Overview

APIs enable vendors to speed time to market and focus on rapid service expansion, with key solutions delivered in an easy to use, plug-and-play format. Managing the large influx of patients, and their associated insurance claims, also requires a streamlined intake process.

Medical Network APIs

Our APIs take standard X12 transactions and translate them to JSON so that they are more accessible to developers and easily integrated into users' applications.

  • The Eligibility API (X12 EDI 270/271) gives providers complete patient insurance benefit profiles for appropriate care delivery, efficient and accurate reimbursement.

  • The Professional Claims API (837P) and the Institutional Claims API (837I) allow healthcare providers and institutions to submit healthcare claims for a service or encounter.

  • The Claims Status API (276/277) is used by the submitter of a medical claim to determine the status of any previously submitted Institutional or Professional claim.

  • The Claims Responses and Reports API provides a direct connection to your mailbox where payers will send their responses and reports to your claims. It enables you to download all claims information from your payer, regardless of claim type. We provide this feature at no cost to you.

  • The Attachment Submission API (X12 EDI 275) enables healthcare providers to submit healthcare claim attachments for a service or encounter. You can consider this API as an important addition to Professional Claims and Institutional Claims.

  • The Attachment Status API enables healthcare providers to get the status of healthcare claim file attachments for a service or encounter. It's particularly helpful for users keeping track of attachments for complex claims. It even provides support for payers that do not offer electronic attachment capabilities and require only fax or mail for attachment submissions.

  • The Attachment Retrieval API lets you search for and download attachment documents for payers.

  • The Claims Lifecycle AI API proactively identifies claims at risk for denial. It works with your Professional Claims drafts and with the Legacy Change Healthcare Claims and ERAs in the Change Healthcare Payer List.

  • The Integrated Rules Professional (837P) and Integrated Rules Institutional (837I) APIs enable you to perform medical specialty-based claim scrubbing and fix any possible errors before sending a Professional claim or Institutional claim to the payer.