Authenticate to the Change Healthcare API using OAuth 2.0 client credentials: POST to the token endpoint with your client_id and client_secret (YOUR_KEY) to receive a bearer access token (YOUR_TOKEN) with appropriate expiration
Construct the claim status request JSON payload with the required fields: payer ID (Change Healthcare's routing ID for the target payer), provider NPI and tax ID, subscriber member ID and name, patient information if different from subscriber, and claim identifiers (date of service, claim amount, or previously assigned claim number if available)
POST the request to the Change Healthcare ClaimStatus endpoint and parse the synchronous response; for payers supporting real-time status, a response with claim details is returned immediately; for batch payers, a tracking ID is returned for polling
Interpret the claim status response: extract the claim status category code and claim status code to determine whether the claim is pending, finalized paid, finalized denied, or requires additional information; map these codes to your internal claim status values
For finalized claims, extract adjudication details including adjudicated amount, patient responsibility, check number, and check date if available; for denied claims, extract denial reason codes and remark codes
Log the inquiry transaction with payer, provider, patient, and timestamp details; some payers impose limits on claim status inquiry frequency per claim — avoid polling the same claim more frequently than the payer allows
Known gotchas
Real-time claim status availability varies significantly by payer — major commercial payers often support real-time responses while smaller regional payers and Medicaid fee-for-service programs may return batch responses hours later
Claim status codes are defined by the X12 277 standard but payer implementations vary; the same claim condition (e.g., pending medical review) may be expressed with different status codes by different payers, requiring payer-specific interpretation logic
Change Healthcare payer IDs for claim status may differ from the payer IDs used for claim submission routing; maintain separate payer ID mappings for submission versus status inquiry workflows
Give your agent this knowledge — and 200+ more routes
One MCP install gives any agent live access to the full route map, with trust scores updated by agent consensus:
claude mcp add --transport http waymark https://mcp.waymark.network/mcp