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GuidesAPI Reference

OPTUM API DEVELOPER PORTAL

  • Quick Start
  • Readme
  • Get Started with Optum APIs
  • API Onboarding
  • Security and Authorization V2
  • Generate an API Token
  • API Environments
  • Access the APIs
  • Try Our APIs
  • API URLs and Endpoints
  • Using our Postman Collection
  • Using the Try It Interface
  • Sandbox Predefined Fields and Values
  • Sandbox API Values and Test Responses
  • Using Test Payers in the Sandbox
  • API Health Check
  • Troubleshoot APIs with Metadata
  • 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
    • 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
    • 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
    • Without Active Coverage (Subscriber) from a Medical Plan

API Examples

  • Overview
    • Access Sandbox Examples
    • Allowed Time Qualifier Reference
    • API Health Check
    • API Request Header
    • API Troubleshooting Tips
    • API Endpoint Usage
    • Associate Claims to ERA
    • Attach Multiple Files to a Transaction
    • Attachments Submission Error Messages
    • Query Specific Attachments Transaction
    • Attachments Request and Response from Payer
    • Attachments JSON-to-EDI Map in a Request
    • Bearer Token Request & Response
    • Benefits Information Codes
    • Check Attachments Submission Status
    • Check Claim Status
    • Claim Responses and Reports - Request & Response
    • ClaimReference Field in Submission Response
    • Claim Status Request & Response
    • Claim Responses and Reports (ERA) Production Endpoints
    • Claim Status X12 EDI 276 Request & 277 Response
    • CMS1500/UB04 Claims Forms
    • Co-Insurance
    • Co-Payment
    • Contents of 277 and 835 Reports
    • Convert 277 or 835 Report
    • Important Contents of the 277 and 835 Reports
    • Corrected Claim in Appeals and Denials
    • Create a Sandbox Account
    • Delete Claims Responses and Reports Files from Mailbox
    • EDI to JSON Translation
    • Eligibility Request & Response
    • X12 EDI 270 Request & 271 Response
    • Eligibility Request_HTML.aspx Endpoint
    • Eligibility Request with Known tradingPartnerServiceId
    • Eligibility Response for Medicare Patient
    • Eligibility API Tips
    • Fetch Payer's Claim Number before Receiving ERA
    • Find Deductible and Co-pay in Eligibility Response
    • Find Prior Authorization Number
    • Find a Specific Attachments Transaction
    • Find a Submitted Request in ConnectCenter
    • Get Adjudication Message after Submitting a Claim
    • Get EOB Files for Payment Received from Payer
    • Get Exact Claim Details of Particular Claim
    • Handle Multiple Authorization Numbers per Claim
    • How to Determine Co-pay without a Card
    • Payer Submissions with unsupported 275 Transactions and that do not accept Faxes
    • Include Primary claim Information for Secondary Claim in the API
    • Identify which Reports relate to which Patients
    • Institutional Claims for Medicare
    • Institutional Claims Request & Response
    • Institutional Claims Syntax Error Response
    • Integrated Rules Institutional Submission and Response
    • Integrated Rules Professional Request & Response
    • Interpret Service Level Information from Sandbox Response
    • JSON-to-EDI API Mapping
    • If Search Does not Show a Specific Record
    • JSON Fields versus X12 EDI Loop Associated with a Field in 275 in an Attachments Request
    • Know if a Claim is forwarded to Payer
    • Manage Adjustment Codes from Payer in Claim Status API
    • Map X12 to CPT and/or ICD-10 Codes
    • Map 835s or 999s
    • Metadata Search Request & Response
    • Payer Batch Totals Data File
    • Download the PayerList to a CSV File
    • Payer Report Data File
    • Physical Mail Packet to Payer
    • Possible InsuranceTypeCodes
    • Primary, Secondary, and Tertiary Claims
    • Primary and Secondary Insurances-Create EDI 837p 5010 Claim for a Client
    • Prof. Claims Request and Response
    • Prof. Claims Add Modifiers to Services/Procedures/other Codes of a Claim
    • RAW-12 Validation Requests & Responses
    • Rejections with Known Good File
    • Remediate Attachments Transaction Issues
    • Render Provider in Loop 2310B
    • Required Fields in ISA06 and ISA08
    • Resubmit a Denied Claim
    • Retrieve Specific Claim Status
    • Search an Eligibility Request by Transaction ID
    • Search Options to Optimize Queries
    • Search for a Specific File in Claims Responses and Reports V2
    • Send an EOB from the Primary Payer with the Claim
    • Send Fax Numbers to Payer
    • ServiceLines Array Record for a Dental Encounter
    • Set Up SFTP
    • Single 277 Claim Status Response
    • Solicited Attachments Transaction
    • Solicited Attachments Response to a 277R Transaction
    • Submit Claim with Remarks
    • Submit Edited Claims
    • Submit Providers Correctly
    • Subscriber without an Active Medical Coverage
    • Submit Rejected Claims
    • Successful Attachments Transaction Response
    • Test Claims in Sandbox
    • Test Claims Responses and Reports Functionality in Sandbox
    • Test different Professional Claims Validation and Submission Responses
    • Test Payer Accounts for each Attachments API Response Type
    • Test Prof. and Inst. Claims for PatientControlNumber in Sandbox
    • Test Production Data without Submitting for Processing
    • Test Rejected/Denied Claim
    • Timeline for Validation and Submission Updates
    • Translate a 277 EDI Claims Responses and Reports File to JSON
    • Translate an 835 EDI Claim Responses and Report File to JSON
    • Unsolicited Attachments Transaction
    • Unsolicited Attachments for a 275 Claim Transaction
    • Use Claim Filing Indicator Code
    • Use Code Snippets in Postman
    • Use Conditional Codes in Institutional Claims
    • Use Convert Report 276, 277, 835
    • Use Fieldset Argument in your Query
    • Use ServiceType Codes
    • Use ServiceType Codes to Identify Business Group
    • Use STC Codes
    • Use Test Payers in Sandbox
      • Use Test API Response Types
      • Use the Test Payer Accounts for each Attachments API Response Type
      • Successful Attachments Transaction
      • Transaction Received by the Clearinghouse
      • Transaction Accepted by the Clearinghouse
      • Successful Receipt of Attachment by Payer
      • Acknowledge Attachment Receipt by Payer
      • Acceptance of Attachment by Payer
      • Partial Acceptance of Multiple Attachments
      • Payer Accepted with Errors
      • Rejection of Attachments Transaction by the Clearinghouse
      • Rejection of Attachment by Payer
      • Rejection of Attachment Due to Request Validation Error
      • Successful Fax Transmission
      • Rejected/Failed Fax Transmissions
      • Successful Fax Transmission
      • Failures to Fax Transmission
      • Failed Mail Attachments
      • Mailed Attachments
      • Track Information for Sent Transactions
      • Understanding Transaction Details
    • Use the Validation Endpoint
    • Use TraceId in your Query Path
    • When to use Dependent Object

FREQUENTLY ASKED QUESTIONS

  • FAQs
    • Security and Authorization FAQs
    • Batch File Formats Supported
    • ConnectCenter FAQs
    • File Types Supported
    • Process after completing Providers' EDI Enrollment
    • Sandbox FAQs

MEDICAL NETWORK ELIGIBILITY V3

  • Eligibility V3 Getting Started
    • Use the Eligibility V3 API
    • Request Body Parameters
    • Use “Bare Minimum” Eligibility Requests
    • Response Body Contents
  • Eligibility JSON-to-EDI API Contents
  • 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
  • Professional Claims FAQs

MEDICAL NETWORK INSTITUTIONAL CLAIMS V1

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

MEDICAL NETWORK INTEGRATED RULES PROFESSIONAL V1

  • Integrated Rules Professional V1 Getting Started
    • Integrated Rules Professional JSON-to-EDI Contents
  • Integrated Rules Professional FAQs

MEDICAL NETWORK INTEGRATED RULES INSTITUTIONAL V1

  • Integrated Rules Institutional V1 Getting Started
    • Integrated Rules Institutional Claims JSON-to-EDI Contents
  • Integrated Rules Institutional FAQs

MEDICAL NETWORK CLAIM STATUS V2

  • Claim Status V2 API Getting Started
    • Request Body Parameters
    • Response Contents
    • Claim Status API JSON-to-EDI Contents
  • 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
    • Trading Partners (PayerList) and Attachments Support
  • Attachments Submission FAQs

MEDICAL NETWORK ATTACHMENTS STATUS V1

  • Attachments Status V1 Getting Started
  • 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
  • Claim Responses and Reports FAQs

DENTAL BENEFITS ADVISOR API

  • Change Log/Release Notes

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 INQUIRY v1

  • Onboarding
  • Getting Started
  • Change Log/Release Notes
  • Frequently Asked Questions
  • Authorization Inquiry JSON-to-EDI API Contents
  • Sandbox Test Responses

PRIOR AUTHORIZATION SUBMISSION V1

  • Authorization Submission JSON-to-EDI API Contents

MEDICAL NETWORK DENTAL ATTACHMENTS API

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

Onboarding

Suggest Edits

Feature Enrollment

XXX

Authentication with Client Credentials

XXX

Data Tenancy

XXX

Existing Medical Network Customers

XXX

Payer List

XXX

Callback Requirements

XXX

Updated 21 days ago


  • Table of Contents
    • Feature Enrollment
    • Authentication with Client Credentials
    • Data Tenancy
    • Existing Medical Network Customers
    • Payer List
    • Callback Requirements
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