Onboarding

Feature Enrollment

Work with the Enhanced Eligibility Support Team to enroll in the Value-Added Features that best aligns with your business needs. For more information on the available pre/post-clearinghouse processing rules, please see the Value-Added Features section.

Authentication with Client Credentials

Authentication for the API utilizes OAuth Client Credentials flow. Please supply the onboarding team with an email to attach to your credentials. We can support user-based credentials or system-based credentials, where user-based refers to each discrete Developer or API Consumer has their own unique credentials, and system-based refers to a single set of credentials used by your Applications. Once credentials are created, they will be delivered via Secure email to the provided email address. See Getting Started for authenticating with the Enhanced Eligibility API and next steps.

Data Tenancy

Enhanced Eligibility is a multi-tenant solution, but you will only ever have access to your data. Every request requires the presence of an HTTP header called x-optum-tenant-id that specifies the ID of the tenant associated with your authentication token. This header is automatically applied via your unique credentials to enforce secure access to your data. If you provide this header yourself, it will automatically be stripped during authentication.

Existing Medical Network Customers

If you are an existing customer of the Medical Network Eligibility API, you can opt-into our "Bring Your Own Key" feature. With this feature, Enhanced Eligibility will submit transactions to Medical Network using your existing credentials. By submitting with your credentials, you maintain your existing Provider enrollments and billing. Please work with the Enhanced Eligibility Support Team to configure this 'Bring Your Own Key' feature.

Eligibility Payer List

For the current payer list supported by Medical Network, please download the list supplied in the "IMN Real-Time Eligibility" section of this link. Use this document to find the "IMN Payer ID" to submit as the tradingPartnerServiceId on the Eligibility Request. If the specific payer requires enrollment, please submit a support request to begin the enrollment process. To verify if enrollment is required, refer to "Enrollment Req'd" column.

If you are unable to send the "IMN Payer ID", please enroll in the Value-Added Feature "Payer Alias".

Callback Requirements for Coverage Discovery

Customer's Callback API

Due to the long-running nature of the Coverage Discovery process, all concluded task responses will be communicated asynchronously back to the customer through a provided callback URL. If enrolled in Coverage Discovery, a Callback API with an OAuth2 authentication endpoint must be built in order to receive task responses. For the expected request body, check out the "Callbacks" tab next to "Parameters" in the Coverage Discovery POST endpoint (download OpenAPI spec from the Overview Page).

In addition, the Customer Callback Example API (link) provides sample responses that will be sent back from Coverage Discovery.

Whitelisting

Both the OAuth2 token endpoint and the callback endpoint must be whitelisted by Optum in order for Coverage Discovery to securely send responses to the Customer's provided callbackUrl. A Firewall Rule must be configured for the Customer's domains which is a process with a 2-week SLA. We recommend wildcard whitelisting for domains (for example: \*.api.providercompany.com)

OAuth - Authentication with Client Credentials

A “token” endpoint must be provided that conforms to the OAuth2 specification. This endpoint should return an “Access Token” that Enhanced Eligibility can use to sign our Callback requests (ref). In addition, the “token” endpoint must use the “Client Credentials” grant_type (ref). Finally, the auth token URL must be within your pre-existing whitelisted domain from the step above. If not, a new Firewall Rule must be configured that will come with a 2-week SLA.

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