Use the Professional Claims V3 API
The Professional Claims APIs are designed for medical providers to submit insurance claims to payers.
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.
Professional Claims endpoints
Task | Endpoint |
|---|---|
Request Method |
|
Bearer Token |
|
API endpoint |
|
Validation endpoint |
|
Healthcheck endpoint |
|
Raw-X12 |
|
Operation Mode | Real-time, one request |
Consumes |
|
Produces |
|
Sandbox URL
https://sandbox.apigw.changehealthcare.com/medicalnetwork/professionalclaims/v3
Production URL
https://apigw.changehealthcare.com/medicalnetwork/professionalclaims/v3
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:
Element | Description |
|---|---|
| Contains important values, such as the |
| Provider identification, including information, such as the |
| Includes the patient's insurance member ID and |
| If necessary, information about the insurance policy holder's dependent who received the medical services. |
| Providers involved with the medical claim. |
| A key block of medical coding information that defines the actual procedures and services rendered for the medical encounter. It contains other JSON blocks including the |
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, 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"
}
}
```
Updated 30 days ago