Determination Prior Authorization

Overview

The Prior Authorization Determination Service API will accept Prior Authorization Determination requests in the form of EDI-X12 278x215 and JSON payloads and return either an EDI-X12 or JSON determination response 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.

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.

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

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

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

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

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