The Professional Claims APIs are designed for medical providers to submit insurance claims to payers.
Before submit your claims to the payer, use our Professional Claims /validation endpoint to check and validate your upcoming claim submission. Our /validation endpoint will not 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.

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NOTE

For more sophisticated checking of Professional claims, consider contracting for our Professional Claims Integrated Rules API, 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.

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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 claimInformation. Our APIs are case-sensitive and your JSON request body must observe this convention.

Professional Claims endpoints and URLs

Professional claims elements

The Professional Claims API contains a series of JSON objects that use various important elements for completing submission of claims, including but not limited to the following:

Using the Healthcheck endpoint

The /healthcheck endpoint verifies that the operating status of the Change Healthcare APIs is optimal and the APIs are running and are accessible. For more information, see API Healthcheck.

Using the Validation endpoint

The /professionalclaims/v3/validation endpoint checks for the correct values of the claimReference object, which confirms that you will be sending the claim to the right place and it will not be rejected by the clearinghouse.

```json
{
    "status": "SUCCESS",
    "controlNumber": "000000001",
    "tradingPartnerServiceId": "9496",
    "claimReference": {
        "correlationId": "200715R999898~18620063139417176",
        "submitterId": "999898",
        "customerClaimNumber": "000000001",
        "patientControlNumber": "12345",
        "timeOfResponse": "2020-07-15T12:44:17.994-05:00",
        "claimType": "PRO",
        "formatVersion": "5010"
    },
    "editStatus": "SUCCESS",
    "payer": {
        "payerName": "EXTRA HEALTHY INSURANCE",
        "payerID": "9496"
    }
}
```