Payer Finder V1 API Parameters

Payer Finder user interface (UI) and API parameters

parStatusA valid parCode is required to get parStatus.
parCodeAn access code required to view the parStatus in the Payer Finder user interface (UI) and API

📝 Contact Optum (formerly, Change Healthcare) support for an access code.
businessNameLabeled Payer Name.
AliasLabeled alternative Payer Name.
serviceIdLabeled Payer ID.
planTypeOne or more from Auto, Blue Cross Blue Shield, Commercial, Delta Dental, Dental, HMO, Medicaid, Medicaid MCO, Medicare, Medicare Advantage, Medicare Supplement, Transportation, Optical, Tricare/Champus, Work Comp.
states📝 States match on both, a single entry and a comma-separated list.
A wildcard match on either a single two-letter abbreviation or a comma-separated list of more than abbreviation.
For example, states=FL would match records with a states value of FL and FL,GA,AL; states=AZ would match on an entry of “AZ” as well as “AZ,CA,PA”.
serviceName(TransactionTypes)One or more from Claim Status, Claims, Real-Time Claims, Claims Attachments, Electronic Funds Transfer, Eligibility, Health Services Review Inquiry, Health Services Review Request, Medical Attachments, Notice of Admission, Remittance (ERA), Remittance Images.
lineOfBusinessOne or more from Dental, Hospital, Medical.
clearingHouse (Suite/ClearingHouse)Acceptable values are:
  • npd(for Legacy Change Healthcare/Emdeon)
  • rpa (for RPA/Capario)
  • dbq (for Exchange/Legacy Relay Health)

📝 Only one value can be submitted in a query. Not including it will result in npd being used. Using more than one will generate an error.
  • wildcard=false: An exact match search is performed for businessName or alias.
  • wildcard=true: A wildcard search is performed.

📝 The default value is true. But the API users may want to set it to false.
serviceModifiedGteFilters a search/export for only those payers whose serviceModified date is greater than or equal to the value provided. If the date is in any format other than YYYY-MM-DD, example: serviceModifiedGte=2022-12-02, an “invalid date format” error is returned.
startThe record number to begin at. '0' is the first number. This is only meaningful if the size is supplied.
sizeThe number of records to return. This is important. For example, searching on “21st century insurance” (wildcard=false) yields over 1,000 records that all have the same serviceId so, a user would only be interested in the first one. Setting size=1 would only return one record instead of more than 1,000 records.
sortThe column name to sort on, and ascending (asc) or descending (desc) order.
sort=alias,asc or
totalHow many hits the query matched.

Available Fields in the Columns drop-down

serviceDateDate of the service.
acceptsSecondaryLetter "Y" or "N" denoting if the payer accepts secondary.
serviceModifiedLabeled date last modified.
enrollmentStatusLabeled enrollment.
parStatus📝 A valid parCode is required to get parStatus.
passThroughFeeLetter "Y" or "N" denoting whether the payer has a pass through fee or not.
payerSearchOptionsURL📝 Shows when clearinghouse is CAP/RPA and Service is Eligibility or Claim Status.
enrollmentAuthorizationURL📝 Shows when clearinghouse is CAP/RPA and Service is Eligibility or Claim Status.