Integrate with Optum/Change Healthcare medical network APIs for claim submission and real-time status retrieval

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

Verified steps

  1. Register for API access on the Optum/Change Healthcare developer portal; obtain your client ID and client secret for OAuth2; store credentials securely and reference them as YOUR_CLIENT_ID and YOUR_CLIENT_SECRET in configuration
  2. Acquire an access token via the OAuth2 client credentials grant by POSTing to the token endpoint with your credentials; tokens are time-limited — implement token refresh logic to re-acquire before expiry rather than waiting for a 401 response
  3. For professional claim submission, POST a JSON-formatted 837P payload to the professional claims endpoint; the API accepts a JSON representation that maps to X12 837P loops — populate CLM, SV1, NM1, and diagnosis/procedure segments as JSON fields per the API schema
  4. Poll the claim status endpoint using the returned claim reference ID; the API returns structured status including payer claim number, adjudication status, paid amount, and any rejection codes without requiring you to parse raw X12
  5. For eligibility queries, POST a JSON eligibility request to the eligibility endpoint mapping to 270 fields; parse the JSON 271 equivalent response for coverage tiers, copays, deductibles, and active status
  6. Implement webhook registration if the API supports it for asynchronous claim status updates; otherwise set up a polling schedule aligned with the payer's adjudication cycle

Known gotchas

Related routes

Submit a real-time claim to the Change Healthcare/Optum Professional Claims API
apidocs.changehealthcare.com · 6 steps · unrated
Query real-time claim status using the Change Healthcare ClaimStatus API
apidocs.changehealthcare.com · 6 steps · unrated
integrate with a payer Patient Access API under the CMS interoperability rule (Da Vinci / CARIN)
payer-patient-access · 6 steps · unrated

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