Payer Finder Request & Response

The Payer Finder API provides two methods for querying payers:

  • Queries using the HTTP URL path;
  • Queries defined by a question mark (?) followed by a structured statement as an extended argument in the path.

📘

NOTE

In general, API queries are not case sensitive. However, the key portions of a key-value pair search parameters are case-sensitive while the value portions are not. The key (a field name)) should be in camel case as while the value can be entered anyway. So, for example, serviceName=eligibility or serviceName=ELIGIBILITY both work while servicename=eligibility does not.

In a sandbox environment, if you want to query for payers that start with business name blue and service name Claims, send a GET request to the following endpoint with your authorization header.

https://sandbox-apigw.changehealthcare.com/medicalnetwork/payerfinder/v1/payers?businessName=blue&serviceName=Claims

In a sandbox environment, if you want to query for payers that start with business name blue and service name Claims, send a GET request to the following endpoint with your authorization header.

https://sandbox-apigw.changehealthcare.com/medicalnetwork/payerfinder/v1/payers?businessName=blue&serviceName=Claims
{  
    "start": 0,  
    "size": 50,  
    "total": 542,  
    "payers": [  
        {  
            "businessName": "Blue Cross Blue Shield of Testing",  
            "alias": "Test Alias",  
            "planType": "Test",  
            "serviceName": "Claims",  
            "lineOfBusiness": "Dental",  
            "serviceDate": "2007-10-19T00:00:00",  
            "serviceId": "61474",  
            "clearingHouse": "NPD",  
            "acceptsSecondary": "N",  
            "reportLevel": "4-Clm Level A/R",  
            "serviceModified": "2007-11-01T00:00:00",  
            "enrollmentStatus": "No Enrollment Required",  
            "serviceNotes1": "Dental Blue Select Product",  
            "passThroughFee": "N"  
        },  
        {  
            "businessName": "Blue Cross Blue Shield of Testing 2",  
            "planType": "Test 2 Alias",  
            "states": "MS",  
            "serviceName": "Claims",  
            "lineOfBusiness": "Hospital",  
            "serviceDate": "2002-04-12T00:00:00",  
            "serviceId": "12B82",  
            "clearingHouse": "NPD",  
            "acceptsSecondary": "Y",  
            "reportLevel": "4-Clm Level A/R",  
            "serviceModified": "2012-03-23T00:00:00",  
            "enrollmentStatus": "Enrollment Required",  
            "enrollmentType": "Registration",  
            "enrollmentMethod": "OKC/POSI Setup",  
            "passThroughFee": "N"  
        }  
   ]  
}

Sending the following request downloads the entire payer list. From this point, add the attributes and arguments to the URL path to query for more-specific information.

https://sandbox-apigw.changehealthcare.com/medicalnetwork/payerfinder/v1/payers
```
{
    "start": 0,
    "size": 50,
    "total": 542,
    "payers": [
        {
            "businessName": "Blue Cross Blue Shield of Testing",
            "alias": "Test Alias",
            "planType": "Test",
            "serviceName": "Claims",
            "lineOfBusiness": "Dental",
            "serviceDate": "2007-10-19T00:00:00",
            "serviceId": "61474",
            "clearingHouse": "NPD",
            "acceptsSecondary": "N",
            "reportLevel": "4-Clm Level A/R",
            "serviceModified": "2007-11-01T00:00:00",
            "enrollmentStatus": "No Enrollment Required",
            "serviceNotes1": "Dental Blue Select Product",
            "passThroughFee": "N"
        },
        {
            "businessName": "Blue Cross Blue Shield of Testing 2",
            "planType": "Test 2 Alias",
            "states": "MS",
            "serviceName": "Claims",
            "lineOfBusiness": "Hospital",
            "serviceDate": "2002-04-12T00:00:00",
            "serviceId": "12B82",
            "clearingHouse": "NPD",
            "acceptsSecondary": "Y",
            "reportLevel": "4-Clm Level A/R",
            "serviceModified": "2012-03-23T00:00:00",
            "enrollmentStatus": "Enrollment Required",
            "enrollmentType": "Registration",
            "enrollmentMethod": "OKC/POSI Setup",
            "passThroughFee": "N"
        }
   ]
}
```