API URLs and Endpoints

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NOTE

Medical Network APIs v1, v2, and v3 (as of 09-02-2021) are deployed to an enhanced cloud-native network connection, which offers improved API speed and reliability. We recommend updating your systems to the following API endpoint URLs at the first opportunity.

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Deprecated

The Accept application/vnd.changehealthcare.medicaleligibility-v2+json header mentioned in v2 need not be sent or incremented; versioning will be managed through the URL path.

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Alert

Do not use the https://apis.changehealthcare.com as it is an old domain and no longer supported.

URL

Sandbox

sandbox-apigw.optum.com/medicalnetwork/

Production

apigw.optum.com/medicalnetwork/

Endpoints

Security and Authorization

We use OAuth2 to create a secure connection with our API users, which requires a bearer authorization token to obtain access. For more information, see Security and Authorization v2.

• Endpoint — apip/auth/v2/token — To request for a bearer token that can be used to access our APIs on the platform.

Healthcheck

The /healthcheck endpoint checks the operating status of the required API. It is a ping for the API entry points to ensure the entry points are accessible. It is the first thing you can do if something goes wrong.

Eligibility

• eligibility/v3 — This endpoint checks if a patient has healthcare coverage with a specific insurance company (payer).
• eligibility/v3/raw-x12 — This endpoint uses the standard X12 EDI 270 Eligibility transaction, and formats it in JSON for an HTTP request. Accepts JSON with a single-string 'x12' property that has a 270 EDI string and produces a JSON response with a single 'x12' property that has a 271 EDI string.

Professional Claims

• professionalclaims/v3/validation — This endpoint checks and validates your upcoming claim submission before sending your claims to the payer.
• professionalclaims/v3/submission — This endpoint to submit your professional claim transaction to the payer.

Integrated Rules Professional

• professionalclaims/advanced/v1/validation/ — This endpoint checks and validates your upcoming submission. It is an enabling tool for making complex provider claims more accurate, and more likely to be accepted and adjudicated by the payer.
• professionalclaims/advanced/v1/raw-x12-validation — Translate back-and-forth between JSON and X12 EDI when the information departs into and returns from the medical network. All fields and JSON objects conform to the EDI 837i transaction standard.

Integrated Rules Institutional

• institutionalclaims/advanced/v1/validation — This endpoint performs advanced rules-based checking and validation of Professional claims based upon the X12 EDI 837i standard. It uses compilations of medical business specialties, called Knowledge Packs, for fine-tuned claim inspection. It does not submit your claim to the payer, and is designed to be complementary to the Professional Claim's /validation endpoint.
• institutionalclaims/advanced/v1/raw-x12-validation/ — Translate back-and-forth between JSON and X12 EDI when the information departs into and returns from the medical network. All fields and JSON objects conform to the EDI 837i transaction standard.

Institutional Claims

• institutionalclaims/v1/validation — This endpoint, prior to submitting an institutional claim, allows the submitter to run claims through extensive repositories of rules and logic to correct potential errors before sending to the payer.
• institutionalclaims/v1/raw-x12-validation — This endpoint translates the standard X12 EDI 837i transactions to JSON format so that it is more accessible to claim readers and developers.
• institutionalclaims/v1/submission — This endpoint submits a validated institutional claim to the payer.
• institutionalclaims/v1/raw-x12-submission — This endpoint translates back-and-forth between JSON and X12 EDI when the information departs into and returns from the medical network. All fields and JSON objects conform to the EDI 837i transaction standard.

Claims Responses and Reports

• reports/v2/ — This endpoint lists the reports.
• reports/v2/{filename} — Depending on the action performed, GET or DELETE, this endpoint retrieves or deletes a single file containing complete information about claim payments, claim status updates, and other communications regarding revenue cycles and adjudication from the payer.
• reports/v2/{filename}/277 and reports/v2/{filename}/835 — This endpoint converts the specific report ID to 277/835 EDI. If /277 is specified in the request URL with its two-letter extension and the correct endpoint type, converts the EDI reports to JSON, that is, responses to EDI 276 Claim Status inquiries. If /835 is specified in the request URL with its two-letter extension and the correct endpoint type, provides detailed payment information for submitted Professional or Institutional claims.

Claim Status

• claimstatus/v2/ — Retrieves the status of a previously submitted claim.
• claimstatus/v2/raw-x12 — The submitter uses a Claim Status request to inquire about the status of a previously submitted claim. The payer returns the response, as an X12 EDI 277 transaction, which is translated back to JSON by the API gateway. It describes where the claim is in the adjudication process (for example, Pending or Finalized).

Attachment Status

• attachments/status/v1/{traceId} — This endpoint retrieves the attachment status summary based on the traceId (the ID returned to submitters or payers when they submit the claim attachment. A traceId can also be retrieved by calling the metadata endpoint).
• attachments/status/v1/metadata — This endpoint searches for, and retrieves the status of attachments submitted by submitter or payer.

Attachments Submission

• submission/v1/uploads — This endpoint allows clients to submit attachments and query their status.

Attachments Retrieval

• attachments/retrieval/v1/search — Search to retrieve a set of document IDs based on upload date range, attachment control number, patient first name, last name, member ID, provider id, provider first name, organization name, claim service start date and claim service end date. By default, testMode is set to false to retrieve the production data. To retrieve the test data, pass the query string as testMode=true. 
• attachments/retrieval/v1/{documentId} — This endpoint lets you download specific attachment documents for payers.

Dental Network Enhanced Eligibility

• dentalnetwork/eligibility/v1/enroll — Enroll Provider for Enhanced Eligibility Estimation of patient eligibility and coverage.
• dentalnetwork/eligibility/v1/benefitestimation — Estimation of patient eligibility and coverage.

Dental Attachment

• /apip/auth/v2/token — Generates bearer token.
• /dentalnetwork/attachments/v1/CreateAttachment — Creates an attachment container that can contain a claim with its attachments. Whenever a claim is submitted with attachment(s), the container creates an Optum Attachment ID.
• /dentalnetwork/attachments/v1/AddAttachment/ — Uploads an attachment file to an existing attachment container with its Optum Attachment ID.
• /dentalnetwork/attachments/v1//UpdateAttachmentFile/ — Update attachment to container: Modifies/updates the attachment file information, such as ImageDate, DocumentTypeCode, Narrative, or OrientationType.
• /dentalnetwork/attachments/v1/GetAllParticipatingPayers — Optum maintains a list of payers that participate in the attachments solutions. This endpoint gets all of the participating payers.
• /dentalnetwork/attachments/v1/IsParticipatingPayer?payerid= — Check participating payer by payer ID: Optum maintains a list of payers that participate in the attachments solutions. This endpoint gets participating payer by Payer.
• /dentalnetwork/attachments/v1/GetPayerBusinessRules?payerid=&procedurecodes=D4241 — Optum stores each payer’s rules for the procedure codes that require an attachment. If an attachment rule exists, it will be returned along with any details related to the attachment requirement.
• /dentalnetwork/attachments/v1/GetAttachmentbyId/ — Gets the attachment container created by the /attachments/v1/CreateAttachment endpoint.
• /dentalnetwork/attachments/v1/GetAttachmentList/ — Gets all the attachment files from the container.
• /dentalnetwork/attachments/v1//DeleteAttachmentFile/ — Submitter can delete files from the attachment container.