How to Integrate Change Healthcare with Your Health App System

Introduction

Change Healthcare, now a part of Optum, is at the forefront of transforming healthcare cloud solutions and innovative technologies. Their platform facilitates the seamless and secure exchange of clinical and financial data between providers, payers, and patients. By leveraging Change Healthcare integration for health apps, you can streamline essential processes such as claims management, eligibility verification, and clinical document exchange. For healthcare providers, cloud-based Change Healthcare integration for mobile health apps not only boosts operational efficiency but also reduces errors, ultimately leading to better care delivery and enhanced patient experiences.

In this blog, we’ll provide a step-by-step guide to integrating Change Healthcare’s APIs and services into your health app. We’ll cover eligibility checks, claims submissions, clinical document exchange, batch processing, and security best practices. By following this guide, healthcare organizations can ensure seamless interoperability and maximize the value of their health IT systems.

Understanding Change Healthcare’s Key Offerings

The Change Healthcare integration services for health apps allow for real-time access to critical data, improving accuracy in claims and eligibility processing. Change Healthcare integration solutions for health apps make it easier to manage clinical records and enhance the patient experience by integrating seamlessly with various healthcare systems.

Eligibility API (270/271)

The Eligibility API allows real-time verification of a patient’s coverage status. By querying payer systems, your app can confirm insurance eligibility before a visit or procedure. This reduces claim denials and improves workflow efficiency. Health apps benefit from automated eligibility checks, saving staff time and enhancing patient experience.

Claims APIs (837P / 837I)

Change Healthcare’s claims submission APIs enable electronic filing of professional (837P) and institutional (837I) claims. Change Healthcare API integration for health apps can automate claim submission and status tracking. This reduces administrative work and accelerates revenue cycles for providers.

Clinical Document Exchange

Clinical Document Exchange supports sharing of CCD, CCDA, or PDF files between providers and payers. Integrating this functionality ensures that patient records are complete and accessible, facilitating coordinated care. Health apps can upload, retrieve, and manage clinical documents seamlessly.

ConnectCenter for Bulk Claims

ConnectCenter or SFTP-based integration enables batch submission of claims. Large healthcare systems or multi-location practices benefit from this approach to process high-volume claims efficiently. It is particularly suitable when dealing with multiple payers or complex billing cycles.

Step-by-Step Process for Integrating Change Healthcare with Health Apps

1. Initial Setup & Legal Onboarding 

Begin by signing a Business Associate Agreement (BAA) with Change Healthcare to handle PHI securely. Ensure that you are set up with the Change healthcare developer portal, which will guide you through the process of API access and integration. Create user accounts, access the developer portal, and set up sandbox environments. The sandbox allows testing without impacting live data.

2. API Integration (Eligibility, Claims, Claim Status)

Integrate Change Healthcare’s REST APIs using OAuth2 for authentication. Configure endpoint calls and handle JSON responses properly. Implement real-time eligibility checks and claims submissions for your app. Validate responses to ensure accurate data processing.

3. Clinical Document Integration

Use the Clinical Document Collector to integrate CCD, CCDA, and other clinical document formats. Implement clinical document exchange solutions using Change Healthcare integration software to ensure secure and seamless document flow. This ensures that your health app can exchange and process patient records efficiently.

4. SFTP / ConnectCenter Setup for Batch Submissions

Configure SFTP or ConnectCenter for large-scale claims submission. Format X12 files correctly and manage them through the ConnectCenter portal. Batch processing reduces manual intervention and supports high-volume operations.

Integration Architecture & Design Considerations

Integrating Change Healthcare’s services into your health app requires a carefully considered architecture. Depending on the scale and complexity of your organization, the integration pattern you choose will affect the overall efficiency and ease of the implementation. The three most common integration patterns are REST APIs, batch processing, and middleware integration, each suited for different needs.

Choosing the Right Integration Pattern

Decide whether REST APIs, batch processing, or middleware is best. Smaller practices may use direct APIs, while large healthcare providers with hospital management system benefit from middleware like Mirth or MuleSoft. Integration patterns should match operational scale.

Handling High-Volume Data & Latency Requirements

Use direct REST APIs for real-time queries and batch processing for high-volume claims. Design workflows to handle large datasets efficiently without compromising performance.

Middleware for Enterprise-Level Integrations

Integration engines help normalize data across multiple EHR/EMR systems. They simplify complex setups, support multi-EHR integration environments, and streamline data flow.

Testing, Validation, and Certification

When integrating Change Healthcare’s services, thorough testing is essential to ensure everything functions as expected in a live environment. Testing should be conducted in stages, starting with a sandbox environment, followed by clearinghouse testing and, if applicable, clinical document certification.

Sandbox Environment

A sandbox environment is crucial for testing your integration before moving to production. It allows you to simulate real-world scenarios, such as patient eligibility checks or claims submissions, without affecting live systems. Test all API integrations in the sandbox before production. Simulate real-world scenarios, such as eligibility checks and claim submissions, to validate functionality.

Clearinghouse Testing for Claims

For claims submissions, clearinghouse testing is an important step. Change Healthcare’s ConnectCenter can facilitate testing through the clearinghouse, where you can submit sample claims and monitor their progress through the claims cycle. Testing ensures that claims are properly formatted, validated, and accepted by the payer. By analyzing the 999 and 277CA acknowledgment responses, you can quickly identify and resolve any issues before going live.

Clinical Document Certification

When integrating clinical document exchange functionality (such as CCD or CCDA), it’s necessary to ensure that your app is certified to handle these documents in compliance with healthcare standards. Certification ensures that the documents exchanged between systems meet the required standards for patient data exchange, supporting interoperability between healthcare systems and improving patient care coordination.

Security, Compliance & Regulatory Considerations

HIPAA Compliance & BAAs

Always ensure HIPAA compliance when exchanging PHI. BAAs with Change Healthcare are essential to protect patient data.

Data Protection & Encryption

Use OAuth2, HTTPS, and AES-256 encryption for secure data transmission. Protect both stored and transmitted data.

Authentication & Authorization

Implement secure access using OAuth2 tokens. Regularly manage and rotate tokens for continued security.

Contingency Planning & Vendor Risk

Plan for outages or incidents, such as ransomware attacks. Ensure business continuity and maintain vendor risk assessments.

Common Pitfalls in Integration & How to Avoid Them

Sandbox vs. Production Differences

When transitioning from a sandbox to a live environment, unexpected errors can arise due to differences in data validation, payer-specific requirements, or system configurations. Ensure that all system variables are tested thoroughly, and be prepared to tweak configurations during the transition.

Dealing with Payer-Specific Companion Guides

Each payer may have unique validation rules for claims submission, often outlined in a companion guide. These guides contain specific rules for claim formats, codes, and billing practices that must be followed to avoid claim denials. Make sure your integration process accounts for these differences by thoroughly reviewing and implementing the necessary payer-specific requirements.

Error Handling & Reconciliation

Effective error handling is crucial for ensuring that claims are successfully processed and paid. Track errors using 999/277CA acknowledgment reports, and reconcile them using 835 remittance data. Establish a process for tracking rejections, correcting issues, and resubmitting claims to ensure smooth financial operations.

Best Practices for Ongoing Maintenance and Monitoring

Error Logging & Exception Handling

Set up automated error logging, alerts, and dashboards to monitor claims processing. This will allow your team to quickly identify issues, resolve them in real time, and prevent bottlenecks in the system. Ongoing monitoring is essential for maintaining an effective integration.

Daily Reconciliation

Perform daily reconciliation of claims and payments, comparing accepted claims with rejections. Use 835 data to track payment statuses and ensure that rejected claims are reviewed and resubmitted promptly.

Optimization for Performance

Continuously monitor and optimize the performance of your integration. This includes reducing latency, improving throughput, and scaling for higher volumes of claims and eligibility checks. Performance optimization ensures that your integration can handle increasing workloads as your organization grows.

End Thoughts 

Integrating Change Healthcare with your health app system streamlines claims processing, eligibility verification, and clinical document exchange. Start with legal onboarding, implement APIs, test thoroughly, and ensure security compliance. Monitor, reconcile, and optimize continuously for peak performance.

Healthcare providers can leverage the Optum Developer Portal and Change Healthcare integration support for hospitals to get started. By following these steps, your health app can achieve seamless interoperability, faster operations, and better patient care outcomes.