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
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
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
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
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
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
The Change Healthcare API environment was subject to a significant cybersecurity incident in 2024; verify current API availability, review updated security requirements, and confirm your integration uses mutual TLS or other enhanced authentication if required by updated security policies
JSON field naming in the Change Healthcare API schema does not always map one-to-one with X12 loop/segment names; use the API's own documentation rather than inferring field names from X12 companion guides
Sandbox test payer IDs and test member IDs provided by the API portal are not interchangeable with production values; submissions with production payer IDs to the sandbox endpoint will be rejected or silently discarded
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claude mcp add --transport http waymark https://mcp.waymark.network/mcp