The Professional Claims API takes the standard X12 EDI 837P transaction and translates it to JSON so it is more accessible to developers and easily integrated into users’ applications.
The ASC X12N Health Care Claim: Professional (837P) transaction allows healthcare providers to submit healthcare claims for a service or encounter. A healthcare claim includes patient information, related diagnoses, procedures performed or services provided, and any related charges. Use the Validation API to check and validate your upcoming submission. Your transaction will not be sent 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.
We also provide EDI-to-JSON mapping documentation, so you can quickly find the EDI segments and loops that map to each JSON attribute in the API.
Please see the API FAQs section for tips and solutions to some of the most common questions asked by customers, developer community, and internal staff about the use of our APIs.