API

Care Cost Estimator

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.

Gain nearly unlimited flexibility and interoperability to meet you or your client's unique needs, accelerating time-to-market and unlocking new revenue opportunities.

Quality Options

Work with cost data from your choice of inputs, including negotiated contracts, regional average or historical claims.

Best In Class

Leverage Change Healthcare's vast clearinghouses and relationship with payers to determine patient eligibility, copay, coinsurance and deductible status, and return an accurate, personalized obligation estimate.

Elegant Integration

Integrate with hospitals' existing branded functionality, automated workflow, or self-serve app to deliver comprehensive, bundled estimates.

Developer Resources

Care Cost Estimator

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 Details

First name, last name, plan, member ID and date of birth to check patient's eligibility.
 

Dependent's Details

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.

Frequently Asked Questions

Q: Do you have a sandbox that I can access?

A: We do have a sandbox environment for testing. Our sandbox environment requires a separate set of secure credentials which you can obtain from your Change Healthcare representative. Please fill out the information in the link below, and then our team will help you get access to sandbox.

Q: How will Care Cost Estimator help my organization and what results can I expect?

A: Care Cost Estimator can help 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.

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

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