specification: FinOps Framework
specificationVersion: '1.0'
schema: https://www.finops.org/framework/
provider: Change Healthcare
providerId: change-healthcare
created: '2026-05-04'
# Provenance stamped 2026-08-11: this artifact was written by the API Evangelist
# bulk sweep dated 2026-05-04, not harvested from the provider. See roadmap#35.
method: generated
modified: '2026-05-05'
reconciled: false
tags:
  - FinOps
  - FOCUS
  - Healthcare
  - EDI
description: 'FOCUS-aligned FinOps framing for Change Healthcare (Optum): per-transaction EDI/clearinghouse
  fees plus contracted clinical interoperability subscriptions.'
notes: Pricing is contract-based per-transaction; meters reflect typical EDI billing lines.
sources:
  - https://www.changehealthcare.com
  - https://www.optum.com/
alignedWith:
  framework: FinOps Foundation Framework
  frameworkUrl: https://www.finops.org/framework/
  dataSpec: FOCUS
  dataSpecVersion: '1.3'
  dataSpecUrl: https://focus.finops.org/focus-specification/v1-3/
publisherName: Optum, Inc. (UnitedHealth Group)
serviceCategory: Healthcare / Data Exchange
billingModel:
  pricingCategory: Per-Transaction + Subscription (Contract)
  billingFrequency: Monthly
  billingCurrency: USD
  chargeCategories:
    - Usage
    - Purchase
    - Tax
    - Adjustment
    - Credit
focusColumns:
  ServiceName: Change Healthcare
  ServiceCategory: Healthcare Data Exchange
  ProviderName: Change Healthcare
  PublisherName: Optum, Inc.
  InvoiceIssuerName: Optum, Inc.
  BillingCurrency: USD
meters:
  - name: eligibility_transactions
    unit: transaction
    aggregation: sum
    dimensions:
      - payer
      - tradingPartner
  - name: claim_status_transactions
    unit: transaction
    aggregation: sum
    dimensions:
      - payer
  - name: claims_submitted
    unit: claim
    aggregation: sum
    dimensions:
      - payer
      - claimType
  - name: era_remittances
    unit: remittance
    aggregation: sum
  - name: prior_auth_transactions
    unit: transaction
    aggregation: sum
  - name: clinical_api_subscription
    unit: month
    aggregation: sum
principles:
  - name: Visibility
    description: Use Change Healthcare reporting and EDI 999/277 acknowledgements to track transaction
      volume; reconcile monthly invoices against transaction counts.
  - name: Allocation
    description: Allocate by payer, line of business, and trading partner using EDI metadata.
  - name: Optimization
    description: Reduce duplicate eligibility checks via caching, batch claims where supported, and audit
      rejection rates to lower retransmissions.
  - name: Accountability
    description: Revenue cycle / clearinghouse manager owns Change Healthcare invoices; review monthly
      against payer mix and rejection trends.
maintainers:
  - FN: Kin Lane
    email: kin@apievangelist.com