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.
Try our APIs
- To try or test our APIs in your own a development platform/tool, download and import our OpenAPI spec provided above by clicking the Download OpenAPI Spec using our sandbox predefined values to familiarize yourself with our APIs.
- If you do not own a development platform to try or test our APIs, use our interactive Try It interface to familiarize yourself with our APIs, for example, generate a bearer token. For information, see using the Try It interface.
| Release Notes | FAQs |
|---|---|
| View API Release Notes for information about the history of programmatic updates for the Professional Claims API. | Check out our Professional Claims API FAQ for help with specific questions about this API. |
NOTE
Please see the API FAQs section for tips and solutions to some of the questions most commonly asked by customers and staff, and in the developer community about the use of our APIs.