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.
Your or your customer's National Provider Identifier.
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.
First name, last name, plan, member ID and date of birth to check patient's eligibility.
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.