Bundle

Telehealth Medical Eligibility and Claims Management Bundle

This grouping of APIs is designed to specifically address challenges faced by telehealth vendors and patients. Streamline your patient intake process with APIs for eligibility checking, claims submission and status, as well as responses and reporting. Powered by AWS.

APIs enable vendors to speed time to market and focus on rapid service expansion, with key solutions delivered in an easy-to-use, plug-and-play manner. For telehealth vendors, managing the large influx of patients during a pandemic also requires a streamlined intake process.

Efficient

Our APIs translate standard ANSI X12 medical transactions to JSON so they are more accessible to developers, enabling efficient integration into users’ applications.

Extensive

We also provide extensive medical network API documentation (through FAQs, Getting Started Guides, JSON-to-EDI mappings, and OpenAPI 3.0 annotated docs).

Supportive

Optum offers a comprehensive API bundle to help manage all aspects of telehealth operation. Providers should verify coverage of telehealth medical services before engaging.

Developer Resources

Telehealth Medical Eligibility and Claims Management Bundle

API Documentation

What's Included

  • Eligibility API

    The Eligibility API (X12 EDI 270/271) provides patient profile and benefits insights to help support accurate care delivery. Its primary function is to verify insurance benefit status for a patient. This information helps ensure timely and accurate reimbursement.

  • Claims

    The Professional Claims API (837P) and the Institutional Claims API (837I) allow healthcare providers to submit healthcare claims for a service or encounter.

  • Claims Status

    Claim submitters use the Claims Status API (276/277) to check on the status of previously submitted claims.

  • Claims Responses and Reports

    Our Claims Responses and Reports API provides a direct connection to your mailbox, where payers will send their responses and reports. Using our API, you can retrieve these valuable payer files for claim status updates, and remittance notifications. Many documents that payers send are unsolicited; our API enables you to regularly check your mailbox for this critical information.

    Providers should verify insurance companies' coverage of telehealth medical services before engaging in telehealth encounters and transactions.

Included Modules

Change Healthcare offers a comprehensive API bundle to help manage all aspects of telehealth operation. Our Telehealth bundle includes the following:
 

Eligibility API

The Eligibility API (X12 EDI 270/271) provides patient profile and benefits insights to help support accurate care delivery. Its primary function is to verify insurance benefit status for a patient. This information helps ensure timely and accurate reimbursement.

 

Claims

The Professional Claims API (837P) and the Institutional Claims API (837I) allow healthcare providers to submit healthcare claims for a service or encounter.

 

Claims Status

Claim submitters use the Claims Status API (276/277) to check on the status of previously submitted claims.

 

Claims Responses and Reports

Our Claims Responses and Reports API provides a direct connection to your mailbox, where payers will send their responses and reports. Using our API, you can retrieve these valuable payer files for claim status updates, and remittance notifications. Many documents that payers send are unsolicited; our API enables you to regularly check your mailbox for this critical information.

Providers should verify insurance companies' coverage of telehealth medical services before engaging in telehealth encounters and transactions.

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