Our APIs enable vendors to accelerate the 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.
Optum (formerly, Change Healthcare) uses OAuth2 to create a secure connection with our API users, which requires a bearer authorization token (
apigw.changehealthcare.com/apip/auth/v2/token/ endpoint) to obtain access.
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 Institutional Claims API (837i) transaction enables institutional healthcare providers to submit healthcare claims for a service or encounter.
The Claim 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 is 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 the attachment documents for payers.
- 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.
- The Dental Benefits Advisor is the cutting-edge alternative to traditional Eligibility & Benefit Inquiry & Response, enabling dental providers to confidently deliver the most accurate payment plan to the patients based on their eligibility.
- The Payer Finder API consolidates payer lists within Optum. This API programmatically exposes our payer lists within your applications (apps). You can find methods to list and search all the payer lists and methods that list unique fields within our payer data to help you find your required payer.
Legacy Relay Health (LRH)/Exchange Payers can be accessed by using our Payer Finder API.
NOTE — PAYER FINDER API
Works with Optum (formerly, Change Healthcare, also internally known as Legacy Change, Emdeon, or Ark) payer list and Revenue Performance Advisor (known internally as RPA or Capario) that are now in the Payer Profile Database.