We also support a dedicated X12-formatted Eligibility API to send your submission in X12 EDI format. It supports the standard syntax for a complete X12 EDI 270 transaction set.
Our Eligibility API solution provides complete patient profile and benefits information, to support health care delivery and more-efficient and accurate reimbursement.
For payers, it means claims spend less time in pending status, and also means fewer rejected and reworked claims.
Frequently Asked Questions
A: Some payers require NPI enrollment before they will process eligibility requests and send responses. For the list of payers who require enrollment, please refer to the payer list on ConnectCenter.. You will need to log in to access this information.
You send the National Provider Identifier (NPI) in all Eligibility requests. Each NPI to be sent in Eligibility requests may need enrollment. An office can enroll one NPI and use that NPI for all requests in their office, or they can enroll additional NPIs.
For more information, your Change Healthcare implementation analyst will be able to help.
A: Each NPI that will use Eligibility requests, requires a separate Enrollment. So there's one NPI per enrollment. The TIN (Taxpayer Identification Number) does not apply, except from its being on the enrollment form. If an office enrolls one NPI, they use that NPI for all requests in that office or they can enroll additional NPIs.
A: We do! You can use our Sandbox environment even before signing a contract. It requires a separate set of secure credentials which you can obtain from your Change Healthcare representative. After receiving your client_id and client_secret for our Sandbox environment, you can test the API in our interactive documentation, use an application such as Postman, or test APIs using your own development console.
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