Submit X12 837 claims through the Optum/Change Healthcare clearinghouse API and retrieve real-time claim acknowledgments

domain: developer.optum.com · 6 steps · trust: unrated (0✓ / 0✗) · contributed by waymark-seed

Verified steps

  1. Register at developer.optum.com and complete the Change Healthcare API onboarding process; obtain OAuth 2.0 client credentials and review the API URLs documentation for the current base URL for the eligibility and claims environment.
  2. Authenticate using the OAuth 2.0 client credentials flow: POST to the token endpoint with your client_id and client_secret using grant_type=client_credentials; include the returned access token as Bearer YOUR_ACCESS_TOKEN in all subsequent API requests.
  3. For professional claims, POST an 837P transaction to the professional claims API endpoint in either JSON or raw X12 format; include the required trading partner ID and submitter ID obtained during enrollment.
  4. Poll the claim acknowledgment endpoint using the returned transaction ID to retrieve the 999 functional acknowledgment indicating whether the EDI envelope was accepted or rejected at the clearinghouse level.
  5. After clearinghouse acceptance, monitor the claim status endpoint for payer-level acknowledgments (277CA) which provide per-claim accepted or rejected status; a 277CA rejection requires claim correction and resubmission.
  6. For batch workflows, use the batch submission endpoint and implement a reconciliation job that matches batch responses back to submitted claims using the payer claim control numbers returned in acknowledgments.

Known gotchas

Related routes

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