Institutional Claims v1 API Getting Started

What is an Institutional Claim? Find out all the details from Change Healthcare's developer documentation.

The ASC X12N Health Care Claim: Institutional (837i) transaction enables healthcare providers to submit institutional healthcare claims for a service or encounter. A healthcare claim includes patient information, related diagnoses, procedures performed or services provided, and any related charges. This API also translates standard X12 EDI 837i transactions to JSON so that it is more accessible to claim readers and developers.

NOTE: A single institutional claim supports up to 999 service line items.

About Claims Validation

Before sending to the payer, you can use the Institutional Claims Validation API endpoint (/validation) to check and validate your upcoming claim submission. Your transaction will not be sent to the payer. The validation does not examine the actual contents of your claim. It checks for the correct well-formed syntax of the submission, and elements such as correctly summing service line charges and verifying codes.

NOTE: Change Healthcare also offers a more data-intensive Integrated Rules Institutional Claims API to check, analyze and correct Institutional Claims submissions. You then use the standard Institutional Claims v1 API to submit your claims.

About ConnectCenter

If you only plan to use a few daily transactions, you may be able to use ConnectCenter for your transaction needs. It performs most of the features supported by an API console, but only allows manual entry for all data needed for a transaction. For providers sending hundreds of daily requests, we recommend using APIs because you can automate the submission processes and have a better fit for your business needs.

Quick Links

Developer Portal – the home of Change Healthcare’s API documentation.

ConnectCenter Change Healthcare’s portal for Medical Network transactions. It contains Change Healthcare’s Payer Lists, the Payer List Enrollments wizard, and other API customer resources.

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