Contents of the Professional Claims Response

Metadata (for Troubleshooting)

Change Healthcare Medical Network APIs support a significant troubleshooting feature called metadata. API users do not need to enable this capability; it is automatic and has no effect on information in any medical transaction. If you encounter any issues with a transaction and need to work with CHC technical support, give the values provided in the `meta` object to the CHC representative.
JSON Response Object Description
{
   "meta": {
       "submitterId": "999898",
       "senderId": "Xxxx.Xxxxxx",
       "billerId": "009998",
       "traceId": "900773a9-c0ba-6aa2-0f61-cfcc30a0200f",
       "applicationMode": "prod"
   },















Give this entire object to CHC
support for troubleshooting. All values
listed in the meta object are automatically
taken from the API request header or
from the secure token.
If they appear, consider the IDs in
the metadata object as a hierarchy
from less specific to most specific:
submitterId as least specific; the
senderId denoting the API customer;
and billerId as the customer medical
department that is responsible for the
billing. ApplicationMode describes the
operating environment, which for API
customers will either be
Production ("prod") or Sandbox.






Claim Reference information

The primary elements of a medical claims submission response consist of the aforementioned meta object, and a claimReference object. It contains a number of tracking values. You can expect to see results similar to the following:

JSON Response Description
{
    "status": "SUCCESS",
    "controlNumber": "000000001",
    "tradingPartnerServiceId": "9496",
    "claimReference": {
        "correlationId": "210322R999898~66684261175841",
        "submitterId": "009998",
        "customerClaimNumber": "000000001",
        "patientControlNumber": "12345",
        "timeOfResponse": "2021-03-22T19:34:08.85-05:00",
        "claimType": "PRO",
        "formatVersion": "5010",
        "rhclaimNumber": "2108151508527"
    },
    "meta": {
        "submitterId": "999898",
        "senderId": "Xxxx.Xxxxxx",
        "billerId": "009998",
        "traceId": "900773a9-c0ba-6aa2-0f61-cfcc30a0200f",
        "applicationMode": "pro"
    },
    "editStatus": "SUCCESS",
    "payer": {
        "payerName": "Unknown",
        "payerID": "9496"
    },









The first response you get back from the
clearinghouse doesn't indicate whether
the claim is being paid; it indicates that the
clearinghouse has accepted the claim and is
getting ready to forward it to the payer.

claimReference is the response's main object.
Key values include the following:

  • customerClaimNumber - An additional claim
    tracking number assigned by the CHC
    clearinghouse.
  • submitterId - Describes the entity that
    submitted the claim. Value is in
    Loop 1000A, element NM109.
  • patientControlNumber - echoes the Patient
    controlNumber back from the
    original request.
  • timeOfResponse - the date and time of the
    response from the clearinghouse.
  • formatVersion - describes the X12 EDI version
    to which the claim conforms.
  • claimType - will be "PRO" for Professional
    or "INST" for Institutional.
  • rhClaimNumber - unique claim number to track
    the claim at the CHC clearinghouse.
    You can use this value to search for
    the claim in ConnectCenter and check
    for updates
    .

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