Professional Claims API v3 Getting Started

What is a Professional Claim? Find out the details from Change Healthcare's developer documentation.

What is a professional claim? The ASC X12N Health Care Claim: Professional (837P) transaction allows physicians and other medical service providers to submit healthcare claims for a medical service or encounter. A healthcare claim includes the following:

  • Patient information;
  • Patient diagnoses, describing details about the patient's condition;
  • Any procedures done, and services rendered;
  • Information about all medical providers involved in the claim;
  • Listings of any related charges for services, procedures and products.

The Change Healthcare Professional Claims API translates the standard X12 EDI 837P transaction to the more-readable Javascript Object Notation (JSON), so it is more accessible to developers and more easily integrated into users’ applications.

Using our API, you send medical claims to insurance payers for adjudication and payment. We design our Professional Claims API for professional providers of medical services and medical products of all kinds, so you can efficiently check, file, and manage your medical claims and successfully receive your payments in a timely manner. We are pleased you chose Change Healthcare!

Using Claims Validation

Before sending your claims to the payer, you can use our Professional Claims Validation API endpoint (/validation) to check and validate your upcoming claim submission. Our Validation endpoint won't send your transaction 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: For more sophisticated checking of Professional claims, [consider contracting for our Professional Claims Integrated Rules API](doc:professional-claims-integrated-rules-api-v1), which applies intelligent rules evaluation to the actual contents of your claim, with rules tailored to the specific needs of your practice.

Many claims get rejected by either the clearinghouses, which forward medicals claims to the payer networks; or by the payers themselves, because of needless mistakes in formatting or syntax.

About ConnectCenter

If you 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 process 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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