Change Healthcare API
Change Healthcare provides APIs for healthcare claims submission, eligibility verification, remittance advice, and prior authorization, enabling AI agents to automate revenue cycle management and insurance transaction workflows.
Score Breakdown
⚙ Agent Friendliness
🔒 Security
HIPAA BAA required. SOC2 Type II. PCI-DSS compliance for payment data. Post-2024 breach incident, enhanced security controls implemented. All PHI access logged.
⚡ Reliability
Best When
You're building revenue cycle management, billing automation, or insurance transaction workflows that require batch and real-time claims processing across multiple payers.
Avoid When
You need clinical data or health records rather than administrative/financial transaction data — the API is purpose-built for billing workflows, not clinical content.
Use Cases
- • Submitting medical claims (837P/837I) to payers for automated revenue cycle management
- • Real-time eligibility and benefits verification before patient appointments
- • Retrieving claim status and remittance advice (835) for payment reconciliation agents
- • Automating prior authorization submission and status checking workflows
- • Processing coordination of benefits and secondary claim submissions
Not For
- • Accessing patient clinical records or EHR data — use Epic FHIR or Redox
- • Direct patient-facing health apps — use consumer-oriented health data platforms
- • Non-US healthcare billing — Change Healthcare is US-focused
Interface
Authentication
OAuth2 client credentials flow for server-to-server integrations. API keys available for some endpoints. BAA required for PHI access. Payer-specific credentialing may be required in addition to Change Healthcare credentials.
Pricing
Enterprise contracts with per-transaction fees. Pricing varies by transaction type (eligibility checks, claims submissions, etc.). Now part of Optum/UnitedHealth Group following 2022 acquisition.
Agent Metadata
Known Gotchas
- ⚠ The February 2024 cyberattack caused widespread outages across US healthcare — agents must implement multi-clearinghouse fallback logic for resilience
- ⚠ BAA and payer-specific trading partner agreements must be established before production transactions — onboarding can take 4-8 weeks
- ⚠ X12 EDI 837/835 formats are complex; REST API wraps EDI but error codes still reference X12 transaction sets requiring domain expertise
- ⚠ HIPAA minimum necessary standard requires agents to only request PHI fields needed for the specific transaction purpose
- ⚠ Payer connectivity varies — not all payers support all transaction types, requiring agent logic to handle payer-specific gaps
- ⚠ Prior authorization APIs are payer-specific and not uniformly available through the clearinghouse
- ⚠ Real-time vs batch processing modes have different latency and error handling patterns that agents must distinguish
Alternatives
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Scores are editorial opinions as of 2026-03-07.