Quick Reference
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
- Successful attachments transaction response
- Sending fax to payer
- What are statusCode attributes?
- 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
- 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
- PayerList
- Professional claim versus institutional claim
- Professional claims v3
- Query specific attachments transaction
- Remediate attachments 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 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 modifiers to services/procedures/other codes of a cliam?
- How to resolve invalid access token error?
I
J
K
- 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
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
- 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 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
- 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
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 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?
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 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 (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 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
- 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?
- 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?
Updated 5 days ago