Sandbox Mock Scenarios

Use this guide to test Sandbox mock responses for Real-Time Eligibility.

This page is intentionally about Sandbox-only fake data, not production behavior. The Sandbox returns canned responses for these mock scenarios. Do not send or use PHI in the Sandbox environment.

Important Sandbox Rules

• All Sandbox mock responses use fake data for developer code-path testing.
• Do not treat these responses as actual payer responses or payer-specific expectations.
• Mock responses can contain strange or divergent data. Names, dates, payer names, benefit details, eligibility outcomes, and linked Coverage Discovery results may not all line up the way real payer data would.
• The x-optum-rcmelig-mock-scenarios header must be an exact, case-sensitive string match.
• Use this header only in Sandbox. If the header is sent to Production, the request is rejected with 403 Permission Denied.
• Mock header scenario support requires the relevant Sandbox configuration to be completed before testing.
• The selected mock scenario controls the canned outcome.

Coverage Discovery Rules

Rows marked Yes in Coverage Discovery Link Header* can produce linked Coverage Discovery mock responses. Those linked responses appear only when Coverage Discovery is enabled for the product in Sandbox and the related mock-response configuration has been completed before testing.

Coverage Discovery responses are asynchronous. Expect any linked mock result through the configured async response path for the product, not in the initial real-time eligibility HTTP response.

With the standard Sandbox Coverage Discovery configuration, a single real-time mock scenario can return multiple linked Coverage Discovery record ids. Some linked CD record ids return success with eligible coverage. Linked CD record ids that do not have a configured mock response will most likely return failure with a transaction status of processing_error, ineligible, or another non-eligible status. The exact set depends on the product's Sandbox Coverage Discovery configuration.

The Request Data Needed column lists special request data required for the linked Coverage Discovery mock path. Blank means there is no known extra request-data requirement beyond using the exact scenario header and otherwise valid Sandbox request data.

Shared Header

Use the same mock scenario header for JSON and X12 real-time eligibility requests.

x-optum-rcmelig-mock-scenarios: <scenario-value>

In Sandbox, this header is required for the scenario rows in this guide.

JSON Real-Time

For normalized JSON real-time requests on POST /rcm/eligibility/v1, use the standard Sandbox request model and one of the JSON scenario header values below.

You can also use the standard IMN Sandbox mock scenarios for the JSON endpoint. When using those IMN mock scenarios, do not send x-optum-rcmelig-mock-scenarios; use the IMN-supported request values instead. Do not combine the IMN mock path with the header-based scenarios in this guide.

JSON Sandbox real-time requests can also use the Medical Network-supported values and tradingPartnerServiceId values documented here:

• Sandbox predefined fields and values
• Eligibility Sandbox API values and test responses

For the JSON endpoint, the payer id shown in the table is sent as tradingPartnerServiceId in the request. These Sandbox routing values are IMN payer ids. To review additional supported payers, use the Optum Customer Connect payer list.

JSON Scenario Headers

• Coverage Discovery link behavior and linked-response notes apply only when Coverage Discovery is enabled for the product in Sandbox.

X12 Real-Time

For X12 real-time requests on POST /rcm/eligibility/v1/real-time/x12, use one of the X12 scenario header values below.

The payer id in the request must align to the scenario. Send the payer id in the X12 NM1*PR*2 segment's PI element:

NM1*PR*2*<PAYER NAME>*****PI*<IMN PAYER ID>~

Example:

NM1*PR*2*TEXAS BLUE CROSS BLUE SHIELD*****PI*SB900~

Most submitted member and demographic details do not drive the returned subscriber, patient, or benefit content. The response remains canned. The payer id still must match the selected scenario.

X12 Scenario Headers

• Coverage Discovery link behavior and linked-response notes apply only when Coverage Discovery is enabled for the product in Sandbox.

Expected Member Story

Dependent and spouse scenarios return a fixed fake subscriber/patient story:

• Spouse scenarios return subscriber JANEONE DOEONE and spouse/patient JOHNTWO DOEONE.
• Dependent child scenarios return subscriber JANEONE DOEONE and child/patient JOHNTWO DOEONE.
• Self scenarios using JANEONE return gender F.
• Self scenarios using JOHNONE return gender M.

These returned names, DOBs, and genders are canned fake data. They do not come from the request payload.

X12 Request Example

ISA*00*          *01*SomePwd   *ZZ*TPG00000       *ZZ*IMNDIRECT      *260101*1201*^*00501*900000001*0*T*:~
GS*HS*SUBMITTER*RECEIVER*20260101*1201*900000001*X*005010X279A1~
ST*270*900000001*005010X279A1~
BHT*0022*13*123456789*20260101*120101~
HL*1**20*1~
NM1*PR*2*WELLCARE HEALTH PLANS*****PI*WLLCR~
HL*2*1*21*1~
NM1*1P*2*EXAMPLE PROVIDER*****XX*1760854442~
HL*3*2*22*0~
NM1*IL*1*ANYLAST*ANYFIRST****MI*ANYMEMBERID~
DMG*D8*19900101*F~
DTP*291*D8*20260101~
EQ*30~
SE*12*900000001~
GE*1*900000001~
IEA*1*900000001~

Send the X12 string in the JSON body:

{
  "x12": "ISA*00*...~IEA*1*900000001~"
}