Telehealth Medical Eligibility and Claims Management Bundle V1

APIs enable vendors to speed time to market and focus on rapid service expansion, with key solutions delivered in an easy-to-use, plug-and-play manner. For telehealth vendors, managing the large influx of patients during a pandemic also requires a streamlined intake process. Our APIs translate standard ANSI X12 medical transactions to JSON so they are more accessible to developers, enabling efficient integration into users’ applications. We also provide extensive medical network API documentation (through FAQs, Getting Started Guides, JSON-to-EDI mapping, and OpenAPI 3.0 annotated docs) so developers can quickly grasp how the content of our APIs fits into their application development.

Optum (formerly, Change Healthcare) offers a comprehensive API bundle to help manage all aspects of telehealth operation. Our Telehealth bundle includes the following:

  • The Eligibility API (X12 EDI 270/271) provides patient profile and benefits insights to help support accurate care delivery. Its primary function is to verify insurance benefit status for a patient. This information helps ensure timely and accurate reimbursement;
  • The Professional Claims API (837P) and the Institutional Claims API (837I) allow healthcare providers to submit healthcare claims for a service or encounter;
  • Claim submitters use the Claim Status API (276/277) to check on the status of previously submitted claims;
  • Our Claims Responses and Reports API provides a direct connection to your mailbox, where payers will send their responses and reports. Using our API, you can retrieve these valuable payer files for claim status updates, and remittance notifications. Many documents that payers send are unsolicited; our API enables you to regularly check your mailbox for this critical information.

Providers should verify insurance companies' coverage of telehealth medical services before engaging in telehealth encounters and transactions.