How do Raw-X12 Eligibility requests and responses work?

We also support an X12 EDI Eligibility request if you choose to implement the 270 transaction set in its native EDI format. The responses you receive will also appear in EDI format.

Ensuring Integrity of X12 Transmissions

When you create and send your X12 content through our API, ensure that the final field in the ISA header, ISA16, contains the colon character (":"). ISA16 is a single-character field that defines the component element separator in the ISA header. For your X12 EDI transactions to work in your contracted APIs you must use the colon character in this field. It should be used only in ISA16 and not for any other X12 header or trailer. See Appendix C of the ASC X12 270 Implementation Guide for more information about the eligibility transaction structure.

NOTE: Before using the Eligibility /Raw-X12 endpoint, contact your Change Healthcare implementation analyst. Our Raw-X12 service requires custom headers with credentials, and other information specific to each customer's contracted Payer List relationships that you will need to obtain from your analyst contact.

The Eligibility Raw-X12 endpoint is as follows:

https://apigw.changehealthcare.com/medicalnetwork/eligibility/v3/raw-x12

NOTE: Check the Eligibility API Mappings document in the Attachments tab for complete Eligibility EDI loop and segment mappings to the JSON fields in eligibility 270 requests and 271 responses.

An X12 EDI Eligibility request appears similar to the following:

POST /medicalnetwork/eligibility/v3/raw-x12 HTTP/1.1
Host: ${apigee_host}
Authorization: Bearer <Your-Access-Token>
Content-Type: application/json
{
    "x12": "ISA*00*          *01*password  *ZZ*999999         *ZZ*RTEXCHANGE     
*200708*0603*^*00501*123456789*0*P*:~GS*HS*999999samp*PAYERID*20200708*0603*12345678
9*X*005010X279A1~ST*270*123456789*005010X279A1~BHT*0022*13*123456789*20200708*0603~
HL*1**20*1~NM1*PR*2*Unknown*****PI*serviceId~HL*2*1*21*1~NM1*1P*2*provider_name*****XX*0123456
789~PRV*AD*PXC*54321g~HL*3*2*22*1~TRN*1*123456789*9EMDEON999~NM1*IL*1*doeOne*johnOne*
***MI*0000000000~REF*SY*555443333~REF*HJ*card123~DMG*D8*18800102*M~HL*4*3*23*0~TRN*1*
123456789*9EMDEON999~NM1*03*1*doeone*janeOne~REF*6P*1111111111~DMG*D8*18160421*F~DTP*2
91*RD8*20100101-20100102~EQ*98~SE*21*123456789~GE*1*123456789~IEA*1*123456789~"
}

An X12 EDI 271 response appears similar to the following:

{
    "x12": "ISA*00*          *01*SomePwd   *ZZ* RTEXCHANGE     *ZZ*999999         
*201006*0641*^*00501*123456789*0*T*:~GS*HB*PAYERID*999999samp*20131015*2219*123456789*X
*005010X279A1~ST*271*946380841*005010X279A1~BHT*0022*11*123456789*20200708*0603~HL*1*
*20*1~NM1*PR*2*Unknown*****PI*PAYERID~HL*2*1*21*1~NM1*1P*2*provider_name*****XX*0123456789~
HL*3*2*22*0~TRN*1*123456789*9EMDEON999*~NM1*IL*1*doeOne*johnOne***~REF*SY*111111111~DMG*
D8*18800102*M~DTP*291*RD8*20160818-20160818~EB*1*IND*30*QM*QMB~DTP*292*RD8*20160818-
20160818~EB*R*IND*30*WA*MEDICARE PART A~DTP*291*RD8*20160818-
20160818~EB*R*IND*30*MB*MEDICARE PART B~DTP*291*RD8*20160818-
20160818~SE*19*946380841~GE*1*123456789~IEA*1*123456789~"    
}

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