Eligibility & Patient Access

A real-time solution that provides patient profile and benefits insights at the point of service to ensure appropriate care delivery, as well as efficient and accurate reimbursement.

Complete Patient Access

Access real-time eligibility and benefits information for providers to ensure appropriate payments are made and received by all parties.

Effectively manage referrals and prior authorizations to achieve improved patient access, as well as reduced administrative and medical costs.

Increase cost savings for payers and providers by ensuring accurate eligibility benefits information at point of service and efficiently managing member data.

Conduct automated eligibility transactions early in the process to help improve claim accuracy and associated cost savings.

Immediately communicate if a patient is eligible for the service being considered, including referrals and prior authorization needs.

Experience a seamless workflow by having real-time transactions driven from existing technology platforms.

Achieve Total Transparency in Benefits

Provider self service

  • Reduce costs by establishing benefit eligibility at point of service to ensure appropriate care is delivered and reimbursed. Real-time transactions are accessed with either a direct or hosted connection. 
  • Serve your provider networks in the best way possible with the availability of comprehensive member eligibility data. Real-time transactions are driven from existing technology platforms for seamless workflow.

Regulatory compliance

  • Facilitate regulatory compliance by connecting to virtually any system for all payer-to-provider HIPAA-mandated transactions with Change Healthcare’s nationwide network. 
  • Government benefit reporting mandates and facilitates HIPAA and CORE compliance. Our clearinghouse is also ENHAC certified.

Broad connectivity

  • Leverage the broad access of our Intelligent Healthcare Network™, which connects 800,000 physicians with 2,100 payers, to effectively expand your connectivity.

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Additional Resources

Streamline Electronic Claim Transaction Processing

Learn how our Medical Network helps payers optimize claims processing efficiency.

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Reduce Transaction Costs and Enable Faster Payments with Medical EDI Network

Learn how the size and capabilities of our Medical EDI Network can help you optimize your revenue cycle.

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7 Criteria for Clearinghouse Success

Learn how the Change Healthcare clearinghouse helps you achieve maximum efficiency and cost savings.

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Access Hundreds of Payers for Real-Time Eligibility, Benefits Data

Learn how RESTful Eligibility API connects you to 2,100-plus payers via a simple, cost-efficient implementation.

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Get Real-Time Eligibility and Benefits Verifications

Learn how access to real-time eligibility and benefits verification facilitates clean-claims, benefiting both providers and payers.

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