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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
  • Use Test Payers in Sandbox
    • Use Test API Response Types
    • Use the Test Payer Accounts for each Attachments API Response Type
    • TESTEP01 Successful Attachments Transaction
    • TESTEP02 Transaction Accepted by the Clearinghouse
    • TESTEP04 Successful Receipt of Attachment by Payer
    • TESTEP05 Acknowledge Attachment Receipt by Payer
    • TESTEP06 Acceptance of Attachment by Payer
    • TESTEP10 Partial Acceptance of Multiple Attachments
    • TESTPP19 Payer Accepted with Errors
    • TESTEP51 Rejection of Attachments Transaction by the Clearinghouse
    • TESTEP52 Rejection of Attachment by Payer
    • TESTEP53 Rejection of Attachment Due to Request Validation Error
    • TESTPP11 Successful Fax Transmission
    • TESTPP12 Rejected/Failed Fax Transmissions
    • TESTPP13 Successful Fax Transmission
    • TESTPP14 Failures to Fax Transmission
    • TESTPP15 Failed Mail Attachments
    • TESTPP16 Mailed Attachments
    • TESTPP17 Track Information for Sent Transactions
    • TESTPP18 Track Information for Sent Transactions
    • Understand Transaction Details
  • API Health Check
    • API Example
  • Troubleshoot APIs with Metadata
  • JSON-to-EDI API Mapping
  • 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

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
  • API Example Eligibility
    • Request and Response
    • Eligibility API Tips
    • Allowed Time Qualifier Reference
    • Request with Known tradingPartnerServiceId
    • Request_HTML.aspx Endpoint
    • Response for Medicare Patient
    • Co-Insurance
    • Co-Payment
    • Find Deductible and Co-pay in Eligibility Response
    • How to Determine Co-pay without a Card
    • Interpret Service Level Information from Sandbox Response
    • Map X12 to CPT and/or ICD-10 Codes
    • Possible InsuranceTypeCodes
    • Set Up SFTP
    • 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
    • Without Active Coverage (Subscriber) from a Medical Plan
    • 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
  • API Example Professional Claims
    • Request and Response
    • CMS1500/UB04 Claims Forms
    • Test Production Data without Submitting for Processing
    • Test Prof. and Inst. Claims for PatientControlNumber
    • Test Rejected/Denied Claim
    • Render Provider in Loop 2310B
    • 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
  • API Example Institutional Claims
    • 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 Claim Status
    • Request and Response
    • Single 277 Claim Status Response
    • Retrieve Specific Claim Status
    • Manage Adjustment Codes from Payer in Claim Status API
    • 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 Attachments Submission
    • Request and Response from Payer
    • Attach Multiple Files to a Transaction
    • Attachments JSON-to-EDI Map in a Request
    • Check Attachments Submission Status
    • Find a Specific Attachments Transaction
    • JSON Fields versus X12 EDI Loop Associated with a Field in 275 in an Attachments Request
    • Solicited Attachments Transaction
    • Remediate Attachments Transaction Issues
    • Send Fax Numbers to Payer
    • Successful Attachments Transaction Response
    • Solicited Attachments Response to a 277R Transaction
    • Query Specific Attachments Transaction
    • Payer Submissions with unsupported 275 Transactions and that do not accept Faxes
    • Physical Mail Packet to Payer
    • Unsolicited Attachments Transaction
    • Unsolicited Attachments for a 275 Claims Transaction
    • Test Payer Accounts for each Attachments API Response Type
    • Timeline for Validation and Submission Updates
    • Use Fieldset Argument in your Query
    • Use Test Payers in Sandbox
  • Attachments Submission FAQs

MEDICAL NETWORK ATTACHMENTS STATUS V1

  • Attachments Status V1 Getting Started
  • Use TraceId in your Query Path
  • 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
  • API Example Claim Responses and Reports
    • Claim Responses and Reports - Request & Response
    • Associate Claims to ERA
    • Contents of 277 and 835 Reports
    • Convert 277 or 835 Report
    • EDI to JSON Translation
    • 277 and 835 Reports Important Contents
    • Map 835s or 999s
    • Identify which Reports relate to which Patients
    • Know if a Claim is forwarded to Payer
    • Fetch Payer's Claim Number before Receiving ERA
    • Get Adjudication Message after Submitting a Claim
    • Get EOB Files for Payment Received from Payer
    • Get Exact Claim Details of Particular Claim
    • Payer Batch Totals Data File
    • Payer Report Data File
    • ServiceLines Array Record for a Dental Encounter
    • Translate a 277 EDI Claims Responses and Reports File to JSON
    • Translate an 835 EDI Claim Responses and Report File to JSON
    • Test Claims Responses and Reports Functionality in Sandbox
    • Use Convert Report 276, 277, 835
    • Delete Claims Responses and Reports Files from Mailbox
  • Claim Responses and Reports FAQs

DENTAL BENEFITS ADVISOR API

  • Change Log/Release Notes

MEDICAL NETWORK PAYERLIST V1

  • PayerList Getting Started
    • PayerList Filter and Sort
  • API Example PayerList
    • Request and Response
    • Download the PayerList to a CSV File
  • 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

Dental FAQs

Suggest Edits

Where can I find the active RTE supported dental payer list?

Find the currently supported payer list. Please use the IMN Real-Time Eligibility & Claim Status Payer List for the specifically requested information.

Updated 27 days ago


  • Table of Contents
    • Where can I find the active RTE supported dental payer list?
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