Submit Edited Claims
The Integrated Rules Institutional API performs advanced rules-based checking and validation of Professional claims based upon the X12 EDI 837i standard. It uses compilations of medical business specialties, called Knowledge Packs, for fine-tuned claim inspection. It does not submit your claim to the payer, and is designed to be complementary to the Professional Claims API /professionalclaims/v3/validation
endpoint.
- You can submit your completed claims to the payer through the standard Institutional Claims Submission API
/institutionalclaims/v1/submission
endpoint (this will incur an additional charge) - Use the Standard Professional Claims API
/professionalclaims/v3/validation
endpoint to check and validate your upcoming submission. It applies a different and simpler set of rules that do not affect or repeat the functions from the Integrated Rules Professional API/professionalclaims/advanced/v1/validation
or Integrated Rules Institutional API/institutionalclaims/v1/submission
endpoint. Your transaction will not be sent to the payer
If you use a different claim submission workflow, you can also submit your claim that way. Consult your Optum representative for more information.
Updated 6 months ago