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Professional Claims V3 Getting Started

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Professional Claims v3 API

The Professional Claims API allows for the creation and submission of claims so that your providers can be reimbursed for their services. This API takes the standard established in the X12 EDI 837P transaction and translates this standard to JSON so it is more accessible to developers and easily integrated into users' applications.

This service includes the /validation endpoint to check and verify your claim prior to submission to the payer. This endpoint checks for the correct well-formed syntax of the submission as well as correctly summing service line charges and verifying codes in order to minimize the chance of rejection by the payer.

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.

Healthcare claims v3 information

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

Our Professional Claims API translates the standard X12 EDI 837P transaction to more-readable Javascript Object Notation (JSON) format, 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 Optum (formerly, Change Healthcare)!

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NOTE

  • If you only plan to use a few daily transactions, you can use our ConnectCenter for your Medical Network transaction needs.
    It provides most of the features supported by an API console but only allows manual entry for all data needed for a transaction. It contains Payer Lists, the Payer List Enrollments wizard, and other API customer resources.
  • For providers sending hundreds of daily requests, we recommend using our APIs to be able to automate the submission processes and have a better fit for your business needs.

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Updated 3 months ago