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Guides API Reference

OPTUM API DEVELOPER PORTAL

Get Started with Optum APIs
Quick Start
API Onboarding
Medical Network API Response and Timeout Times
Security and Authorization V2
API Environments
API URLs
Create a Sandbox Account
Generate a Bearer Token
Try Our APIs
API Health Check
Sandbox Predefined Fields and Values
Sandbox API Values and Test Responses
Troubleshoot APIs with Metadata
Understanding JSON-to-EDI API Mapping
Metadata Search Feature
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

FREQUENTLY ASKED QUESTIONS

FAQs

MEDICAL NETWORK ELIGIBILITY V3

Eligibility V3 Getting Started
Eligibility Sandbox API Values and Test Responses
Rejections with Known Good File
Eligibility JSON-to-EDI API Contents
API Example Eligibility
Eligibility FAQs

MEDICAL NETWORK PROFESSIONAL CLAIMS V3

Professional Claims V3 Getting Started
API Example Professional Claims
Professional Claims FAQs

MEDICAL NETWORK INSTITUTIONAL CLAIMS V1

Institutional Claims V1 Getting Started
- Institutional Claims API JSON-to-EDI Contents
API Example Institutional Claims
Institutional Claims FAQs

MEDICAL NETWORK CLAIM STATUS V2

Claim Status V2 API Getting Started
Claim Status Sandbox API Values and Test Responses
API Example Claim Status
Claim Status FAQs

MEDICAL NETWORK ATTACHMENTS RETRIEVAL V1

Attachments Retrieval V1 Getting Started
Attachments Retrieval JSON-to-EDI API Contents
API Example Attachments Retrieval API
Attachments Retrieval FAQs

MEDICAL NETWORK ATTACHMENTS SUBMISSION V1 API

Attachments Submission V1 Getting Started
API Example Attachments Submission
Attachments Submission FAQs

MEDICAL NETWORK ATTACHMENTS STATUS V1

Attachments Status V1 Getting Started
Use TraceId in your Query Path
API Example Attachments Status API
Attachments Status FAQs

Medical Network Attachment Submission Prior Authorization API

Attachments Submission Prior Auth (275x211) API V1 Getting Started
Test/Try Our APIs
275X211 Prior Authorization JSON-to-EDI Mapping
API Examples Attachments Submission Prior Auth
- Request and Response

MEDICAL NETWORK CLAIM RESPONSES AND REPORTS (ERA) API

Claim Responses and Reports V2 Getting Started
API Example Claim Responses and Reports
Claim Responses and Reports FAQs

MEDICAL NETWORK PAYERLIST V1

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

Enhanced eligibility api v1

Onboarding (Providers & Channel Partners)
Onboarding
Getting Started
- Sandbox Mock Scenarios
- Customer Callback Example API
Value-Added Features
Troubleshooting and Support
Frequently Asked Questions
Change Log/Release Notes

PRIOR AUTHORIZATION API V1

Prior Authorization V1 Getting Started
Determination Prior Authorization
- Determination Request Body
- Determination Response Body
Inquiry Prior Authorization
Submission Prior Authorization
Authorization (Orchestration) Prior Authorization
- Authorization (Orchestration) Request Body
- Authorization (Orchestration) Response Body
Notice of Admission
Prior Authorization API FAQs
Prior Auth AAA Error Codes Requests and Possible Resolutions
Prior Authorization Release Notes

Medical Network Inter-Operability APIs

Interoperability APIs built on FHIR Getting Started
Important References
Test/Try Our APIs
Technical Information
Prior Authorization Support API Getting Started V1
- API Example Prior Authorization
Clinical Data Exchange API Getting Started
- API Example Clinical Data Exchange
Coverage Requirements Discovery API Getting Started
- API Example Coverage Requirement Discover
Documentation Templates and Rules
- API Example Documentation Templates and Rules

MEDICAL NETWORK DENTAL ATTACHMENTS API

Dental Attachments Getting Started
- Request Body Content
- Response Body Content
Dental FAQs

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
Resubmit a Denied Claim
Test different Professional Claims Validation and Submission Responses

Updated 15 days ago

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