Directory › Optum (Change Healthcare)
Optum (Change Healthcare): pricing signals, access, and small-practice fit
Change Healthcare — historically ~1/3 of US medical claims — is now operated by Optum (UnitedHealth Group). Real REST/JSON + native X12 APIs over the Intelligent Healthcare Network (2,200+ payers) with a free sandbox, but production is sales-gated and price-opaque. The Feb 2024 ransomware outage made this the canonical single-clearinghouse concentration-risk example.
Visit Optum (Change Healthcare) →API docs
What it does
270/271 Eligibility & benefits837 Claim submission835 ERA / remittance276/277 Claim status278 Prior authorization
- 270/271 Eligibility & benefits — Real-time check of whether a patient's coverage is active and what it covers (X12 270 request / 271 response).
- 837 Claim submission — Submit professional/institutional/dental claims to payers (X12 837P/837I/837D).
- 835 ERA / remittance — Electronic remittance advice — how the payer adjudicated a claim and what it paid (X12 835).
- 276/277 Claim status — Ask a payer the status of a submitted claim (X12 276 request / 277 response).
- 278 Prior authorization — Request/inquire on prior authorization for a service (X12 278).
Real-time: yes · Batch: yes
Known pricing signals
| Item | What's public |
|---|---|
| sandbox | published Free sandbox (no contract, no financial obligation), but provisioned via a rep — not instant Source: developer.optum.com / marketplace.optum.com sandbox · verified 2026-06-22 |
| Per claim | reported / estimate ~$0.25–$0.50 per claim at mid-volume Forum/RCM-blog estimate, NOT official. Marketplace gates real pricing behind login/quote. Source: RCM blog estimates (medsolercm.com, oneosevenrcm.com) · verified 2026-06-22 |
| production | no public price Production pricing is login/quote-gated; no official rate card found. No public source — vendor quotes per account. |
Access requirements
Free sandbox via a rep; production is sales-gated (contracts, data-use agreements, payer enrollment, implementation analyst). ERA/EFT enrollment typically effective in ~10 business days (third-party).
Best-for-small-practice
Enterprise-gated. Third-party guides steer solo/small practices to Office Ally or Claim.MD instead. Small practices usually reach Optum indirectly via a PM/EHR vendor.
Reliability flag: the Feb 2024 ALPHV/BlackCat ransomware attack took systems offline for weeks (~190M people affected, confirmed Jan 2025; ~$2.45B total cost). Cite as concentration-risk context.
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Find the right one →Independent transparency directory. Pricing and access details are compiled from public vendor pages and practitioner reports and are dated and confidence-tagged — published = vendor's own public page, reported = third-party/forum estimate, no public price = none found. We do not invent numbers. Last verified 2026-06-22. Not affiliated with any vendor; verify current terms directly before contracting. Some outbound links may be referral links.