{"openapi":"3.0.1","info":{"title":"Medical Network Claim Status V2","description":"276 Claim Status","version":"V2"},"servers":[{"url":"https://sandbox-apigw.optum.com","description":"Optum"}],"tags":[{"name":"Claim Status API","description":"Claim Status API"}],"paths":{"/v1/claimStatus/raw-x12/enhanced":{"post":{"tags":["Claim Status API"],"summary":"Check Claim Status x12","operationId":"rawX12Enhanced","parameters":[{"name":"Authorization","in":"header","description":"Bearer Your-Access-Token<br/>Example: <b>Bearer eyJraWQiOiIxIiwid…</b>","required":true,"schema":{"type":"string"}}],"requestBody":{"content":{"application/json":{"schema":{"$ref":"#/components/schemas/RawX12RequestExtension"}}},"required":true},"responses":{"200":{"description":"OK","content":{"application/json":{"schema":{"$ref":"#/components/schemas/ExtendedClaimStatusResponse"}}}}}}},"/medicalnetwork/claimstatus/v2/":{"post":{"tags":["Claim Status API"],"summary":"Check Claim Status","operationId":"claimstatus","parameters":[{"name":"Authorization","in":"header","description":"Bearer Your-Access-Token<br/>Example: <b>Bearer eyJraWQiOiIxIiwid…</b>","required":true,"schema":{"type":"string"}}],"requestBody":{"content":{"application/json":{"schema":{"$ref":"#/components/schemas/Request"}}},"required":true},"responses":{"200":{"description":"OK","content":{"application/json":{"schema":{"$ref":"#/components/schemas/Response"}}}}}}},"/medicalnetwork/claimstatus/v2/healthcheck":{"get":{"tags":["Claim Status API"],"summary":"Health Check","operationId":"healthCheck","parameters":[{"name":"Authorization","in":"header","description":"Bearer Your-Access-Token<br/>Example: <b>Bearer eyJraWQiOiIxIiwid…</b>","required":true,"schema":{"type":"string"}}],"responses":{"200":{"description":"OK","content":{"application/json":{"schema":{"$ref":"#/components/schemas/HealthCheckResponse"}}}}}}},"/medicalnetwork/claimstatus/v2/raw-x12":{"post":{"tags":["Claim Status API"],"summary":"Check Claim Status x12","operationId":"rawX12","parameters":[{"name":"Authorization","in":"header","description":"Bearer Your-Access-Token<br/>Example: <b>Bearer eyJraWQiOiIxIiwid…</b>","required":true,"schema":{"type":"string"}}],"requestBody":{"content":{"application/json":{"schema":{"$ref":"#/components/schemas/RawX12Request"}}},"required":true},"responses":{"200":{"description":"OK","content":{"application/json":{"schema":{"$ref":"#/components/schemas/Response"}}}}}}}},"components":{"schemas":{"Encounter":{"type":"object","properties":{"beginningDateOfService":{"type":"string","description":"Loop: 2200D or 2200E, Segment: DTP, Element: DTP03, Notes: Date Time Period - Start Date","example":"20100101"},"endDateOfService":{"type":"string","description":"Loop: 2200D or 2200E, Segment: DTP, Element: DTP03, Notes: Date Time Period - End Date","example":"20100102"},"trackingNumber":{"maxLength":50,"minLength":1,"type":"string","description":"Loop: 2200D or 2200E, Segment: TRN, Element: TRN02, Notes: This is the claim status tracking number assigned to the status query for the claim.","example":"ABCD"},"tradingPartnerClaimNumber":{"maxLength":50,"minLength":1,"type":"string","description":"Loop: 2200D or 2200E, Segment: REF, Element: REF02, Notes: This is the payer assigned claim number. descriptions goes in REF02 where REF01=1K"},"locationIdentifier":{"maxLength":50,"minLength":1,"type":"string","description":"Loop: 2200D or 2200E, Segment: REF, Element: REF02, Notes: Required if application or location system identifier is known. descriptions goes in REF02 where REF01=LU"},"billingType":{"maxLength":50,"minLength":1,"type":"string","description":"Loop: 2200D or 2200E, Segment: REF, Element: REF02, Notes: Billing type reference ID. 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NM108=XX"},"spn":{"maxLength":80,"minLength":2,"type":"string","description":"Loop: 2100B, 2100C, Segment: NM1, Element: NM109, Notes: Service Provider Number. Maps to provider SPN. NM108=SV"},"tin":{"maxLength":80,"minLength":2,"type":"string","description":"Loop: 2100B, 2100C, Segment: NM1, Element: NM109, Notes: Taxpayer’s Identification Number. Maps to provider TIN. NM108=FI"},"taxId":{"maxLength":80,"minLength":2,"type":"string","description":"Loop: 2100B, Segment: NM1, Element: NM109, Notes: Taxpayer’s Identification Number used when ProviderType = BillingProvider","example":"0123456789"},"etin":{"maxLength":80,"minLength":2,"type":"string","description":"Loop: 2100B, Segment: NM1, Element: NM109, Notes: Electronic transmitter identification Number (ETIN) used when ProviderType = BillingProvider"},"providerType":{"pattern":"BillingProvider|ServiceProvider","type":"string","description":"Segment: NM1, Notes: Code for entity (Billing or Service) Billing Provider: Loop 2100B, NM101=41 (required), Service Provider: Loop 2100C, NM101=1P if not present it is added and assigned tin = BillingProvider taxId","example":"BillingProvider","enum":["BillingProvider","ServiceProvider"]}},"description":"Loop: 2100B, Loop: 2100C"},"Request":{"required":["controlNumber","providers","subscriber"],"type":"object","properties":{"controlNumber":{"maxLength":9,"minLength":9,"type":"string","description":"Header, Segment: ST02 (no loop), Notes: Transaction Set Control Number","example":"123456789"},"tradingPartnerName":{"type":"string","description":"Loop: 2100A, Segment: NM1, Element: NM103, Notes: organizational name"},"tradingPartnerServiceId":{"maxLength":80,"minLength":2,"type":"string","description":"Loop: 2100A Segment: NM1, Element: NM109, Notes: we send this as MN108 as PI = Payer Identification","example":"serviceId"},"providers":{"maxItems":2147483647,"minItems":1,"type":"array","description":"Loop: 2100B, Loop: 2100C","items":{"$ref":"#/components/schemas/Provider"}},"subscriber":{"$ref":"#/components/schemas/Subscriber"},"dependent":{"$ref":"#/components/schemas/Member"},"encounter":{"$ref":"#/components/schemas/Encounter"},"serviceLineInformation":{"$ref":"#/components/schemas/ServiceLineInformation"}}},"ServiceLineInformation":{"type":"object","properties":{"productOrServiceIDQualifier":{"type":"string","description":"Loop: 2210D, 2210E, Segment: SVC, Element: SVC01-1, Notes: Allowed Values are 'AD' American Dental Association Codes, 'ER' Jurisdiction Specific Procedure and Supply Codes, 'HC' Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes, 'HP' Health Insurance Prospective Payment System (HIPPS) Skilled Nursing Facility Rate Code, 'IV' Home Infusion EDI Coalition (HIEC) Product/Service Code, 'N4' National Drug Code in 5-4-2 Format, 'NU' National Uniform Billing Committee (NUBC) UB92 Codes, 'WK' Advanced Billing Concepts (ABC) Codes","enum":["AD","ER","HC","HP","IV","N4","NU","WK"]},"procedureCode":{"type":"string","description":"Loop: 2210D, 2210E, Segment: SVC, Element: SVC01-2, Notes: Procedure Code maps to Product/ServiceID"},"procedureModifiers":{"maxItems":4,"minItems":0,"type":"array","description":"Loop: 2210D, 2210E, Segment: SVC, Element: SVC01-3 to SVC01-6, Notes:  Procedure Modifier","items":{"type":"string","description":"Loop: 2210D, 2210E, Segment: SVC, Element: SVC01-3 to SVC01-6, Notes:  Procedure Modifier"}},"lineItemChargeAmount":{"type":"string","description":"Loop: 2210D, 2210E, Segment: SVC, Element: SVC02, Notes: Maps to Monetary Amount, This amount is the original submitted charge."},"revenueCode":{"type":"string","description":"Loop: 2210D, 2210E, Segment: SVC, Element: SVC04, Notes: Identifying number for a product or service"},"unitsOfServiceCount":{"type":"string","description":"Loop: 2210D, 2210E, Segment: SVC, Element: SVC07, Notes: Maps to Quantity, Numeric value of quantity accepted"},"lineItemControlNumber":{"type":"string","description":"Loop: 2210D, 2210E, Segment: REF, Element: REF02 when REF01 = FJ, Notes: Maps to  Reference Identification"},"serviceLineDate":{"type":"string","description":"Loop: 2210D, 2210E, Segment: DTP, Element: DTP03, Notes: When sent with serviceLineEndDate it will be used as the start date for Date Time period, if sent without serviceLineEndDate will use DTP02 = D8"},"serviceLineEndDate":{"type":"string","description":"Loop: 2210D, 2210E, Segment: DTP, Element: DTP03, Notes: DTP03 enddate and DTP02=RD8"}},"description":"Loop: 2220D or 2220E"},"Subscriber":{"required":["firstName","lastName","memberId"],"type":"object","properties":{"memberId":{"maxLength":80,"minLength":2,"type":"string","description":"Loop: 2100D, Segment: NM1, Element: NM109, Notes: The subscriber's insurance member ID. Maps to subscriberId.","example":"0000000000"},"firstName":{"maxLength":35,"minLength":1,"type":"string","description":"Loop: 2100D, Segment: NM1, Element: NM104, Notes: The subscriber's first name as specified on their policy","example":"johnone"},"lastName":{"maxLength":60,"minLength":1,"type":"string","description":"Loop: 2100D, Segment: NM1, Element: NM103, Notes: The subscriber's last name as specified on their policy.","example":"doeone"},"gender":{"pattern":"F|M|U","type":"string","description":"Loop: 2000D, 2000E, Segment: DMG, Element: DMG03, Notes: The subscriber's gender as specified on their policy.","example":"M","enum":["M","F","U"]},"dateOfBirth":{"type":"string","description":"Loop: 2000D, Segment: DMG, Element: DMG02, Notes: The birth date as specified on the policy for the subscriber. 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PER03=PER05=PER07=ED","example":"111111"},"email":{"type":"string","description":"Segment: PER, Element: PER04, PER06 or PER08, Notes: Payer's email. PER03=PER05=PER07=EM","example":"test@test.com"},"fax":{"type":"string","description":"Segment: PER, Element: PER04, PER06 or PER08, Notes: Payer's facsimile number. PER03=PER05=PER07=FX","example":"123-456-7890"},"phone":{"type":"string","description":"Segment: PER, Element: PER04, PER06 or PER08, Notes: Payer's telephone number. PER03=PER05=PER07=TE","example":"123-456-7890"},"phoneExtension":{"type":"string","description":"Segment: PER, Element: PER04, PER06 or PER08, Notes: Payer's telephone extension. PER05=PER07=EX","example":"0000"}},"description":"Segment: PER"},"ErrorDetail":{"type":"object","properties":{"field":{"type":"string","description":"Attribute that is bad"},"value":{"type":"string","description":"Value of bad attribute"},"code":{"type":"string","description":"Code for the error. Example: INVALID_VALUE"},"description":{"type":"string","description":"Description of the error code. Value provided in payer id should be a valid Optum assigned ERA payer ID"},"location":{"type":"string","description":"Segment/location where the error occurred. If this is a network/system error, there is no location attribute. Example: $.payerBenefits[0].payer"},"followupAction":{"type":"string","description":"Any follow action required for the error. For AAA errors, this would be value for AAA04"}}},"ErrorResponse":{"type":"object","properties":{"code":{"type":"string","description":"Code for the error.","example":"INVALIDMISSINGINPUTDATA"},"description":{"type":"string","description":"Description of the error code. Value provided in payer id should be a valid Optum assigned ERA payer Id."},"transactionIdentifier":{"$ref":"#/components/schemas/TransactionIdentifier"},"errors":{"type":"array","items":{"$ref":"#/components/schemas/ErrorDetail"}}}},"Payer":{"type":"object","properties":{"organizationName":{"type":"string","description":"Segment: NM1, Element: NM103, Notes: Payers’s organization name.","example":"TestPayer"},"payerIdentification":{"type":"string","description":"Segment: NM1, Element: NM109, Notes: Payers’s identification number established through trading partner agreement. NM108=PI","example":"12345"},"centersForMedicareAndMedicaidServicePlanId":{"type":"string","description":"Segment: NM1, Element: NM109, Notes: Use when reporting Health Plan ID (HPID) or Other Entity Identifier (OEID). NM108=XV","example":"12345"},"contactInformation":{"$ref":"#/components/schemas/ContactInformation"}},"description":"Loop: 2100A"},"Response":{"type":"object","properties":{"controlNumber":{"type":"string","description":"Provided by the submitter in the 270 Request. Transaction Set Control Number."},"tradingPartnerServiceId":{"type":"string","description":"ID used by Clearing House for the trading partner."},"payer":{"$ref":"#/components/schemas/Payer"},"providers":{"type":"array","description":"Loop: 2100B and 2100C","items":{"$ref":"#/components/schemas/Provider"}},"subscriber":{"$ref":"#/components/schemas/Subscriber"},"dependent":{"$ref":"#/components/schemas/Member"},"claims":{"type":"array","description":"Loop: 2200D and 2200E","items":{"$ref":"#/components/schemas/Claim"}},"reassociationKey":{"type":"string","description":"Segment: ISA, Element: ISA13, Notes: Interchange control number"},"errorResponse":{"$ref":"#/components/schemas/ErrorResponse"},"status":{"type":"string","description":"Loop: 2200D, Segment: STC, Element: STC01, Health care claim status, Used to convey status of the entire claim or specific service line."},"transactionSetAcknowledgement":{"type":"string","description":"The 999 acknowledgment code"},"implementationTransactionSetSyntaxError":{"type":"string","description":"The 999 syntax error code"},"x12":{"type":"string","description":"Basic x12 edi response (for x12 endpoint)"},"meta":{"$ref":"#/components/schemas/ResponseMeta"}},"description":"Response"},"ResponseMeta":{"type":"object","properties":{"submitterId":{"type":"string","description":"submitterId assigned to this request"},"senderId":{"type":"string","description":"senderId assigned to this request"},"billerId":{"type":"string","description":"billerId assigned to this request"},"traceId":{"type":"string","description":"Unique Id assigned to each request by Optum"},"applicationMode":{"type":"string","description":"Used by Optum to identify where this request can be found for support"}},"description":"Meta data about the request"},"Service":{"type":"object","properties":{"serviceIdQualifierCode":{"type":"string","description":"Loop: 2220D, 2220E, Segment: SVC, Element: SVC01-1, Notes: Code identifying the type/source of the descriptive number used in Product/Service ID. 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This is the line item total on the current claim service status."},"amountPaid":{"type":"string","description":"Loop: 2220D, 2220E, Segment: SVC, Element: SVC03, Notes: Amount paid for the service."},"revenueCode":{"type":"string","description":"Loop: 2220D, 2220E, Segment: SVC, Element: SVC04, Notes: National uniform billing committee revenue code."},"submittedUnits":{"type":"string","description":"Loop: 2220D, 2220E, Segment: SVC, Element: SVC07, Notes: Original submitted units of service."}},"description":"Loop: 2220D, 2220E, Segment: SVC, Notes: Service Line Information"},"ServiceDetail":{"type":"object","properties":{"service":{"$ref":"#/components/schemas/Service"},"status":{"type":"array","description":"Loop: 2220D, 2220E, Segment: STC, Notes: Service Line Status Information","items":{"$ref":"#/components/schemas/Status"}}},"description":"Loop: 2220D, 2220E"},"Status":{"type":"object","properties":{"statusCategoryCode":{"type":"string","description":"Loop: 2220D and 2220E, Segment: STC, Element: STC01-1, Notes: The health care claim status category code. 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