Providers use the Professional Claims APIs to submit their medical procedure claims to their payers. To access them for testing, you can use our Postman collection or your own API console. The best way to investigate our APIs is through our Sandbox API version, which enables you to test our APIs without sending an actual claim to your payer.
Use the Professional Claims validation endpoint to check your request:
Validation does not send your transaction to the payer. It checks for the correct well-formed syntax of your submission. It does not check the accuracy of the information included in your submission, so you will need to separately ensure that the claim is complete and accurate before submission.
The Submission endpoint submits your professional claim transaction to the payer:
The Validation and Submission endpoints both use the same request model. Avoid sending any claim until you have tested your submission process, and validated your claim!
The Professional Claims API Healthcheck service endpoint, which checks the operating status of the API engine, is:
Updated 10 months ago