Primary Flow APIs

Details of the APIs that facilitate the claims exchange flow

CoverageEligibility

  • Eligibility check

  • /coverageeligibility/check (provider->HCX, HCX->payor)

  • /coverageeligibility/on_check (payor->HCX, HCX->provider)

Claims

  • PreDetermination submission

  • /predetermination/submit (provider->HCX, HCX->payor)

  • /predetermintation/on_submit (payor->HCX, HCX->provider)

  • PreAuth submission

  • /preauth/submit (provider->HCX, HCX->payor)

  • /preauth/on_submit (payor->HCX, HCX->provider)

  • Claim submission

  • /claim/submit (provider->HCX, HCX->payor)

  • /claim/on_submit (payor->HCX, HCX->provider)

Payments

  • Payment notice and acknowledgement

  • /paymentnotice/request (payor>HCX, HCX->provider-)

  • /paymentnotice/on_request (provider->HCX, HCX->payor)

Following OpenAPI 3.0 specification details these APIs in detail. These API specs can be opened in swagger editor via this link.

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