Contents of the Claim Status API Request

Consult the OpenAPI 3.0 JSON specification for our EDI 276 Claim Status submission for more details on the Change Healthcare Claim Status API.

The Claim Status request body is a relatively brief and straightforward piece of information, since you're not submitting a claim but only inquiring after an existing one. It consists of a single instance of the following objects:

  • Standard header information (controlNumber, tradingPartnerServiceId)
  • The billing provider information (providers object)
  • Subscriber (with the optional dependent object)
  • Encounter (the doctor's visit that's the origin of the claim filing)

Different payers have different recommendations for what you must include in a request. For example, Blue Cross affiliates such as BCBSNC require the npi (provider identifier) in EDI 276 requests, and recommends adding the Patient Account Number (in Loop 2200D, element REF01) to associate submitted requests to correct responses.

{
                "controlNumber": "000000001",
                "tradingPartnerServiceId": "serviceId",
                "providers": [{
                                "organizationName": "TestProvider",
                                "taxId": "0123456789",
                                "providerType": "BillingProvider"
                },
                {
                                "organizationName": "happy doctors group",
                                "npi": "1760854442",
                                "providerType": "ServiceProvider"
                }],
                "subscriber": {
                                "memberId": "0000000000",
                                "firstName": "johnone",
                                "lastName": "doeone",
                                "gender": "M",
                                "dateOfBirth": "18800102",
                                "groupNumber": "0000000000"
                },
                "dependent": {
                                "firstName": "janeone",
                                "lastName": "doeone",
                                "gender": "F",
                                "dateOfBirth": "18800101",
                                "groupNumber": "0000000000"
                },
                "encounter": {
                                "beginningDateOfService": "20100101",
                                "endDateOfService": "20100102",
                                "trackingNumber": "ABCD"
                }
}

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