Use the Eligibility V3 API

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NOTE

The JSON attributes in our APIs use snake-case, with the first letter of the attribute in lower case, as in tradingPartnerServiceId (the Payer ID; this will vary based on the payer you want to connect to). Our APIs are case-sensitive and your JSON request body must adhere to this convention.

Eligibility sandbox environment endpoint

https://sandbox-apigw.optum.com/medicalnetwork/eligibility/v3

Eligibility production environment endpoint

https://apigw.optum.com/medicalnetwork/eligibility/v3

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BASE URLs

The production endpoint (/eligibility/v3) queries to determine the patient eligibility through an X12 270 request. It formats the request in JSON format for an Eligibility status HTTP query for a patient. It receives an EDI 271 response, which is translated to JSON as the response body. It makes this popular EDI transaction more accessible to developers and to users’ applications. We manage the X12 standards in the background and provide you efficient access to medical subscriber or dependent plan membership, copays, co-insurances, deductibles, and more, in an easy-to-use and human-readable format.

Eligibility endpoints components

API components

X12 EDI support

We support a dedicated X12-formatted Eligibility API to send your submission in X12 EDI format. It supports the standard syntax for a complete X12 EDI 270 transaction set.

Postman Collection

Try our Postman collection!

OpenAPI specification

Download our OpenAPI 3.0 Spec.

Using ConnectCenter Payer values in the API

Obtain Payer ID values from the Legacy payer list. The payer list is searchable by payer name or by their serviceId. The serviceId is the searchable numeric 5-digit ID associated with each service provided by the listed payer.