ACN

Attachment Control Number.

AD

Admitting.

ANSI

American National Standards Institute.

API

Change Healthcare APIs for the next generation of healthcare applications!

  • Medical Network Eligibility V3 API: Provides complete patient profile and benefits information to support for delivering healthcare with more efficient and accurate reimbursement.
  • Care Cost Estimator API: Out-Of-Pocket Estimation API service used for both Estimation and Accumulation of Benefits.
  • Vaccination Data Intake Service API: Gives immunization providers and authorized users a simple way to add data to the Vaccination Record Service and issue certified vaccination credentials.
    The Vaccination Data Intake API is a companion to the Vaccination Credential Sharing API and Vaccination Credential Verification API for secure sharing and verification of the vaccination record.
  • Vaccination Credential Sharing and Verification APIs: Are Vaccination Credential Initiative, and allow authorized client applications to request and verify immunization credentials in the form of 'Smart Health Cards' from the Change Healthcare Vaccination Record solution.
  • Professional Claims API and the Institutional Claims API:
    • Allow healthcare providers and institutions to submit healthcare claims for a service or encounter.
  • Claims Status API: Used by the submitter of a medical claim to determine the status of any previously submitted Institutional or Professional claim.

BI

Billing

Bundled Cost

A bundled cost is the price that a provider charges for a given service.

CCE

Care Cost Estimator.

CCN

Claim Control Number.

CI

Commercial Insurance.

CMS

Centers for Medicare and Medicaid.

CPID

Claim Payer Identification (for claims process only).

Change Healthcare Payer List (also internally known as Legacy Change, Emdeon, or Ark)

For our Submitters who are given a 9-digit submitter ID, and typically do not utilize APIs to submit their transactions. If you have a 6-digit submitter ID, you will want to use the below mentioned ConnectCenter payer ID.

ClaimInformation

A key block of medical coding information that defines the actual procedures and services rendered for the medical encounter. It contains other JSON blocks including the serviceLines objects that contain the professionalService line item charges and diagnosis information.

ClaimReference

Contains important values, such as the payerId, customerClaimNumber, the claimType, and other values that mostly will be managed programmatically.

CLIA

Clinical Laboratory Improvement Amendment.

COB

Coordination of Benefits.

ConnectCenter (aka Legacy Relay Health (LRH) Payer List

A portal for our customers who are utilizing our Clearance or Assurance solutions. When you log into ConnectCenter it does show all payer lists so that may be what you are looking for. If you are using our APIs for Claims and Eligibility you will want to use the ConnectCenter payer list.

ControlNumber

A single arbitrary value that the requestor defines in the initial Eligibility API transaction request, perhaps by a random number generator. All parties to the Eligibility transaction refer to this number to ensure accurate responses and completion of the exchange. ControlNumbers must be defined as a nine-digit unsigned numeric value.

CSA

Customer service announcements.

DCN

Document Control Number.

Dependent

Dependent of the policy holder (information about the insurance policy holder's dependent who received the medical services.

DMERC

Durable Medical Equipment Regional Carrier Certificate.

DRG

Diagnosis Related Group.

DMG

Demographic information.

DOB

Date-of-Birth.

DOS

Date-of-Service: date of provider service to the subscriber.

EDI

Electronic data interchange.

ERA

Electronic Remittance Advice.

EOB

Explanation of Benefits.

ESRD

End Stage Renal Disease.

ETIN

Electronic Transmitter Identification Number.

HCI

Health Care Information.

G

HCPCS

Healthcare Common Procedure Coding System: defines reference codes for items and services provided in the delivery of healthcare.

HIPAA

Health Insurance Portability and Accountability Act.

Healthcheck

The `/healthcheck` endpoint verifies that the operating status of the Change Healthcare APIs is optimal and the APIs are running and accessible.

  • status: "OK" for successful health check

ICN

Internal Control Number.

InNetworkIndicator Values

N (Out of Network), U(Unknown), W (Not Applicable), Y (In Network).

K

L

M

NAIC

National Association of Insurance Commissioners.

NCCI

National Correct Coding Initiative.

NPI

National Provider ID number for the submitting provider.

NUBC

National Uniform Billing Committee.

Pagination

Works with the query parameters size and page. Its maximum size is 1000. Page numbering starts at page 0.

ParCode

An access code required to view any additional information about payers, such as the parStatus in the Payer Finder user interface (UI) and API. Contact support for an access code.

ParStatus

An indication of whether or not a provider agrees to participate in the Medicare program and agrees to always accept the Medicare assignment for services rendered to Medicare beneficiaries.

Payer

Insurance company where the claim is going to.

Payer ID

Unique ID number that is assigned to an insurance company for the purpose of transmitting provider claims electronically. It can be found on the back of the insurance card.

PHI

Personal health information.

PMI

Personal medical information.

Providers

The providers involved with the medical claim.

QMB

Qualified medicare beneficiary.

Realtime Payer ID

Used by Eligibility or Claims status.

ReassociationKey

A tracking number associated with the eligibility transaction so that we can look up the transaction being sent.

Receiver

Payer.

Required

The Required field indicates mandatory information.

REST API

Revenue Performance Advisor (known internally as RPA or Capario) Payer List

Another product that has a specific payer list for users of that product. Change Healthcare Attachment is a payer list for customers who are sending attachments through Change Healthcare.

Rural FQHC

Rural Health Clinics and Federally Qualified Health Centers.

SBC

Summary of benefits and coverage.

serviceLines and serviceDate

serviceLines is an array of one or more medical services, procedures, or products for the encounter each of which, is specified as a serviceDate record in the array.

serviceTypeCode

Here is a complete list of service codes. Service Type Code-30 is most commonly used and provides general benefit information in the response. Depending on your need for specific eligibility information, the service type code might change.

Situational

Specific information may be you can included or omitted depending on the individual encounter.

Subscriber

Medical insurance policy holder; includes the patient's insurance member ID and insurance policyNumber.

SDK

A Software Dev Kit lets developers test applications before deploying on the production server.

Submitter

Provider submitting the claim; identification of the provider, including information, such as the organizationName.

Submitter ID

The submitter is your account number with Change Healthcare used to identify transactions routing to and from specific customers. A submitter ID is assigned to any entity submitting healthcare transactions to a payer.

Token

A hashed alphanumeric representation of sensitive data, such as a authorization token.

TraceID

The `traceId` is a unique 128-bit UUID value (as an example, `3ba21288-3f65-11eb-a512-6ab12069ade5`) that Change Healthcare returns to the submitter as an acknowledgement when they receive every new attachments transaction. A traceId can also be retrieved by calling the metadata endpoint.

TradingPartnersServiceID

This is the Payer ID (a number you will find on your insurance card). This is required to request benefit information from an insurance carrier. This will vary based on the payer you want to connect to. Here is a list of test Trading Partner Service ID.

UMO

Utilization Management Organization.

VCI

Vaccination Credential Initiative, a cross-industry consortium that includes Change Healthcare.

For an alphabetical list of topics, see Quick Reference