Payer Finder FAQs
NOTE
Please see the Change Healthcare API FAQs section for tips and solutions to some of the most common questions asked by customers, developer community, and internal staff about the use of the Change Healthcare API.
What is Payer Finder v1 API?
Payer Finder v1 API is the replacement for Trading Partner v7 API that developers can use to programmatically search for the right payer in each transaction. It is a complete re-write with a new database supporting a better data model than the Trading Partner v7 API resulting in increased accuracy. Furthermore, a server-less infrastructure that delivers better performance.
NOTE ā PAYER FINDER API
Works with NPD (also internally known as Legacy Change Healthcare, Emdeon, or Ark) payer list and Revenue Performance Advisor (RPA)/Capario (known internally as RPA or Capario) that are now in the Payer Profile Database.
Does not work with ConnectCenter (aka Legacy Relay Health (LRH)); it is planned for later release.
What is happening to Trading Partner v7 API?
The Trading Partner v7 API is no longer supported. The Trading Partner v7 API requests will not work from October 15, 2022. You should update any code that uses it, to use Payer Finder v1 API. We strongly encourage you to make the transition to Payer Finder API as soon as possible, as it is more accurate and more robust.
Which payer lists does Payer Finder API support?
Currently, the API can query the Payer Profile Database for payers associated with the RPA/Capario payer list or the NPD payer list.
A future release will include the inclusion of ConnectCenter payers.
How can I access the Payer Finder APIs?
Change Healthcareās Payer Finder APIs allow you to retrieve individual Payer information, including any or all services offered by that Payer.
- Use
GET /payerfinder/v1/payers
request to query our Payer Performance Database to obtain more specific information. - Use the
GET
request to build a query and filter for subsets of Payer Finder information from the payer list.
Example
https://apigw.changehealthcare.com/medicalnetwork/payerfinder/v1/payers
The API paths are the requests you send to the API engine to perform lookup tasks to the database. See Payer Finder v1 API queries for examples.
For more information, see Payer Finder APIs.
What information needs to be included in the API request header?
See API FAQ.
What does typical Payer Finder API request look like?
The Payer Finder API provides two methods for querying payers:
- Queries using the HTTP URL path;
- Queries defined by a question mark (
?
) followed by a structured statement as an extended argument in the path.
NOTE
In general, API queries are not case sensitive. However, the key portions of a key-value pair search parameters are case-sensitive while the value portions are not. The key (a field name)) should be in camel case as while the value can be entered anyway. So, for example,
serviceName=eligibility
orserviceName=ELIGIBILITY
both work whileservicename=eligibility
does not.
Sending the following request downloads the entire payer list. From this point, add the attributes and arguments to the URL path to query for more-specific information.
https://apigw.changehealthcare.com/medicalnetwork/payerfinder/v1/payers
What does a typical Payer Finder v1 API response look like?
In a sandbox environment, if you want to query for payers that start with business name blue
and service name Claims
, send a GET
request to the following endpoint with your authorization header.
https://sandbox.apigw.changehealthcare.com/medicalnetwork/payerfinder/v1/payers?businessName=blue&serviceName=Claims
Example
```
{
"start": 0,
"size": 50,
"total": 542,
"payers": [
{
"businessName": "Blue Cross Blue Shield of Testing",
"alias": "Test Alias",
"planType": "Test",
"serviceName": "Claims",
"lineOfBusiness": "Dental",
"serviceDate": "2007-10-19T00:00:00",
"serviceId": "61474",
"clearingHouse": "NPD",
"acceptsSecondary": "N",
"reportLevel": "4-Clm Level A/R",
"serviceModified": "2007-11-01T00:00:00",
"enrollmentStatus": "No Enrollment Required",
"serviceNotes1": "Dental Blue Select Product",
"passThroughFee": "N"
},
{
"businessName": "Blue Cross Blue Shield of Testing 2",
"planType": "Test 2 Alias",
"states": "MS",
"serviceName": "Claims",
"lineOfBusiness": "Hospital",
"serviceDate": "2002-04-12T00:00:00",
"serviceId": "12B82",
"clearingHouse": "NPD",
"acceptsSecondary": "Y",
"reportLevel": "4-Clm Level A/R",
"serviceModified": "2012-03-23T00:00:00",
"enrollmentStatus": "Enrollment Required",
"enrollmentType": "Registration",
"enrollmentMethod": "OKC/POSI Setup",
"passThroughFee": "N"
}
]
}
```
NOTE
The case used for the
institutionalClaims
argument in the URL. After theservices
keyword, you must specify the desired value (here, that isinstitutionalClaims
) in the case exactly as shown in the API.
Which data fields/JSON attributes can I use in the Payer Finder API for searching?
You can search using any of the following query
parameters:
Query parameters
Field | Description |
---|---|
businessName | Payer's name |
alias | An alternative payer name |
planType | One or more from Auto, Blue Cross Blue Shield, Commercial, Dental, Medicaid, Medicare, Tricare/Champus, Work Comp |
serviceName | One or more from Claims Status, Claims, Claims Attachments, Electronic Funds Transfer, Eligibility, Health Services Review Inquiry, Health Services Review Request, Medical Attachments, Notice of Admission, Remittance (ERA) |
lineOfBusiness | One or more from Dental, Hospital, Medical |
states | A wildcard match on either a single two-letter abbreviation or a comma-separated list of more than abbreviation. For example, states=AZ would match on an entry of āAZā as well as āAZ,CA,PAā |
serviceId | Payer's ID |
clearingHouse | Acceptable values are, npd (for Legacy Change Healthcare/Emdeon) and rpa (for RPA/Capario) |
You can string together multiple values for the same parameter.
- Create an
OR
clause so that the preceding fields return the records with a Claims or Eligibility service name:
/payers?serviceName=Claims&serviceName=Eligibility
- Sort using the field name and
asc
ordesc
separated by a comma (,) symbol assigned to the sort parameter:
/payers?serviceName=Claims&sort=lineOfBusiness,asc
- Control how many records and which to start from, using the
size
andstart
parameters:
/payers?businessName=aetna&size=25&start=50
This query returns 25 records having businesName with aetna starting with record number 50.
Which data fields/JSON elements are returned by a Payer Finder API search?
The Payer Finder API returns a list of payers with the following data fields/JSON elements:
Data fields/JSON elements
Field | Description |
---|---|
businessName | Payer's name |
alias | Payer's alternative name |
planType | One or more from Auto, Blue Cross Blue Shield, Commercial, Dental, Medicaid, Medicare, Tricare/Champus, Work Comp |
states | Single, two-letter abbreviation (states=AZ) or several separated by the comma (,) symbol (states=AZ,PA). Exact records are returned so states=AZ,PA the query returns different records than the states=AZ&states=PAquery |
serviceName | One or more from Claims Status, Claims, Claims Attachments, Electronic Funds Transfer, Eligibility, Health Services Review Inquiry, Health Services Review Request, Medical Attachments, Notice of Admission, Remittance (ERA) |
lineOfBusiness | One or more from Dental, Hospital, Medical |
serviceDate | Date of the service |
serviceId | Payer's ID (also known as a trading partner service ID), is an identifier specific to an API or service |
clearingHouse | npd for Change Healthcare or Emdeon, clearingHouse , or CAP for the RPA, or Capario, clearinghouse |
acceptsSecondary | Letter "Y" or "N" denoting if the payer accepts secondary |
reportLevel | ā |
serviceModified | Last time the service was modified |
enrollmentStatus | Denotes whether the payer requires enrollment or not |
passThroughFee | Letter "Y" or "N" denoting whether the payer has a pass through fee or not |
parStatus | š A valid parCode is required to get parStatus |
The API also returns:
start
: tells where the offset startssize
: number of payers displayed in the response, which will default to '50' and can be changed through query parameter (size
)total
: how many hits the query matched
What are the Payer Finder API error types and their format?
If you are searching to see if a particular service is supported by a payer, and you do not specify the serviceName
argument in the correct case, you will get a Nothing Found
error:
```json
[ ]
```
Querying for a value using the serviceId
or with any other supported attribute that does not match anything in the database, will yield the same result.
Can I get the .csv to the Eligibility Payer Guide comprising the Payer Name, Payer ID, and X12 requirements?
Yes, you can export the payers to .csv
file.
Is there a place where I can get a list has the more universal payer ID that I am looking for?
You can find the payer list here: NPD or RPA/Capario payer list.
How I can make payer list more user friendly, I want to show it like the Change Healthcare has.
You can take the payer list (download it as a CSV file) and use it. For more information, see Payer Finder. Otherwise, you are limited to the the ConnectCenter view.
Do your APIs send the payer actual allowable amount for the claimed services in any variable, kindly tell the name of that variable (if any)?
The payer's actual allowable amount would come through in the 835 file from the payer. This is the payment file when the claim has been completely processed.
How to download the payer list to a .csv file?
- Go to NPD or RPA/Capario payer list.
NOTE
If you do not provide /npd or /cap option, it defaults to /npd.
- Enter the payer name in the text box and click Enter.
- Click Export.
The CSV file for the selected payer name downloads.
How can I look up the Provider NPI, Trading Partner Service ID? The API expects these values.
- Control Number: 000000001 ā is set by you, this is a unique number that follows the transaction from start to finish
- Trading Partner Service ID: serviceId ā is a payer id, review a payer list: RPA/Capario or NPD.
- Provider organization name: happy_doctors_group and Provider npi: 0123456789 ā Provided by you. For example, if you are checking eligibility for a patient, what physician or facility is the patient seeing or going to or who did they see if you are checking post visit. You need that to check eligibility.
Use the Payer Finder API to view the payer list.
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Updated 3 days ago