Quick Reference

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AAAError codes About Optum Marketplace Access the Optum APIs Access token error Sandbox examples Eligibility API examples Request and Response Eligibility API tips Allowed Time Qualifier Reference Request with known TradingPartnerServiceId Request_HTML.aspx Endpoint Response for Medicare patient Co-insurance Co-payment Find deductible and co-pay in Eligibility response How to determine co-pay without a card Interpret service level information from sandbox response Map X12 to CPT and/or ICD 10 codes Possible insurance typecodes Set up SFTP Subscriber without an active medical coverage Search options to optimize queries Search an Eligibility request by transaction ID Use serviceType codes to identify business group Subscriber without active coverage from a medical plan When to use dependent object Attachments Submission API examples Request and response from payer Attach multiple files in one transaction Map JSON-to-EDI in an Attachments request Check Attachments Submission status Search for a specific Attachments transaction JSON fields in an attachment request versus X12-EDI loop associated with a field in the 275 request Solicited Attachments transaction Remediate Attachments transaction issues Send fax numbers to payer Successful Attachments transaction response Solicited Attachments response to a 277r transaction Query specific Attachments transaction Payer submissions with unsupported 275 transactions and do not accept faxes Physical mail packet to payer Unsolicited Attachments transaction Unsolicited Attachments for a 275 Claims transaction Test payer accounts for each Attachments API response type Timeline for validation and submission updates Use fieldset argument in your query Use the test payers in sandbox API Attachments status Use traceid in your query path Claim Status API examples Request and response Single 277 Claim Status response Retrieve specific Claim Status Manage adjustment codes from payer in Claim Status API Use STC codes	Annotated EDI 275 submission API examples API environments Sandbox account Production account API components API credentials API healthcheck API categories Attachments Retrieval v1 Attachments status v1 Attachments submission v1 Claims status v2 Claim response & reports Dental benefits advisor Dental Attachments Eligibility v3 Best practices & workflow Institutional claims v1 PayerList v1 Professional claims v3 API request header API reference Get started Ask a question API URLs Appeals & Denials Attachments file requirements Attachments in EDI Attachments status v1 Attachment Status endpoints Attachments status verification endpoint Attachments Status API healthcheck endpoint Metadata search Using metadata search Required metadata search values Filtering metadata searches Metadata search responses Statuscode and message fields Attachments submission v1 Authorization token Authorization numbers per claim Available claims responses and reports v2

A

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Annotated EDI 275 submission

API examples

B	C (continued)
Best practices & workflow for Eligibility API Batch attachments electronic interchange companion guide Batch 275 submission requirements Attachments file requirements Attachments file requirements Attachments file EDI requirements Basic requirements for batch 275 submissions Building the batch 275 submission Exclusions for batch 275 Bearer token Bearer token lifespan Bearer token request header Bearer token request Browse by product C Claim frequency code for resubmission of rejected Claim CPID (Payer ID) Client checklist Change log Checking Claim Status Claims file retrieval best practices Claim filing payment codes ClaimReference information ClaimInformation attributes Claim Status code Claim submission workflow Claim processing and reporting workflow Claims Appeals & Denials Claim Status updates Claim adjudication and denial	Claim status versus claim reports & responses Client SDK Co-insurance Co-payment ConnectCenter ConnectCenter (aka Legacy Relay Health (LRH) Payer List Contents of claim status request Contents of eligibility request Contents of eligibility response Control ID for Claim submission Converting Report 277 and Report 835 Claim Payer Identification (CPID (for claims process only)) for paper claims D Definitions claimReference field in submission response claimReference object fields tradingPartnerServiceId Dental benefits advisor Dental Attachments Developer tutorials Difference Claim status versus Claim Responses & Reports Institutional claims and professional claims Professional claim and institutional claim E EDI Annotated EDI 275 submission Supported EDI transactions Attachments file EDI requirements Electronic remittance API Endpoints Claim status Raw-X12 endpoint Core endpoints Healthcheck endpoints Check and validate your upcoming submission Transaction not sent to the payer Environments Sandbox Production EOB How do we get the EOB files, explain the payment EOB files for the claims? How to get the EOB Files for payment received from payer? Error messages API Errors DNS Error Invalid Access Token Proxy Error for Auth Token generation using the Try It interface in Dev Portal Why is the Claim Submission API is giving 400 error for the test values? Loop 2310B (rendering provider name) is missing? Other Payer Primary ID# Is Missing or Invalid AAA error codes and resolutions AAA errors Error message examples

B

C (continued)

C

D

Definitions

Professional claim and institutional claim

E

EDI

Electronic remittance API

Endpoints

Environments

EOB

Error messages

API Errors

AAA error codes and resolutions

E	E (continued)
Attachments submission Generic unable to process Submitted ID is not passed in header Wrong payer specified File attachment missing in transaction File attachment contains virus PayerAddress missing in solicited attachment transaction Entire payerAddress block missing Typo in controlNumber or missing digit ControlNumber missing Missing files in solicited transaction Invalid characters in request File type not supported Eligibility Error message formatting Required value errors AAA errors AAA error message examples AAA error & possible resolutions 999 errors HTTP errors Institutional claims Professional claims Elements of eligibility request Elements of eligibility object Elements of provider object Elements of subscriber object Elements of dependents object Elements of encounter object Elements of eligibility response Identification & policy confirmation Elements of eligibility object Elements of subscriber object Elements of payer object — Identifying the payer Elements of planStatus object Elements of benefitsInformation object — navigating the insurance codes Elements of serviceType segment	Eligibility error messages Error message formatting Required value errors Eligibility v3 Best practices & workflow Retrievable Eligibility information Eligibility API functionality Eligibility request body API components Endpoints Endpoint components X12 EDI Institutional claims v1 error messages Claims v1 error responses Syntax error response from validation endpoint Claims format error response Professional claims error messages Typo in diagnosisTypeCode DiagnosisTypeCode's associated diagnosisCode is incorrect Incorrect value in service line chargeable amount Examples AAAError message examples Attachments submission query Attachments submission request Bearer token example Claim status request Testing rejected/denied claims EDI to JSON translation Eligibility request

E

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Attachments submission

Eligibility

999 errors

HTTP errors

Institutional claims

Professional claims

Elements of eligibility request

Elements of eligibility response

Eligibility error messages

Eligibility v3

Endpoint components

X12 EDI

Institutional claims v1 error messages

Claims v1 error responses

Professional claims error messages

Examples

F	F (continued)
FAQs Does Optum support checking if a members insurance covers specific service events (based on CPT Code)? Do you have any API which sends electronic remittance notices regarding payments? Does Optum try to match the claim and attachment? Do your APIs send the payer actual allowable amount for the claimed services in any variable? Failed mail attachments Frequently Asked Questions Attachments status A typical payer response Query for specific attachments transaction Use trace ID in query path Use fieldset parameter in query What does my status message mean? Attachments submission Attach multiple files in one transaction A typical attachments request A typical attachments response Check status of submission Fax number & attachments submission File attachments format types supported Handling payer submissions for unsupported 275 transaction & unaccepted faxes JSON-to-EDI mapping for attachments submission Query for specific attachments transaction Solicited versus unsolicited attachments Unsolicited Key JSON elements in unsolicited attachments transaction Solicited Key JSON elements in solicited attachments transaction Successful attachments transaction response Sending fax to payer What are statusCode attributes? Unsolicited Key JSON elements in unsolicited attachments transaction Solicited Key JSON elements in solicited attachments transaction Successful attachments transaction response Sending fax to payer What are statusCode attributes? Using traceID in query path Using fieldset parameter in query Querying examples Batch 275 submissions FAQ Non-Optum medical attachments submission File format supported File size limitation Worker's compensation versus medical attachments Claim responses & reports Retrievable report file types Endpoint for Claims responses & reports v2 Search for a file Translate 277 EDI file to JSON Translate 835 EDI file to JSON Endpoint to delete a file Types of files from mailbox A typical request and response Understand EDI to JSON translation Convert EDI file to JSON Important contents of 277 and 835 reports Information in the 277 file	Claims status Claim status Raw-X12 endpoint Claim status versus claim reports & responses EDI to JSON translation Hierarchical level (HL) segments Integrity of X-12 transmissions X-12 EDI 277 transmission example Raw X-12 EDI coding for API call Request header information Sequence of segments STC segments What is tracking number field Limitation to check pending claims status A typical claim status request A typical claim status response Eligibility v3 A typical Eligibility API request Request body example A typical Eligibility API response Response body example Information received from payer Search options to optimize queries X12 EDI support Raw-X12 eligibility request & response Ensure integrity of X12 transactions X12 EDI request example X12 EDI 271 response Using Dependent object in submissions General FAQs Institutional claims v1 What is a typical institutional claims v1 request A typical institutional claims v1 response> Institutional claims for Medicare Institutional claims versus professional claims ClaimReference field in submission response Electronically billing worker's compensation Cache/draft feature PayerList Professional claim versus institutional claim Professional claims v3 Healthcare claims v3 information Query specific attachments transaction Use traceID in query path Use fieldSet parameter in query Remediate attachments transaction issues Formatting attachments File size Cannot retrieve record by search Rejections with good file Fax & email issues Meaning of status message Metadata search Fields FieldSet What is claimReference field in submission response ClaimReference object fields PayerFaxNumber What is tradingPartnerServiceId TraceID Tracking number Fetching tool for claims First-time users Filtering metadata search
FAQs Does Optum support checking if a members insurance covers specific service events (based on CPT Code)? Do you have any API which sends electronic remittance notices regarding payments? Does Optum try to match the claim and attachment? Do your APIs send the payer actual allowable amount for the claimed services in any variable? Failed mail attachments Frequently Asked Questions Attachments status A typical payer response Query for specific attachments transaction Use traceID in query path Use fieldset parameter in query What does my status message mean? Attachments submission Attach multiple files in one transaction A typical attachments request A typical attachments response Check status of submission Fax number & attachments submission File attachments format types supported Handling payer submissions for unsupported 275 transaction & unaccepted faxes JSON-to-EDI mapping for attachments submission Query for specific attachments transaction	Solicited versus unsolicited attachments Unsolicited Key JSON elements in unsolicited attachments transaction Solicited Key JSON elements in solicited attachments transaction Successful attachments transaction response Sending fax to payer What are statusCode attributes? Using traceID in query path Using fieldset parameter in query Querying examples Batch 275 submissions FAQ Non-Optum medical attachments submission File format supported File size limitation Worker's compensation versus medical attachments Claim responses & reports Retrievable report file types Endpoint for Claims responses & reports v2 Search for a file Translate 277 EDI file to JSON Translate 835 EDI file to JSON Endpoint to delete a file Types of files from mailbox A typical request and response Understand EDI to JSON translation Convert EDI file to JSON Important contents of 277 and 835 reports Information in the 277 file
FAQs (continued) Claims status Claim status Raw-X12 endpoint Claim status versus claim reports & responses EDI to JSON translation Hierarchical level (HL) segments Integrity of X-12 transmissions X-12 EDI 277 transmission example Raw X-12 EDI coding for API call Request header information Sequence of segments STC segments What is tracking number field Limitation to check pending claims status A typical claim status request A typical claim status response Eligibility v3 A typical Eligibility API request Request body example A typical Eligibility API response Response body example Information received from payer Search options to optimize queries X12 EDI support Raw-X12 eligibility request & response Ensure integrity of X12 transactions X12 EDI request example X12 EDI 271 response Using Dependent object in submissions	FAQs (continued) General FAQs Institutional claims v1 What is a typical institutional claims v1 request A typical institutional claims v1 response Institutional claims for Medicare Institutional claims versus professional claims ClaimReference field in submission response Electronically billing worker's compensation Cache/draft feature PayerList Professional claim versus institutional claim Professional claims v3 Healthcare claims v3 information Fields FieldSet What is claimReference field in submission response ClaimReference object fields PayerFaxNumber What is tradingPartnerServiceId TraceID Tracking number Fetching tool for claims First-time users Filtering metadata search

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FAQs

Attachments status

Attachments submission

Unsolicited

Key JSON elements in unsolicited attachments transaction

Solicited

Key JSON elements in solicited attachments transaction

Unsolicited

Key JSON elements in unsolicited attachments transaction

Solicited

Key JSON elements in solicited attachments transaction

Querying examples

Batch 275 submissions FAQ

Claim responses & reports

Claims status

X-12 EDI 277 transmission example

Eligibility v3

A typical Eligibility API request

Request body example

A typical Eligibility API response

Response body example

Healthcare claims v3 information

Query specific attachments transaction

Fields

FAQs

Frequently Asked Questions

Attachments status

Attachments submission

Solicited versus unsolicited attachments

Unsolicited

Key JSON elements in unsolicited attachments transaction

Solicited

Key JSON elements in solicited attachments transaction

Querying examples

Batch 275 submissions FAQ

Claim responses & reports

FAQs (continued)

Claims status

X-12 EDI 277 transmission example

Eligibility v3

A typical Eligibility API request

Request body example

A typical Eligibility API response

Response body example

FAQs (continued)

G	H
General FAQs Generate a client SDK Generic unable to process error message for attachments submission Guide for batch attachments electronic exchange Guidelines for predicting rate of unique claims submitted	Help Send a message Other modes of communication Ask a question in dev community How to's How do we get the EOB files, explain the payment EOB files for the claims? How to get the EOB Files for payment received from payer? How can payers be mapped from one EMR to another? How to interpret a 999 response? How to generate client SDK? How to handle mailed attachments? How to translate EDI to JSON? How to try our APIs? How to map JSON-to-EDI? How to use predefined fields and values? How to use the sandbox? How to use test payers in sandbox? HIPAA validation support How can I check the operating status of the APIs? How does a Raw-X12 Validation request and response work? HTTP error code response How can serviceType codes be used to identify business groupings? How are the claim and the attachments linked together? How could I get the submitted claim status with Claim Status API? How do we know that our claim has been forwarded to payer? How to avoid the error "Other Payer Primary ID# Is Missing or Invalid" when the other payer doesn't have a payor ID How can I look up the Provider NPI, Trading Partner Service ID? The API expects these values? How to download the payer list to a .csv file? How I can make payer list more user friendly, I want to show it like the Optum has? How can I add modifiers to services/procedures/other codes of a claim? How to resolve invalid access token error?

G

H

Help

How to's

I	J
Interpreting a 999 response Institutional claims v1 Institutional claims FAQs Institutional claims v1 request Request example Institutional claims v1 response Response example Error responses Raw-X12 validation request and response Invalid access token error Is it possible to submit multiple claims at once in batches?	JSON-to-EDI mapping Mapping JSON to EDI JSON-to-EDI mapping for Attachments submission JSON-to-EDI API contents Attachments Retrieval JSON-to-EDI Attachments Status JSON-TO-EDI Attachments Submissions JSON-to-EDI contents Claims Status v2 JSON-to-EDI Eligibility JSON-to-EDI Institutional Claims v1 JSON-to-EDI Professional Claims JSON-to-EDI

K	L
Key Claim information attributes Key components of Claim status response Key JSON elements in solicited attachments transaction Key JSON elements in unsolicited attachments transaction Ket JSON attributes of multiple payouts in 835 report Ket JSON attributes of multiple payouts in 277 report Key parameters to verify patient's medical coverage Key terminology — Batch attachments EDI interchange Key values of Claims response	Large reports handling Legacy authorization List of Rejection Codes validating Claims submission

K

L

M	O
Mapping JSON to EDI Mapping one EMR to another Metadata search Using metadata search Required metadata search values Filtering metadata searches Metadata search request Metadata search response StatusCode & statusMessage fields Multiple authorization numbers per claim	Office hours OpenAPI Spec: Click the required API link in the API reference section to download the OpenAPI spec Other than serviceType 98, which other code can I use? Other than the X3 and R5 report types, what are the other report types and in what format is this data?

P	Q
Prerequisites to send attachments and details about PWK segment Professional Claims v3 Endpoints Elements Try it Claims validation endpoint Claim submission endpoint Claim submission X12 endpoint Claim validation X12 endpoint Professional claims v3 API healthcheck endpoint Using the healthcheck endpoint Using the validation endpoint Request body elements Providers object Other required attributes Subscriber object Dependents object ClaimsInformation object Key claimInformation attributes Claim filing payment codes HealthCareCodeInformation object ServiceLines object Production users	Q&A from developer community Querying For a specific attachment transaction Optimize queries using search options Using traceId parameter in query path Using fieldSet parameter in query Querying accurately Quick start

P

Q

Prerequisites to send attachments and details about PWK segment

Professional Claims v3

Providers object

Other required attributes

Production users

R	S
Revenue Performance Advisor Payer List Raw-X12 validation request and response Reports v2 Available claims responses & reports Files retrieval & retention best practices SD and SF reports Reports versus patients Report types Requests Bearer token request Bearer token request example Eligibility request Institutional claims v1 request Request example Professional claims v3 request body elements Providers object Other required attributes Subscriber object Dependents object ClaimsInformation object Key claimsInformation attributes Claims filing payment codes HealthCareCodeInformation object ServiceLines object Responses Bearer token response Institutional claims v1 Response example Professional claims Key values of claims response Metadata search responses Release notes Retrieve cost estimate for multiple providers with a single API Resubmitting a Denied Claim	SD & SF reports mapping Security & Authorization v2 Security & Authorization v2 OpenAPI spec Search options Optimize queries by search option Service type codes Optum supported serviceType codes Sign up for API testing StatusCode response Standard attachment transaction statusCode responses Transaction received by clearinghouse Transaction accepted by clearinghouse Successful reception of Attachments by payer Acknowledgement of Attachments reception by payer Acceptance of Attachments by payer Partial acceptance of multiple Attachments Rejection of attachments transaction by clearinghouse Rejection of Attachments by payer Rejection of Attachments due to request validation Error Rejected/failed fax transmissions Successful fax transmission Failures to fax transmission Failed mail attachments Mailed attachments Tracking information for sent transactions Submitter ID Support Send a message Other modes of communication Ask a question in dev community

R

S

Request example

Professional claims v3 request body elements

Providers object

Other required attributes

Responses

Response example

Professional claims

Key values of claims response

Metadata search responses

Optimize queries by search option

Service type codes

Optum supported serviceType codes

T	U
Test payer IDs Test responses Tips Time qualifications Token automation TradingPartnerServiceID Troubleshoot APIs with metadata TRY our APIs	Using Using Claims validation Using fieldSet parameter in query Using Metadata search Using test payerIDs In the sandbox For each Attachments API response type Using traceID in query path

W	W (continued)
What kinds of response can be seen in submissions? What does a typical Attachments response from the payer look like? What do the statusCode Attributes mean? What do the status messages mean? What is a typical Attachments API request? What is a typical Attachments response from payer? What is the difference between Solicited and Unsolicited Attachments? What is a successful Attachments transaction response? What are the JSON-To-EDI mappings for the Attachments Submission request? Which file formats does Attachments Submission API support? What information goes in the API request header? What is authorization token endpoint? What are the guidelines to predict the rate of unique claims submitted for a practice? What is the difference between Institutional Claim and Professional Claim? What is the trackingNumber field? Where are the controNumbers from? What grants types are supported? What if my API includes user context? What is the difference between OAuth v1 and v2? What is a typical Eligibility API request? What is a typical Eligibility API response?	What does Eligibility information look like when received from the payer? When do I need to use a Dependent object in my submissions? What about cases where a subscriber/patient has no/is not covered by a medical/associated plan? What is a typical Professional Claims API request? What is a typical Professional Claims validation API response? What is claimReference field in the Submission response? What is a typical Institutional Claims API request? What is a typical Institutional Claims response? What are Institutional Claims errors? What is s tradingPartnerServiceId? What is the difference between Professional Claims and Institutional Claims? What is a typical Claim Status API request? What is a typical Claim Status API response? What is the difference between Claims Status and Claims Responses and Reports What types of files does the Claims Responses & Reports API get from mailbox? What is a typical Claims Responses & Reports API request and response?

W

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W (continued)	W (continued)
What is the difference between 'Access Token' & 'IMA-Token' Where can we get the adjudication message after submitting a claim? Which payer should I select? What does the status message mean? Are they file size limitations? Should I be running multiple requests for 98, MH and A6 for each patient to get their complete eligibility? Will a Payer send same ERA to multiple clearinghouses? Where can I get a list has the more universal payer ID that I am looking for?	What is filename structure? What is MN-ClientId and MN-ClientSecret in all the Claims Attachment endpoints? What are the most important contents of the 277 and 835 Reports? What is Batch Attachments Electronic Interchange companion guide? What is Y, N, U, and W? Workflow Claims API workflow and best practices Claims reject or denied workflow/a> Claim submission Claim processing and reporting Eligibility API and best practices What is the Claim submission flow in Optum What is the difference between the Optum Payer List, Revenue Performance Advisor Payer List, ConnectCenter Payer List, and Attachment Payer List? What is a StatusTypeCode?

Developer Community Q&A	Developer Community Q&A (continued)
CMS1500/UB04 Claims forms master list Are there guidelines for predicting the rate of unique claims submitted for a practice? Before submitting a cliam, can I enter the claim, save it, and have it released when ready? Do the doctors have to be re-registered in all each Medicare variant in order to return benefits correctly? Do we need to use same control ID for a claim in submission and checking its claim status? Do the doctors have to be re-registered in all each Medicare variant in order to return benefits correctly? Do we need to use same control ID for a claim in submission and checking its claim status? How many line items can be on a single claim? If the Primary claims are sent electronically, will the Secondary/Tertiary claims be sent electronically as well all the time? Is a list of Eligibility AAA errors with a description available?	Can the modifier code be added to the first submission or I need to submit another claim with frequency code 7, just to add the modifier? Does the Revenue Performance Advisor work with claims submitted with the API as well as claims submitted through the revenue advisor interface? Can we make multiple claims in one API call? Do you bill for a failed claim due to technical error? How can I add modifiers to the services/procedures/other codes of a claim? How can I send the rendering provider in loop 2310B? How can I send an EOB from the primary payer with the claim? How can I look up the Provider NPI, TradingPartnerService ID? The API expects these values? I am trying to test out a scenario where the clinic would enter a specific service type code and want to get patient benefits for that specific service code? What is the Claim submission Flow in Optum?

Developer Community Q&A

Developer Community Q&A (continued)