Medical claims are bills that healthcare providers submit to the patient's insurance provider. Claim billings contain specialized insurance codes that describe the care a patient receives from the provider. Our APIs help automate and manage the process of submitting and monitoring the status of submitted claims. The Claim Status v2 API checks to verify the current status of any claim you submit to insurance payers that are supported by our Change Healthcare payer lists.
The submitter uses a Claim Status request to ask about the status of a previously submitted claim. The payer returns the response, as an X12 EDI 277 transaction, which is translated back to JSON by the API gateway. It describes where the claim is in the adjudication process (for example, Pending, or Finalized).
Claim Status' main task is to check the status of a claim in the payer’s system. When the claim adjudication is complete, the response provides the result of the claim (for example, Paid, or Denied). For denied or rejected outcomes, the response includes the reasons for the denial.
If a provider has not received a payer report on a claim, or if they have not received payment, they run a claim status request to find out the most recent status of that claim. You may also need to check your Change Healthcare mailbox on a regular basis. The Claim Status API does not do this.
If you want another tool for managing Claims reports, see our Claims Responses & Reports API `/claimstatus/v2/. Thank you for choosing Change Healthcare!
Claim Reports and Responses is a complementary API to Claim Status that performs an associated but different task. It is a fetching tool for claims information from your mailbox. The Claim Status API gives you the current status of your claim but does not download the contents of your payer's claim report. For more information, see Claims Responses and Reports.
The JSON attributes in our APIs use snake-case, with the first letter of the attribute in lower case as in
tradingPartnerServiceId. Our APIs are case-sensitive and your JSON request body must observe this convention.
The Claims Status v2 endpoints consist of the following:
Real-time, one request
Always defaults to
- If you only plan to use a few daily transactions, you can use our ConnectCenter for your Medical Network transaction needs.
It provides most of the features supported by an API console but only allows manual entry for all data needed for a transaction. It contains Change Healthcare’s Payer Lists, the Payer List Enrollments wizard, and other API customer resources.
- For providers sending hundreds of daily requests, we recommend using our APIs to be able to automate the submission processes and have a better fit for your business needs.
Updated 27 days ago