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OPTUM API DEVELOPER PORTAL
Quick Start
Readme
Get Started with Optum APIs
API Onboarding
Security and Authorization V2
API Request Header
Generate an API Token
API Example
API Environments
Create a Sandbox Account
Access Sandbox Examples
Access our APIs
API URLs
Use the Try It Interface
HTTP Response Codes
Sandbox Predefined Fields and Values
Sandbox API Values and Test Responses
Using Test Payers in the Sandbox
API Health Check
API Example
Troubleshoot APIs with Metadata
Metadata Search Feature
Metadata Search Request & Response
Glossary
Quick Reference
API RELEASE NOTES
API Release Notes
API WORKFLOW
Attachments Workflow and Best Practice
Claims API Best Practices and Workflow
Claims Submission Workflow
Claims Rejected or Denied Workflow
Claim Processing and Reporting Workflow
Eligibility API Best Practices and Workflow
OPTUM API IMPLEMENTATION
Generate a Client SDK
ERROR MESSAGES
Overview
AAA Error Codes Requests and Possible Resolutions
Attachments Submission Error Messages
DNS Error
Eligibility Error Messages
Eligibility API: Unable to Process the Request at this Time
Error X-CHC-MN-Attachments-Payer Field is Mandatory
406 Error when running Auth Token Example
HTTP Error Response Codes
If Search Does not Show a Specific Record
Institutional Claims Error Messages
Invalid Access Token Error in Sandbox
79 (Invalid Participant Identification) Error
NPI Error
Other Payer Primary ID is Missing or Invalid
Patient Account Number Validation Error
Patient Eligibility not Found with Entity
Professional Claims Error Messages
Validation Endpoint Issue
Without Active Coverage (Subscriber) from a Medical Plan
API Examples
Overview
Associate Claims to ERA
Attachments Submission Error Messages
Query Specific Attachments Transaction
Attachments JSON-to-EDI Map in a Request
Check Attachments Submission Status
Claim Responses and Reports - Request & Response
Claim Responses and Reports (ERA) Production Endpoints
CMS1500/UB04 Claims Forms
Co-Insurance
Co-Payment
Contents of 277 and 835 Reports
Convert 277 or 835 Report
Important Contents of the 277 and 835 Reports
Delete Claims Responses and Reports Files from Mailbox
EDI to JSON Translation
Fetch Payer's Claim Number before Receiving ERA
Find Deductible and Co-pay in Eligibility Response
Find a Specific Attachments Transaction
Find a Submitted Request in ConnectCenter
Get Adjudication Message after Submitting a Claim
Get EOB Files for Payment Received from Payer
Get Exact Claim Details of Particular Claim
How to Determine Co-pay without a Card
Payer Submissions with unsupported 275 Transactions and that do not accept Faxes
Identify which Reports relate to which Patients
Interpret Service Level Information from Sandbox Response
JSON-to-EDI API Mapping
JSON Fields versus X12 EDI Loop Associated with a Field in 275 in an Attachments Request
Know if a Claim is forwarded to Payer
Manage Adjustment Codes from Payer in Claim Status API
Map X12 to CPT and/or ICD-10 Codes
Map 835s or 999s
Payer Batch Totals Data File
Download the PayerList to a CSV File
PayerList Request and Response
Payer Report Data File
Physical Mail Packet to Payer
Possible InsuranceTypeCodes
Remediate Attachments Transaction Issues
Render Provider in Loop 2310B
Search for a Specific File in Claims Responses and Reports V2
Send Fax Numbers to Payer
ServiceLines Array Record for a Dental Encounter
Set Up SFTP
Solicited Attachments Transaction
Solicited Attachments Response to a 277R Transaction
Successful Attachments Transaction Response
Test Claims Responses and Reports Functionality in Sandbox
Test Payer Accounts for each Attachments API Response Type
Timeline for Validation and Submission Updates
Translate a 277 EDI Claims Responses and Reports File to JSON
Translate an 835 EDI Claim Responses and Report File to JSON
Unsolicited Attachments Transaction
Unsolicited Attachments for a 275 Claim Transaction
Use Convert Report 276, 277, 835
Use Fieldset Argument in your Query
Use Test Payers in Sandbox
Use Test API Response Types
Use the Test Payer Accounts for each Attachments API Response Type
Successful Attachments Transaction
Transaction Received by the Clearinghouse
Transaction Accepted by the Clearinghouse
Successful Receipt of Attachment by Payer
Acknowledge Attachment Receipt by Payer
Acceptance of Attachment by Payer
Partial Acceptance of Multiple Attachments
Payer Accepted with Errors
Rejection of Attachments Transaction by the Clearinghouse
Rejection of Attachment by Payer
Rejection of Attachment Due to Request Validation Error
Successful Fax Transmission
Rejected/Failed Fax Transmissions
Successful Fax Transmission
Failures to Fax Transmission
Failed Mail Attachments
Mailed Attachments
Track Information for Sent Transactions
Understanding Transaction Details
Use TraceId in your Query Path
FREQUENTLY ASKED QUESTIONS
FAQs
API Troubleshooting Tips
Security and Authorization FAQs
Batch File Formats Supported
ConnectCenter FAQs
File Types Supported
Process after completing Providers' EDI Enrollment
Sandbox FAQs
What is a tradingPartnerServiceId?
MEDICAL NETWORK ELIGIBILITY V3
Eligibility V3 Getting Started
Request Body Parameters
Use “Bare Minimum” Eligibility Requests
Response Body Contents
Required Fields in ISA06 and ISA08
X12 EDI 270 Request & 271 Response
Benefits Information Codes
Rejections with Known Good File
Eligibility JSON-to-EDI API Contents
Eligibility API Example
Request and Response
Eligibility API Tips
Allowed Time Qualifier Reference
Request with Known tradingPartnerServiceId
Request_HTML.aspx Endpoint
Response for Medicare Patient
Subscriber without an Active Medical Coverage
Search Options to Optimize Queries
Search an Eligibility Request by Transaction ID
Use ServiceType Codes to Identify Business Group
When to use Dependent Object
Eligibility FAQs
MEDICAL NETWORK PROFESSIONAL CLAIMS V3
Professional Claims V3 Getting Started
Use the Professional Claims V3 API
Request Body Parameters
Response Contents - Professional Claims
Professional Claims JSON-to-EDI Contents
Professional Claims API Example
Test Production Data without Submitting for Processing
Test Prof. and Inst. Claims for PatientControlNumber
Test Rejected/Denied Claim
Resubmit a Denied Claim
Test different Professional Claims Validation and Submission Responses
Professional Claims FAQs
MEDICAL NETWORK INSTITUTIONAL CLAIMS V1
Institutional Claims V1 Getting Started
Request and Response Body
Institutional Claims API JSON-to-EDI Contents
Institutional Claims API Example
Request and Response
Create an EDI 837p 5010 Claim for a Client-Primary and Secondary Insurances
ClaimReference Field in Submission Response
Corrected Claim in Appeals and Denials
Handle multiple authorization numbers per claim
Send an EOB from the Primary Payer with the Claim
RAW-12 Validation Requests & Responses
Test Production Data without Submitting for Processing
Test Claims in Sandbox
Test Prof. and Inst. Claims for PatientControlNumber in Sandbox
Test Rejected/Denied Claim
Use Conditional Codes in Institutional Claims
Use Claim Filing Indicator Code
Submit Claim with Remarks
Institutional Claims FAQs
MEDICAL NETWORK CLAIM STATUS V2
Claim Status V2 API Getting Started
Request Body Parameters
Response Contents
Claim Status API JSON-to-EDI Contents
API Example
API Example
Single 277 Claim Status Response
Retrieve Specific Claim Status
Use STC Codes
Claim Status FAQs
MEDICAL NETWORK ATTACHMENTS RETRIEVAL V1
Attachments Retrieval V1 Getting Started
Attachments Retrieval JSON-to-EDI API Contents
Attachments Retrieval FAQs
MEDICAL NETWORK ATTACHMENTS SUBMISSION V1 API
Attachments Submission V1 Getting Started
Standard Attachment Transaction StatusCode Responses
Associating Attachment Submissions to a Claim
Attachment Submission API Use Cases and Results
Attachment Submissions API JSON-to-EDI Contents
Optum Batch Attachment Electronic Interchange Companion Guide
API Example
Request and Response from Payer
Attach Multiple Files to a Transaction
Attachments Submission FAQs
MEDICAL NETWORK ATTACHMENTS STATUS V1
Attachments Status V1 Getting Started
Attachments Status FAQs
MEDICAL NETWORK CLAIM RESPONSES AND REPORTS (ERA) API
Claim Responses and Reports V2 Getting Started
Available Claim Responses and Reports V2
SD and SF Reports Mapping
Claim File Retrieval and Retention Best Practices
Claim Responses and Reports FAQs
DENTAL BENEFITS ADVISOR API
Change Log/Release Notes
MEDICAL NETWORK PAYERLIST V1
PayerList Getting Started
PayerList Filter and Sort
PayerList FAQs
Enhanced eligibility api v1
Onboarding
Getting Started
Change Log/Release Notes
Frequently Asked Questions
Troubleshooting and Support
Value-Added Features
Customer Callback Example API
PRIOR AUTHORIZATION API V1
Prior Authorization V1 Getting Started
Onboarding with Prior Authorization API
Inquiry Prior Authorization
Inquiry Request Body
Inquiry Response Body
Inquiry JSON-to-EDI API Contents
Inquiry Sandbox Test Responses
Production Inquiry Sandbox Test Responses
Submission Prior Authorization
Submission Request Body
Submission Response Body
Submission JSON-to-EDI API Contents
Submission Sandbox Test Responses
Prior Authorization API FAQs
Prior Authorization Release Notes
MEDICAL NETWORK DENTAL ATTACHMENTS API
Dental Attachments Getting Started
Request Body Content
Response Body Content
Dental FAQs
API Example
Suggest Edits
Request and Response from Payer
Updated 1 day ago
