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.