Payer Finder V1 FAQs

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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.

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NOTE — PAYER FINDER API

Works with Change Healthcare (also internally known as Legacy Change, Emdeon, or Ark) payer list and Revenue Performance Advisor (known internally as RPA or Capario) that are now in the Payer Profile Database.
Does not work with ConnectCenter (aka Legacy Relay Health (LRH)) but 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 Revenue Performance Advisor payer list or the Change Healthcare payer list.

A future release will include the inclusion of ConnectCenter payers.

How can I access the Payer Finder APIs?

Change Healthcare’s Payer Finder APIs allow you to retrieve individual Payer information, including any or all services offered by that Payer.

  • See 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.
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 What do typical Payer Finder v1 API queries look like? 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.

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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 or serviceName=ELIGIBILITY both work while servicename=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
```
{
    "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"
        }
   ]
}
```

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NOTE

The case used for the institutionalClaims argument in the URL. After the services keyword, you must specify the desired value (here, that is institutionalClaims) 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:

FieldDescription
businessNamePayer's name
aliasAn alternative payer name
planTypeOne or more from Auto, Blue Cross Blue Shield, Commercial, Dental, Medicaid, Medicare, Tricare/Champus, Work Comp
serviceNameOne 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)
lineOfBusinessOne or more from Dental, Hospital, Medical
statesA 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 “AZ” as well as “AZ,CA,PA”
serviceIdPayer's ID
clearingHouseAcceptable values are, npd (for Legacy Change Healthcare/Emdeon) and rpa (for Revenue Performance Advisor/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 or desc 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 and start 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:

FieldDescription
businessNamePayer's name
aliasPayer's alternative name
planTypeOne or more from Auto, Blue Cross Blue Shield, Commercial, Dental, Medicaid, Medicare, Tricare/Champus, Work Comp
statesSingle, 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
serviceNameOne 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)
lineOfBusinessOne or more from Dental, Hospital, Medical
serviceDateDate of the service
serviceIdPayer's ID (also known as a trading partner service ID), is an identifier specific to an API or service
clearingHousenpd for Change Healthcare or Emdeon, clearingHouse, or CAP for the RPA, or Capario, clearinghouse
acceptsSecondaryLetter "Y" or "N" denoting if the payer accepts secondary
reportLevel
serviceModifiedLast time the service was modified
enrollmentStatusDenotes whether the payer requires enrollment or not
passThroughFeeLetter "Y" or "N" denoting whether the payer has a pass through fee or not
parStatus📝 A valid parCode is required to get parStatus

The API also returns:

  • start: tells where the offset starts
  • size: 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.


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