Q&A 2023 Dev Community

If the Primary claims are sent electronically, will the Secondary/Tertiary claims be sent electronically as well all the time?

For the secondary claim to be paid electronically, the primary payer must accept secondary claim.

These payers can be reviewed in the Change Healthcare Payer Finder tool. The ‘Accepts Secondary’ column is not automatically displayed.

1. Click the gear (highlighted below) at the top-right of the list.

2. From the menu that shows, select the Accepts Secondary checkbox.

3. Save your settings.

This will display an additional column. Those with a ‘Y’ designation, accept secondary claims.

However, the secondary payer must also process claims electronically and the appropriate payer ID must be included within the claim for the process to be fully electronic.

Is the usageIndicator field something that is respected by the clearinghouse and/or payers? Is submitting real data with a "T" usageIndicator value a valid way to test production data without actually submitting it for processing? How is this field interpreted?

You are correct. Sending a claim with the "T" usageIndicator is a valid way to test production data without submitting for processing. The claim will be passed through our clearinghouse edits, including any payer specific edits for the payer listed on the claim. Clearinghouse reports will be returned, but if the claim is accepted, it will not be sent to the payer for further processing.

In certain responses from certain Payers, it can be seen that a deductible is mentioned for Health Benefit Plan Coverage (serviceType code 30) whereas, no deductible is mentioned for other benefits returned in the same response by the payer. In such cases, is the deductible amount mentioned in Health Benefit Plan Coverage applicable to the rest of the services as well?

Typically, the deductible would only apply to the specific service type code that is being returned and referenced in the same object. If the information is not being returned for the other service type codes, that would most likely mean that there is no deductible for the specified service.

Is there a best practices checklist and workflow for Eligibility API?

Yes, refer to Eligibility API Best Practices & Workflow guide.

Is there a list of all the rejection codes Change Healthcare gives for validation when submitting claims?

We have a basic list of AAAError codes. Additionally, a list of Claim Status response codes that are maintained by the X12 organization. Lastly, we have a list of Change Healthcare edits available in the ConnectCenter >> Payer Tools tab >> Edit Search option for more error messages and their description.. Based on the edit message being returned the information may be entered in the incorrect location as the information should be specific to the patient.

Where can I get the Consolidated 270/271 Implementation Guide?

You need to license it directly from the X12 org.

How can serviceType codes be used to identify business groupings?

ServiceType codes are used to identify business groupings for healthcare services and benefits. Include the serviceType in the Care Cost Estimator API request body, and then submit to payers on an eligibility and benefit inquiry transaction to get patient’s eligibility and benefit details for out-of-pocket cost estimate. The serviceType code consists of value and valueType. An example:

"service": {
    "codes": [
      {
        "value": "98",
        "valueType": "ServiceTypeCode"
      }

Each payer may have different supported service types for eligibility and benefit inquiries. You may visit individual payer site to find supported serviceType codes and the serviceType code best to use for the procedure you or your patients are trying to get an estimate of out-of-pocket cost. We recommend you purchase and use the 270 Implementation Guide specs.
Or
List of serviceType codes you can find on Connect Center >> under Verification >> Start New Eligibility Request >> drop-down list under ‘Service Information’ >> Service Type.

If you are not sure what service type code to use, you can use serviceType code “30” for a general Health Benefit Plan Coverage inquiry.

Here is a list of official list from the x12 org.

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NOTE

Only serviceType codes with Starting date: 09/20/2009 will be active.

Related Topics

• API Reference
• Troubleshoot APIs with Metadata