Claim Responses and Reports - Request & Response
The core request does not send a request body, it simply queries for the entire contents of the customer's mailbox.
https://sandbox-apigw.optum.com/medicalnetwork/reports/v2
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 attempting the 'retry' operation.
The API returns a complete listing of all documents available to a customer.
```json
{
"reports": [
"X3000000.XX",
"R5000000.XY",
"R5000000.XX",
"X3000000.AB",
"X3000000.AC",
"X3000000.ZZ",
"R5000000.XZ",
"R5000000.YZ",
"R5000000.WA",
"R5000000.WB",
"R5000000.WC"
],
"meta": {
"applicationMode": "sandbox",
"senderId": "IN_APIP_MN_CHC_TestApp2",
"traceId": "08071b63-0d28-45f5-4702-e9b62a3336cb"
}
}
```
By appending the X3 or R5 filename to the request, the X12 EDI contents of the file shows (the following is an example; your documents will show different information).
https://sandbox-apigw.optum.com/medicalnetwork/reports/v2/R5000000.XZ
X12 EDI Contents Example
Add the 835 suffix to the path, and the API translates the same content to a more-readable JSON.
https://sandbox-apigw.optum.com/medicalnetwork/reports/v2/R5000000.XZ/835
```JSON
{
"transactions": [
{
"detailInfo": [
{
"assignedNumber": "1",
"paymentInfo": [
{
"claimPaymentInfo": {
"claimFilingIndicatorCode": "12",
"claimFrequencyCode": "1",
"claimPaymentAmount": "500",
"claimStatusCode": "1",
"facilityTypeCode": "11",
"patientControlNumber": "5554555444",
"patientResponsibilityAmount": "300",
"payerClaimControlNumber": "94060555410000",
"totalClaimChargeAmount": "800"
},
"claimSupplementInformation":
(...)
```
You specify the Report file in the request URL, including its two-letter extension, along with the correct endpoint type. The endpoint will always be either /277 or /835.
https://sandbox-apigw.optum.com/medicalnetwork/reports/v2/{filename}/277
The file, which is available in the sandbox API implementation, is for a relatively brief single-claim 277 claim status response.
```json
{
"transactions": [
{
"controlNumber": "0001",
"referenceIdentification": "000000001",
"transactionSetCreationDate": "20201201",
"transactionSetCreationTime": "120558",
"payers": [
{
"organizationName": "PREMERA",
"payerIdentification": "430",
"claimStatusTransactions": [
{
"provider": {
"organizationName": "CHC3",
"etin": "000000000"
},
"claimStatusDetails": [
{
"serviceProvider": {
"organizationName": "HAPPY DOCTORS GROUP",
"npi": "1111111111"
},
"patientClaimStatusDetails": [
{
"subscriber": {
"lastName": "DOEONE",
"firstName": "JOHNONE",
"memberId": "0000000000"
},
"claims": [
{
"claimStatus": {
"referencedTransactionTraceNumber": "000000001",
"informationClaimStatuses": [
{
"statusInformationEffectiveDate": "20200613",
"totalClaimChargeAmount": "100",
"claimPaymentAmount": "80",
"adjudicatedFinalizedDate": "20200609",
"remittanceDate": "20200613",
"remittanceTraceNumber": "1111111",
"informationStatuses": [
{
"healthCareClaimStatusCategoryCode": "F1",
"healthCareClaimStatusCategoryCodeValue": "Finalized/Payment-The claim/line has been paid.",
"statusCode": "65",
"statusCodeValue": "Claim/line has been paid."
}
]
}
],
"tradingPartnerClaimNumber": "AAAAAAAAAAA1",
"patientAccountNumber": "00000",
"clearinghouseTraceNumber": "111111111111111",
"claimServiceBeginDate": "20200214",
"claimServiceEndDate": "20200214"
},
"serviceLines": [
{
"service": {
"serviceIdQualifierCode": "HC",
"serviceIdQualifierCodeValue": "Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes",
"procedureCode": "97161",
"procedureModifiers": [
"95"
],
"chargeAmount": "100",
"amountPaid": "80",
"submittedUnits": "1"
},
"serviceClaimStatuses": [
{
"effectiveDate": "20200613",
"serviceStatuses": [
{
"healthCareClaimStatusCategoryCode": "F1",
"healthCareClaimStatusCategoryCodeValue": "Finalized/Payment-The claim/line has been paid.",
"statusCode": "65",
"statusCodeValue": "Claim/line has been paid."
}
]
}
],
"beginServiceLineDate": "20200214",
"endServiceLineDate": "20200214"
}
]
}
]
}
]
}
]
}
]
...
```
The lengthy example is a completed record for a single claim in a multiple-claim report.
You can determine how many claims the current 277 file contains by looking for the following three JSON attributes in a group:
```json
"organizationName": "PREMERA",
"payerIdentification": "430",
"claimStatusTransactions": [
```
Each of these attributes is a complete claims entry in the transactions list.
Updated about 1 month ago