Determination Prior Authorization

Overview

The Prior Authorization Determination Service API will accept Prior Authorization Determination requests in the form of EDI-X12 278x215 or JSON payloads and return both EDI-X12 and JSON determination responses to the consumer.

API translates the standard X12 EDI 278x215 payloads to more readable JSON format, so it is more accessible to developers and easily integrated into users’ applications. The X12 standards are managed in the background, and give you efficient access to medical information in a more easy-to-use, human-readable format.

• Get authentication/bearer token

https://sandbox-apigw.optum.com/apip/auth/v2/token

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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.

• Check API health

https://sandbox-apigw.optum.com/rcm/prior-authorization/v1/healthcheck

• A standard X12 EDI 278 transaction request

Formats the 278 transaction in JSON format for an determination request. Accepts JSON with a single string 'x12' property that has a 278 EDI string and produces a JSON response with a single 'x12' property that has a 215 EDI string.

https://sandbox-apigw.optum.com/rcm/prior-authorization/v1/determination/x12

• A JSON Inquiry request to the payer or clearinghouse

Accepts an EDI JSON object model request and produces a JSON object model response.

https://sandbox-apigw.optum.com/rcm/prior-authorization/v1/determination/json

Sandbox URL

https://sandbox-apigw.optum.com/rcm/prior-authorization/v1

Production URL

https://apigw.optum.com/rcm/prior-authorization/v1