Quick Reference
A
- AAAError codes
- About Optum Marketplace
- Access the Optum APIs
- Access token error
- Adding a new payer to payer list
- Annotated EDI 275 submission
- API collections
- Eligibility v3 API collection
- Professional Claims v3 API collection
- Institutional Claims v1 API collection
- Claim Responses and Reports (ERA) API collection
- Integrated Rules Institutional v1 API collection
- Integrated Rules Professional v1 API collection
- Claims Status v2 API collection
- Attachments Submission v1 API collection
- Attachment Status v1 API collection
- Attachment Retrieval v1 API collection
- Dental Benefits Advisor v1 API collection
- Dental Attachment v1 API collection
- API examples
- Sandbox examples
- Add new payer
- Time qualifier reference
- API health check
- API request header
- API troubleshooting tips
- Associate Claims to ERA
- Attach multiple files to transaction
- Query specific attachments transaction
- Attachments request & response from payer
- JSON-to-EDI map in an Attachments request
- Auth token request & response
- Benefits information codes
- Check Attachments submission status
- Check claim status (CS)
- Claim response information
- Claim responses & reports (ERA) request/response
- Claim status request & response
- ClaimReference field in the submission response
- CS X12 EDI 276 request & 277 response
- CMS1500/UB04 claims form
- Co-insurance
- Co-payment
- 277 & 835 reports contents
- Convert 277 or 835 report
- Corrected claim in appeals & denials
- Create sandbox
- Delete claims responses & 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 claim number before ERA
- Find deductible & co-pay in Eligibility response
- Find prior auth number
- Find specific Attachments transaction
- Find submitted request in ConnectCenter
- Get adjudication message after submitting claim
- Get EOB files for payment received from payer
- Get exact claim details of particular claim
- Handle multiple auth numbers per claim
- Payer submissions with unsupported 275 transactions and faxes
- Add primary claim information for secondary claim
- Identify reports relating to specific patients
- Institutional claims for medicare
- Institutional claims request & response
- Institutional claims syntax error response
- Integrated rules institutional submission & response
- Integrated rules professional request & response
- Interpret serviceLevel information from sandbox response
- JSON-to-EDI mapping
- When search does not show record
- JSON fields versus X12 EDI loop with a 275 field in Attachments request
- Manage adjustment codes from payer in Claim Status
- Map X12 to CPT and/or ICD-10 codes
- Map 835s or 999s
- Map payers from one EMR to another
- Payer batch totals data file
- Look up provider NPI & Trading Partner Service ID
- Payer report data file
- Send physical mail packet to payer
- Possible insurance type codes
- Primary, secondary & tertiary claims
- Create EDI 837p 5010 claim for a client
- Prof.claims request & response
- Add modifiers to codes of a claim
- Rejections with known good file
- Remediate Attachment transaction issues
- Render provider in loop 23108
- Required fields in ISA06 & ISA08
- Resubmit a denied claim
- Retrieve specific claim status
- Search Eligibility request by transaction ID
- Search options to optimize queries
- Search for a specific file in claims responses & reports
- Send an EOB from primary payer with claim
- Send fax numbers to payer
- Service line array record for a dental encounter
- Set up SFTP
- Single 277 claim status response
- Solicited Attachments transaction
- Solicited Attachments response to 277R transaction
- Submit claim with remarks
- Submit edited claims
- Submit providers correctly
- Submit multiple claims in batches
- Subscriber without active medical coverage
- Submit rejected claims
- Successful Attachments transaction response
- Test claims in sandbox
- Test Prof.Claims validation & submission responses
- Test payer accounts for Attachments response type
- Test production data without submitting for processing
- Test rejected/denied claim
- Timeline for validation & submission updates
- Translate a 277 EDI claims responses & reports file to JSON
- Translate a 835 EDI claims responses & reports file to JSON
- Unslocited 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 query
- Use service type codes
- Use service type codes to identify business group
- Use test payers in sandbox
- Use test API response types
- Use the test payer accounts for each Attachments response type
- Transaction received by clearinghouse
- Transaction accepted by clearinghouse
- Successful receipt of Attachments by payer
- Acknowledge attachment receipt by payer
- Acceptance of attachment by payer
- Partial acceptance of multiple attachments
- Rejection of Attachments transaction by clearinghouse
- Rejection of attachment by payer
- Succesful fax transmission
- Failures to fax transmission
- Failed mail attachments
- Track information for sent transactions
- Use STC codes
- Use trace ID in query path
- Validation API issue
- Using dependent object
A (continued)
- Attachments Retrieval v1
- Attachment status v1
- Attachments submission v1
- Claims status v2
- Claim response & reports
- Dental benefits advisor
- Dental Attachment
- Eligibility v3
- Institutional claims v1
- Integrated rules professional v1
- Professional claims v3
- Using metadata search
- Required metadata search values
- Filtering metadata searches
- Metadata search responses
B
- Best practices & workflow for Eligibility API
- Batch attachment electronic interchange companion guide
- Batch 275 submission requirements
- Attachment file requirements
- Attachment 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
- Client checklist
- Change log
- Checking Claim Status
- Optum (formerly, Change Healthcare, Legacy Change Emdeon, or ARK)/Attachments Payer List
- 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 onlyc)) for paper claims
D
- Definitions
- Dental benefits advisor
- Dental Attachment
- Developer tutorials
- Difference
E
- EDI
- Electronic remittance API
- Endpoints
- Environments
- EOB
- Error messages
- API Errors
- DNS Error
- Invalid Access Token
- Proxy Error for Auth Token generation using the TryIt 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
- AAAerror codes and resolutions
- Attachment 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
- 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
- Eligibility v3
- Best practices & workflow
- Retrievable Eligibility information
- Eligibility API functionality
- Eligibility request body
- API components
- Endpoints
- X12 EDI
- Institutional claims v1 error messages
- Professional claims error messages
- Typo in diagnosisTypeCode
- DiagnosisTypeCode's associated diagnosisCode is incorrect
- Incorrect value in service line chargeable amount
- 999 errors
E (continued)
- Examples
- AAAerror message examples
- Attachment submission query
- Attachments submission request
- Bearer token example
- Claim status request
- Testing rejected/denied claims
- EDI to JSON translation
- Eligibility request
- Raw-X12 endpoint
- Shorter request
- Longer request
- Request with known tradingPartnerServiceId
- X12 Eligibility EDI request
- Eligibility response
- Institutional claims v1 request
- Institutional claims v1 response
- Integrated rules institutional submission
- Integrated rules institutional response
- Integrated rules institutional validation API
- Sandbox examples
- X12 EDI examples
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
- Attachment status
- A typical payer response
- Query for specific attachment transaction
- Use traceID in query path
- Use fieldset parameter in query
- What does my status message mean?
- Attachment submission
- Attach multiple files in one transaction
- A typical attachments request
- A typical attachments response
- Check status of submission
- Fax number & attachments submission
- File attachment 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
- Successful attachments transaction response
- Sending fax to payer
- What are statusCode attributes?
- Batch 275 submissions FAQ
- Non-Optum medical attachment 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
- 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
- A typical Eligibility API response
- 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
- Integrated rules institutional v1
- How to submit edited claims
- Integrated rules institutional submissions
- A typical integrated rules institutional response
- Integrated rules professional
- A typical integrated rules professional request
- A typical integrated rules professional response
- How to submit an edited claims
- Does it have submission endpoint
- Raw-X12 validation request and response
- Integrated rules versus regular institutional claims
- Professional claim versus institutional claim
- Standard professional claims API versus integrated rules professional API
- Professional claims v3
- Query specific attachments transaction
- Remediate attachment transaction issues
G
H
- 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 attachment 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 modifiers to services/procedures/other codes of a cliam?
- How to resolve invalid access token error?
I
- Interpreting a 999 response
- Institutional claims v1
- Institutional claims FAQs
- Institutional claims v1 request
- Institutional claims v1 response
- Error responses
- Institutional rules institutional v1
- FAQs
- Endpoints
- Raw-X12 validation request and response
- Integrated rules institutional API value add
- Knowledge pack for institutional claims
- Institutional claims submission
- Integrated rules professional v1
- Integrated rules professional request
- Integrated rules professional response
- HIPAA validation support
- Invalid access token error
- Is it possible to submit multiple claims at once in batches?
J
- JSON-to-EDI mapping
- JSON-to-EDI API contents
- Attachments Retrieval JSON-to-EDI
- Attachments Status JSON-TO-EDI
- Attachment Submissions JSON-to-EDI contents
- Claims Status v2 JSON-to-EDI
- Eligibility JSON-to-EDI
- Institutional Claims v1 JSON-to-EDI
- Integrated Rules Institutional Claims JSON-to-EDI
- Integrated Rules Professional JSON-to-EDI
- Professional Claims JSON-to-EDI
K
- Key Claim information attributes
- Key components of Claim status response
- Key JSON elements in solicited attachment transaction
- Key JSON elements in unsolicited attachment 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 attachment EDI interchange
- Key values of Claims response
- Knowledge Packs
L
M
- 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?
O
P
- Prerequisites to send attachments and details about PWK segment
- Postman collection
- Attachment retrieval
- Attachment status
- Attachments submission v1
- Claims responses & reports v2
- Claims status API
- Eligibility v3
- Institutional claims
- Integrated rules institutional
- Integrated rules professional
- Professional claims
- 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
- Production users
Q
S
- SD & SF reports mapping
- Security & Authorization v2
- Security & Authorization v2 OpenAPI spec
- Search options
- Service type codes
- Sign up for API testing
- StatusCode response
- Standard attachment transaction statusCode responses
- Transaction received by Change Healthcare clearinghouse
- Transaction accepted by Change Healthcare clearinghouse
- Successful reception of Attachment by payer
- Acknowledgement of Attachment reception by payer
- Acceptance of Attachment by payer
- Partial acceptance of multiple Attachments
- Rejection of attachment transaction by Change Healthcare clearinghouse
- Rejection of Attachment by payer
- Rejection of Attachment due to request validation Error
- Successful tax transmission
- Rejected/failed fax transmissions
- Successful fax transmission
- Failures to fax transmission
- Failed mail attachments
- Mailed attachments
- Tracking information for sent transactions
- Submitter ID
- Support
T
- Test payer IDs
- Test responses
- Tips
- Time qualifications
- Token automization
- TradingPartnerServiceID
- Troubleshoot APIs with metadata
- TRY our APIs
U
- Using
V
- Validation endpoint
W
- 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 an Integrated Rules Institutional Submission?
- What is the difference between Institutional Claim and Professional Claim?
- What is the difference between Integrated Rules API and Institutional Claims?
- 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?
W (Continued)
- What does Eligibility information look like when received from the payere?
- When do I need to use a Dependednt 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 a typical Integrated Rules Professional API request?
- What a typical Integrated Rules Professional API response?
- What is the biggest value add of Integrated Rules Institutional API?
- What is a typical Integrated Rules Institutional API response?
- What is the difference between Professional Claims and Institutional Claims?
- What is the difference between the Integrated Rules Professional API and Professional Claims API?
- 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 (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?
W (Continued)
- 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 Payer Finder v1 API
- What is happening to Trading Partner v7 API?
- Which payer lists does Payer Finder API support?
- What is a typical Payer Finder v1 API request?
- What is a typical Payer Finder v1 API response?
- Which search data files/JSON attributes can be used in the Pyer Finder API?
- Which search data files/JSON elements does the Payer Finder API return?
- What are the Payer Finder API error types and formats?
- What is Batch Attachment Electronic Interchange companion guide?
- What is Y, N, U, and W?
- Workflow
- Claim submission
- Claim processing and reporting
- Eligibility API and best practices
- Payer Finder 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, Change Healthcare Attachment Payer List?
- What is a StatusTypeCode?
Developer Community Q&A
- 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?
- 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?
- 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?
- 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?
- How to download the payer list to a .csv file?
- 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?
- 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 (continued)
- How to avoid the "OTHER PAYER PRIMARY ID# IS MISSING OR INVALID" error when the other payer doesn't have a payor ID and for which the claims are set up to be sent by paper?
- What is Professional Claims API and what is it used for?
- How can I get patient benefits for a specific servicetype code?
- Do the doctors need to be re-registered in all each Medicare variant in order to return benefits correctly?
- Does the Revenue Performance Advisor work with claims submitted with the API as well as claims submitted through the revenue advisor interface?
- What servicetype code can be used to bill clients for a non-professional/non-specialist visit but more like evaluation and management services?
- What is the Claim submission Flow in Optum?
- Do we need to use same control ID for a claim in submission and checking its claim status?
- How can I add modifiers to the services/procedures/other codes of a claim? How can you express that a CPT code had to be added to a claim so that the payer haver sufficient support or their adjudication?
- 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?
- Where can I find the Prior Authorization Number?
- Where can we include the primary claim information on the API request for the secondary claim?
- What API can I use to fetch the payer's claim number before we receive the ERA, ideally the next day after the claim is submitted successfully?
- What is the tradingPartnerServiceId?
- What would be the correct co-insurance amount for Professional (Physician) Visit?
Updated 8 days ago