Use the Claim Status API

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NOTE

The JSON attributes in our APIs use snake-case, with the first letter of the attribute in lower case as in tradingPartnerServiceId. Our APIs are case-sensitive and your JSON request body must observe this convention.

Eligibility endpoints components

The Claims Status v2 endpoints consist of the following:

APIs components

The Claims Status API supports the X12 EDI 276 transaction. It translates this standard to JSON for developer accessibility and integration into users’ applications.

The submitter uses a Claim Status request to ask about the status of a previously submitted claim. The payer returns the response, as an X12 EDI 277 transaction, which is translated back to JSON by the API gateway. It describes where the claim is in the adjudication process (for example, Pending, or Finalized).

Claim Status' main task is to check the status of a claim in the payer’s system. When the claim adjudication is complete, the response provides the result of the claim (for example, Paid, or Denied). For denied or rejected outcomes, the response includes the reasons for the denial.

If a provider has not received a payer report on a claim, or if they have not received payment, they run a claim status request to find out the most recent status of that claim. You may also need to check your Change Healthcare mailbox on a regular basis. The Claim Status API does not do this.

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NOTE

Claim Reports and Responses is a complementary API to Claim Status that performs an associated but different task. It is a fetching tool for claims information from your mailbox. The Claim Status API gives you the current status of your claim but does not download the contents of your payer's claim report. For more information, see Claims Responses and Reports.

X12 EDI Support

We also support a dedicated Raw X12 Claims Status API to format your submission in X12 EDI format. It supports the standard syntax for a complete X12 EDI 276 transaction set.