API URLs and Endpoints
NOTE
Medical Network APIs v1, v2, and v3 (as of 09-02-2021) are deployed to an enhanced cloud-native network connection, which offers improved API speed and reliability. We recommend updating your systems to the following API endpoint URLs at the first opportunity.
Deprecated
The
Accept application/vnd.changehealthcare.medicaleligibility-v2+json
header mentioned in v2 need not be sent or incremented; versioning will be managed through the URL path.
Alert
Do not use the
https://apis.changehealthcare.com
as it is an old domain and no longer supported.
URL
Sandbox
sandbox.apigw.changehealthcare.com/medicalnetwork/
Production
apigw.changehealthcare.com/medicalnetwork/
Endpoints
Security and Authorization
We use OAuth2 to create a secure connection with our API users, which requires a bearer authorization token to obtain access. For more information, see Security and Authorization v2.
- Endpoint โ
apip/auth/v2/token
โ To request for a bearer token that can be used to access our APIs on the platform.
Healthcheck
The /healthcheck
endpoint checks the operating status of the required API. It is a ping for the API entry points to ensure the entry points are accessible. It is the first thing you can do if something goes wrong.
Payer Finder API
payerfinder/v1/payers
โ Searches and shows a list of payers.payerfinder/v1/payers/export
โ Exports the payers list to a CSV format.payerfinder/v1/payers/fields
โ Returns a list of possible unique field values in the Payer Profile Database.
Eligibility
eligibility/v3
โ This endpoint checks if a patient has healthcare coverage with a specific insurance company (payer).eligibility/v3/raw-x12
โ This endpoint uses the standard X12 EDI 270 Eligibility transaction, and formats it in JSON for an HTTP request. Accepts JSON with a single-string 'x12' property that has a 270 EDI string and produces a JSON response with a single 'x12' property that has a 271 EDI string.
Professional Claims
professionalclaims/v3/validation
โ This endpoint checks and validates your upcoming claim submission before sending your claims to the payer.professionalclaims/v3/submission
โ This endpoint to submit your professional claim transaction to the payer.
Integrated Rules Professional
professionalclaims/advanced/v1/validation/
โ This endpoint checks and validates your upcoming submission. It is an enabling tool for making complex provider claims more accurate, and more likely to be accepted and adjudicated by the payer.professionalclaims/advanced/v1/raw-x12-validation
โ Translate back-and-forth between JSON and X12 EDI when the information departs into and returns from the medical network. All fields and JSON objects conform to the EDI 837i transaction standard.
Integrated Rules Institutional
professionalclaims/advanced/v1/validation
โ This endpoint performs advanced rules-based checking and validation of Professional claims based upon the X12 EDI 837i standard. It uses compilations of medical business specialties, called Knowledge Packs, for fine-tuned claim inspection. It does not submit your claim to the payer, and is designed to be complementary to the Professional Claim's/validation
endpoint.professionalclaims/advanced/v1/raw-x12-validation/
โ Translate back-and-forth between JSON and X12 EDI when the information departs into and returns from the medical network. All fields and JSON objects conform to the EDI 837i transaction standard.
Institutional Claims
institutionalclaims/v1/validation
โ This endpoint, prior to submitting an institutional claim, allows the submitter to run claims through extensive repositories of rules and logic to correct potential errors before sending to the payer.institutionalclaims/v1/raw-x12-validation
โ This endpoint translates the standard X12 EDI 837i transactions to JSON format so that it is more accessible to claim readers and developers.institutionalclaims/v1/submission
โ This endpoint submits a validated institutional claim to the payer.institutionalclaims/v1/raw-x12-submission
โ This endpoint translates back-and-forth between JSON and X12 EDI when the information departs into and returns from the medical network. All fields and JSON objects conform to the EDI 837i transaction standard.
Claims Responses and Reports
reports/v2/
โ This endpoint lists the reports.reports/v2/{filename}
โ Depending on the action performed,GET
orDELETE
, this endpoint retrieves or deletes a single file containing complete information about claim payments, claim status updates, and other communications regarding revenue cycles and adjudication from the payer.reports/v2/{filename}/277
andreports/v2/{filename}/835
โ This endpoint converts the specific report ID to 277/835 EDI. If/277
is specified in the request URL with its two-letter extension and the correct endpoint type, converts the EDI reports to JSON, that is, responses to EDI 276 Claim Status inquiries. If/835
is specified in the request URL with its two-letter extension and the correct endpoint type, provides detailed payment information for submitted Professional or Institutional claims.
Claim Status
claimstatus/v2/
โ Retrieves the status of a previously submitted claim.claimstatus/v2/raw-x12
โ The submitter uses a Claim Status request to inquire 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).
Attachment Status
attachments/status/v1/{traceId}
โ This endpoint retrieves the attachment status summary based on thetraceId
(the ID returned to submitters or payers when they submit the claim attachment. A traceId can also be retrieved by calling the metadata endpoint).attachments/status/v1/metadata
โ This endpoint searches for, and retrieves the status of attachments submitted by submitter or payer.
Attachments Submission
submission/v1/uploads
โ This endpoint allows clients to submit attachments and query their status.
Attachments Retrieval
attachments/retrieval/v1/search
โ Search to retrieve a set of document IDs based on upload date range, attachment control number, patient first name, last name, member ID, provider id, provider first name, organization name, claim service start date and claim service end date. By default,testMode
is set to false to retrieve the production data. To retrieve the test data, pass the query string astestMode=true
.ยattachments/retrieval/v1/{documentId}
โ This endpoint lets you download specific attachment documents for payers.
Dental Network Enhanced Eligibility
dentalnetwork/eligibility/v1/enroll
โ Enroll Provider for Enhanced Eligibility Estimation of patient eligibility and coverage.dentalnetwork/eligibility/v1/benefitestimation
โ Estimation of patient eligibility and coverage.
Updated 3 months ago