Care Cost Estimator API v1

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Overview

Note: Product currently in Beta

Care Cost Estimator API is a flexible API that can be used by technology partners and developers to add robust, personalized cost estimation capabilities to new and existing provider solutions, and to address the following challenges that healthcare providers are facing today:

  • 91% of consumers would like to know pricing information in advance of care¹.
  • Commercially insured patients are twice as likely to pay their total obligation if they receive an advance estimate².
  • 30% of patient responsibility ($200 billion) is never collected³.

With Care Cost Estimator API, you and/or your customers can have:

Best-in-Class Performance

  • Work with cost data from your choice of inputs, including negotiated contracts, regional average or historical claims.
  • Leverage Change Healthcare's vast clearinghouses and relationship with payers to determine patient eligibility, copay, coinsurance and deductible status.
  • Return an accurate and personalized obligation estimate.

Simple, Elegant Integration

  • Integrate with hospitals' existing branded functionality, automated workflow, or self-serve app to deliver comprehensive, bundled estimates.
  • Gain nearly unlimited flexibility and interoperability to meet you or your client's unique needs, accelerating time-to-market and unlocking new revenue opportunities.

How does Care Cost Estimator API work?

Care Cost Estimator API requires the following inputs to estimate patient's out-of-pocket spending:

  • Bundled cost of the service or procedure. If you or your customer is a hospital, talk to your Change Healthcare representative to discuss how True View Plus Cost Transparency Solution can help you meet CMS transparency mandates and provide bundled cost for Care Cost Estimate API to use.
  • NPI: your or your customer's National Provider Identifier.
  • Payer ID: Payer ID is what Change Healthcare clearinghouses use to route claims electronically to that payer. Care Cost Estimator API uses Payer ID as one of the mandatory inputs to check your patient's eligibility. Talk to your Change Healthcare representative to confirm the Payer IDs of the plans you or your customers have contracts with.
  • Service Type Code: service type code identifies business groupings for health care services or benefit. Care Cost Estimator API uses Service Type Code as one of the mandatory input fields to get copay and coinsurance applicable to the service or procedure for estimate.
  • Subscriber's first name, last name, plan, member ID and date of birth to check patient's eligibility.
  • Dependent's first name, last and date of birth: if you are querying dependent's eligibility, Care Cost Estimator API needs to have the dependent information as well as subscriber's information listed above for estimate Or Care Cost Estimator API can accept manual inputs of patient's deductible, out of pocket max, spending in this benefit year, copay and coinsurance to calculate patient's out-of-pocket spending.

¹How CHOP's Price Transparency Initiative Boosted Patient Satisfaction, Advisory Board, 2018
²Understanding Patient Financial Preferences, Advisory Board, 2018
³National Health Expenditures by Type of Service and Source of Funds, CY 1960-2017, CMS.gov