The Integrated Rules Professional API performs advanced rules-based checking and validation of Professional claims based upon the X12 EDI 837p standard. It uses compilations of medical business specialties, called Knowledge Packs, for fine-tuned claim inspection. It does not submit your claim to the payer, and is designed to be complementary to the Professional Claims API.
- You can submit your completed claims to the payer through the standard Professional Claims Submission API (this will incur an additional charge):
You may use the the standard Professional Claims API validation endpoint to check and validate your upcoming submission. It applies a different and simpler set of rules that don't affect or repeat the functions from the Integrated Rules Professional API. Your transaction will not be sent to the payer:
If you use a different claim submission workflow, you can also submit your claim that way. Consult your Change Healthcare representative for more information.
Updated about 1 year ago