Response Contents - Professional Claims

Metadata for troubleshooting


Change Healthcare Medical Network APIs support a significant troubleshooting feature called metadata. For more information, see Metadata for troubleshooting.

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NOTE

API users need not 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 Change Healthcare technical support, give the values provided in the meta object to the Change Healthcare representative.

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NOTE

The meta feature is not supported in the Claims Responses and Reports v1 APIs.

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
{
    "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 does not 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:

Key Value

Description

customerClaimNumber

An additional claim tracking number assigned by the Change Healthcare 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

Date and time of the response from the clearinghouse.

formatVersion

Describes the X12 EDI version to which the claim confirms.

claimType

  • "PRO" for Professional.
  • "INST" for Institutional.

rhClaimNumber

unique claim number to track the claim at the Change Healthcare clearinghouse. You can use this value to search for the claim in ConnectCenter and check for updates.


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