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PayerList V1 Getting Started

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PayerList v1 API

The Medical Network PayerList v1 API provides information about payer networks for all available transactions. This API supports operations related to health checks, retrieving payer lists, exporting payer lists, and getting fields.

  • API supports Multi-Domain Governance (MDG)
  • API to programmatically searches for the right payer in each transaction
  • The read-only API queries for information in your payer database for key information

PayerList v1 API endpoints

This endpoint retrieves a list of payers based on the provided query parameters. It returns paginated results including payer details such as plan name, system, IDs, transaction types, and enrollment information.

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

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

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

This endpoint exports a list of payers based on the provided query parameters. It returns paginated results similar to the "Get Payers" endpoint but is intended for exporting data.

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

This endpoint checks the health status 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

PayerList UI

Our enhanced PayerList v1 UI includes these salient features:

  • Provides reliable, up-to-date, and relevant Payer information across different clearinghouses for different transactions
  • Clears routing information from ingress to egress across different clearinghouses
  • Seamlessly updates PayerList information for customers
  • Helps to understand which PayerList to filter by, to avoid mix and match of our PayerList data, and to avoid errors when using the payer data in other application to submit eligibility, claims, and claim status and so on
  • A server-less infrastructure that delivers better performance
  • Retrieves customer-specific payers instead of downloading the entire PayerList
  • Enables you to learn the details about payer services so you can refine your claims and other submitted information

Please see the API Examples section for examples.

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

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NOTE

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

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NOTE

DO NOT perform load or production data testing in the sandbox environment. Please use the sandbox ONLY to view sample API responses to HTTP requests using our predefined values and to familiarize yourself with our APIs.

For load testing and production data resting, we recommend using our APIs in production environment.

You can use the PayerList API with the Revenue Performance Advisor (RPA).

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NOTE

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


Related Topics

Updated 13 days ago