Technical Reference Guide

Our Ancillary Benefits Management Diagnostic Testing Pricer API Technical Reference Guide will contain all the essential information the user will need to integrate with an API and serve as a ready reference source should you encounter a problem. Users can also view and download API data dictionary. Note: This guide is intended to be referenced by information technology personnel.

Key Inputs
• The API accepts data elements used to identify the service and applicable pricing methodology, including:
• Test identifier (such as a DEX Z-Code where applicable)
• Date of service
• Fee schedule or pricing methodology
• Provider identifier
• Response

The API returns:
• Allowed price or reimbursement amount based on the applicable pricing data set and pricing rules
• Business Value

The Diagnostic Testing Pricer API helps organizations:
• Automate pricing determinations
• Apply consistent fee schedule and policy logic at a more granular level than CPT or procedure code-based pricing
• Reduce manual pricing review and processing effort on client systems unable to support pricing at a more granular level
• Support scalable integration with health plan and other ABM workflows

Security and Access

The API is secured using OAuth 2.0 authentication and is available through the Optum LINK API Gateway. Access requires appropriate user authentication and a valid subscription to the Diagnostic Testing Pricer service.

Data Use Notice
Certain pricing determinations may utilize proprietary third-party reference data, including DEX Z-Codes. Users are responsible for complying with all applicable licensing, confidentiality, and permitted use requirements associated with such data sources.

Endpoints