Claims API is part of the Member Payments API suite. The Claims API allows consumers to pay their patient obligations to a provider using adjudicated claims.
Claims API creates a claim in the Change Healthcare Payments system and allows Change Healthcare to create unique identifiers for each entity associated with the claim that can be used to process payments as well as build ledgers and transaction history. A claim is sent to the Change Healthcare Payments platform by an external entity, such as a Payer, to generate the obligation.
The Claim API creates the claim and generates the provider, policy holder, and patient records associated with the claim if specified. The return values are the Change Healthcare unique identifiers for the payer, provider, policy holder, patient, and claim as well as a provider status and reason fields to indicate whether the provider is blocked or not.
Why is this API Required?
This API allows Change Healthcare to uniquely identify the claim as well as create unique identifiers payer, provider, member and patient entities associated with the claim. This is essential to help ensure accurate disbursement of funds to the provider, to help a provider apply those funds to the correct patient/patient obligation as well as to build out transaction history and ledgers.
Why is this provider blocked?
A provider can be blocked and unblocked only by Change Healthcare Customer Service. If the provider is blocked, then no further payments will be processed for that provider until they are unblocked.
A provider may be blocked for variety of reasons such as:
- Change Healthcare is unable to accurately locate and disburse funds to the provider.
- Provider may choose not to receive payments from Change Healthcare.
- Compliance rules, such as the provider being on the Office of Foreign Assets Control list.
|API Name||API Version||Date Introduced||Available Until|
- Initial release