Claim Status V2 API Getting Started
Track down your submitted medical claims with our Claim Status API!
Claim Status v2 API
Medical claims are bills that healthcare providers submit to the patient's insurance provider. Claim billings contain specialized insurance codes that describe the care a patient receives from the provider. Our APIs help automate and manage the process of submitting and monitoring the status of submitted claims. The Claim Status v2 API verifies the current status of any claim you submit to insurance payers that are supported by our payer lists.
The Claim Status API translates the standard X12 EDI 276 transaction (see example, Claim Status X12 EDI 276 Request & 277 Response to the more-readable Javascript Object Notation (JSON), so it is more accessible to developers and more easily integrated into users’ applications. Our API also translates the 277 Claim Status Response body from its originating EDI to the more-understandable JSON.
The submitter uses a Claim Status request to ask 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).
The main task of the Claim Status API is to check the status of a claim in the payer’s system. When the claim adjudication is complete, the response provides the result of the claim (for example, Paid, or Denied). For denied or rejected outcomes, the response includes the reasons for the denial.
If a provider has not received a payer report on a claim, or if they have not received payment, they run a claim status request to find out the most recent status of that claim. You may also need to check your Optum (formerly, Change Healthcare) mailbox on a regular basis. The Claim Status API does not do this.
If you want a tool for managing Claims reports, see our Claims Responses and Reports V1 API /claimstatus/v2/.
NOTE
Claim Responses and Reports is a complementary API to Claim Status that performs an associated, but a different task. It is a fetching tool for claims information from your mailbox. The Claim Status API gives you the current status of your claim but does not download the contents of your payer's claim report. For more information, see Claims Responses and Reports.
NOTE
The JSON attributes in our APIs use snake-case, with the first letter of the attribute in lower case as in
tradingPartnerServiceId. Our APIs are case-sensitive and your JSON request body must observe this convention.
Endpoints components
The Claim Status v2 endpoints consist of the following:
| Task | Endpoint |
|---|---|
| Request Method | POST |
| Bearer Token | /apip/auth/v2/token |
| API endpoint | claimstatus/v2/ |
| Raw-X12 endpoint | claimstatus/v2/raw-x12 |
| API Healthcheck | /claimstatus/v2/healthcheck |
| Operation Mode | Real-time, one request |
| Consumes | Application/json |
| Produces | Application/json |
API components
See API components.
Sandbox endpoint
Production endpoint
BEARER TOKEN LIFESPAN
The lifespan of a Bearer token is one hour (3600 seconds) for both sandbox and production environments.
We recommend automating transactions to use the tokens generated over the token lifespan. Obtaining tokens for each transaction is less efficient and does not improve the security criteria for any transactions.
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 Optum’s 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 4 months ago