Medical Network Claims Lifecycle AI v2

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Overview

Using artificial intelligence, the Claims Lifecycle AI API proactively identifies claims at risk for denial.

Using professional claim information, this service returns a score indicating a claim’s likelihood for denial, lists the top three likely reasons for denial, and insights based on the denial category. Rejection criteria also display a probability score. When you finish editing a claim, you can submit it to the payer using our Professional Claims API.

The Claims Lifecycle AI API works with Professional Claims drafts and with the Legacy Change Healthcare Claims and ERAs in the Change Healthcare Payer List. It accepts Payer IDs that are listed within that clearinghouse. (See http://support.changehealthcare.com/customer-resources/payer-lists, and select Change Healthcare Payer List). Future updates to the Claims Lifecycle AI API will enable the API to be compatible with all clearinghouses in the Change Healthcare system.

API Onboarding

Most of our APIs are private and require credentials to gain access. Begin by obtaining your client_id and client_secret for our sandbox test environment. (Contact your Change Healthcare representative if you do not have this information.)

Find out more about our security protocols and their implementation.

NOTE: You use a separate Change Healthcare-issued credential pair for your production API work.

You can test the APIs from within our interactive documentation (see the API page), use an application such as Postman, or use your own development platform.

Try our Postman Collection! Run in Postman

The goal for onboarding is to ensure API customers can automate their API consumption process. For end use, API consumption shouldn't require 'seeing' the APIs; preferably, a number of tasks can be automated:

  • API bearer token automation, using OAuth2 token retrieval.
  • A data entry console to make claims requests and eligibility requests. It's a characteristic feature of medical facilities where public medical encounters take place.
  • Abstraction of the majority of complex data that's required for a successful request, so you can easily make requests and get replies efficiently without confusion. For example, Control Numbers exist in all of our APIs as a required value that's generated, assigned and sent by the provider or institution to identify each transaction. When the provider's office sends a request, they should never have to worry about defining and entering those values, and they should be handled programmatically.
  • Auditing and tracking for all transactions.

For token automation, you can apply one of the following:

  • Get a unique token for each transaction.
  • Apply the same token across all transactions in the full token lifespan (tokens for production APIs have a two-hour/7200 second lifespan) and automatically refresh the token just before it expires.

NOTE: We suggest automating token generation over the token lifespan, or close to it, instead of tokenizing each individual transaction.

API Endpoints

The endpoints for the Eligibility API collection are as follows.

  • This is the primary Claims Lifecycle AI prediction endpoint:

    https://apis.changehealthcare.com/ai/claims-lifecycle/medical-network/v2/prediction

  • Claims Lifecycle AI also supports a GET /healthcheck call to check that the service you're trying to use is up and running:

    https://apis.changehealthcare.com/ai/claims-lifecycle/medical-network/v2/healthcheck

You submit the claim using your standard workflow or use another Change Healthcare API to do so.

  • Each of our API collections also contains an endpoint for obtaining new authorization tokens:

    https://apis.changehealthcare.com/apip/auth/v2/token

Using the API

In our interactive documentation, select the API tab, and select the green POST API object. Scroll down to the Authorization field, enter the word Bearer, and paste your token into the Bearer Token field.

If you are using our Postman collection or a similar development console, ensure your client_id and client_secret for your production account are installed in your Authorization API request body, or that you set up your environment variables to refer to these credentials whenever you require a token. If you correctly set up your environment variables, you can install the collection in Postman (for example), and simply run the Authorization API to obtain a token whenever you need it, which will automatically be used by the other APIs in the collection.

For Sandbox and production API testing, you can also edit the request body. Don't use real-world values in Sandbox API usage. Doing so will produce errors.

For Sandbox usage, we also provide predefined values to simulate Personal Medical Information (PMI) in the Sandbox environment. For successful use of Sandbox APIs, you must use these "fake patient" values for your testing. Check the FAQ page section Sandbox predefined fields and values for more information.

For further details about Claims Lifecycle AI API usage, see the FAQ page.