Claim Responses and Reports V2 Getting Started
Claim Responses and Reports API
Access all your Professional Claims and Institutional Claims files using our Claim Responses and Reports API.
The Claim Responses and Reports API provides a direct connection to your mailbox where payers will send their final claim responses and reports. Use this API to access your mailbox for all the files containing complete information about claim payments, claim status updates, and other communications regarding revenue cycles and adjudication from the payer.
Reports API offers significant improvements to the developer seeking to implement file-fetching and EDI content conversion capabilities to their users' medical transaction console:
- A fully updated OpenAPI Spec with extensive annotation supporting medical coding and explanation of relationships between JSON attributes and the EDI loops and segment that affect those attributes.
- Rewritten JSON specifications for clarity and understandability.
- Renamed
ServiceDetailsobject toserviceLinesto match our other APIs. - Updates to support a new 'transactions' JSON object for the /835 and /277 endpoints. It lists out each 277 or 835 transaction contained within the report, each with all claims and service lines, when multiple transactions are completed by the payer.
This API is complementary to other Claims APIs, such as Claims Status, Institutional Claims, and Professional Claims. For example, the Claims Status API provides status summaries of a claim; it does not download the actual claim data.
NOTE
You can use this API with your contracted APIs at no additional cost.
We recommend using this API along with your main Claims API to give you the complete basic functionality to manage your professional or institutional claims. Typically, you will need a suite of three Optum APIs to do your most effective Claims work:
- Submit your claims with Professional Claims or Institutional Claims API.
- Efficiently check on outstanding claims status with Claims Status.
- Download your finished Claim files with the Reports v2 API.
NOTE
The finished/downloaded Claim files are not available permanently for retrieval. For more information, please follow the recommended file retrieval workflow, best practices, and retention rules.
413 response scenarios for large amount of data/reports
Our service will return a response with a 413 if the file size is too large for real-time retrieval.
- Your file will be processed offline.
- You can continue to retry for the 413 response file.
Eventually once we have processed your file, it will begin a response stream for the large file. Traditional HTTP clients will handle the stream just fine. - Please allow 5 minutes between each retrying attempt.
NOTE
During the offline processing of large files/reports, because the large amount of data is being chunked during this process, it might take up to five minutes for our service to complete processing the large files/reports. Please be patient and observe the status change from "413 (processing)" to "200 (success)" before retrying.
Streaming and non streaming versus responses to better handle large files from Reports v2
Streaming: large amount of data is being chunked, that is, you will receive one chunk as a response.
EDI 277 and EDI 835 can now stream larger files. Be advised that the file sizes can be large MBs, so handling a stream may be necessary to handle the size of the file. The response headers will show Transfer-Encoding: chunked indicating a response stream. Stream handling occurs automatically on the traditional HTTP clients.
Reporting for Multiple Claims
Our Claim Responses and Reports v2 API supports the combination and reception of multiple Professional or Institutional claims in a single 277 or 835 report.
NOTE
- If you only plan to use a few daily transactions, you can use our ConnectCenter for your Medical Network transaction needs.
It provides most of the features supported by an API console but only allows manual entry for all data needed for a transaction. It contains Payer Lists, the Payer List Enrollments wizard, and other API customer resources.- For providers sending hundreds of daily requests, we recommend using our APIs to be able to automate the submission processes and have a better fit for your business needs.
Related Topics
Updated about 2 months ago