This product allows for significant savings in time and a higher propensity for acceptance on the first submission.
Prior to submitting an institutional claim, the Institutional Claims Validation endpoint allows the submitter to run claims through extensive repositories of rules and logic in order to correct potential errors before to sending to the payer.
The ASC X12N Health Care Claim: Institutional (837i) transaction enables healthcare providers to submit healthcare claims for a service or encounter.
A healthcare claim includes patient information, related diagnoses, procedures performed or services provided, and any related charges.
This API also translates standard X12 EDI 837i transactions to JSON so that it is more accessible to claim readers and developers.
Q: What's the difference between an Institutional claim and a Professional claim?
A: Institutional billings use the 837i transaction. Professional billing typically uses the 837p transaction (or the CMS-1500 form in hard copy). We support both types of electronic claims and transactions in separate API products.
Institutional billing also sometimes encompasses collections, while Professional claims and billing typically doesn't. Professional billing controls the billing of claims generated for work performed by physicians, suppliers, and other non-institutional providers for both outpatient and inpatient services. People handling Professional claims typically understand both billing and insurance coding. Our APIs help support and automate insurance coding.
Q: How do Institutional Claims work for Medicare?
A: Medicare payers accept claims only for subscribers. If you want to submit a dependent claim with a Medicare payer, submit the dependent as a subscriber in the claim request.
Q: Do you have a sandbox that I can test before signing a contract?
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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