Change Healthcare API
Change Healthcare publishes 70+ REST APIs for eligibility, claims, remittance, attachments, and prior auth through a self-serve developer portal with a sandbox. The JSON is a wrapper over X12 EDI, so EDI semantics leak through, and docs split across Change and Optum portals.
Frequently asked questions
Change Healthcare scores C on the API Report Card. Change Healthcare publishes 70+ REST APIs for eligibility, claims, remittance, attachments, and prior auth through a self-serve developer portal with a sandbox. The JSON is a wrapper over X12 EDI, so EDI semantics leak through, and docs split across Change and Optum portals.
Change Healthcare has an official API, but teams routinely hit its limits: gated access, partial coverage, or paid tiers. Most end up supplementing it with exports or an unofficial API layer like Supergood.
Change Healthcare (now part of Optum) operates the largest US medical claims clearinghouse and a broad revenue-cycle-management suite. It validates and routes electronic claims, eligibility, remittance, prior-authorization and attachment transactions between providers and virtually all US payers.
Healthcare RCM / Clearinghouse, Typically for providers, health systems, payers, and health-tech companies needing payer connectivity and claims processing. Providers and their practice-management/EHR systems submit claims, check eligibility (X12 270/271), receive remittances (835), and manage prior auth and attachments through the clearinghouse; health-tech firms integrate via the API platform.
Largest US claims clearinghouse; processes 15B+ transactions annually representing $1.5T+ in claims, connected to nearly all commercial/Medicare/Medicaid payers. Now Optum's medical network.
Intermediary network, Carries critical claims/eligibility/remittance data, but as a clearinghouse it is a transaction network/intermediary between providers and payers, not the provider's own trapped system-of-record.
Formed via 2017 merger (Emdeon + Change Healthcare); acquired by UnitedHealth/Optum in 2022. Modern API platform (JSON-over-X12, FHIR) actively expanded with self-service developer resources.
X12/EDI semantics still leak through the JSON APIs (steep learning curve). Portal/branding split across Change Healthcare and Optum domains. Full sourced list under Sources below.
Common alternatives include Availity, Waystar, Office Ally, Stedi, Experian Health. Graded alternatives appear under "More from the report card" below.
Grades measure one thing: can a customer's engineering team get their own data out programmatically? We check six things (whether a real API exists, how access is gated, data coverage, auth quality, docs and developer experience, and stability) and roll them into a letter grade. Grades get re-verified, and they only move on evidence.
Yes. Supergood maintains an unofficial Change Healthcare API and MCP server so AI agents and internal tools can read and write Change Healthcare data. See the Change Healthcare integration docs at supergood.ai/docs/change-healthcare-api.