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PayerList Getting Started

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PayerList API

The PayerList API empowers you to programmatically access and integrate accurate, up-to-date payer list data into your systems to eliminate manual processes and enable smarter transaction workflows.

Key features

  • Unified access and filtering of payer list — at a hierarchical level, system is the highest level and is the only required parameter. You can filter and sort by using the system parameter to get a complete list of payers and transactions with their related information for a specific system/clearinghouse. You can further filter and sort based on transactionType, payerId, enrollment, and other parameters to search across transactions. For a complete filters and sorting list, see PayerList filter and sort.

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TIP

Use the system parameter to get a complete list of payers and transactions with their related information for a specific system/clearinghouse.

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NOTE

system is the only required parameter (for example, Exchange real-time and Exchange batch both use system=EXCH but they have different transactionType parameters).

/payerlist/v1/payers?system=[SYSTEM]&transactionType=[TRANSACTIONTYPE_1] &transactionType=[TRANSACTIONTYPE_2] &transactionType=[TRANSACTIONTYPE_N]

For more examples, see PayerList examples.

  • Available accurate real-time payer data – you can reliably access the latest payer data to view the availability of different clearinghouses or payers available to connect to, and gain access to the clearinghouses for all of the payers without relying on static documents.
  • Developer-friendly integration – our PayerList API empowers you to programmatically search for payers without having to manually look things up

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NOTE

  • If you only plan to use a few daily transactions, you can use our PayerList V1 API user interface (UI) for your Medical Network transaction needs.
    It provides most of the features supported by an API console but only allows manual entry for all data needed for a transaction. It contains PayerLists, the PayerList Enrollments wizard, and other API customer resources.
  • For providers sending hundreds of daily requests, we recommend using our APIs to automate the submission processes and have a better fit for your business needs.

PayerList v1 API endpoints

The /payers endpoint retrieves payer lists across transactions, with filters for payer ID, transaction type, and enrollment criteria in a specific clearinghouse.

https://apigw.optum.com/medicalnetwork/payerlist/v1/payers

The /fields endpoint retrieves the available fields for querying the payer data. It returns arrays of systems/clearinghouses and transaction types.

https://apigw.optum.com/medicalnetwork/payerlist/v1/fields

The /export endpoint exports the payer list based on the selected query parameters. It returns paginated results similar to the GET payers endpoint, but is intended for exporting the data in a CSV format.

https://apigw.optum.com/medicalnetwork/payerlist/v1/payers/export
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Payers export to CSV file

The /healthcheck endpoint checks the status of the health of the API. It returns the current version, health status, and timestamps related to payer data loading.

https://apigw.optum.com/medicalnetwork/payerlist/v1/healthcheck

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Legacy Relay Health (LRH)/Exchange Payers can be accessed by using our PayerList API.

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Works with Optum PayerList (also internally known as Legacy Change, Emdeon, or Ark) and Revenue Performance Advisor (known internally as RPA or Capario) that are now in the Payer Profile Database.


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PayerList API uses Security and Authorization V2 to access the APIs.


Related Topics

Updated about 4 hours ago