The Integrated Rules Institutional API performs advanced rules-based checking and validation of Professional claims based upon the X12 EDI 837i 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 Institutional 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 9 months ago