Eligibility 3.0 Getting Started

Our Eligibility API uses the standard X12 EDI 270 eligibility transaction, and formats it in JSON for an HTTP request. It makes this popular EDI transaction set more accessible to developers and to users’ applications. We manage the X12 standards behind the scenes and give you efficient access to medical subscriber or dependent information about their plan membership, copays, coinsurances, deductibles, and more in an easy-to-use, human-readable format.

We also support a dedicated X12-formatted Eligibility API to send your submission in X12 EDI format. It supports the standard syntax for a complete X12 EDI 270 transaction set.

Our Eligibility API solution provides complete patient profile and benefits information, to support health care delivery and more-efficient and accurate reimbursement. Providers get better front-end information to improve claiming processes and reimbursement rates. For payers, it means claims spend less time in pending status, and also means fewer rejected and reworked claims.

About ConnectCenter

If you only plan to use a few daily transactions, you may be able to use ConnectCenter for your transaction needs. It performs most of the features supported by an API console, but only allows manual entry for all data needed for a transaction. For providers sending hundreds of daily requests, we recommend using APIs because you can automate the submission processes and have a better fit for your business needs.

Quick Links

Developer Portal – the home of Change Healthcare’s API documentation.

ConnectCenter Change Healthcare’s portal for Medical Network transactions. It contains Change Healthcare’s Payer Lists, the Payer List Enrollments wizard, and other API customer resources.