Change Healthcare (Optum) API

Overview

Change Healthcare is one of the largest healthcare clearinghouses and technology companies in the United States, processing billions of clinical and financial transactions annually between providers, payers, and pharmacy networks. The company is now operating under Optum following its acquisition by UnitedHealth Group, and its network spans claims submission, eligibility verification, prior authorization, and remittance advice across the commercial insurance, Medicare, Medicaid, and pharmacy benefit markets. The scale of Change Healthcare's transaction volume means that a health system or mid-to-large physician group is almost certainly routing some portion of its claims through the Change Healthcare network, making it a required integration for many RCM and billing automation products.

The February 2024 cyberattack changed the access picture materially. The incident, widely described as the largest healthcare data breach in US history, disrupted claims processing for weeks across thousands of provider organizations and exposed the risks of concentrated dependency on a single clearinghouse. In the aftermath, Change Healthcare tightened its partner access requirements: API access now requires a formal partner agreement plus an elevated security review that goes beyond the standard enrollment. Development teams that previously relied on less formal integration paths or were mid-enrollment when the breach occurred now face a more involved process to receive production credentials. There is no self-serve developer path.

Many health systems responded to the outage by actively seeking backup integration paths. Legal and compliance teams at provider organizations are now evaluating whether concentrating all clearinghouse transactions through a single partner agreement represents an acceptable operational risk. For healthtech companies building RCM, eligibility, or remittance tools, this environment creates both urgency around the Change Healthcare integration and demand from health system customers for alternatives they can fall back on.

Integuru generates a production-ready HTTP API for Change Healthcare using direct HTTP requests against the same endpoints the Change Healthcare web application uses internally. Claims submission, eligibility verification, prior authorization tracking, and remittance data are all reachable through Integuru's API without a formal partner agreement and security review gating the build. The Production plan's 24/7 on-call maintenance team handles session management, re-authentication, and endpoint changes. Integuru can be deployed in HIPAA-compliant environments; discuss your compliance requirements when you chat with us.

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Why Teams Need This Integration

Change Healthcare's clearinghouse volume and its concentration in the hospital and health system market make it a non-optional integration for most RCM-adjacent products. The post-breach partner program and the backup-path demand from health system customers make the case for building through Integuru even stronger than it was before 2024.

RCM platforms and billing automation tools for hospitals. Hospital billing teams and revenue cycle automation products that process claims through Change Healthcare need programmatic access to submit_claim, get_claim_status, and list_claims across high encounter volumes. For a billing platform serving multiple health systems, the partner security review is a per-organization dependency that serializes the integration rollout. Integuru's per-account authentication model handles multiple health system instances without a separate partner review for each one.

Backup clearinghouse integration for health system compliance requirements. Following the February 2024 breach, legal and compliance teams at health systems are actively addressing the risk of single-clearinghouse concentration. A health system whose primary clearinghouse relationship runs through Change Healthcare needs a backup path that can be activated if the primary channel experiences another disruption. Integuru provides that path: claims, eligibility, and remittance actions that function as a live API without depending on the same partner agreement channel as the primary integration.

Eligibility verification and real-time coverage tools. check_eligibility and get_eligibility_response surface real-time eligibility data from payers on the Change Healthcare network, returning coverage details, deductible balances, and copay amounts for patient access tools, scheduling platforms, and front-desk automation products. The breach-related outage in 2024 disrupted eligibility verification at thousands of provider locations, creating visible demand for alternative eligibility paths alongside the primary clearinghouse relationship.

Remittance reconciliation and payment analytics. get_remittance_advice and list_payments retrieve remittance data from payers transacting through Change Healthcare, including payment amounts, adjustment codes, and denial reasons. Revenue cycle analytics platforms that need to reconcile payments across clearinghouses require Change Healthcare remittance data to close the revenue loop for health system customers.

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RCM Workflows This Integration Covers

The ten planned actions span the core revenue cycle workflows that Change Healthcare manages between providers and payers:

• Claims management: submit_claim sends professional and institutional claims through Change Healthcare's clearinghouse to the designated payer. get_claim_status retrieves adjudication status and rejection codes. list_claims returns paginated claim records filtered by date, payer, provider, and status.
• Eligibility verification: check_eligibility submits a real-time inquiry for a patient against a specified payer. get_eligibility_response returns coverage details, deductible balances, copay amounts, and in-network status for the patient's active plan.
• Prior authorization: submit_prior_auth initiates a PA request through Change Healthcare's network for a procedure or service. get_prior_auth_status returns the authorization decision including approval, denial reason, and payer reference number.
• Remittance and payments: get_remittance_advice retrieves remittance batches with payment amounts, adjustment codes, and denial reasons. list_payments surfaces electronic remittance payments with deposit dates and totals.
• Patient financial data: get_patient_balance retrieves the outstanding patient responsibility after payer adjudication and remittance posting.

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Adjacent Integrations

Integuru already covers several of the EHR platforms whose health system and physician group customers route claims through Change Healthcare. The athenahealth integration guide addresses the MDP partner program barrier for one of the most common EHR platforms connected to Change Healthcare's clearinghouse, with eleven planned actions spanning patient records, clinical notes, and billing data. The Kareo integration guide addresses the billing and clinical workflow gap for independent practices on Tebra. The Modmed integration is the most complete EHR integration on Integuru today, with 21 live actions spanning claims, payments, insurance policies, and full patient management.