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 claim 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).
If the claim is finalized, the response provides the disposition of the claim (for example, Paid, or Denied). For denied or rejected outcomes, the response includes the reasons for the denial or rejection.
You won't be able to obtain the claim response file itself; this file details the payments for each line item for the claim. To do that, use Change Healthcare's Claims Responses and Reports API. It works as a complement to the Claims Status API.
We also provide EDI-to-JSON mapping documentation, so you can quickly find out the EDI segments and loops that map to each JSON attribute in the API.