do you have a sandbox that I can test before signing a contract?

We sure do. After receiving your client_id and client_secret for our sandbox environment, you can test the API from within our interactive documentation, using an application such as Postman, or from your own stack.

Try our Postman Collection Run in Postman

What information needs to go in the request header?

In the header for an API request, you need to pass an authorization token. You can get the token by making an API call to:

curl -X POST \
  'https://sandbox.apis.changehealthcare.com/apip/auth/v2/token' \
  -H 'Content-Type: application/json' \
  -d '{
  "client_id": "<Your-ClientId>",
  "client_secret": "<Your-ClientSecret>",
  "grant_type": "client_credentials"
}'

This is a precursor to making an API call, which might have the following headers:

Content-Type: application/json
Authorization: Bearer <Your-Access-Token>

Read all about our protocols in the Security -> Authorization section of this portal.

When you're ready for production, simply remove sandbox from the URL.

What does a typical API call look like?

The API uses a POST HTTPS call. You provide the input as JSON in the body of the request:

```bash curl -X POST \ https://sandbox.apis.changehealthcare.com/ros/rezolv_rem_apc/v1/ \ -H 'Accept: application/json' \ -F 'request={ { "clientTransactionIdentifier": "jkdfsh-sdfkgjhskad_asdgkjsadgh@kjhsdgajk", "patient": { "age": 23, "gender": "M", "beneficiaryDeductibleAmount": 254.77, "bloodDeductiblePints": 2 }, "claim": { "admitDate": "2018-10-10", "dischargeDate": "2018-10-10", "dischargeStatus": "02", "icdVersion": "0", "billType": "131", "conditionCodes": [ "AA" ], "occurenceCodes": [ "GH" ], "admitDiagnosisCode": "P98263", "principalDiagnosisCode": "R42F44", "secondaryDiagnosisCodes": [ "GH3463" ], "valueCodes": [ { "code": "54", "amount": 2498 } ], "serviceLines": [ { "lineItemNumber": 1, "hcpcsCode": "98253", "hcpcsModifier1": "AA", "hcpcsModifier2": "EX", "hcpcsModifier3": "00", "hcpcsModifier4": "4E", "hcpcsModifier5": "QQ", "serviceDate": "2018-10-10", "revenueCode": "0222", "serviceUnits": 27, "lineCharge": 52.99, "lineItemActionFlag": 0 } ] }, "provider": { "npi": "4374357547453", "oscarMedicareNumber": "072005" }, "oppsFlag": 1 }

Change Log

API Name API Version Date Introduced Available Until
Ambulatory Payment Classification v1 05/28/2020 TBD

Release Notes:

v1

  • Initial offering of Ambulatory Payment Classification.